JCPSLP Vol 22 No 2 2020

Learning from our clients

The readers, the writers and the documents A scoping review of the information accessibility and health literacy demands of allied health reports Harmony Turnbull, Leigha Dark, Ian Skinner, and Bronwyn Hemsley

This scoping review aimed to review extant literature in order to describe the readers and writers of allied health reports, determine the accessibility of allied health reports, and identify barriers and facilitators influencing the accessibility of allied health reports. We searched five scientific databases using relevant search terms relating to the accessibility of allied health reports. Nineteen peer-reviewed papers representing five allied health disciplines and six countries were included. In these papers there was little demographic diversity represented in the readers. People with disability, including communication disability, were rarely included. The small body of research that exists has suggested that few allied health reports are written at a level that supports information accessibility. There is not enough research to determine the outcomes of strategies, the barriers, or the facilitators to improving accessibility. Limited evidence is available to guide allied health professionals in producing information accessible reports for their clients. I n Australia, allied health professionals are university- qualified health professionals with expertise in prevention, assessment, and treatment of a range of health conditions. The term “allied health professionals” encompasses a range of health professions providing diagnostic and therapeutic health services to improve health and wellbeing; however, it does not encompass medical, dental, or nursing professionals (Allied Health Professions Australia, n.d.). Allied health professionals write reports about, and for, their clients who are also referred to in the literature as patients, consumers or health care recipients. These reports are written for a range of purposes including communicating assessment findings, documenting therapy progress, and establishing the need for funding. In recent years the readers of allied health reports have changed to include people with disability, their family members, support workers, educators, government employees, and

funding-body representatives (Bigby & Fyffe, 2011). This is a shift from the “traditional” audience of allied health reports which has been health professionals, and increases the responsibility of allied health professionals to address the health literacy needs of diverse readers (Groth-Marnat & Horvath, 2006). In the context of individualised funding, and consumer-directed health care, there is an increased focus on clients making informed choices and taking control of their service needs to achieve functional goals (Dickinson, Needham, & Sullivan, 2014). Being able to access and use information from allied health reports facilitates this process, but is also dependent on the health literacy of the readers (Wühlisch & Pascoe, 2011). According to Sørensen et al. (2012), health literacy involves accessing, understanding, appraising, and using health information to make appropriate health decisions. Poor health literacy is a barrier to accessing and using written materials to inform decisions about health care (Nutbeam, 2000). The health literacy of clients can be supported by increasing the information accessibility of allied health reports, along with other strategies. Accessible information is presented in ways that enable the inclusion of the majority of people (Hitt, 2018). Current guidelines for producing accessible written information include recommendations for the use of Plain English (Plain English Foundation, 2016), Plain Language (The International Plain Language Federation, 2018), Plain Writing (United States Government, 2010), Easy English (Accessible Information Service, 2015), Easy Read (Change, 2016), and aphasia- friendly formats (Rose, Worral, Hickson, & Hoffmann, 2011). These formats share the common aim of changing the structure, organisation and presentation of written information to be more easily understood by the reader (Garwood, 2014). In order to improve the information accessibility and health literacy demands of allied health reports it is important to consider factors concerning the readers and writers of allied health reports, the allied health reports, and the contexts in which allied health reports are created and read (Garwood, 2014). Considering these factors, the specific aims of this review were to: 1. Describe the readers and the writers of allied health reports that are represented in the research 2. Determine the accessibility and health literacy demands of allied health reports 3. Identify the reported barriers and facilitators influencing the accessibility and health literacy demands of allied health reports.

KEYWORDS ALLIED HEALTH HEALTH LITERACY INFORMATION ACCESSIBILITY READABILITY

READER- FRIENDLY REPORT WRITING

THIS ARTICLE HAS BEEN PEER- REVIEWED This manuscript has undergone independent editorial review.

Harmony Turnbull (top) and Leigha Dark

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JCPSLP Volume 22, Number 2 2020

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