What we found
A published trial mailed one of two cover letters to 2,702 women. AWCL scored both without knowing which one got more replies.
One trial is one trial. When we ran the same blind test on 18 more published trials, AWCL's ranking picked the version that got more people to act no more often than chance. AWCL measures how a piece is built for a frightened reader. It does not predict how many people will reply.
Letter A Got more back
Surveys sent back26%
Deadline givenThree weeks
AWCL ranked itHigher
Letter B
Surveys sent back21%
Deadline givenNone
AWCL ranked itLower
What AWCL caught: Letter A said what to do, and by when.
McBride E, Mase H, Kerrison RS, Marlow LAV, Waller J. BMC Medical Research Methodology, 2021.
Not reading level
Thirty-seven cancer-center documents were scored with AWCL and, separately, with two readability formulas.
9%
of the Emotional Safety score is explained by reading grade.
5%
of the Action Clarity score is explained by reading grade.
37of 37
documents failed the same check: breaking a complicated procedure into numbered steps.
A trial that points the same way
In a 2003 randomized trial across 44 institutions, an easy-to-read consent form lowered patients' anxiety about consenting and raised their satisfaction. Their understanding didn't change.
Coyne CA and colleagues, Journal of Clinical Oncology, 2003. A consent form for a clinical trial, and someone else's research, not AWCL's.
AHRQ, TalkingQuality: readability formulas don't measure comprehension.
Try it on your own material
A pilot shows it, on your own material, in the number you already watch.
AWCL reads the material, not the patient. No study yet ties a score to a medical outcome.
Where the science comes from
Emotion, 2007. Anxiety takes up the working memory a task needs.
Psychological Bulletin, 2016. Across 177 samples and 22,061 people, anxiety went with lower working memory.
Journal of the Royal Society of Medicine, 2003. Between 40 and 80 percent of what a clinician tells a patient is forgotten right away.
Making health information usable is the organization's job, not only the patient's.