Health Literacy Consulting Tips
January 2007

Readability Goals

January is often the time of year when people set goals. These goals may be personal, such as deciding to exercise more and weigh less. Or goals may be about business, like committing an organization to consistently take customers' needs into account.  

In terms of health literacy, many organizations set readability goals for their written materials. The goals I most often hear about are reading grade levels. These are numbers that (somehow) correspond with the number of years a person went to school.

But in my opinion, there are problems using reading grade levels as readability goals. In this month’s Health Literacy Consulting Tip, I answer questions that organizations often ask.   

How are reading grade levels determined?
Reading grade levels are determined by using a “readability assessment tool.” Two commonly-used tools are the Fry and SMOG. These calculate reading grade level based on two objective factors: 1) the number of syllables in words, and 2) the number of words in sentences.

What is the problem with reading grade levels?

  • Factors. Most readability assessment tools look only at word and sentence length. But these are just two of more than 100 factors that affect reading ease. Others are more subjective such as organization, tone, graphics, and personal relevance.
  • Purpose. Many readability assessment tools were designed about 50 years ago to determine which textbooks to give school children. They were not designed to assess written health information for adults. Also, few adults actually read at grade level. Instead, they may read several levels below their last completed year of school.
  • Personal relevance. Conversely, adults may read at higher grade levels when topics are of personal relevance. For instance, people diagnosed with cancer are likely to comprehend multi-syllabic words like “chemotherapy” and “radiation” regardless of their reading grade level.      

How can reading grade levels best be used?
In my experience, reading grade levels are an excellent way of getting organizations to pay attention – especially when there is a huge gap between the skills of readers and levels of materials. When working at a hospital several years ago, I made a report to department managers about the average grade level of our teaching materials compared to the average literacy level of our patients. Thanks to this report, my health literacy project was funded!

Should reading grade levels be a standard for good writing?
No. Writers familiar with readability assessment tools can quickly learn how to get “good grades" by writing choppy sentences filled with short words. But this doesn’t necessarily mean that readers will find the text informative, appealing, or understandable.  

So what should I use as a readability goal?
To me, a more useful goal is to always include readers in the materials review process. This means getting their feedback starting with the first draft. Take readers' feedback seriously and consider making their suggested changes. For most organizations, reader feedback is the most effective and rewarding way of meeting readability goals.   

Make a resolution to respond to your readers' needs.
Here are some resources I offer as help:

For permission to include Health Literacy Consulting Tips in your organization's newsletter, please contact Helen Osborne by e-mail at:, or by phone at: 508-653-1199.