Though pamphlets are a commonly used form of patient education, studies suggest that written materials may be inappropriate for many people.  Further, consents are cumbersome for many readers, thus yielding the question as to whether consent is truly informed and understood.

Often, what seems to be the simplest of writing is far too advanced for those with lower literacy capabilities.  The NALS study published in 1993 estimated that 40 to 44 million people in the American population have low literacy skills. More than a decade later, The National Assessment of Adult Literacy finds that literacy skills remain low in the US population, with more than half of the population reading below the 8th grade level.

AMC Cancer Research Center. (1994). Beyond the Brochure: Alternative Approaches to Effective Health Communication. Denver, USA.

Kirsch, I., Jungeblut, A., Jenkins, L., & Kolstad, A. (1993). National Adult Literacy Survey (NALS).  1993. Adult Literacy in America: A First Look at the Findings of the National Adult Literacy Survey. Washington DC: National Center for Education Statistics.

National Center for Education Statistics. (2005). National Assessment of Adult Literacy. Washington DC: Author.

South Carolina Department of Education. (2005).  The state of literacy in America: Estimates of the local, state, and national levels. Retrieved January 25, 2006 from, http://www.sclrc.org/NalsNarrative.htm

Wilson , F. L., Mood D. W., Risk J., and Kershaw, T. (2003). Evaluation of Education Materials using Orem's Self-Care Deficit Theory. Nursing Science Quarterly, 16(1), 68-69.

Wonch, D. D. (2005). Readability testing. Retrieved Jan. 17, 2006, from, http://www1.va.gov/visns02/vet/ed/aritcles/readability.doc>