Readability — What is it and why does it matter?

Readability -- What is it and why does it matter?

If you write for the public, you probably know about readability formulas. In fact, every Microsoft Word user has access to these through the Check Grammar Option.

So if you’re concerned about patients’ ability to understand and use a document, can readability formulas help make it happen?

What readability formulas measure

In general, readability fomulas, particularly the computerized readability checkers, measure 2 elements:

  • Sentence length, and
  • Word length.

Some measure the length of words in characters, while others count sylllables. This article on readability includes a guide to online readability tests. (Long article, scroll down.)

What readability formulas don’t measure

Is the word familiar? Will readers recognize it at a glance? “Fake” and “feign” are one-syllable words that score the same on common readability tests. But most readers see “feign” a lot less often than “fake.” Also, "feign" contains a silent letter, so many readers won’t know how to say it, even in their heads.

To continue the Game of Thrones theme here, what about “realm” and “kingdom?” According to most readability formulas, “kingdom” is less readable. It has two syllables instead of one and seven characters instead of five. But which word are most people more likely to recognize at a glance? That’s the more readable word.

To make text readable, use familiar words

When someone knocks at your door, you either recognize them instantly or notice that they’re a stranger. If you see a friend, you let them in. If you see a stranger, you have to figure out if they're OK. A brown UPS uniform means yes, your package from Zappos is here. There’s something familiar about the person that allows you to act: open the door, take the package, go try on your new sunglasses.

If the person’s appearance yields no clues, you might skip answering the door or wave them away. Same with a completely unfamiliar word. Even highly literate readers often skip words they don't recognize, since their goal is to comprehend the main message.

Why is familiar important?

Most of us – health care workers, administrators, marketers, word people – were trained to read critically, look things up, and sound things out. Under stress, such as getting a life-threatening diagnosis or preparing for an uncomfortable procedure, we are less likely to do this. We just want to know what to do, and it's hard to concentrate. Literacy expert J. David Cooper says, “Rapid and effortless word recognition is the main component of fluent reading.” And why do we read? To get the meaning. (Cooper, J. David. (2000). Literacy: Helping Children Construct Meaning. Boston, MA: Houghton Mifflin Company.)

Consider the context

Readability also depends on your reader’s familiarity with and interest in the topic. Test yourself by reading the following paragraph:

Line is lengthened by releasing spare line immediately after the power stroke is completed. For a visual key, look for the forward loop of line passing the rod tip. That is the time to release (shoot) line into the cast. The amount of energy put into the forward cast has to be increased slightly to account for the line being shot.

You can read it. But do you understand it? Unless you’re familiar with Spey casting, probably not. The ability to read the words, or most of them, doesn’t mean you automatically understand the information. Does your lack of comprehension make you dumb? Not at all. You simply know about as much about this arcane style of fly fishing as your patients know about clinical trials or how to manage a G-tube.

Tear down this wall
Patients don't spend all their time in the health care world. Many of them -- many of us, when we are patients -- feel about as comfortable as you would if I put you on the Sandy River in my spare pair of waders and handed you my beloved Beulah Platinum 6126 equipped with a 425-grain Skagit Max head and a Lady Gaga steelhead fly. If I gave you instructions, they'd need to be simple to enable you to stay on your feet, get some line in the water and cast correctly, avoiding getting snagged on the river bottom. Right?

The stakes in patient information are much, much higher. The patient needs to understand insurance and payments, so she doesn't get stuck with a co-pay she can't handle. Or his patient's prostate cancer is back, and he needs to decide on a salvage treatment. A child with sickle cell disease needs to get to the hospital if she has certain symptoms.

Let's not erect extra walls between our patients and what they need to do. The walls of confusion, worry about money, fear of mortality and impotence, and uncertainty about whether to call the doctor all potentially keep the patients above from taking needed action. Adding unfamiliar words and long sentences, writing in a judgy tone, or simply failing to leave any white space on a document? Those things don't help -- they hinder.

Computerized formulas do have a place. I've found to be helpful for web content. But Instead of relying on computerized formulas exclusively, the most effective way to learn if your audience can understand and use your materials is to … ask them.

Field testing? We don’t have the budget for that!

Before you start worrying, five to eight folks are enough for a field test. It’s best to do field testing in person. Watching field test participants is important because they may say they’re doing fine, but clearly struggle. Here are some testing guidelines from


I'm always happy to talk with you about making documents more readable. Email me or call (503) 734-6853 to chat.

Spring and early summer schedule

Out of office: May 13
Memorial Day holiday: May 30
Vacation: June 16-24

Recommended Reading

The happiest country on earth?
British journalist Helen Russell is just like us. Overworked, overstressed, compensating with shopping or [insert your time-to-unwind indulgence here].

Then her husband is transferred to LEGO headquarters in Denmark. She leaves her magazine job, switches to freelance journalism, and as writers will do, chronicles the rest in My Year of Living Danishly. Cue LEGO Movie song "Everything is Awesome." Or is it?

The concept of hygge, constant consumption of beer, and gorgeous organization of her new compatriots astound Russell and will surprise you, too. There's a lot of pastry, but your dog better be well behaved. By the end of the year, of course, her life has changed. Food for thought and highly entertaining.

The neuroscience of (your) happiness

Healthy Brain, Happy Life by neuroscientist Wendy Suzuki tells you how to be more energetic, less stressed, and just plain happier. I love this concept. Unfortunately, I had a crazy-busy fall. The kind of vigorous exercise Suzuki recommends -- and in which she personally leads large lecture classes, Spandex and all -- dropped off my radar for a couple of months. But Suzuki's own story, liberally interwoven with neuroscience findings in this book, shows that all the things you know you should be doing really make a difference. You can get rid of stress by exercising hard. You can train yourself to work less and enjoy more healthful foods. Your life, paradoxically, becomes richer when you lift your nose off the grindstone. 

What else relieves stress? A 2009 study from the University of Sussex showed that reading for just 6 minutes decreased volunteers' heart rates and muscle tension more than taking a walk, listening to music, or drinking a cup of tea or coffee. So this spring, pick up one of these volumes. Set your phone alarm for 6 minutes - or go crazy and make it 10, and learn while you relax.

Hello! I'm Dr. Genevieve Long. I write and edit for patients and health care providers, specializing in patient education, plain language, and health literacy as well as marketing communications.

I belong to the American Medical Writers Association, the Plain Language Association International, and the National Association of Science Writers. In my spare time, I fly fish, walk my black Labs, do yoga, and read consumer health books and mystery novels.

Email me or call (503) 734-6853 to discuss your project. I'm always happy to hear from you!

Recent Projects

  • Patient education on living with migraine (print and online)
  • Patient guide on preparing for surgery
  • Info sheets on pediatric venipuncture, caring for your child's IV, and external shunts
  • Online patient education on managing hypoparathyroidism
  • Marketing materials for providers -- esophageal cancer clinical program
  • Website on deep brain stimulation -- patient and provider versions with accompanying print guides
  • Web content on cancer care for older adults
  • Profiles of nurse researchers and educators for new department website