Background/Purpose: Existing guidelines for disease education require that written materials not exceed 6th grade reading level. Evidence shows that 90% of cardiovascular educational literature is written at or above the 8th grade level. Moreover, evidence points to variations in linguistic style, also called register, as important to lay understanding and response to disease education. The purpose of the current study was to: a) provide a description of linguistic register of current stroke education brochures; b) assess the degree to which lexical, syntactic, and discourse register features relate to Flesch-Kincaid measures; and c) provide an expanded framework for assessment of stroke literature accessibility.
Method: Framed by critical discourse analysis and guided by Biber’s conceptual model of linguistic register, nine brochures originating from five national organizations yielding a sample of 9,903 words comprising 820 lines of text were analyzed for syntactic, lexical and discourse characteristics. Descriptive data on features were analyzed within and across brochures using linguistic analysis software. Flesch-Kincaid readability scores for each brochure permitted correlational analysis against quantitative linguistic data.
Results: Flesch-Kincaid readability scores for stroke brochures ranged from 38.60 to 75.0 with a sample median of 63.20, or grade level 7.2. Linguistic register was found to vary within and across the body of brochures, and included features of biomedical, everyday, and advertising registers, with a predominance of biomedical register. Syntactic and lexical features used in analysis of register variation were found to vary independent of Flesch Kincaid measures. These included nominalization (Spearman’s rho = -.02, p = .97), lexical density (Spearman’s rho = -.57, p - .13), and specialized/technical vocabulary (Spearman’s rho = -.317, p = .41).
Conclusion and Discussion: Flesch Kincaid scores obtained in this sample reinforced prior concerns of reading levels which exceed current guidelines in stroke brochures. Quantitative and qualitative linguistic analyses identified numerous features consistent with biomedical and advertising registers which varied independent of Flesch Kincaid measures.