Writing to Grade Level

I’ve been asked how to write patient education or information sheets for the general public, ensuring that it is at the appropriate grade level. Some people feel that it is very easy to “write down” to a lower reading level, while others are very intimidated about the very idea.

In my opinion, writing to a lower grade reading level, most often Grade 8, is not writing down. Nor is it when I’m asked to write to a Grade 6 reading level. Writing down or, as some say, dumbing down, insinuates that the people who are reading the copy are not as smart as we are. I had a rather lively debate with a fellow writer once about this. This writer said that the best way to see if your text was good for a Grade 6 reading level was to find some children in that grade and have them read it.

Although I understand the reasoning, I disagreed with that approach. An adult with a 6th grade reading level has way more than 12 years of life experience. So, their ability to understand certain concepts could greatly outstrip those of a 12-year-old. Just because one’s reading is at a certain level, doesn’t mean that the comprehension or the experience is at that level.

There is a movement called the plain language movement. It came to be because so much documentation is written in such complicated language that it is getting ridiculously difficult to understand. In fact, according to the Plain Language website, in June 1998, US President Bill Clinton issued a memo requiring government agencies to write in plain language.

That all being said, plain language varies between reading levels. So, how do we tell what reading level we have?

The easiest and most commonly used judge of reading level comes with the Microsoft Word program, the Flesch-Kincaid Readability Test . It’s not extremely accurate because it uses the number of words per sentence, the number of syllables per word, and so on. This is a big drawback when you are writing patient education sheets because there are times when you need to use bigger technical terms and they automatically shoot up your reading level. In cases like this, if I’m using the FK test to check my reading level, I will take out the complicated medical terms for the assessment and then get a more accurate reading level that way.

There are companies and experts who can tell you reading levels, but I prefer to use the common sense approach. This means things like:
No long sentences
Limited or no use of semi-colons
Bullet lists whenever possible
Short paragraphs
Simpler words over the multi-syllable words.

Just those five points make a big difference in reading level.

If you want to write simple, concise, and easy-to-understand material, think short and sweet. Read your text out loud to yourself. Use active voice, avoid passive. The sentence “The patient took the medication and felt much better,” sounds a lot easier to understand than, “The medication given to the patient provided significant improvement.” Are there any sentences that leave you gasping for breath because they’re so long? Do you have any lists that could be bulleted? Think about simplicity. Explain all your long or complicated terms the first time they’re used and then abbreviate or use the everyday term when possible.

Just out of curiosity, I checked the Flesch-Kincaid reading level of this piece to the above paragraph: it clocked in at grade 9.9. When I removed the bullet list above, it jumped to 10.4.

I truly enjoy the challenge of meeting different grade levels. One client sometimes asks me to write the same patient education information in both grades 6 and 8 levels. Grade 8 is a piece of cake most times, I think. Grade 6 can be enormously challenging, but it’s a challenge I like.

We want to encourage people to read our work, we don’t want them to get frustrated, and we don’t want them to feel as if we’re talking down to them. That’s important to remember.

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