DOI: 10.32322/jhsm.1981731 ISSN: 2636-8579

Assessing psycholinguistic barriers in Turkish patient information leaflets: a natural language processing approach

Muhammed İnan, Cenk Aypak
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Aims: To evaluate psycholinguistic barriers in Turkish patient information leaflets (PILs) using a computational corpus-linguistic approach, and to introduce a composite metric, the Cognitive Alienation Index (CAI), integrating structural readability with nocebo-term and medical-jargon density.Methods: A cross-sectional corpus of 144 Turkish PILs retrieved from the Turkish Medicines and Medical Devices Agency (TİTCK) was processed using a custom NLP pipeline in R. Two domain-specific lexicons (119 nocebo and 181 medical-jargon stems) were applied using stem-based morphological matching, with densities normalised per 1000 words. Structural readability was assessed using the Ateşman and Bezirci-Yılmaz indices. The CAI combined nocebo and jargon densities divided by the Ateşman readability score. Z-scores with Benjamini-Hochberg false discovery rate (FDR) correction identified outlier leaflets. Multiple linear regression assessed component contributions.Results: Mean Ateşman readability was 46.88 (SD 7.80), indicating generally difficult texts. Mean nocebo and jargon densities were 17.57 and 8.88 per 1000 words, respectively. Mean CAI was 6.02 (range 1.11-15.34). After false discovery rate correction, only two leaflets remained significant outliers, both for jargon density. Multiple regression showed that nocebo density was the strongest contributor to CAI (β=0.676), followed by jargon density (β=0.314) and readability (β=-0.283). CAI rankings remained robust across alternative weighting schemes (Spearman ρ≥0.894).Conclusion: Turkish PILs demonstrate substantial structural and psycholinguistic complexity, driven primarily by nocebo language and reduced readability, with jargon density representing a largely independent barrier. As a proof-of-concept, the CAI offers a practical screening tool for prioritising leaflets for plain-language revision, particularly among anticoagulant/antiplatelet, antimetabolite, and thyroid medications.

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