Literacy, readability and cultural barriers: critical factors to consider when educating older African Americans about anticoagulation therapy

The number of patients on anticoagulation therapy has increased dramatically over the past two decades. Yet, few studies have examined the psychosocial barriers of low literacy, culture and inappropriate patient education materials used to teach older African Americans about their anticoagulation therapy. The aims of this study were to investigate literacy levels among older patients, and evaluate the readability and determine the cultural sensitivity of written information used in an anticoagulation management clinic. A descriptive, correlational design was used. Patients' (n = 62) knowledge levels and the readability and cultural sensitivity of written materials were examined. The Rapid Estimate of Adult Literacy in Medicine (REALM) was used to measure reading skills of patients, while the SMOG formula (a formula for assessing readability) was used to test the readability of written educational materials used in an Anticoagulation Management Clinic. A Knowledge Information Profile, developed for this study by one of the authors (Wilson), was used to measure patient knowledge about warfarin, medication side-effects and food sources of vitamin K. A modified, culturally sensitive and easy-to-read pamphlet was used as an alternative teaching tool in the study. The results of the study revealed the average self-reported for highest grade completed in school was twelfth grade; however, the actual mean reading skills were between seventh and eighth grade. The readability of the written information was three to four grades higher than patients' reading abilities. None of the patient education materials were culturally sensitive. This study underscores the importance of having information that is understandable and culturally relevant to prevent the outcome of internal bleeding. Nurses have a vital role in educating patients and ensuring that teaching materials are appropriate for the target population.