Background: Health literacy requires reading and writing skills as well as knowledge of health topics and health systems. Materials written at high reading levels with ambiguous, technical or dense text, often place great comprehension demands on consumers with lower literacy skills. This study developed and used an instrument to analyze cervical cancer prevention materials for readability, comprehensibility, suitability, and message design. Methods: The Suitability Assessment of Materials (SAM) was amended for ease of use, inclusivity, and objectivity with the encouragement of the original developers. Other novel contributions were specifically related to "comprehensibility" (CAM). The resulting SAM + CAM was used to score 69 materials for content, literacy demand, numeric literacy, graphics, layout/typography and learning stimulation variables. Expert reviewers provided content validation. Inter-rater reliability was "substantial" (x = .77). Results: The mean reading level of materials was 11 lb grade. Most materials (68%) scored as "adequate" for comprehensibility, suitability, and message design; health education brochures scored better than other materials. Only one-fifth were ranked "superior"for ease of use and comprehensibility. (Conclusions: Most written materials bave a readability level that is too high and require improvement in ease of use and comprehensibility for the majority of readers.
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