scholarly journals Readability of Online Patient Educational Materials for Coronary Artery Calcium Scans and Implications for Health Disparities

2020 ◽  
Vol 9 (18) ◽  
Author(s):  
Fatima Rodriguez ◽  
Summer Ngo ◽  
Grayson Baird ◽  
Sujana Balla ◽  
Randy Miles ◽  
...  
Keyword(s):  
Coronary Artery ◽  
News Media ◽  
Coronary Artery Calcium ◽  
Grade Level ◽  
Cardiovascular Health ◽  
Reading Level ◽  
Medical Decision ◽  
Educational Materials ◽  
Search Terms ◽  
Reading Grade Level

Background Coronary artery calcium (CAC) scans can help reclassify risk and guide patient‐clinician shared treatment decisions for cardiovascular disease prevention. Patients increasingly access online patient educational materials (OPEMs) to guide medical decision‐making. The American Medical Association (AMA) recommends that OPEMs should be written below a 6th‐grade reading level. This study estimated the readability of commonly accessed OPEMs on CAC scans. Methods and Results The terms “coronary artery calcium scan,” “heart scan,” and “CAC score” were queried using an online search engine to identify the top 50 commonly accessed websites based on order of search results on December 17, 2019. Grade‐level readability was calculated using generalized estimating equations, with observations nested within readability metrics from each website. Results were compared with AMA‐recommended readability parameters. Overall grade‐level readability among all search terms was 10.9 (95% CI, 9.3–12.5). Average grade‐level readability of OPEMs for the search terms “coronary artery calcium scan,” “heart scan,” and “CAC score,” was 10.7 (95% CI, 9.0–12.5), 10.5 (95% CI, 8.9–12.1), and 11.9 (95% CI, 10.3–13.5), respectively. Professional society and news/media/blog websites had the highest average reading grade level of 12.6, while health system websites had the lowest average reading grade level of 10.0. Less than half of the unique websites (45.3%) included explanatory images or videos. Conclusions Current OPEMs on CAC scans are written at a higher reading level than recommended for the general public. This may lead to patient misunderstanding, which could exacerbate disparities in cardiovascular health among groups with lower health literacy.

Quality, Readability, and Trends for Websites on Ankyloglossia

2018 ◽  
Vol 127 (7) ◽  
pp. 439-444 ◽  
Author(s):  
Nicole Leigh Aaronson ◽  
Johnathan Edward Castaño ◽  
Jeffrey P. Simons ◽  
Noel Jabbour
Keyword(s):  
Grade Level ◽  
Reading Level ◽  
Google Trends ◽  
Optimal Range ◽  
Flesch Reading Ease ◽  
Search Terms ◽  
Reading Grade Level ◽  
Public Health Information ◽  
Ease Score ◽  
Readability Formula

Objective: This study evaluates the quality and readability of websites on ankyloglossia, tongue tie, and frenulectomy. Methods: Google was queried with six search terms: tongue tie, tongue tie and breastfeeding, tongue tie and frenulectomy, ankyloglossia, ankyloglossia and breastfeeding, and ankyloglossia and frenulectomy. Website quality was assessed using the DISCERN instrument. Readability was evaluated using the Flesch-Kincaid Reading Grade Level, Flesch Reading Ease Score, and Fry readability formula. Correlations were calculated. Search terms were analyzed for frequency using Google Trends and the NCBI database. Results: Of the maximum of 80, average DISCERN score for the websites was 65.7 (SD = 9.1, median = 65). Mean score for the Flesch-Kincaid Reading Grade Level was 11.6 (SD = 3.0, median = 10.7). Two websites (10%) were in the optimal range of 6 to 8. Google Trends shows tongue tie searches increasing in frequency, although the NCBI database showed a decreased in tongue tie articles. Conclusions: Most of the websites on ankyloglossia were of good quality; however, a majority were above the recommended reading level for public health information. Parents increasingly seek information on ankyloglossia online, while fewer investigators are publishing articles on this topic.

scholarly journals Poor Readability of AOSSM Patient Education Resources and Opportunities for Improvement

2018 ◽  
Vol 6 (11) ◽  
pp. 232596711880538 ◽  
Author(s):  
Rafael Kakazu ◽  
Adam Schumaier ◽  
Chelsea Minoughan ◽  
Brian Grawe
Keyword(s):  
Patient Education ◽  
Grade Level ◽  
Sports Medicine ◽  
Cross Sectional Study ◽  
Reading Level ◽  
Eighth Grade ◽  
Cross Sectional ◽  
Education Resources ◽  
Reading Grade Level ◽  
Readability Formula

Background: Appropriate education on the disease processes associated with orthopaedic pathology can affect patient expectations and functional outcome. Hypothesis: Patient education resources from the American Orthopaedic Society for Sports Medicine (AOSSM) are too complex for comprehension by the average orthopaedic patient. Study Design: Cross-sectional study. Methods: Patient education resources provided by the AOSSM were analyzed with software that provided 10 readability scores as well as opportunities for improving readability. The readability scores were compared with the recommended eighth-grade reading level. Results: A total of 39 patient education resources were identified and evaluated. The mean ± SD reading grade-level scores were as follows: Coleman-Liau Index, 12.5 ± 1.11; New Dale-Chall Readability Formula, 10.9 ± 1.37; Flesch-Kincaid Grade Level, 9.9 ± 1.06; FORCAST Readability Formula, 11.4 ± 0.51; Fry Readability Formula, 12.8 ± 2.79; Gunning Fog Index, 11.9 ± 1.37; Raygor Readability Index, 13.1 ± 2.37; Simple Measure of Gobbledygook, 12.3 ± 0.90; Automated Readability Index, 11.2 ± 1.18; and New Automated Readability Index, 10.6 ± 1.27. After averaging the reading grade-level scores, only 1 patient education resource was found to be written at an 8th- to 9th-grade level, and 14 (36%) were written above a 12th-grade level. All scores were significantly different from the eighth-grade level ( P < .0065). The percentage of complex words and long words were 19.6% ± 2.67% and 41.4% ± 3.18%, respectively. Conclusion: Patient education resources provided by the AOSSM are at a significantly higher reading level than recommended. Simple changes can drastically improve these scores to increase health literacy and possibly outcome.

scholarly journals Readability of the American, Canadian, and British Otolaryngology–Head and Neck Surgery Societies’ Patient Materials

2021 ◽  
pp. 019459982110332
Author(s):  
Joo Hyun Kim ◽  
Elysia Grose ◽  
Justine Philteos ◽  
David Forner ◽  
Christopher W. Noel ◽  
...  
Keyword(s):  
Patient Education ◽  
Head And Neck ◽  
Grade Level ◽  
Neck Surgery ◽  
Cross Sectional Study ◽  
Reading Level ◽  
Head And Neck Surgery ◽  
Cross Sectional ◽  
Patient Comprehension ◽  
Reading Grade Level

Objective Patient education materials across 3 national English otolaryngology–head and neck surgery (OHNS) societies: the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS), the Canadian Society of Otolaryngology–Head and Neck Surgery (CSOHNS), and Ear, Nose, and Throat United Kingdom (ENT UK) were examined to determine whether they are written at a level suitable for patient comprehension. Study Design Cross-sectional study. Setting Online patient materials presented through OHNS national societies. Methods Readability was calculated using the Flesch-Kincaid Grade Level, Flesch-Kincaid Reading Ease Score, and Simple Measure of Gobbledygook Index. All public patient education materials available through the CSOHNS, AAO-HNS, and ENT UK websites were assessed. Patient education materials were grouped into categories by subspecialty. Results In total, 128 patient materials from the 3 societies were included in the study. All 3 societies required a minimum grade 9 reading comprehension level to understand their online materials. According to Flesch-Kincaid Grade Level, the CSOHNS required a significantly higher reading grade level to comprehend the materials presented when compared to AAO-HNS (11.3 vs 9.9; 95% CI, 0.5-2.4; P < .01) and ENT UK (11.3 vs 9.4; 95% CI, 0.9-2.9; P < .01). Patient education materials related to rhinology were the least readable among all 3 societies. Conclusion This study suggests that the reading level of the current patient materials presented through 3 national OHNS societies are written at a level that exceeds current recommendations. Promisingly, it highlights an improvement for the readability of patient materials presented through the AAO-HNS.

Abstract 07: Association of Social Network Characteristics With Cardiovascular Health and Coronary Artery Calcium in South Asians: The Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Nilay S Shah ◽  
Mark D Huffman ◽  
Sadiya S Khan ◽  
John A Schneider ◽  
Juned Siddique ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Disease ◽  
Social Network ◽  
Coronary Artery ◽  
High Risk ◽  
Coronary Artery Calcium ◽  
Cardiovascular Health ◽  
South Asians ◽  
High Risk Population ◽  
Lower Odds

Introduction: South Asian Americans (SAs) have disproportionately high burden of poor cardiovascular health (CVH) and CVD, which may be influenced by people within their social network (SN). We examined the association of SN characteristics and SN member (“alter”) health with CVH and coronary artery calcium (CAC) in SAs to identify targets for CVD prevention in this high-risk community. Hypothesis: Smaller SN size and worse alter health is associated with poor CVH and CAC in SAs. Methods: In 699 SAs in the MASALA Study, SN characteristics (size, density, proportion of kin or SA ethnicity), alter health status (self-report of an alter with high blood pressure [HTN], hyperlipidemia [HL], heart disease, diabetes, or stroke), CVH score (0-14, based on poor, intermediate, or ideal blood pressure, cholesterol, glucose, physical activity, diet, weight, and smoking), and CAC data were collected between 2016-2018. Multiple logistic regression evaluated the association of SN characteristics or alter health with prevalent CVH and CAC. Results: Participants were mean age 59±9 years and 43% women. Mean CVH score was 8.9±1.9, median CAC score 8 (range 0 - 4217). SNs were mean 6±3 people, density 79±26%, 72±28% kin, 88±23% SA ethnicity; 48% had an alter with HTN, 42% with HL, 18% with heart disease, 40% with diabetes, and 2% with stroke. A 1-person larger SN size was associated with a 19% higher odds of ideal vs. poor CVH in men (p=0.02), and an 11% lower odds of CAC in women (p=0.05, Table). In men, having at least 1 alter with HTN or HL was associated with a 58% or 54% lower odds of ideal vs. poor CVH (p=0.03, p=0.04), and having at least 1 alter with HL was associated with a 78% higher odds of CAC (p=0.05). No associations were seen between other SN characteristics, nor alters with other CVD risk factors, and CVH or CAC. Conclusions: In SAs, larger SN size was associated with better CVH. Having a SN member with HTN or HL may be associated with poorer CVH and CAC. Interventions to increase SN size or target SN member CVH may promote CVH in this high-risk population.

Measuring Text Readability Using Reading Level

2019 ◽  
pp. 93-103
Author(s):  
James C. Brewer
Keyword(s):  
Grade Level ◽  
The United States ◽  
Reading Level ◽  
The Internet ◽  
Web Pages ◽  
Wide Audience ◽  
Reading Grade Level ◽  
Text Readability ◽  
Worldwide Phenomenon ◽  
The Military

Reading grade level calculations have been in use for over a century in the United States and have guided the selection of texts used in school programs. Government agencies at all levels, the military in its various branches, and editors of publications have found such formulas of use in setting policy or determining who can participate in programs. As readership is now a worldwide phenomenon with English as the primary language of the internet, reading grade level calculations can also be useful in creating web pages and assigning reading texts to large multi-user classes (MOOCs) run over the internet. In this regard, it is possible for faculty to be assured that the material is reachable to a wide audience by checking reading grade level and providing additional guidance for the more difficult items in the form of discussion or focused questions. Authors can use the formulas as a tool to check the quality of their own writing and improve sections which are unnecessarily complex.

scholarly journals Misinformation in Patient Handouts About Upper Extremity Conditions

2020 ◽  
Vol 7 (6) ◽  
pp. 1331-1335
Author(s):  
Casey M O’Connor ◽  
Joost Kortlever ◽  
David Ring
Keyword(s):  
Upper Extremity ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Grade Level ◽  
Cognitive Biases ◽  
Average Rate ◽  
Professional Associations ◽  
Reading Level ◽  
Reading Grade Level

This study investigated handouts regarding common upper extremity problems for inaccuracies, distracting information, and concepts that reinforce common unhelpful cognitive biases. We reviewed handouts on upper extremity conditions from 2 electronic medical records and 2 professional associations. We categorized information as inaccurate, distracting, and risk of reinforcing common unhelpful cognitive biases. Reading level, quality, and the ability of patients to process and take action was also rated. We found an average rate of inaccurate statements of 1.9 per 100 words, distracting statements of 0.73 per 100 words, and statements reinforcing common unhelpful cognitive biases of 2.1 per 100 words. Handouts from electronic medical records were rated higher quality and had higher reading grade level, but on average were constructed for better understandability. Patient handouts have a notable rate of inaccuracies, distractions, and information that may reinforce less adaptive cognitions. Greater attention is merited to making patient handouts readable, understandable, hopeful, and enabling.

scholarly journals Life’s Simple 7 Cardiovascular Health Metrics and Progression of Coronary Artery Calcium in a Low-Risk Population

2019 ◽  
Vol 39 (4) ◽  
pp. 826-833 ◽  
Author(s):  
Seolhye Kim ◽  
Yoosoo Chang ◽  
Juhee Cho ◽  
Yun Soo Hong ◽  
Di Zhao ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Calcium ◽  
Cardiovascular Health ◽  
Subclinical Atherosclerosis ◽  
Heart Association ◽  
Healthy Adults ◽  
Inverse Association ◽  
Life Habits ◽  
Life’S Simple 7 ◽  
Life's Simple 7

Objective— We examined the association of cardiovascular health (CVH) metrics with the development and progression of coronary artery calcium (CAC) among apparently healthy adults. Approach and Results— This cohort study included 65 494 men and women 30 years of age and older free of cardiovascular disease at baseline who underwent a comprehensive exam including CAC scoring. CVH metrics were defined according to the American Heart Association Life’s Simple 7 metrics based on smoking, diet, physical activity, body mass index, blood pressure, total cholesterol, and fasting glucose. CVH scores range from 0 (all metrics considered unhealthy) to 7 (all metrics considered healthy). Participants were followed-up for a maximum of 6.6 years. Compared with participants with ideal CVH scores 0–1, the multivariable-adjusted difference in the change in geometric means of CAC scores over 5 years of follow-up were −0.40 (−0.62 to −0.19), −0.83 (−1.03 to −0.63), −1.06 (−1.25 to −0.86), −1.22 (−1.42 to −1.03), and −1.05 (−1.42 to −0.69) in participants with ideal CVH scores 2, 3, 4, 5, and 6–7, respectively. The inverse association between CVH scores and progression of CAC was observed both in participants with no CAC and in those with CAC detectable at baseline. Conclusions— A higher ideal CVH metrics score was strongly associated with a lower prevalence of CAC and with lower progression of CAC in males and females in a large cohort of healthy adults. Our findings suggest that maintaining a healthy life habits could help reduce the development and progression of subclinical atherosclerosis and ultimately prevent clinically cardiovascular event.

Are English-Language Pedometer Instructions Readable?

2010 ◽  
Vol 7 (3) ◽  
pp. 375-380 ◽  
Author(s):  
Lorraine S. Wallace ◽  
Kenneth Bielak ◽  
Brian Linn
Keyword(s):  
Grade Level ◽  
English Language ◽  
Reading Level ◽  
Minimal Amount ◽  
White Space ◽  
User Friendliness ◽  
12Th Grade ◽  
Reading Grade Level ◽  
Steps Per Day ◽  
Grade Reading Level

Background:We evaluated readability and related features of English-language instructions accompanying pedometers, including reading grade level, layout/formatting characteristics, and emphasis of key points.Methods:We identified 15 pedometers currently available for purchase in the US. Reading grade level was calculated using Flesch-Kinkaid (FK) and SMOG formulas. Text point size was measured with a C-Thru Ruler. Page and illustration dimensions were measured to the nearest millimeter (mm) with a standard ruler. Layout features were evaluated using the criteria from the User-Friendliness Tool.Results:FK scores ranged from 8th to 11th grade, while SMOG scores ranged from 8th to 12th grade. Text point size averaged 6.9 ± 1.9 (range = 4−11). Instructions averaged 8.7 ± 9.0 (range = 0−36) illustrations, most about the size of a US quarter. While many instructions avoided use of specialty fonts (n = 12; 80.0%), most used a minimal amount of white space. Just 4 (26.7%) sets of instructions highlighted the target goal of 10,000 steps-per-day.Conclusion:Pedometer instructions should be revised to meet the recommended 6th grade reading level. Paper size instructions are printed on should be enlarged, thereby allowing for larger text and illustrations, and additional white space. Recommended number of steps per day and proper pedometer positioning should also be predominantly highlighted.

scholarly journals Dupuytren's Contracture: The Readability of Online Information

2021 ◽  
Vol 8 ◽  
pp. 237437352110564
Author(s):  
Shayan Hosseinzadeh ◽  
Philip Blazar ◽  
Brandon E Earp ◽  
Dafang Zhang
Keyword(s):  
Patient Information ◽  
Grade Level ◽  
Sixth Grade ◽  
Reading Level ◽  
Dupuytren’S Contracture ◽  
Online Information ◽  
Flesch Reading Ease ◽  
Dupuytren's Contracture ◽  
Reading Grade Level ◽  
Grade Reading Level

Dupuytren's contracture is a common hand pathology for which consultation and treatment are largely at the patient's discretion. The objective of this study was to evaluate the readability of current online patient information regarding Dupuytren's contracture. The largest public search engines (Google, Yahoo, and Bing) were queried using the search terms “Dupuytren's contracture,” “Dupuytren's disease,” “Viking's disease,” and “bent finger.” The first 30 unique websites by each search were analyzed and readability assessed using five established algorithms: Flesch Reading Ease, Gunning-Fog Index, Flesch–Kincaid Grade level, Coleman–Liau index, and Simple Measure of Gobbledygook grade level. Analysis of 73 websites demonstrated an average Flesch Reading Ease score of 48.6 ± 8.0, which corresponds to college reading level. The readability of websites ranged from 10.5 to 13.3 reading grade level. No article was written at or below the recommended sixth grade reading level. Information on the internet on Dupuytren's contracture is written at higher than recommended reading grade level. There is a need for high-quality patient information on Dupuytren's contracture at appropriate reading grade levels for patients of various health literacy backgrounds. Hospitals, universities, and academic organizations focused on the development of readable online information should consider patients’ input and preferences.

scholarly journals READABILITY OF THE DISABLEMENT OF THE PHYSICALLY ACTIVE (DPA) SCALE IN PEDIATRIC ATHLETES

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0010
Author(s):  
Ashley N. Marshall ◽  
Kenneth C. Lam
Keyword(s):  
Grade Level ◽  
Reading Level ◽  
Median Score ◽  
Adolescent Athletes ◽  
Physically Active ◽  
Reading Material ◽  
Reading Grade Level ◽  
Patient Reported ◽  
Computer Based ◽  
Grade Reading Level

Background: The assessment of patient outcomes in pediatric (ie, youth and adolescent) athletes is critical for comprehensive and whole person healthcare. The Disablement of the Physically Active scale (DPA) is a relatively new generic patient-reported outcome measure (PROM) that was designed specifically for athletic and highly functional patient populations. While the DPA has been used to evaluate health-related quality of life (HRQOL) in adults, little is known about its use in pediatric athletes. The selection of PROMs for pediatric athletes presents with unique challenges, particularly regarding the ability of these athletes to effectively understand the instruments to which they are completing. Therefore, the purpose of this study was to examine the readability of the DPA in pediatric athletes through (1) participant-based and (2) computer-based analyses. Methods: Participant-based analysis was utilized to conduct a preliminary investigation into the subjective readability (ie, a participant’s perceived ability to successfully read the material) of the DPA. Participants were youth athletes (n=13, age=8.7±1.3 years) recruited from a local community athletics league. An investigator administered the San Diego Quick Assessment of Reading Ability to determine each participant’s current reading grade level. Participants were then instructed to read each item of the DPA and circle any words that they did not understand. Frequency counts and percentages were determined for each word identified by participants, within each item of the DPA. Computer-based analysis was utilized to assess the objective readability of the DPA. The Flesch Reading Ease (FRE), Flesch-Kincaid Reading Level (FK), and Gunning Fog Index (FOG) scores were calculated for each item of the DPA. FRE scores range from 0 to 100, with lower scores indicating more difficult reading material. The FRE score is converted to an approximate reading level (FK), ranging from pre-primer (<0) to college (>12), with higher reading level indicating more difficult reading material. Similar to the FK formula, the FOG formula computes to an approximate reading grade level associated with the U.S. education system. Summary statistics (mean± standard deviation, median, and range) were used to report scores for each DPA item. We also reported the number (%) of items that exceeded the 5th – 6th grade reading level, which is the maximum recommended threshold for pediatric patients. Results: It was determined that the average reading grade level of the participants was 3±1.4 years. In regards to subjective readability, participants did not understand an average of 22.1% (48.3/219 words) of the entire DPA scale, with a range across items of 3.1% (Pain = 0.15/5 words) to 34.9% (Overall Fitness = 5.2/15 words). There were 40 instances where greater than 50% of the participants did not recognize a word, and seven words throughout the scale that 100% (13/13) of the participants did not understand: endurance, stability, pivoting, coordination, cardiovascular, endurance and colleagues. For objective readability, FRE scores ranged from 5.8 (very confusing) to 119.7 (very easy) across items. The mean and median across all items was 42.4±33.4 (difficult), and 41.4 (difficult), respectively. The FK reading level ranged from -2.8 (pre-primer) to 13.8 (college), with a mean score of 8.8±4.8 and median score of 8.9. The FOG reading level ranged from 1 (1st grade) to 13.8 (college), with a mean score of 9.3±3.8 and median score of 10.5. When considering both the FK and FOG scores, 81.8% (9/11) of the items exceeded the 5th – 6th grade reading level threshold. Conclusions/Significance: These findings indicate that the overall readability of the DPA may not be appropriate for pediatric athletes. Thus, findings using the DPA in pediatric athletes for clinical or research purposes should be interpreted with caution. Future research is warranted to develop a pediatric version of the DPA, utilizing the results of this study for guidance, as no other generic PROM currently exist for assessing HRQOL specifically in youth and adolescent athletes.

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