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readability, cardiac rehabilitation, patient education, occupational therapy, literacy



  1. Johnson, Janelle L. MS, OTR/L
  2. Stern, Erica B. PhD, OTR/L, FAOTA


PURPOSE: Printed materials play a major role in cardiac rehabilitation (CR) patient education. Past studies have demonstrated a marked disparity between the average American reading ability (8th grade) and the readability levels of printed CR patient materials. This study compares the readability of facility-developed patient education materials used by rural and urban CR sites in Minnesota.


METHODS: By random selection, 30 rural and 30 urban CR sites were invited to submit printed education materials addressing home programs, exercise and activity guidelines, and leisure and recreation. Materials from 7 rural and 10 urban sites were submitted and assessed using the SMOG and SMOG-C readability formulas.


RESULTS: On the average, the materials from both urban and rural CR sites were written at a 10th-grade level. More than 87% of the sites required reading skills above the eighth-grade level. An independent t test showed no significant difference in the readability levels between the urban and rural sites. This study primarily compared readability across sites. However, the distribution of the 36 pieces of written material also was examined. Only 9% of the urban materials and 14% of the rural materials were written at or below the targeted eighth-grade level.


CONCLUSIONS: There was no significant difference in mean readability levels between urban and rural CR sites in Minnesota. On the average, the readability levels were two grades higher than recommended, with 87.5% of the CR sites expecting patients to learn information from materials too difficult for average American adults. The large number of polysyllabic words appears to be the main culprit for difficult readability levels.