Readability, suitability and comprehensibility in patient education materials for Swedish patients with colorectal cancer undergoing elective surgery: a mixed method design
Journal article, 2014

Objective: To characterize education materials provided to patients undergoing colorectal cancer surgery to gain a better understanding of how to design readable, suitable, comprehensible materials. Method: Mixed method design. Deductive quantitative analysis using a validated suitability and comprehensibility assessment instrument (SAM. +. CAM) was applied to patient education materials from 27 Swedish hospitals, supplemented by language technology analysis and deductive and inductive analysis of data from focus groups involving 15 former patients. Results: Of 125 patient education materials used during the colorectal cancer surgery process, 13.6% were rated 'not suitable', 76.8% 'adequate' and 9.6% 'superior'. Professionally developed stoma care brochures were rated 'superior' and 44% of discharge brochures were 'not suitable'. Language technology analysis showed that up to 29% of materials were difficult to comprehend. Focus group analysis revealed additional areas that needed to be included in patient education materials: general and personal care, personal implications, internet, significant others, accessibility to healthcare, usability, trustworthiness and patient support groups. Conclusion: Most of the patient education materials were rated 'adequate' but did not meet the information needs of patients entirely. Discharge brochures particularly require improvement. Practice implications: Using patients' knowledge and integrating manual and automated methods could result in more appropriate patient education materials.

Readability assessment in material

Colorectal cancer

Patient education materials


Suitability assessment in material

Focus groups

Language technology analysis

Comprehensibility assessment in material

Surgical care


Frida Smith

University of Gothenburg

Sahlgrenska University Hospital

E. Carlsson

University of Gothenburg

Sahlgrenska University Hospital

D. Kokkinakis

University of Gothenburg

M. Forsberg

University of Gothenburg

Karl Kodeda

Sahlgrenska University Hospital

University of Gothenburg

R. Sawatzky

Trinity Western University

F. Friberg

University of Stavanger

University of Gothenburg

J. Ohlen

University of Gothenburg

Ersta Sköndal University College

Patient Education and Counseling

0738-3991 (ISSN)

Vol. 94 2 202-209

Subject Categories

Health Care Service and Management, Health Policy and Services and Health Economy


Social and Clinical Pharmacy



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