2 min read
Every October, Health Literacy Month asks healthcare teams to look at patient-facing materials through the patient’s eyes. Discharge instructions and consent forms usually get the scrutiny. The PRO questionnaire that lands on a patient’s phone two weeks after surgery rarely does.
It should.
The readability gap
The average adult reads at roughly an 8th- or 9th-grade level, and about one in five reads at a 5th-grade level or below. That range is why patient materials need to be written with the reader in mind. Organizations differ on the exact target, with guidance ranging from a 5th-grade level to an 8th-grade level, but the goal is the same: meet patients where they are.
PRO measures don't always fit that range. A recent analysis of 35 commonly cited orthopedic joint PROMs found that they required an 8th- to 9th-grade reading level on average, and only 6 of the 35 met a 6th-grade threshold. Widely used PRO instruments, including WOMAC, SF-36, KOOS, and IKDC, all exceeded that threshold.
Findings vary by method, and not every instrument is a problem. The takeaway? Readability deserves a second look.
Where you have control
Validated instruments are tested as written, so rewording them isn't a simple fix. Instrument selection is one lever. PROMIS, for example, was built with literacy attention required during item development.
Everything around the instrument is also within your control:
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The invitation. "Complete your PRO assessment" means little to most patients. "Your care team wants to hear how your knee is feeling" does the job.
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The introduction. Two plain sentences on why the questions matter and how long they take to complete sets the tone.
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The delivery. Mobile-friendly layouts and one question at a time reduce effort for everyone.
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The language. Offering instruments in a patient's preferred language, where validated translations exist, is one of the most direct ways to improve readability.
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The follow-up. A reminder in the same plain tone beats a clinical-sounding nudge.
A quick readability audit
Examine what a patient actually receives, from the first text message to the final screen. Then ask:
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Could a patient understand the invitation without knowing what a PRO is?
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Do you know the reading level of each instrument in your program?
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Where a choice exists, are you using measures that are appropriate for your patient population?
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Does the survey work comfortably on a phone, in one hand?
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Do you track drop-off by question, not just overall completion?
That last one matters most. The questions where patients stop often point straight at the confusing item.
Why it matters
If patients can't easily understand a question, their answer may not reflect what you're trying to measure. PatientIQ's automated engagement programs reach a blended PRO collection rate above 80%, across a network that has collected 76M+ outcomes. We've seen how much the patient experience around a questionnaire shapes the data that comes back.
This Health Literacy Month, complete your own PRO workflow as a patient would. You may be surprised by what you find.
Want help making your PRO experience more patient-friendly? Talk to the PatientIQ team about how we help health systems and practices improve engagement and data quality.
Sources
- AHRQ Health Literacy Universal Precautions Toolkit, Tool 11: ahrq.gov
- Uppal H, et al. Readability Analysis of Commonly Cited Patient-Reported Outcome Measures in the Orthopaedic Joint Literature (December 2025): PubMed
- Readability of Patient Education Materials From High-Impact Medical Journals: A 20-Year Analysis (AMA and NIH recommendations): PMC
- Promoting Personal Health Literacy Through Readability, Understandability, and Actionability of Online Patient Education Materials (Joint Commission recommendation), Journal of the American Heart Association: AHA Journals
- PROMIS Instrument Development and Validation Scientific Standards: fda.gov