Abstract
BACKGROUND: The provision of patient information leaflets (PILs) is an important part of health care. PILs require evaluation, but the frameworks that are used for evaluation are largely under-informed by theory. Most evaluation to date has been based on indices of readability, yet several writers argue that readability is not enough. We propose a framework for evaluating PILs that reflect the central role of the patient perspective in communication and use methods for evaluation based on simple linguistic principles. THE PROPOSED FRAMEWORK: The framework has three elements that give rise to three approaches to evaluation. Each element is a necessary but not sufficient condition for effective communication. Readability (focussing on text) may be assessed using existing well-established procedures. Comprehensibility (focussing on reader and text) may be assessed using multiple-choice questions based on the lexical and semantic features of the text. Communicative effectiveness (focussing on reader) explores the relationship between the emotional, cognitive and behavioural responses of the reader and the objectives of the PIL. Suggested methods for assessment are described, based on our preliminary empirical investigations. CONCLUSIONS: The tripartite model of communicative effectiveness is a patient-centred framework for evaluating PILs. It may assist the field in moving beyond readability to broader indicators of the quality and appropriateness of printed information provided to patients.