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Appendix C:

Formulas for Calculating Readability

Using SMOG

Perhaps the quickest way to check a reading level manually is to use the SMOG estimating formula. G.

Harry McLaughlin created SMOG (Simply Measure of Gobbledygook) in 1969 to estimate they years

of education needed to understand a piece of writing.

Here’s a quick way to estimate reading level.

• Simply count the number of words with three or more syllables in three chains of 10 sentences in

difference parts of your draft.

• Then look up the approximate grade level in this chart.

• The SMOG formula can predict the grade level difficulty within 1.5 grades in 68 percent of passages.

McLaughlin worked with programming expert Alain Trottier to produce a free SMOG calculator. The

online calculator can service 30 to 2000 words at this link: www.harrymclaughlin.com/SMOG.htm.

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Appendix C:

Formulas for Calculating Readability (continued)

Using Fry Formula

In 1977, Dr. Edward Fry created one of the most widely used readability formulas. Fry calculates the

grade reading level by averaging the number of sentences and syllables per hundred words.

Steps for you to follow:

• Randomly choose three samples from your document with 100 words each.

• Count the number of sentences in the hundred words, estimating length of the fraction of the last

sentence to the nearest 1/10th.

• Count the total number of syllables in the 100-word passage. Do not count numbers. Do count proper

nouns. If you don’t have a hand counter available, an easy way is to simply put a mark above every

syllable after the first syllable in each word. Then, when you get to the end of the passage, count the

number of marks and add 100 to include the first syllable in each word that you did not mark.

• Find the average number of sentences and the average number of syllables for the three samples by

dividing the total of all three samples by three.

• Use the graph on the next page to plot the average sentence length and number of syllables. The two

lines will intersect at the approximate grade level. If a great deal of variability is found, try putting

more sample counts into the average

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Appendix C:

Formulas for Calculating Readability (continued)

Fry Graph* for Estimating Grade Levels

Average Number of Sentences

(Per 100 words)

Average Number of Syllables

(Per 100 words)

* From: Fry, Edward. Elementary Reading Instruction. 1977, McGraw-Hill

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Appendix C:

Formulas for Calculating Readability (continued)

Using Fry on Short Documents

When your document has fewer than 300 words, you can use an adaptation of the Fry method.

1. Count total words, total sentences, and total syllables for the entire text. (Note: hyphenated words

count as one word.)

2. Do these calculations:

- Multiply the number of sentences by 100 and divide by the total number of words. This will give you

the average number of sentences per 100 words.

- Multiply the number of syllables by 100 and divide by the number of total words. This will give you

the average number of syllables per 100 words.

3. Plot the averages on the Fry graph to find the readability score.

Here is an example with fewer than 100 words.

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Appendix C:

Formulas for Calculating Readability (continued)

Here are two examples testing 100 words:

Example 1:

Example 2:

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Appendix C:

Formulas for Calculating Readability (continued)

Using Lexile Readability Analyzer

Lexile Analyzer

produced by MetaMetrics

, allows you to test the readability of your text by generating a

Lexile

measure. (A free, limited version is available at www.Lexile.com

.) The Analyzer measures sentence

length and the familiarity of words used. Your word choice will be compared to word frequencies within a large

database of literature.

The Lexile

measure is a text difficulty score followed by an “L”. The scale ranges from below 200L for

beginning-reader material to above 1700L for advanced text.

Lexile

Value

Grade Level

300L

grade

400L

grade

1300L

grade

Using PMOSE/IKIRSCH Document Readability Formula

Researchers Mosenthal and Kirsch developed a measure for assessing document complexity, called the

PMOSE/ IKIRSCH document readability formula. The PMOSE/IKIRSCH formula measures complexity based

on three factors:

•

The structure of the document,

•

The density of the information,

•

The relative dependence on information from other documents.

This tool is particularly useful for documents that include forms, tables, graphs, charts, and lists.

PMOSE/IKIRSCH measures the readability of information organized in rows and columns. The formula uses

the number of rows and columns, the structure, and the number of labels and items to assess the chart or table.

Scores range from Level 1 to Level 5 Proficiency. The Proficiency Level can be translated into a grade-level

equivalent.

Proficiency

Grade Level

Equivalent

Level 1

Grade 4

>8 years of schooling

Level 2

Grade 8

to high school diploma

Level 3

Grade 12

some education after high school

Level 4

15 years of schooling

college degree equivalent

Level 5

16 years of schooling or

advanced post college degree

The next page is the Mosenthal and Kirsch’s worksheet that you can apply to your text. Please note that the

complexity of word choice is not a consideration in this tool.

Appendix C:

Formulas for Calculating Readability (continued)

Appendix D:

Resources

Books

Bigwood S, Spore M. Presenting Numbers, Tables, and Charts. New York: Oxford University Press; 2003.

Debus, M. Methodological Review: A Handbook for Excellence in Focus Group Research, Academy for Education Development;

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Doak C, Doak L, eds. Pfizer Principles for Clear Health Communication: A Handbook for Creating Patient Education Materials that

Enhance Understanding and Promote Health Outcomes, Pfizer; 2

Edition, 2004.

(www.pfizerhealthliteracy.com/pdf/PfizerPrinciples.pdf

)

Doak C, Doak L, Root J. Teaching Patients with Low Literacy Skills. 2nd ed. Philadelphia, PA: J.B. Lippincott Company; 1996.

(www.hsph.harvard.edu/healthliteracy/doak.html

)

Graham L. Basics of Design: Layout and Typography for Beginners. Albany, NY: Delmar; 2001.

Kirsch I, Jungeblut A, Jenkins L, Kolstad A. Adult Literacy in America: A first look at the findings of the National Adult Literacy

Survey. 3rd edition. Vol. 201. Washington, DC: National Center for Education, U.S. Department of Education; 2002.

Kutner M, Greenberg E, Jin Y, Paulsen C. The Health Literacy of American’s Adults: Results from the 2003 National Assessment of

Adult Literacy (NCES2006-483). Washington, DC: U.S. Department of Education; 2006.

Lohr, Linda. Creating Graphics for Learning and Performance: Lessons in Visual Literacy. NJ: Merrill Prentice Hall; 2003.

Lynch P, Horton S. Web Style Guide, 2nd edition; 2005.

National Cancer Institute. Clear & Simple: Developing Effective Print Materials for Low-literate Readers. Pub. No. NIH 95-3594.

Washington, DC: DHHS; 1995.

National Cancer Institute. Making Health Communication Programs Work.(aka “Pink Book”) U.S. Department of Health and Human

Services; National Institutes of Health; 2004.

Nelson R. Consumer Informatics: Applications and Strategies in Cyber Health Care (Health Informatics). Springer; 2004.

Nielsen-Bohlman L, Panzer A, Kindig D, eds. Health Literacy: A Prescription to End Confusion. Committee on Health Literacy,

Board on Neuroscience and Behavioral Health, Institute of Medicine of the National Academies. Washington, DC: The National

Academies Press; 2004.

Osborne H. Overcoming Communication Barriers in Patient Education. NAL Call No.: R118 O83 2001 ISBN: 083422030X.

Gaithersburg, MD: Aspen Publishers, Inc; 2001.

Rudd RE, Anderson JE, Oppenheimer S, Nath C. Health Literacy: An Update of Public Health and Medical Literature. Chapter 6 in

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175-204, 2007.

Southern Institute on Children and Families. The Health Literacy Style Manual. Covering Kids and Families National Program Office.

Columbia, SC: Maximus (Reston, VA); 2005.

Strunk W. Jr., White E. The Elements of Style. New York, NY: MacMillan; 1979.

Thompson T, Dorsey A, Miller K, Parrott R, eds. Handbook of Health Communication. Mahwah, NJ: Lawrence Erlbaum Associates;

2003.

Appendix D:

Resources (continued)

Journal Articles, Reports, Brochures, Pamphlets, and Miscellaneous Publications

Albright J, de Guzman C, Acebo P, Paiva D, Faulkner M, Swanson J. Readability of patient education materials: Implications for

clinical practice. Applied Nursing Research 1996; 9(3):139-43.

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Baker L, Wilson F. Consumer health materials recommended for public libraries: Too tough to read? Public Libraries 1996;

35(2):124-30.

Baker L, Wilson F, Kars M. The readability of medical information on InfoTrac: Does it meet the needs of people with low literacy

skills? Ref User Serv Q 1997; 37(2):155-60.

Baker S. Who can read consumer product information? American Journal of Health-System Pharmacy 1997; 27(2):126-31.

Baker D, Parker R, Williams M, Clark W, Nurss J. The relationship of patient reading ability to self-reported health and use of health

services. American Journal of Public Health 1997; 87:1027-30.

Basara L, Juergens J. Patient package insert readability and design. American Pharmacy 1994; NS34(8):48-53.

Brownson K. Education handouts. Are we wasting our time? Journal for Nurses in Staff Development 1998; 14(4):176-82.

Carmona R. Improving Americans’ health literacy. Journal of the American Dietetic Association 2005; 105:1345.

Cardinal B, Seidler T. Readability and Comprehensibility of the Exercise Life (brochure). Perceptual and Motor Skills 1995; 80:399-

402.

Coey L. Readability of printed educational materials used to inform potential and actual ostomates. Journal of Clinical Nursing 1996;

5:359-366.

Davis R, Jackson R, Bocchini J, Arnold C, Mayeaux E, Murphy P. Comprehension is Greater Using a Short Vaccine. Information

Pamphlet with Graphics and Simple Language. Journal of General Internal Medicine 1994; 9(Supp. 2):103.

Davis, T, Bocchini J, Jr, Fredrickson D, Arnold C, Mayeaux E, Murphy P, Jackson, RH, Hanna, N, Paterson, M. Parent

Comprehension of Polio Vaccine Information Pamphlets. Pediatrics 1996; 97(6):804-10.

Davis T, et al. Improving Vaccine Risk/Benefit Communications with an Immunization Education Package: A Pilot Study.

Ambulatory Pediatrics 2002; 2(3):193-200.

Feldman S, Quinlivan A, Williford P, Bahnson J, Fleischer A, Jr. Illiteracy and the readability of patient education materials. A look at

Health Watch. North Carolina Medical Journal 1994; 55(7):290-2.

Gabriel V, Stephenson T. Readability of patient information leaflets. Journal of Pediatric Pharmacy Practice 1998; 3(1):29-32.

Grotsy R. Plain Language: It’s effect on organizational performance. Clarity. May 2004; 51:17-19.

Hobbie C. Maximizing healthy communication: Readability of parent educational materials. Journal of Pediatric Health Care 1995;

9(2):92-3.

Hospital Case Management, It’s on paper but do they understand it? Simple testing gets written handouts on target. Hospital Case

Management 1999; 7(4):75-6, 80.

Appendix D:

Resources (continued)

Houts p, Doak C, Doak L, Loscalo,M. The role of pictures in improving health communication: a review of research on attention,

comprehension, recall, and adherence. Patient Education and Counseling 2006; 61:173-190.

Johnson H. Readability study of client health education materials: A resource for assuring the effectiveness of written materials.

Raleigh (NC): North Carolina State Dept. of Environment, Health, and Natural Resources. May, 128 p. Available from: ERIC

Document Reproduction Service, Springfield, VA 1994; No. ED382934.

Katz M, Kripalani S, Weiss B. Use of pictorial aids in medication instructions: A review of the literature. American Journal of Health-

System Pharmacists. December 1, 2006; 63:2391-2397.

Kleimann S, Enlow B. Is plain language appropriate for well-educated and politically important people? Results of research with

congressional correspondence. Clarity. November 2003; 50:4-11.

Koba H. Putting it plainly becomes communications. Mission of Ontario, Ministry of Health. Journal of the Canadian Medical

Association 1993; 148(7):1202-03.

Kreuter M, Strecher V, Glassman B. One size does not f t all: The case for tailoring print materials. Society of Behavioral Medicine

1999; 21:276-83.

Kripalani S, Weiss B. Teaching about health literacy and clear communication. Journal of General Internal Medicine 2006, 21(8):888-

90.

Massett, H. Evaluation of CDC Print Materials. Presentation to the Office of Communication, CDC. December; 1996.

Meade C, Howser D. Consent forms: How to determine and improve their readability. Oncology Nursing Forum 1992; 19(10):1523-

28.

Meade C, McKinney W, Barnas G. Educating patients with limited literacy skills: The effectiveness of printed and videotaped

materials about colon cancer. American Journal of Public Health 1994; 84(1):119-21.

Michielutte R, Bahnson B, Beal P. Readability of the public education literature on cancer prevention and detection. Journal of Cancer

Education 1990; 5(1):55-61.

Michielutte R, Bahnson J, Dignan M, Schroeder E. The use of illustrations and narrative text style to improve readability of a health

education brochure. Journal of Cancer Education 1992; 7(3):251-60.

Montori V, Rothman R. Weakness in numbers: the challenge of numeracy in health care. Journal of General Internal Medicine 2005;

20:1071-1072.

Neuhauser, L. & Kreps, G. Online cancer communication interventions: Meeting the literacy, linguistic and cultural needs of diverse

audiences.

Patient Education and Counseling.

Available online: doi:10.1016/j.pec.2008.02.015

Parker R, Gazmararian J. Health literacy: essential for health communication. Journal of Health Communication 2003; 8:S116-8.

Plimpton S, Root J. Materials and strategies that work in low literacy health communication. Public Health Reports 1994; 109(1):86-

92.

Rice M, Valdivia L. A simple guide for design, use, and evaluation of educational materials. Health Education Quarterly 1991;

18(1):79-85.

Riche J. Text and reader characteristics affecting the readability of patient literature. Reading Improvement 1991; 28(4):287-92.

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