Diabetes Pamphlets: What are Their Demands on Health Numeracy?

The purpose of this study was to characterize the quantitative concepts embedded in written diabetes pamphlets in order to infer the level of knowledge individuals need in order to understand these materials. We conducted a content analysis of 150 samples of 100 words, selected from 50 pamphlets related directly to diabetes treatment or prevention. The content of the samples was classified as: general information; nutrition; exercise and fitness; general prevention of complications; or prevention of specific complications. A range of quantitative concepts (e.g., counting numbers, percents), were coded and analyzed, as well as reading ease and grade level. ANOVAs on the Flesch Reading Ease (F[4, 145]=9.02, p = .000), and the Flesch-Kincaid Reading Level (F[4, 145]=7.62, p = .000) revealed overall differences in the samples as a function of content, with pamphlets dealing with general information having the lowest level of reading ease and the highest reading level, placing them at the 9th grade. There was also a significant difference among the pamphlets as a function of content in terms of the frequency of advanced quantitative concepts (e.g., statistics, computations, etc.) they contained (F[4, 145] = 6.38, p = .000) as well as number of verbal expressions of quantity, such as “reduce” (F[4, 145] = 2.65, p < .05). Interestingly, those pamphlets dealing with general information had the greatest frequency of advanced quantitative concepts but the fewest verbal expressions of quantity. The results of this study will be discussed in terms of improving the design of written diabetes materials.