From Grade 11 to a Pocket Card: Rewriting a Sun Safety Handout for the Workers Who Actually Read It
Student Name
American College of Education
NUR4073: Health Promotion
Module 6 Assignment
Instructor Name
December 7, 2026
Why the Handout Needed Rewriting
Health information only helps people who can read, understand and act on it. The National Assessment of Adult Literacy, the most recent national measurement of health literacy in the United States, placed 36 percent of American adults at the two lowest of its four health literacy levels, meaning they could manage only simple, concrete health information such as finding one piece of information in a short text (Kutner et al., 2006). Many clinicians overestimate how much of their written material patients can use, and the gap is widest for adults with less formal education, those whose first language is not English and older adults.
The handout in question is a single page the landscaping company distributes to new crew members, titled Solar Radiation Hazard Awareness. The company, crew and document are composites written for this assignment. After the sun safety toolbox talk planned earlier in this course, the foreman mentioned that most workers throw the handout away unread. A handout nobody reads is not a teaching tool; it is a record that teaching was attempted. Before rewriting it, the nurse measured what was wrong with it.
Measuring the Original
Three measures were used. The first was reading grade level using the SMOG formula, which estimates the years of education needed to understand a text from the number of words with three or more syllables in a sample of sentences (McLaughlin, 1969). The original handout of 612 words scored at about grade 11. Weiss (2007) recommends that patient materials be written at or below a sixth-grade reading level for general audiences, so the handout was five grades too hard for its readers before any other problem was considered.
The second and third measures came from the Patient Education Materials Assessment Tool, which rates printed and audiovisual materials for understandability, whether readers can process and explain key messages, and actionability, whether readers can identify what to do (Shoemaker et al., 2014). The tool was developed with expert review and tested for reliability, and in consumer testing materials rated more actionable produced better comprehension. The original handout scored 45 percent on understandability and 25 percent on actionability, well below the 70 percent level commonly used to mark a material as acceptable.
The item-by-item ratings showed where the problems lay. The handout used medical terms without explanation, such as erythema and actinic damage; it opened with statistics about skin cancer incidence rather than with what to do; it gave no specific amounts or times; and it contained no pictures. Its one instruction, apply broad-spectrum sunscreen of adequate SPF at appropriate intervals, was accurate and impossible to follow.
The Rewrite, Sentence by Sentence
The rewrite followed four principles: lead with actions, use everyday words, give exact amounts and times, and cut everything that does not help the reader act. The original opening sentence read: Occupational exposure to ultraviolet radiation constitutes a significant risk factor for the development of cutaneous malignancies among outdoor workers. The revised opening reads: The sun can hurt your skin at work. Here are four things that protect you. The revision replaces a claim about risk with a promise of something useful, in two short sentences.
The original instruction on sunscreen read: Apply broad-spectrum sunscreen of adequate SPF at appropriate intervals throughout the work period. The revision reads: Use sunscreen that says SPF 30 or higher. Use one teaspoon on your face and neck and one on each arm. Put it on again at lunch and at 2 p.m. Each sentence contains one action, and the amounts and times match what the crew practiced at the toolbox talk.
The original section on skin changes used the terms lesion, asymmetry and pigmentation. The revision reads: Look at your hands, arms and neck once a week. Show a nurse or doctor any spot that is new, getting bigger, bleeding or looks different from your other spots. A small drawing shows two spots side by side, one ordinary and one irregular. Every change moved the text from what the writer knew toward what the reader could do next.
The revised card has 118 words on each side, one picture for each of four actions and the same text in Spanish on the reverse, translated by a certified translator and checked by the bilingual foreman for the words the crew actually uses. Its SMOG score is about grade 5.
Testing With Real Readers
A readability score measures the words on the page, not whether a worker can use them, so the revised card was tested with readers before printing. The nurse re-rated it with the Patient Education Materials Assessment Tool, and it scored 83 percent on understandability and 80 percent on actionability. She then gave the card to five crew members who had not attended the toolbox talk, including two whose first language is Spanish, and asked each to read it and then explain in their own words what to do. This is the teach-back method applied to a written material rather than a spoken lesson.
Four of the five explained all four actions correctly. One worker understood the sunscreen and hat actions but thought the skin check meant looking for sunburn. The drawing was revised to make the irregular spot darker and the word sunburn was added to a separate line, so the difference between a burn and a changing spot would be clear. The card was then printed and laminated, and the company agreed to stop distributing the original handout.
What the Revision Left Out
Cutting the handout from 612 words to 118 meant deciding what workers did not need on the card. The skin cancer statistics were removed, along with an explanation of the difference between ultraviolet A and ultraviolet B radiation and a paragraph on the company's liability. None of that information was wrong, and some of it matters to supervisors, so it was moved to a separate one-page sheet for the foreman rather than deleted. The card keeps only what a worker needs at the truck in the morning or at lunch: when the sun is strongest, how much sunscreen to use and when to reapply, what to wear and what to look for on the skin.
Leaving information out can feel like withholding it, and writers often resist it for that reason. The Patient Education Materials Assessment Tool treats a focus on a small number of key messages as part of understandability (Shoemaker et al., 2014), and the reader test confirmed the choice: none of the five workers asked about anything the card had dropped. Anyone who wants more can ask the nurse or the foreman, and the card says so in one line at the bottom.
Conclusion
The original sun safety handout was accurate, complete and almost useless to the workers who received it. Measuring it before rewriting showed that it was five grades above a suitable reading level and scored far below acceptable understandability and actionability. Rewriting sentence by sentence around actions, everyday words and exact amounts produced a card at about fifth-grade level, and testing it with real readers caught a misunderstanding no score would have revealed. The work took a few hours, and it is the difference between material that records teaching and material that continues it after the nurse has gone.
References
Kutner, M., Greenberg, E., Jin, Y., & Paulsen, C. (2006). The health literacy of America's adults: Results from the 2003 National Assessment of Adult Literacy (NCES 2006-483). U.S. Department of Education, National Center for Education Statistics.
McLaughlin, G. H. (1969). SMOG grading: A new readability formula. Journal of Reading, 12(8), 639-646.
Shoemaker, S. J., Wolf, M. S., & Brach, C. (2014). Development of the Patient Education Materials Assessment Tool (PEMAT): A new measure of understandability and actionability for print and audiovisual patient information. Patient Education and Counseling, 96(3), 395-403. https://doi.org/10.1016/j.pec.2014.05.027
Weiss, B. D. (2007). Health literacy and patient safety: Help patients understand (2nd ed.). American Medical Association Foundation.
How this NUR 4073 Module 6 example is structured
NUR 4073 Module 6 often closes on health literacy and rewriting your own materials for a real reader; your classroom's instructions decide which material and which tools. This example establishes why health literacy matters with national data, scores the original handout with named tools before changing a word, and then shows the rewrite as paired before-and-after passages with the principle behind each change. The final section tests the revision with actual readers, because a readability score measures the text, not whether a worker can act on it. The order, measure, revise, test, is the method the module is teaching.
NUR4073 Module 6 questions, answered
What does NUR4073 Module 6 usually ask for?
NUR4073 Module 6 often focuses on health literacy and asks students to evaluate and rewrite patient education material so a real reader can understand and use it. Many sections expect a readability measure and a before-and-after comparison. Your classroom's instructions decide which material to revise and which assessment tools are required.
Which tools can I use to assess patient education materials?
A readability formula such as SMOG gives an estimated reading grade level. The Patient Education Materials Assessment Tool, known as PEMAT, rates understandability and actionability. Readability alone is not enough, because short words can still be confusing, so pair a formula with PEMAT and with testing by real readers.
What reading level should patient materials target?
Health literacy guidance commonly recommends a sixth-grade reading level or lower for general audiences. Lower is often better for materials meant to prompt action, such as instruction cards. Reading level is only one factor; clear actions, exact amounts, pictures and plain words matter as much.
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