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OBSTETRICS AND GYNECOLOGY. 1996 Sep; 88(3 Suppl):72S-77S.A review of the research literature on the impact of functional literacy on contraceptive use failed to identify any study specifically devoted to this association; however, there have been 46 studies published in the past twenty years that addressed this topic as part of a broader analysis. For example, a survey of 2659 patients presenting for acute care at two urban US hospitals revealed that 42% could not read and understand basic medical instructions. Furthermore, studies have demonstrated that the package insert instructions accompanying contraceptives generally require a tenth-grade education, placing then beyond the comprehension of those at highest risk of unplanned pregnancy and sexually transmitted diseases. Literacy status is a better marker for educational attainment than number of years of schooling completed--the variable traditionally used--given variations in the quality of education. Future research should focus on the actual tasks required to comply with contraceptive instructions; once this knowledge package has been defined, ways to best communicate this information that do not involve reading can be developed. The Program for Appropriate Technology in Health guide for preparing family planning materials for low-literate audiences in developing countries is recommended to US health educators as well. Finally, low-literate patients themselves should be consulted about ways to address this communication barrier.
IMAGE - THE JOURNAL OF NURSING SCHOLARSHIP. 1990 Spring; 22(2):96-100.The readability of contraceptive package inserts appears to be a critical factors in ensuring proper use of the method. The patient package inserts prepared by commercial manufacturing generally require a reading level above 8th grade to be adequately comprehended, which places functionally illiterate and poorly educated acceptors at high risk of noncompliance. To remedy this situation, family planning service providers in many areas have developed their own generic instructions geared to the populations they serve. In this study, readability levels were analyzed for 26 sets of patient package inserts included with commercially distributed contraceptives and 24 sets of generic instructions prepared by health care agencies in Northern California. 6 standardized readability formulas were applied to data on 4 types of contraceptives: jellies, foams, creams, and vaginal sponge; diaphragms; oral contraceptives (OCs); and condoms. The mean readability of the 4 groups of contraceptive patient package inserts was grade 10.21, while that for the generic inserts was grade 8.17. There was a significant difference between the readability scores of commercially and locally prepared inserts for 3 (diaphragm, OCs, and condoms) of the 4 product categories studied. The lowest readability score (grade 5.5) was found in a generic leaflet accompanying OC, while the highest score (grade 13.6) was obtained for a condom package insert. These findings indicate that the commercial patient package inserts, whose mean readability score is always beyond the 10th grade level, may be too difficult to comprehend for most individuals at risk of unwanted pregnancies. Continued development of generic inserts is urged, as is research on the use of pictures, posters, audio and videotapes, anatomical models, and computer-assisted instruction for those with low literacy skills.