Readability and health literacy level of post-exposure prophylaxis patient education materials offered after sexual assault

Background: The link between readability of patient education materials and patient outcomes has been well established. Patients who experience sexual assault often present to the emergency department in an acute trauma response state. Stress interferes with memory and learning. Patients routinely receive medication to prevent sexually transmitted infections after sexual assault. HIV post-exposure prophylaxis (PEP) success is dependent on completing a 28-day course. Only 24% of sexually assaulted patients complete HIV PEP. Methods: This descriptive study used three validated tools to assess readability and evaluate the understandability of HIV PEP patient education materials following sexual assault. Patient education materials (n = 21) were collected through a variety of databases, government sources, and secondary reference review. Each researcher independently scored all materials. Inter-rater reliability was assured after robust. Discussion: Final scores were used to determine readability and health literacy levels. Results: All educational materials far exceeded the recommended readability level (Range = 7th grade to college). Those with the highest readability included visual cues. The Patient Education Materials Assessment Tool (PEMAT) understandability scores ranged from 38 to 94%, and actionability scores ranged from 40 to 100%. Using a cut score of 80%, approximately 57% of the educational materials were understandable, while only 14% were actionable. Conclusions: Expert agencies recommend a sixth-grade or below reading level for patient education reading materials. Our data show that post-exposure patient education materials following sexual assault are difficult to understand. This mismatch between the patient education material's readability and health literacy levels and the recommended standards will likely limit the success of post-exposure prophylaxis course of treatment following sexual assault.