In order to help patients retain the most information, audiologists know that it is often helpful to provide written materials to supplement verbal counseling. One of the easiest ways to choose effective written materials is to apply readability tests to evaluate their reading level.

Readability tests were originally created to evaluate the appropriateness of books for students at certain ages or grade levels. They apply a mathematical formula or graph to the text to calculate a U.S. grade level, reading age or reading ease score.

Although there are several readability tests, the Flesch-Kincaid Grade Level and the Flesch Reading Ease scores are the most widely used outside of the educational setting, and both tests are available as part of most grammar or editing software offered today (e.g., Microsoft WordT, KWordT, LotusT, WordProT).

The software functionality typically needs to be activated. On the WordT toolbar, access the "Help" function and search for "readability." From the search results, choose "display readability statistics" to obtain instructions for activating the readability statistic functionality. Once activated, the "Spelling and Grammar" function will automatically provide the Flesch Reading Ease score and the Flesch-Kincaid Grade Level score after checking spelling and grammar.

The Flesch Reading Ease score measures reading on a scale from 100 (easy) to 0 (very difficult to read) using the following formula: 206.85-(1.015x Average Sentence Length, ASL)-(84.6 x Average Syllable per word, ASW). Examples of score interpretation are: score of 90-100 easily read by an average 5^th grader; 60-70-8/9^th grader; 0-30-college graduate.

The Flesch-Kincaid Grade Level formula formally translates the 0-100 score to a U.S. grade level using the following formula: (.39 x ASL)+(11.8 x ASW)-15.59. A score of 5.2 would indicate material readable by a 5^th grader. The formulas are accurate to approximately +/- 1 year. U.S. grade levels can be converted to reading ages by adding a value of 5; this allows use of readability test results outside the United States.

Other methods for evaluating readability include Gunning 'FOG' Readability test, Fry Readability Graph, Powers-Sumner-Kearl Formula, McLaughlin 'SMOG' Formula, and FORCAST Formula.

When using readability tests, some cautionary advice is in order. First, understand that reading comprehension differs from reading ability. Formulas cannot measure comprehension, interest or suitability to a reader's needs. Material may receive a low-grade level score but be incomprehensible to the reader. Second, consider other things that a formula cannot, such as: logical organization of the material; gender, class or cultural bias in the material; primary language of the intended reader; and the possibility of illiteracy. Think of readability formulas as screening tests that merely offer a prediction that the text is appropriate for a particular parent or caregiver.

Finally, when writing versus evaluating material, it is sensible to be cognizant of the reading level; however, do not try to write to the formula as you risk decreasing comprehension. For example, consider the phrase "visual cues." The word 'visual' has three syllables and will decrease reading ease; however, if changed to "cues that can be seen" (all one-syllable words), the flow of the material is broken and ultimately the reader's ability to comprehend the text is reduced. Audiology terms will ultimately decrease reading ease because of their multi-syllabic nature. If audiology terms are defined using more easily read text, the audiology terms can be removed when determining overall grade level or reading ease scores.

This article has a Flesch Reading Ease score of 30 with a Flesch-Kincaide Grade Level of 13.

Melanie Sisson, AuD, is associate director of clinical trials at Pfizer Inc. and a practicing pediatric audiologist at Lawrence and Memorial Hospital in CT. She recently authored the Workbook for Parents of Children who are Newly Identified as Hard of Hearing, published by Oticon Pediatrics. Contact her at melanie.sisson@pfizer.com.