Comprehensibility of Health-Related Documents for Older Adults with Different Levels of Health Literacy: A Systematic Review

Abstract

A systematic review was conducted to assess the available evidence for the effectiveness of interventions aiming to improve the comprehensibility of health-related documents in older adults (≥50) with different levels of health literacy. Seven databases were searched (2005 forward), and references in relevant reviews were checked. The selection procedure was conducted by 2 independent reviewers. Data extraction and assessment of the quality of the resulting studies were conducted by 1 reviewer and checked for accuracy by a 2nd reviewer. A total of 38 intervention studies had a study population of older adults (n = 35) or made an explicit comparison between age groups, including older adults (n = 3). Inconsistent evidence was found for the importance of design features to enhance the comprehensibility of health-related documents. Only for narratives and multiple-feature revisions (e.g., combining revisions in textual and visual characteristics) did the included studies provide evidence that they may be effective for older adults. Using narrative formats and/or multiple-feature revisions of health-related documents seem to be promising strategies for enhancing the comprehensibility of health-related documents for older adults. The lack of consistent evidence for effective interventions stresses the importance of (a) replication and (b) the use of standardized research methodologies.

Acknowledgments

We are very thankful to research assistants Aline Douma, Mayke Musters, Jacqueline Quartero, and Bram Roenhorst for their contributions to this article. Furthermore, we are very grateful to Monika Koester of BZgA: Bundeszentrale für gesundheitliche Aufklärung, who contributed to the pilot session for the title review.

Notes

¹The authors explained this counterintuitive finding by stating that texts with higher readability scores according to Flesch RE (shorter words and sentences) may have suffered from decreased textual cohesion, making it more difficult for older adults with smaller working memories to integrate the information content.

²“Common information included material that was widely publicized, easily accessible, and that replicated general CCS [Canadian Cancer Society] introductory information available for all cancer types” (Donelle et al., 2008, p. 2).