Health Literacy · Plain Language · AHRQ-Aligned
Patient Education
Readability Checker
Check whether your patient education materials, consent forms, discharge instructions, medication guides, and all patient-facing documents meet the plain language standards required by AHRQ, AMA, Joint Commission, and NIH. Free. No signup. No patient data stored.
Bobcat Toolbox Pro is aligned with standards from these major healthcare organizations
AHRQ
Agency for Healthcare Research & Quality
≤ Grade 6
AMA
American Medical Association
≤ Grade 6
JC
The Joint Commission
≤ Grade 5 (recommended)
NIH
National Institutes of Health
≤ Grade 8
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Understanding the Scores
What Each Readability Scale Measures — and Why It Matters
Bobcat Toolbox Pro uses four industry-standard readability formulas — each measuring a different dimension of text complexity. Together they give you a complete picture of how your patients will experience your materials.
Developed for the U.S. Navy and adopted by the Department of Defense, the Flesch-Kincaid Grade Level formula combines average sentence length and average syllables per word to produce a U.S. school grade equivalent. A score of 8.0 means an 8th grader could read it comfortably. AHRQ recommends targeting Grade 4–6 for patient materials.
Why it matters for healthcare: Most American adults read 2–3 grade levels below their completed education. A college-educated patient may functionally read at a 10th grade level — and struggle with a discharge instruction written at Grade 12. The FK formula is the most widely cited in healthcare compliance.
Simple Measure of Gobbledygook — developed by G. Harry McLaughlin in 1969. SMOG counts polysyllabic words (3+ syllables) — the single biggest driver of comprehension difficulty in health documents. Medical jargon like "myocardial infarction" (7 syllables), "pharmacological" (6), and "contraindicated" (6) dramatically inflate SMOG scores.
Why it matters for healthcare: AHRQ specifically recommends SMOG as the preferred formula for health materials because it focuses on the words patients actually struggle with — complex medical terminology. SMOG intentionally produces slightly higher (more conservative) scores, which AHRQ considers appropriate when patient safety is at stake.
A companion to Flesch-Kincaid, Reading Ease produces a score from 0 to 100 — higher is easier. Scores of 60–70 correspond to plain English accessible to most adults. Scores below 30 indicate text found in academic journals or legal documents. AHRQ recommends targeting 60 or higher for patient materials.
Why it matters for healthcare: The Reading Ease score is intuitive for non-technical staff — a nurse reviewing patient handouts immediately understands that a score of 35 is problematic without needing to interpret grade levels. It's particularly useful for training content creators on plain language principles.
Developed by Robert Gunning in 1952, the Fog Index combines average sentence length with the percentage of complex words (3+ syllables). It was originally designed to assess newspaper and business writing. A Fog score above 12 indicates text that requires a college education to understand comfortably.
Why it matters for healthcare: The Fog Index is especially sensitive to long, complex sentences — a common pattern in consent forms and discharge instructions that combine multiple instructions in a single sentence. It complements SMOG by capturing sentence-level complexity that SMOG doesn't fully weight.
How Bobcat Toolbox Pro calculates your AHRQ compliance score
The AHRQ Standard score shown above is a composite of your Flesch-Kincaid Grade Level and SMOG Index — the two formulas specifically recommended by the AHRQ Health Literacy Toolkit, Tool 11. By averaging these two scores, Bobcat Toolbox Pro provides a balanced assessment that accounts for both sentence structure (FK) and vocabulary complexity (SMOG), which together are the primary drivers of patient comprehension difficulty.
Why These Organizations Matter
The Standards Behind the Scores
Non-compliance with these organizations' plain language standards can affect accreditation status, patient safety outcomes, and legal exposure. Here's what each organization requires — and what's at stake.
AHRQ
Agency for Healthcare Research and Quality — U.S. Department of Health and Human Services
AHRQ is the lead federal agency for patient safety and healthcare quality. Their Health Literacy Universal Precautions Toolkit is the gold standard framework for plain language in U.S. healthcare. AHRQ's Tool 11 specifically recommends readability assessment using Flesch-Kincaid and SMOG, targeting a 4th–6th grade reading level. Studies funded by AHRQ show that patients with low health literacy have higher rates of hospitalization, worse chronic disease management, and higher healthcare costs.
✓ Target: 4th–6th grade (Grade ≤ 6) · Flesch Reading Ease ≥ 60
⚠ Risk: Materials above grade 6 contribute to medication errors, missed follow-up appointments, and preventable readmissions — the three most costly patient outcomes in U.S. healthcare.
AMA
American Medical Association — the largest association of physicians and medical students in the United States
The AMA's health literacy guidelines recommend patient materials be written at no higher than a 6th grade reading level. This recommendation is grounded in the finding that the average American reads at a 7th–8th grade level — but reads health information 2–3 grade levels lower due to unfamiliar terminology and stress. The AMA's health literacy initiatives include training programs for physicians on communicating effectively with patients of all literacy levels.
✓ Target: Grade 6 or below · Assessed using Flesch-Kincaid
⚠ Risk: The AMA has identified low health literacy as a stronger predictor of poor health than age, income, employment status, or education level.
Joint Commission
The Joint Commission — accredits and certifies nearly 22,000 U.S. healthcare organizations
The Joint Commission's accreditation standards directly address patient education and communication. Their standards require hospitals to provide education "in a manner understandable to the patient" — and health literacy experts and accreditation consultants recommend a 5th grade reading level or lower for written materials to comfortably meet Joint Commission patient education standards. During surveys, Joint Commission reviewers may request evidence that patient education materials meet plain language standards. Materials that patients cannot understand may result in Requirements for Improvement during Joint Commission surveys that must be addressed before the next accreditation cycle.
✓ Recommended: Grade 5 or below · Health literacy experts recommend this threshold to meet Joint Commission patient education standards
⚠ Risk: Joint Commission findings related to patient communication can affect accreditation status — which directly impacts a hospital's ability to receive Medicare and Medicaid reimbursement.
NIH
National Institutes of Health — the primary U.S. federal agency for biomedical and public health research
The NIH recommends a 7th–8th grade reading level for general health information intended for the public — reflecting the average American reading level. For patient education materials targeting diverse or vulnerable populations, the NIH aligns with AHRQ's stricter 6th grade recommendation. NIH-funded research consistently shows that health information written above the 8th grade level significantly reduces patient comprehension and adherence, particularly in populations with lower educational attainment.
✓ Target: Grade 8 or below for general health content
⚠ Note: For patient education specifically targeting chronic disease management, discharge instructions, or medication adherence, NIH researchers recommend aligning with AHRQ's stricter Grade 6 standard.
Informational Use Only. Readability scores are based on mathematical formulas and are provided for educational purposes. A passing score does not guarantee patient comprehension or accreditation compliance. Use alongside AHRQ PEMAT and professional judgment. Not affiliated with AHRQ, AMA, Joint Commission, or NIH. Do not paste documents containing Protected Health Information (PHI). See our
Terms of Service.