scholarly journals Bladder Cancer Health Literacy: Assessing Readability of Online Patient Education Materials

2020 ◽  
pp. 1-8
Author(s):  
Lauren E. Powell ◽  
Theodore I. Cisu ◽  
Adam P. Klausner
Keyword(s):  
Bladder Cancer ◽  
Health Literacy ◽  
Patient Education ◽  
Search Engine ◽  
Reading Ability ◽  
Health Care Expenditure ◽  
Reading Level ◽  
T Test ◽  
Grade Levels ◽  
Grade Reading Level

BACKGROUND: Understanding of health-related materials, termed health literacy, affects decision makings and outcomes in the treatment of bladder cancer. The National Institutes of Health recommend writing education materials at a sixth-seventh grade reading level [6]. The goal of this study is to assess readability of bladder cancer materials available online. OBJECTIVE: The goal of this study is to characterize available information about bladder cancer online and evaluate readability. METHODS: Materials on bladder cancer were collected from the American Urological Association’s Urology Care Foundation (AUA-UCF) and compared to top 50 websites by search engine results. Resources were analyzed using four different validated readability assessment scales. The mean and standard deviation of the materials was calculated, and a two-tailed t test for used to assess for significance between the two sets of patient education materials. RESULTS: The average readability of AUA materials was 8.5 (8th–9th grade reading level). For the top 50 websites, average readability was 11.7 (11–12th grade reading level). A two-tailed t test between the AUA and top 50 websites demonstrated statistical significance between the readability of the two sets of resources (P = 0.0001), with the top search engine results being several grade levels higher than the recommended 6–7th grade reading level. CONCLUSIONS: Most health information provided by the AUA on bladder cancer is written at a reading ability that aligns with most US adults, with top websites for search engine results exceeding the average reading level by several grade levels. By focusing on health literacy, urologists may contribute lowering barriers to health literacy, improving health care expenditure and perioperative complications.

scholarly journals Readability of Patient-Reported Outcome Measures in Adult Audiologic Rehabilitation

2018 ◽  
Vol 27 (2) ◽  
pp. 208-218 ◽  
Author(s):  
Alana Douglas ◽  
Rebecca J. Kelly-Campbell
Keyword(s):  
Health Literacy ◽  
Outcome Measures ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Reading Level ◽  
Response Scale ◽  
Grade Levels ◽  
Patient Reported ◽  
Grade Reading Level ◽  
Audiologic Rehabilitation

Purpose The purpose of this study was to examine the readability of published patient-reported outcome measures (PROMs) designed for use in adult audiologic rehabilitation. The readability results were compared with the readability levels recommended for health information by health literacy experts. Method Reading grade levels were calculated using the Flesch–Kincaid Grade Level Formula (Flesch, 1948), Gunning Fog Index (Gunning, 1952), Simple Measure of Gobbledygook (McLaughlin, 1969), and FORCAST (Caylor, Sticht, Fox, & Ford, 1973) readability formulas for 10 published PROMs. Descriptive statistics were computed across the different PROM sections: instructions, items, response scale, and overall contents of the measure directed toward respondents. Results The majority of the PROM sections exceeded the 6th grade reading level recommended by health literacy experts, regardless of the formula applied. All PROM sections exceeded the 6th grade reading level when calculated according to the FORCAST formula, the most appropriate readability formula for use with a nonnarrative text format, such as PROMs. Conclusions When developing or reevaluating PROMs designed for use in adult audiologic rehabilitation, researchers should consider ways to improve the readability of their measure, as poor readability may affect the validity of the empirical data collected using the PROM. Additionally, the adequate readability of audiologic PROMs is required if patient/family-centered care values are to be adhered to within the field of adult audiologic rehabilitation.

scholarly journals Health care and social media: What patients really understand

F1000Research ◽  
2017 ◽  
Vol 6 ◽  
pp. 118 ◽  
Author(s):  
Kyle Hoedebecke ◽  
Lindsey Beaman ◽  
Joy Mugambi ◽  
Sanam Shah ◽  
Marwa Mohasseb ◽  
...  
Keyword(s):  
Health Care ◽  
Social Media ◽  
Health Literacy ◽  
Grade Level ◽  
Reading Level ◽  
Lower Grade ◽  
Grade Levels ◽  
Low Health Literacy ◽  
Patient Health ◽  
Grade Reading Level

Background: Low health literacy is associated with decreased patient compliance and worse outcomes - with clinicians increasingly relying on printed materials to lower such risks. Yet, many of these documents exceed recommended comprehension levels. Furthermore, patients look increasingly to social media (SoMe) to answer healthcare questions. The character limits built into Twitter encourage users to publish small quantities of text, which are more accessible to patients with low health literacy. The present authors hypothesize that SoMe posts are written at lower grade levels than traditional medical sources, improving patient health literacy. Methods: The data sample consisted of the first 100 original tweets from three trending medical hashtags, leading to a total of 300 tweets. The Flesch-Kincaid Readability Formula (FKRF) was used to derive grade level of the tweets. Data was analyzed via descriptive and inferential statistics. Results: The readability scores for the data sample had a mean grade level of 9.45. A notable 47.6% of tweets were above ninth grade reading level. An independent-sample t-test comparing FKRF mean scores of different hashtags found differences between the means of the following: #hearthealth versus #diabetes (t = 3.15, p = 0.002); #hearthealth versus #migraine (t = 0.09, p = 0.9); and #diabetes versus #migraine (t = 3.4, p = 0.001). Conclusions: Tweets from this data sample were written at a mean grade level of 9.45, signifying a level between the ninth and tenth grades. This is higher than desired, yet still better than traditional sources, which have been previously analyzed. Ultimately, those responsible for health care SoMe posts must continue to improve efforts to reach the recommended reading level (between the sixth and eighth grade), so as to ensure optimal comprehension of patients.

scholarly journals Readability of Patient Education Materials From High-Impact Medical Journals: A 20-Year Analysis

2021 ◽  
Vol 8 ◽  
pp. 237437352199884
Author(s):  
Michael K Rooney ◽  
Gaia Santiago ◽  
Subha Perni ◽  
David P Horowitz ◽  
Anne R McCall ◽  
...  
Keyword(s):  
Patient Education ◽  
Grade Level ◽  
Treatment Options ◽  
Sixth Grade ◽  
High Impact ◽  
Reading Level ◽  
Eighth Grade ◽  
Medical Journals ◽  
Grade Levels ◽  
Grade Reading Level

Comprehensive patient education is necessary for shared decision-making. While patient–provider conversations primarily drive patient education, patients also use published materials to enhance their understanding. In this investigation, we evaluated the readability of 2585 patient education materials published in high-impact medical journals from 1998 to 2018 and compared our findings to readability recommendations from national groups. For all materials, mean readability grade levels ranged from 11.2 to 13.8 by various metrics. Fifty-four (2.1%) materials met the American Medical Association recommendation of sixth grade reading level, and 215 (8.2%) met the National Institutes of Health recommendation of eighth grade level. When stratified by journal and material type, general medical education materials from Annals of Internal Medicine were the most readable ( P < .001), with 79.8% meeting the eighth grade level. Readability did not differ significantly over time. Efforts to standardize publication practice with the incorporation of readability evaluation during the review process may improve patients’ understanding of their disease processes and treatment options.

scholarly journals Assessment of Online Patient Education Materials Designed for People with Age-Related Macular Degeneration

2020 ◽  
Author(s):  
Jennifer K Fortuna ◽  
Anne Riddering ◽  
Linda Shuster ◽  
Cassie Lopez-Jeng
Keyword(s):  
Health Literacy ◽  
Patient Education ◽  
Macular Degeneration ◽  
Reading Ability ◽  
Reading Speed ◽  
Reading Level ◽  
Age Related Macular Degeneration ◽  
Age Related ◽  
The Mean ◽  
Readability Level

Abstract Background Age-related macular degeneration (AMD) is a chronic eye condition that leads to permanent vision loss in the central visual field. Difficulty reading is one of the most common complaints from patients with this condition. Reading comprehension may be poorer due to slower reading speed, increased demands of decoding and poorer quality of visual input. The internet has become the most widely accessible source of patient education materials (PEMs). Optical devices improve access to text, but they do not promote processing and understanding of written patient education materials. Methods Online PEMs were sourced from websites of national organizations providing patient education materials designed for people with AMD. The Flesch-Kincaid Grade Level formula and the Suitability Assessment of Materials instrument were used to assess the readability and suitability of PEMs. Descriptive statistics were used to compare online PEMs by organization based on national guidelines for readability level (≤ sixth grade) and the recommended suitability score (≥ 70%) for superior material. Results One hundred online PEMs were evaluated from websites of 16 professional organizations. The mean readability level was 9.3 (range 5.0-16.6). The mean suitability score was 53% (range 18%-78%). Only six (6%) of PEMs met the recommended readability level and suitability score. Conclusion The majority of online PEMs included in this study were written at a reading level considerably higher than the average U.S. adults reading ability. To promote health literacy, the readability of PEMs must match the reading capacity of the target audience. Existing guidelines for promoting health literacy should consider how age and visual impairment create additional barriers to processing and understanding of written health information. Additional research is needed to determine optimal design characteristics of PEMs for people with AMD. Future studies should also explore the effectiveness of PEMs that have been modified based on evidence-based guidelines for patients with low health literacy and low vision.

scholarly journals Computerized versus hand-scored health literacy tools: a comparison of Simple Measure of Gobbledygook (SMOG) and Flesch-Kincaid in printed patient education materials

2018 ◽  
Vol 106 (1) ◽  
Author(s):  
Kelsey Leonard Grabeel ◽  
Jennifer Russomanno ◽  
Sandy Oelschlegel ◽  
Emily Tester ◽  
Robert Eric Heidel
Keyword(s):  
Health Literacy ◽  
Patient Education ◽  
Grade Level ◽  
Medical Center ◽  
Academic Medical Center ◽  
Reading Level ◽  
Rater Reliability ◽  
Simple Measure ◽  
Grade Levels ◽  
Academic Medical

Objective: The research compared and contrasted hand-scoring and computerized methods of evaluating the grade level of patient education materials that are distributed at an academic medical center in east Tennessee and sought to determine if these materials adhered to the American Medical Association’s (AMA’s) recommended reading level of sixth grade.Methods: Librarians at an academic medical center located in the heart of Appalachian Tennessee initiated the assessment of 150 of the most used printed patient education materials. Based on the Flesch-Kincaid (F-K) scoring rubric, 2 of the 150 documents were excluded from statistical comparisons due to the absence of text (images only). Researchers assessed the remaining 148 documents using the hand-scored Simple Measure of Gobbledygook (SMOG) method and the computerized F-K grade level method. For SMOG, 3 independent reviewers hand-scored each of the 150 documents. For F-K, documents were analyzed using Microsoft Word. Reading grade levels scores were entered into a database for statistical analysis. Inter-rater reliability was calculated using intra-class correlation coefficients (ICC). Paired t-tests were used to compare readability means.Results: Acceptable inter-rater reliability was found for SMOG (ICC=0.95). For the 148 documents assessed, SMOG produced a significantly higher mean reading grade level (M=9.6, SD=1.3) than F-K (M=6.5, SD=1.3; p<0.001). Additionally, when using the SMOG method of assessment, 147 of the 148 documents (99.3%) scored above the AMA’s recommended reading level of sixth grade.Conclusions: Computerized health literacy assessment tools, used by many national patient education material providers, might not be representative of the actual reading grade levels of patient education materials. This is problematic in regions like Appalachia because materials may not be comprehensible to the area’s low-literacy patients. Medical librarians have the potential to advance their role in patient education to better serve their patient populations.

Readability Assessment of Patient Education Materials on Major Otolaryngology Association Websites

2012 ◽  
Vol 147 (5) ◽  
pp. 848-854 ◽  
Author(s):  
Jean Anderson Eloy ◽  
Shawn Li ◽  
Khushabu Kasabwala ◽  
Nitin Agarwal ◽  
David R. Hansberry ◽  
...  
Keyword(s):  
Patient Education ◽  
Sixth Grade ◽  
Reading Level ◽  
Flesch Reading Ease ◽  
Education Material ◽  
Individual Assessment ◽  
Honestly Significant Difference ◽  
Significant Difference ◽  
Grade Reading Level ◽  
Post Hoc

Objective Various otolaryngology associations provide Internet-based patient education material (IPEM) to the general public. However, this information may be written above the fourth- to sixth-grade reading level recommended by the American Medical Association (AMA) and National Institutes of Health (NIH). The purpose of this study was to assess the readability of otolaryngology-related IPEMs on various otolaryngology association websites and to determine whether they are above the recommended reading level for patient education materials. Study Design and Setting Analysis of patient education materials from 9 major otolaryngology association websites. Methods The readability of 262 otolaryngology-related IPEMs was assessed with 8 numerical and 2 graphical readability tools. Averages were evaluated against national recommendations and between each source using analysis of variance (ANOVA) with post hoc Tukey’s honestly significant difference (HSD) analysis. Mean readability scores for each otolaryngology association website were compared. Results Mean website readability scores using Flesch Reading Ease test, Flesch-Kincaid Grade Level, Coleman-Liau Index, SMOG grading, Gunning Fog Index, New Dale-Chall Readability Formula, FORCAST Formula, New Fog Count Test, Raygor Readability Estimate, and the Fry Readability Graph ranged from 20.0 to 57.8, 9.7 to 17.1, 10.7 to 15.9, 11.6 to 18.2, 10.9 to 15.0, 8.6 to 16.0, 10.4 to 12.1, 8.5 to 11.8, 10.5 to 17.0, and 10.0 to 17.0, respectively. ANOVA results indicate a significant difference ( P < .05) between the websites for each individual assessment. Conclusion The IPEMs found on all otolaryngology association websites exceed the recommended fourth- to sixth-grade reading level.

Readability of Waiver of Liability Forms Used in Collegiate Intramural and Recreational Sports Programs

2003 ◽  
Vol 27 (2) ◽  
pp. 37-46 ◽  
Author(s):  
Benjamin J. White ◽  
Bradley J. Cardinal
Keyword(s):  
Grade Level ◽  
Ninth Grade ◽  
Reading Level ◽  
Recreational Sports ◽  
Intended Audience ◽  
Moderating Variables ◽  
Grade Levels ◽  
Sports Programs ◽  
Micro Power ◽  
Grade Reading Level

Waiver of liability forms should be written at a reading level consistent with that of the intended audience. On average, students read three grade levels below the last grade they completed in school. Therefore, waivers should be written no higher then the ninth-grade level. The main goal of this study was to assess the reading level of intramural and recreational sport waiver of liability forms, compared to the ninth-grade level. Nine NIRSA member schools and nine non-NIRSA member schools were randomly selected from each of NIRSA's six regions. Readability was assessed using the Readability Calculation software (Micro Power & Light, Dallas, TX) for MacIntosh. A one-sample t-test was performed to compare the forms to the ninth-grade reading level. Forms were written significantly higher than the ninth-grade level (t[26]=14.53, p<.0001). An analysis of variance was performed to assess possible moderating variables. No significant differences were found. Font size was also measured, and forms were found to have been written at a significantly higher level then the recommended 12-point font (t[28]=-2.88, p<.01). This study brings into question the efficacy of waiver of liability forms used in many collegiate/university intramural and recreational sports programs.

scholarly journals Achilles Tendon Repair: Can Patients Read, Understand, and Act on Online Educational Resources?

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0022
Author(s):  
Burke Gao ◽  
Alan G. Shamrock ◽  
Trevor Gulbrandsen ◽  
John E. Femino ◽  
Cesar de Cesar Netto ◽  
...  
Keyword(s):  
Patient Education ◽  
Achilles Tendon ◽  
Grade Level ◽  
Elective Surgery ◽  
Tendon Repair ◽  
Reading Level ◽  
Achilles Tendon Repair ◽  
Grade Reading Level ◽  
Google Search ◽  
Online Patient Education

Category: Sports; Trauma Introduction/Purpose: Patients often access online resources to learn about orthopedic procedures prior to undergoing elective surgery. In order to be fully understood by the average English-speaking adult, online health information must be written at an elementary school reading level. To be helpful to patients, educational resources should also be generally understandable and have actionable direction that positively affects healthcare interactions. There are several previously validated indices for accessing the reading level of written materials. The Patient Education Materials Assessment Tool (PEMAT) provides a reliable and validated method to measure the understandability and actionability of education materials. The purpose of this study was to utilize PEMAT and readability algorithms to quantify readability, understandability and actionability of online patient education materials related to Achilles tendon repair. Methods: Online patient education materials were identified using two independently conducted Google engine searches with the term ‘Achilles tendon repair’. Using the top 50 search results, articles were included if they specifically served to educate patients regarding TAA. Exclusion criteria included news articles, non-text materials (video), research manuscripts, industry websites, and articles not related to Achilles tendon repair. The readability of included articles was quantified using the validated Flesch-Kincaid Grade Level index. The PEMAT form for printed materials was used to assess understandability and actionability using a 0-100 scale for both measures of interest. Spearman’s correlation coefficient was utilized to examine the relationship between a website’s average rank on Google (from first to last) and its readability, understandability, and actionability. P-values of less than 0.05 were considered significant. Results: Thirty-one websites met inclusion criteria. The mean Flesch Kincaid reading grade level was 10.8+-2.9, with only one website written below the 6th grade reading level. Higher Flesch-Kincaid grade was associated with later Google seach rank (rho: 0.488, p=0.010). Mean understandability and actionability scores were 67.1+-16.4% and 38.3+-28.4%, respectively. Among understandability criteria, only 12.9% (n=4) of articles included summaries and just 38.7% (n=12) included visual aids. Among actionability categories, 74% (n=23) of websites identified at least one action for readers, while only 60.8% (n=14) of these studies broke down actions into explicit, easy to understand steps. Actionability scores were not correlated with Google search rank (rho: -0.02, p=0.888), while higher understandability scores were associated with later Google search rank (rho: 0.45, p=0.017). Conclusion: Only one website describing Achilles tendon repair was written at or below the nationally recommended 6th grade reading level. Overall, Achilles tendon repair online educational materials scored poorly with respect to readability, understandability, and actionability. Articles that appeared earlier in the Google search had lower readability and understandability scores. In the era of shared decision making, it is vital that patients understand procedures, as well as the risks and benefits prior to undergoing elective surgery. These results suggest that current publicly available resources for Achilles tendon repair remain inadequate for patient education.

An Evaluation Of The Quality Of Patient-Oriented Online Resources For Hemodialysis Access (Preprint)

2021 ◽  
Author(s):  
Mark Davies
Keyword(s):  
Patient Education ◽  
Vascular Surgery ◽  
Search Engines ◽  
Reading Level ◽  
Online Resources ◽  
Hemodialysis Access ◽  
Patient Resources ◽  
Meta Search ◽  
Grade Reading Level

BACKGROUND Patients and families increasingly turn to the internet for information and resources regarding their medical conditions. These searches are conducted in an independent and unsupervised manner, often without guidance from providers. Multiple reports in the medical oncology literature have cast significant doubt on the accuracy and currency of the data found on patient-focused websites OBJECTIVE To critically appraise the quality of patient-focused online resources concerning hemodialysis access procedures. METHODS A recently validated search strategy using the meta-search engines Google, Dogpile, and Yippy with the query “hemodialysis access” was performed on a cleared-cache web browser during January 2020. Inclusion criteria for the study were websites intended for patient education in English. Exclusions criteria consisted of online monographs, academic journals, and sites requiring paid subscription. Three independent reviewers evaluated the websites using a validated, structured rating tool that scored the Affiliation, Accountability, Interactivity, Structure and Organization, Readability, and Content of the websites. Inter-rater reliability was quantified by calculated kappa coefficients for each element of the instrument. RESULTS Out of more than 27 million collective search results using the three meta-search engines, the first 269 hits were considered for analysis. Only 63 unique patient-oriented sites were acceptable for analysis. 46% were sponsored by commercial entities. Accountability and interactivity were weak across sites. Readability as determined by Flesch-Kincaid and SMOG indices ranged from 6th grade to post-graduate level. 19% were written at a college reading level or higher, however these sites had content quality comparable to those utilizing more elementary prose. 85% of non-commercial domain sites were free of inaccuracies compared to 59% of commercial sites (P=.02). Non-commercial domain sites trended toward more comprehensive content as well as superior readability (average 10th grade reading level compared to average 11th grade reading level, P=.08). The average composite score of all the websites was 2.8 out of a maximum possible weighted score of 7.8, indicating poor global quality of websites. Kappa coefficients were 0.7 or greater for a random sample of 10 websites. CONCLUSIONS This is the first report on the quality of online patient resources in vascular surgery. The study demonstrates that online patient education resources regarding hemodialysis access are poor and require input from the vascular surgery community. Providers need to be aware and understand this issue and seek to inform and mitigate misinformation and potential misguidance. The vascular surgery community should invest in more readable and comprehensive web resources. CLINICALTRIAL n.a

Assessment of the Readability of Online Patient Education Material from Major Canadian Pediatric Associations (Preprint)

2021 ◽  
Author(s):  
Alice Man ◽  
Courtney van Ballegooie
Keyword(s):  
Patient Education ◽  
Medical Information ◽  
Health Behaviours ◽  
Reading Level ◽  
Pediatric Society ◽  
Word Analysis ◽  
Education Material ◽  
Preventative Health ◽  
Grade Reading Level ◽  
Online Patient Education

BACKGROUND Online patient education materials (PEMs) are frequently written above the recommended reading level in North America. Poor PEM readability limits the accessibility of medical information to individuals with average to lower literacy levels. Pediatric hospital and association websites have not only been shown to be a preferred source of information among caregivers but have also become a necessity in the COVID-19 pandemic. The readability of Canadian pediatric association websites has not yet been assessed quantitatively. OBJECTIVE To assess the readability of online Canadian pediatric association PEMs to determine if the content of the material is written at a reading level that the majority of Canadians can understand. METHODS PEMs were extracted from ten Canadian pediatric associations and evaluated for their reading level using ten validated readability scales. Associations underwent a difficult word analysis and cross association comparisons were assessed. RESULTS Online PEMs were identified from three pediatric association websites, where the grade reading level was found to be 8.8 +/- 1.8 for the Caring for Kids website, 9.5 +/- 2.2 for the Pediatric Endocrine Group website and 13.1 +/- 2.1 for the Atlantic Pediatric Society website. The difficulty word analysis identified that 19.9% of words were unfamiliar overall. CONCLUSIONS The online PEMs were found to be written above the recommended seventh grade reading level for Canadians. Consideration should be made to create PEMs at an appropriate grade reading level for both patients and their caregivers to encourage health literacy and ultimately promote preventative health behaviours and child health outcomes.

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