Assessing and Developing Health Materials

As we develop written materials for the general public, we need to think about vocabulary and sentence structure, organization of ideas, as well as layout and design elements so that we can eliminate as many unnecessary barriers as possible.

We need to consider the reading process.  Reading is a complicated task. The components of reading include the following:

Alphabetics: the process of using letters in an alphabet to represent sounds in the spoken word. Needed skills include knowledge of basic sounds [phonemes] and an understanding of the relationship between these sounds and letters [phonics].

Fluency: ability to read with speed and ease.

Vocabulary: knowledge of the meaning of a word. Understanding less common words requires background knowledge.

Reading comprehension: a construction process. This process involves all the elements of a reading process to derive meaning from text.

Beginning readers are developing skills in sounding out words. They learn to link sound to meaning. Over time, they learn about linked words in short sentences. They often read one word at a time and may skip over unfamiliar words. New readers may tire easily. As a result, new readers often focus on individual words and have difficulty focusing on the meaning of a sentence.

Intermediate readers are building background knowledge and vocabulary. At the same time, they are improving word recognition and fluency. They are learning to derive meaning from text and to make inferences.

Advanced readers read with speed and ease. They understand the context and can make inferences. They are using the written word and applying literacy skills to a variety of academic and mundane tasks.

Assessment Tools

The PMOSE/IKIRSCH Document Readability Formula by P. Mosenthal and I. Kirsch.  This innovative assessment tool focuses on documents-materials in the form of lists, charts and graphs.  Unlike prose, which is full sentences, documents provide different challenges based on format.  This formula offers a scoring mechanism for assessing documents.

The SMOG  by G. McLaughlin.  This tool is for assessing the reading level of prose [material in sentence and paragraph format] and is very useful for field work.  Click here for an overview of the SMOG and directions for use.  There is also an online calculator.  This Java application calculates a SMOG score for any length of text that is typed or pasted in.  It can be accessed at

The SAM by Doak, Doak and Root.  The SAM, developed by Len and Ceci Doak, offers a tool for assessing texts.  The SAM enables reviewers to move beyond mere readability assessments and consider the many important aspects of materials such as organization format, design and culture-that ease or hinder reading, comprehension and use.  Information on SAM can be found on pg 51-60 of the Doak, Doak and Root book Teaching Patients with Low Literacy Skills, Second Edition.

General Guidelines

Guidelines for Creating Materials

Guidelines for Assessing Materials

Guidelines for Rewriting Materials

Sample Materials

Click here for sample materials and plain language glossaries

Additional Resources

Click here for additional resources on creating and assessing web and print materials.