10/10/2017 NCI Informed Consent Template – Optional Resource on Readability Tools Page 2
• Delete titles, phrases, fragments, headers and lists that are not complete sentences. This
includes lists of side effects that are not written as complete sentences (although you can
include bulleted items that are written as complete sentences).
• Delete periods that don’t mark the end of a sentence, such as numerals in a number list
(1. or 2.); abbreviations (Celeste B. Jones, M.D.); or periods used in decimals (10.3).
• Delete phone numbers and URLs.
Readability formulas were designed for use on narrative, flowing text that consists of complete
sentences. They were not designed to measure phrases, fragments or lists.
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If you include
phrases, fragments, headers and lists that are not complete sentences, your readability software
will not give you an accurate sentence count. If you don’t remove extra periods, your software
may count more sentences than there are, giving you a lower readability score.
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It is normal to see some variability across the tools. However, you will ideally see similar results
from different tools. You can first put your document through MS Word’s Readability Function,
and then put it through the Online-Utility readability assessment tool at
https://www.online-
utility.org/english/readability_test_and_improve.jsp. Then, compare the results.
One good way to check the accuracy of your results is to conduct both an online and manual
readability analysis of your document. NCI’s Pink Book, “Making Health Communications
Programs Work, available at
https://www.cancer.gov/publications/health-communication/pink-
book.pdf, provides instructions on how to conduct a manual SMOG readability analysis (pages
162-166). You can then compare your results to the SMOG reading level you got from the
Online-Utility tool. MS Word Readability does not give a SMOG score.
Limitations of Readability Formulas:
• There is not a one-to-one correlation between the grade level of a specific document and
a person’s reading ability. For example, if you use the Flesch-Kincaid Readability
Formula to analyze your informed consent document and you get a score of 10
th
grade, it
does not mean that all adults reading at the 10
th
grade level will understand the text.
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• Readability formulas do not measure many factors that affect reading ease, including the
familiarity of vocabulary and concepts, clarity of writing, concept density, format and
design, cultural relevance, believability, or the reader’s readiness to learn.
9,10
• Because most readability formulas give you averages, they do not tell you which sections
of text are hardest to read. You can select some of the potentially more difficult passages,
such as paragraphs with drug names, complicated medical procedures, and very long
sentences, when doing a manual SMOG analysis.
(2010, accessed October, 2017).
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Doak, C, Doak L, Root J. (1996). Teaching Patients with Low Literacy Skills. Philadelphia, PA: J.P. Lippincott.
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Toolkit for Making Written Material Clear and Effective. CMS. (2010).
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Toolkit for Making Written Material Clear and Effective. CMS. (2010).
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Doak, C, Doak L, Root J. (1996).
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Toolkit for Making Written Material Clear and Effective. CMS. (2010).