JCPSLP Vol 22 No 2 2020

achieve desirable readability statistics. Five studies (Brown et al., 2016; Donaldson et al., 2004; Mallin, Schellenberg, et al., 2012; Roggenbuck et al., 2015; Weddig, 1984) examined the readability and other characteristics of the documents which are presented in Table 1. Readability measures used in the studies included Fry’s readability formula, Flesch Reading Ease, Flesch-Kincaid level, and Simple Measure of Gobbledygook (SMOG) measures ( n = 4) (Brown et al., 2016; Donald & Kelly-Campbell, 2016; Mallin, Schellenberg, et al., 2012; Weddig, 1984). One study used three of these measures (Donald & Kelly- Campbell, 2016). One study incorporated a qualitative measure of the readability of assessment reports and concluded that readability statistics alone are not a reliable indicator of ease of comprehending a document (Mallin, Schellenberg, et al., 2012). In studies where readability of the documents was assessed, high grade reading levels (grade 10 or higher) were found (Brown et al., 2016; Donaldson et al., 2004; Mallin, Schellenberg, et al., 2012; Weddig, 1984). Two of the included studies found that the readability of the documents improved (e.g., lower grade level, reduced jargon, simpler sentence structures) following training of the allied health professionals (Brown et al., 2016; Roggenbuck et al., 2015). Barriers and facilitators to improving information accessibility Identifying barriers and facilitators to improving the information accessibility of health reports was not incorporated into the aims of the included studies. However, the barriers and facilitators were, at times, discussed in the discussion section of the papers. Barriers and facilitators to accessibility discussed related to the writer (skills, knowledge, attitudes, practice context), the reader (feelings of inadequacy), and resources (access to examples, training, and time). These factors are presented in Table 2. Discussion and implications The clinical practice of report writing is a significant component of allied health service provision and one that remains a challenging and complex issue. However, the results of this review highlight the lack of research attention given to the accessibility of allied health reports or understanding the specific characteristics of the readers and the writers of allied health reports. There is a lack of consistent investigation and reporting practices which results in a discordant collection of study aims and outcomes, making it difficult to address the aims of this review with confidence. The cultural, linguistic and disability diversity that is apparent in many communities is not yet reflected in the participants of the included studies. The current research does not appear to adequately represent the 22% of people in the US (Ryan, 2013) and Australia (Australian Bureau of Statistics, 2017a) who speak languages other than English; nor the 11% of Australians who do not speak English at all, or do not speak it well (Australian Bureau of Statistics, 2017a). Even including those who speak English, at least 18.7% of people in the US (Taylor, 2018), and 18.5% in Australia (Australian Bureau of Statistics, 2016) have a disability, with an estimated 4.9 million people in the US (2.1%) (Taylor, 2018), and 1.2 million Australians (5%) (Australian Bureau of Statistics, 2017b), having a communication disability. Thus, research to date into the views or needs of readers of allied health reports does

Records identified through database searching ( n = 109)

Additional records identified through other sources ( n = 8)

Records after duplications removed ( n = 39)

Records screened ( n = 39)

Records excluded ( n = 15)

Full-text articles excluded with reasons ( n = 5)

Full-text articles assessed for eligibility ( n = 24)

Studies included in qualitative synthesis ( n = 19)

Figure 1. Search process

2014), speech-language pathology ( n = 2) (Donaldson et al., 2004; Flynn & Parsons, 1994), and audiology ( n = 1) (Donald & Kelly-Campbell, 2016). Studies were conducted in the USA ( n = 7) (Brown et al., 2016; Miller & Watkins, 2010; Pelco et al., 2009; Rahill, 2018; Roggenbuck et al., 2015; VandenBoom et al., 2018; Weddig, 1984), Canada ( n = 5) (Mallin, Beimcik, et al., 2012; Mallin, Schellenberg, et al., 2012; Wiener, 1985, 1987; Wiener & Kohler, 1986), Australia ( n = 3) (Donaldson et al., 2004; Fletcher et al., 2015; Flynn & Parsons, 1994), the UK ( n = 2) (Makepeace & Zwicker, 2014; Phelps et al., 2004), New Zealand ( n = 1) (Donald & Kelly-Campbell, 2016), and France ( n = 1) (Cassini et al., 2011). Practice settings included educational settings (i.e., schools) ( n = 10) (Fletcher et al., 2015; Mallin, Beimcik, et al., 2012; Mallin, Schellenberg, et al., 2012; Miller & Watkins, 2010; Pelco et al., 2009; Rahill, 2018; Weddig, 1984; Wiener, 1985, 1987; Wiener & Kohler, 1986), primary care settings (i.e., hospitals and hospital clinics) ( n = 3) (Cassini et al., 2011; Phelps et al., 2004; Roggenbuck et al., 2015), public clinic ( n = 1) (Makepeace & Zwicker, 2014), university clinic ( n = 1) (Donaldson et al., 2004) and mixed locations ( n = 2) (Roggenbuck et al., 2015; VandenBoom et al., 2018). Two studies provided no information about practice context (Donald & Kelly- Campbell, 2016; Flynn & Parsons, 1994). Information accessibility and health literacy demands of the documents The majority of studies ( n = 14) used “model” reports (i.e., reports written specifically to achieve the aims of the research); therefore these are not included for analysis in this review as they are not representative of allied health reports written by clinicians for their clients. The modifications to documents in the included studies appear to focus on manipulating features such as formatting to

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JCPSLP Volume 22, Number 2 2020

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