Comparing undergraduate and postgraduate students on an integrative learning lesson in health literacy and health communication across two international medical schools

Healthcare professional students should be engaged in best practice regarding communication with patients, including awareness of the relationship between patient health literacy and use of patient information leaflets (PILs). Such PILs should have good readability, use health psychology theory content to maximise motivation and provide practical assistance for behaviour change, and provide good quality, unbiased information for patients. We describe a compulsory first semester flexible learning student project that requires identification, quantification and application of these indices to enhance PIL design, comparing findings across 2 international sites, and undergraduate and graduate student cohorts. After ethical approval was provided, a cross-sectional survey of first semester students across two RCSI sites (Dublin [undergraduate and graduate entry programmes], Malaysia) investigated readability (Flesch score), quality ratings (DISCERN) and health psychology theory content in six international PILs promoting physical activity. Students were also asked to propose theory-based improvements for the PILs, and submitted a report. While Flesch readability scores were variable among PILs, no differences were reported in pre- or post-modification Flesch scores (for all PILs averaged) among student groups. Importantly, student-added content was not detrimental to average Flesch scores. In comparison to the Dublin cohort, identification of theories in PILs differed in various ways between the Malaysian and graduate students. For example, graduate students were significantly more likely to identify a theory that was not taught on the course, possibly indicating a greater ability to integrate material outside the core course content. Furthermore, graduate students were more critical of the quality of the PILs, as evidenced by lower ratings on the DISCERN overall and reliability subscales. In contrast, the Malaysian undergraduate cohort provided higher DISCERN overall and reliability ratings than the Dublin undergraduates. Importantly, the results have highlighted significant differences between undergraduate and graduate entry groups, but also differences between undergraduate cohorts across Dublin and Malaysia. Such findings may reflect differences in teaching across sites, or cultural differences that are important for education. Overall, this integrative learning project addresses the international relevance of student engagement in material that highlights patient health literacy issues and the usefulness of theory to guide good quality communication.