READABILITY AND SUITABILITY OF ENROLLMENT FORMS FOR THE STATE CHILDREN'S HEALTH INSURANCE PROGRAM   Lee M. Sanders, Steven Federico, Mary Ann Abrams, Benard Dreyer, William Cull, Janet Ohone-Frempong, Terry Davis.. Pediatrics, University of Miami, FL; Pediatrics, University of Colorado, CO; Pediatrics, Iowa Health Systems, IA; Pediatrics, New York University, NY; American Academy of Pediatrics, Elk Grove, IL; Clear Language Group; Medicine and Pediatrics, Louisiana State University, LA.  Presented at the 2007 Pediatric Academic Societies' Annual Meeting.

Background: At least 1 in 5 US adults cannot read basic health information. Low parent health literacy is associated with decreased access to care for children. The mechanism for this association remains unclear.

Objective: To assess the readability and suitability of enrollment forms for the State Children's Health Insurance Program (SCHIP).

Design/Methods: SCHIP enrollment forms were acquired from each of the 50 states and the District of Columbia. For each form, readability and suitability scales were scored by 2 trained research assistants (mean scores; kappa > 0.8 for each scale). Text readability was assessed with the Lexile framework. Document suitability (its complexity, structure, and density) was assessed by 3 measures: the PMOSE/IKirsch scale, the Suitability Assessment of Materials (SAM) scale, and a new measure designed to reflect adherence to written standards commissioned by the US Department of Health and Human Services (DHHS). “Readable” and “suitable” were considered to be < 8th-grade equivalency (the median ability of the US adult population).

Results: Median grade level for text readability was 10 (range 6-14). Median grade level for document suitability was 8 (range 4-12) by PMOSE/IKirsch and 7 (range 4-14) by SAM. Forms from 27 states met federal standards for document suitability. Forms from 6 states were both readable and suitable. See Table.