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

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.

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Total Ankle Arthroplasty: Can Patients Read, Understand, and Act on Online Educational Resources?

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00082 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0008

Author(s):

Alan G. Shamrock ◽

Burke Gao ◽

Trevor Gulbrandsen ◽

John E. Femino ◽

Cesar de Cesar Netto ◽

...

Keyword(s):

Elementary School ◽

Patient Education ◽

Grade Level ◽

Elective Surgery ◽

Reading Level ◽

Total Ankle Arthroplasty ◽

Educational Resources ◽

Ankle Arthroplasty ◽

Google Search ◽

Online Patient Education

Category: Ankle Arthritis; Ankle 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 their 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 total ankle arthroplasty (TAA). Methods: Online patient education materials were identified using two independently conducted Google engine searches with the term ‘ankle replacement’. 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 TAA. The readability of included articles was quantified using the validated Flesch-Kincaid Grade Level index. The PEMAT form (Figure 1) 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: Forty-one websites met inclusion criteria. The mean Flesch Kincaid reading grade level was 13.7+-15.3 (range: 6.3-16.8), with no website written at an elementary school level. Article readability scores were not associated with Google search rank (p>0.301). Mean understandability and actionability scores were 70.4+-15.3 and 24.4+-24.3, respectively. Among understandability categories, only 9.8% (n=4) included summaries and only 46.3% (n=19) included visual aids. Among actionability categories, 58.5% (n=24) of websites identified at least one action for readers, but only 16.7% (n=4) of these studies broke down actions into explicit, easy to understand steps. Higher actionability scores were significantly associated with earlier Google search rank (rho:- 0.44, p=0.004), while higher understandability scores were associated with later Google search rank (rho: 0.53, p<0.001). Conclusion: No website describing TAA was written at or below the nationally recommended 6th grade reading level. Overall, TAA online educational materials scored poorly with respect to readability, understandability, and actionability. Article actionability but not understandability correlated with an earlier Google search rank. 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 TAA remain inadequate for patient education.

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Readability and quality assessment of internet-based patient education materials related to nasal septoplasty

Journal of Otolaryngology - Head and Neck Surgery ◽

10.1186/s40463-021-00507-z ◽

2021 ◽

Vol 50 (1) ◽

Author(s):

Elysia M. Grose ◽

Connor P. Holmes ◽

Kaishan A. Aravinthan ◽

Vincent Wu ◽

John M. Lee

Keyword(s):

Patient Education ◽

Grade Level ◽

Reading Level ◽

Common Procedure ◽

Flesch Reading Ease ◽

Quality And Reliability ◽

Google Search ◽

The Impact ◽

Online Patient Education ◽

Nasal Septoplasty

Abstract Background Given that nasal septoplasty is a common procedure in otolaryngology – head and neck surgery, the objective of this study was to evaluate the quality and readability of online patient education materials on septoplasty. Methods A Google search was performed using eight different search terms related to septoplasty. Six different tools were used to assess the readability of included patient education materials. These included the Flesch-Kincaid Grade Level, Flesch Reading Ease, Gunning-Fog Index, Simple Measure of Gobbledygook Index, Coleman-Liau Index, and Automated Readability Index. The DISCERN tool was used to assess quality and reliability. Results Eighty-five online patient education materials were included. The average Flesch-Reading Ease score for all patient education materials was 54.9 ± 11.5, indicating they were fairly difficult to read. The average reading grade level was 10.5 ± 2.0, which is higher than the recommended reading level for patient education materials. The mean DISCERN score was 42.9 ± 10.5 and 42% (36/85) of articles had DISCERN scores less than 39, corresponding to poor or very poor quality. Conclusion The majority of online patient education materials on septoplasty are written above the recommended reading levels and have significant deficiencies in terms of their quality and reliability. Clinicians and patients should be aware of the shortcomings of these resources and consider the impact they may have on patients’ decision making.

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Assessing the Readability of Online Information About Achilles Tendon Ruptures

Foot & Ankle Specialist ◽

10.1177/1938640019888058 ◽

2019 ◽

Vol 13 (6) ◽

pp. 470-477 ◽

Cited By ~ 1

Author(s):

Olivia D. Perez ◽

Hasani W. Swindell ◽

Carl L. Herndon ◽

Peter C. Noback ◽

David P. Trofa ◽

...

Keyword(s):

Achilles Tendon ◽

Grade Level ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Tendon Repair ◽

Sixth Grade ◽

Reading Level ◽

Online Information ◽

Level Of Evidence ◽

Grade Reading Level

The American Medical Association (AMA) and National Institutes of Health (NIH) currently suggest that health care materials be written at a sixth-grade reading level. Our study investigates the readability of online information on Achilles rupture and reconstruction. Achilles tendon rupture, Achilles tendon repair, and Achilles tendon reconstruction were queried using advanced search functions of Google, Bing, and Yahoo!. Individual websites and text from the first 3 pages of results for each search engine were recorded and categorized as physician based, academic, commercial, government and nongovernmental organization, or unspecified. Individual readability scores were calculated via 6 different indices: Flesch-Kincaid grade level, Flesch Reading Ease, Gunning Fog, SMOG, Coleman-Liau index, and Automated Readability Index along with a readability classification score and average grade level. A total of 56 websites were assessed. Academic webpages composed the majority (51.8%), followed by physician-based sources (32.1%). The average overall grade level was 10.7 ± 2.54. Academic websites were written at the highest-grade level (11.5 ± 2.77), significantly higher than physician-based websites ( P = .040), and only 2 were written at, or below, a sixth-grade reading level. Currently, online information on Achilles tendon rupture and reconstruction is written at an inappropriately high reading level compared with recommendations from the AMA and NIH. Level of Evidence: Level IV

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Readability of Online Patient Information Relating to Cleft Palate Surgery

The Cleft Palate-Craniofacial Journal ◽

10.1177/10556656211013177 ◽

2021 ◽

pp. 105566562110131

Author(s):

Christopher V. Lavin ◽

Evan J. Fahy ◽

Darren B. Abbas ◽

Michelle Griffin ◽

Nestor M. Diaz Deleon ◽

...

Keyword(s):

Health Care ◽

Cleft Palate ◽

Grade Level ◽

Reading Level ◽

Online Information ◽

Health Care Education ◽

Search Results ◽

Cleft Palate Repair ◽

Grade Reading Level ◽

Google Search

Objective: It is important for health care education materials to be easily understood by caretakers of children requiring craniofacial surgery. This study aimed to analyze the readability of Google search results as they pertain to “Cleft Palate Surgery” and “Palatoplasty.” Additionally, the study included a search from several locations globally to identify possible geographic differences. Design: Google searches of the terms “Cleft Palate Surgery” and “Palatoplasty” were performed. Additionally, searches of only “Cleft Palate Surgery” were run from several internet protocol addresses globally. Main Outcome Measures: Flesch-Kincaid Grade Level and Readability Ease, Gunning Fog Index, Simple Measure of Gobbledygook (SMOG) index, and Coleman-Liau Index. Results: Search results for “Cleft Palate Surgery” were easier to read and comprehend compared to search results for “Palatoplasty.” Mean Flesch-Kincaid Grade Level scores were 7.0 and 10.11, respectively ( P = .0018). Mean Flesch-Kincaid Reading Ease scores were 61.29 and 40.71, respectively ( P = .0003). Mean Gunning Fog Index scores were 8.370 and 10.34, respectively ( P = .0458). Mean SMOG Index scores were 6.84 and 8.47, respectively ( P = .0260). Mean Coleman-Liau Index scores were 12.95 and 15.33, respectively ( P = .0281). No significant differences were found in any of the readability measures based on global location. Conclusions: Although some improvement can be made, craniofacial surgeons can be confident in the online information pertaining to cleft palate repair, regardless of where the search is performed from. The average readability of the top search results for “Cleft Palate Surgery” is around the seventh-grade reading level (US educational system) and compares favorably to other health care readability analyses.

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

10.2196/preprints.31820 ◽

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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Readability Analysis of Online Patient Educational Materials on Blepharoplasty

The American Journal of Cosmetic Surgery ◽

10.1177/07488068211028344 ◽

2021 ◽

pp. 074880682110283

Author(s):

Manish J. Patel ◽

Parth V. Shah ◽

Stuti P. Garg ◽

Robert T. Cristel

Keyword(s):

Grade Level ◽

Content Delivery ◽

Reading Level ◽

Fifth Grade ◽

Educational Materials ◽

Medical Provider ◽

Common Procedure ◽

Grade Reading Level ◽

Available Information ◽

Online Patient Education

Blepharoplasty is a common procedure for correction of eyelid appearance. Online educational material among surgical procedures is often written higher than the recommended fifth-grade level. The objective of this study is to evaluate the readability of online patient education materials (OPEMs) available on Google for patients interested in blepharoplasty. Using 6 different pre-established readability scores, the top 100 Google results on blepharoplasty were screened for analysis. A total of 87 OPEMs were found to be relevant yielding an average grade reading level of 11.90 (range 7-20; 95% confidence interval [CI], 11.45-12.33). In addition, OPEMs readability scores were not influenced by whether the author was a medical provider. This study demonstrated the average reading level for available information on blepharoplasty is higher than the recommended fifth-grade reading level. Readability is only one metric for evaluating comprehendible information; however, authors of online medical education need to be more conscious of the public’s ability to comprehend and should tailor their content delivery appropriately.

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Critical Quality and Readability Analysis of Online Patient Education Materials on Parotidectomy: A Cross-Sectional Study

Annals of Otology Rhinology & Laryngology ◽

10.1177/00034894211066670 ◽

2022 ◽

pp. 000348942110666

Author(s):

Elysia Miriam Grose ◽

Emily YiQin Cheng ◽

Marc Levin ◽

Justine Philteos ◽

Jong Wook Lee ◽

...

Keyword(s):

Patient Education ◽

Grade Level ◽

Critical Role ◽

Cross Sectional Study ◽

Online Information ◽

Cross Sectional ◽

Flesch Reading Ease ◽

Ease Score ◽

Google Search ◽

Online Patient Education

Purpose: Complications related to parotidectomy can cause significant morbidity, and thus, the decision to pursue this surgery needs to be well-informed. Given that information available online plays a critical role in patient education, this study aimed to evaluate the readability and quality of online patient education materials (PEMs) regarding parotidectomy. Methods: A Google search was performed using the term “parotidectomy” and the first 10 pages of the search were analyzed. Quality and reliability of the online information was assessed using the DISCERN instrument. Flesch-Kincaid Grade Level (FKGL) and Flesch-Reading Ease Score (FRE) were used to evaluate readability. Results: Thirty-five PEMs met the inclusion criteria. The average FRE score was 59.3 and 16 (46%) of the online PEMs had FRE scores below 60 indicating that they were fairly difficult to very difficult to read. The average grade level of the PEMs was above the eighth grade when evaluated with the FKGL. The average DISCERN score was 41.7, which is indicative of fair quality. There were no significant differences between PEMs originating from medical institutions and PEMs originating from other sources in terms of quality or readability. Conclusion: Online PEMs on parotidectomy may not be comprehensible to the average individual. This study highlights the need for the development of more appropriate PEMs to inform patients about parotidectomy.

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Quality of Patient Education Materials on Safe Opioid Management in the Acute Perioperative Period: What Do Patients Find Online?

Pain Medicine ◽

10.1093/pm/pny296 ◽

2019 ◽

Vol 21 (1) ◽

pp. 171-175 ◽

Cited By ~ 8

Author(s):

Gunjan Kumar ◽

Kellie M Jaremko ◽

Alex Kou ◽

Steven K Howard ◽

T Kyle Harrison ◽

...

Keyword(s):

Patient Education ◽

Grade Level ◽

Perioperative Period ◽

Postoperative Pain Management ◽

Sixth Grade ◽

Reading Level ◽

Specific Content ◽

Caregiver Education ◽

Institutional Review ◽

Grade Reading Level

Abstract Objective Guidelines on postoperative pain management recommend inclusion of patient and caregiver education on opioid safety. Patient education materials (PEMs) should be written at or below a sixth grade reading level. We designed this study to compare the readability of online PEMs related to postoperative opioid management produced by institutions with and without a regional anesthesiology and acute pain medicine (RAAPM) fellowship. Methods With institutional review board exemption, we constructed our cohort of PEMs by searching RAAPM fellowship websites from North American academic medical centers and identified additional websites using structured Internet searches. Readability metrics were calculated from PEMs using the TextStat 0.4.1 textual analysis package for Python 2.7. The primary outcome was the Flesch-Kincaid Grade Level (FKGL), a score based on words per sentence and syllables per word. We also compared fellowship-based and nonfellowship PEMs on the presence or absence of specific content-related items. Results PEMs from 15 fellowship and 23 nonfellowship institutions were included. The mean (SD) FKGL for PEMs was grade 7.84 (1.98) compared with the recommended sixth grade level (P < 0.001) and was not different between groups. Less than half of online PEMs contained explicit discussion of opioid tapering or cessation. Disposal and overdose risk were addressed more often by nonfellowship PEMs. Conclusions Available online PEMs related to opioid management are beyond the recommended reading level, but readability metrics for online PEMs do not differ between fellowship and nonfellowship groups. More than two-thirds of RAAPM fellowship programs in North America are lacking readable online PEMs on safe postoperative opioid management.

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Readability of the Most Commonly Accessed Online Patient Education Materials Pertaining to Pathology of the Hand

Hand ◽

10.1177/1558944717726138 ◽

2017 ◽

Vol 13 (6) ◽

pp. 705-714 ◽

Cited By ~ 6

Author(s):

Sheriff D. Akinleye ◽

Garret Garofolo-Gonzalez ◽

Michael Montuori ◽

Maya Deza Culbertson ◽

Jennifer Hashem ◽

...

Keyword(s):

Carpal Tunnel Syndrome ◽

Patient Education ◽

Carpal Tunnel ◽

Tendon Injuries ◽

Reading Level ◽

Average Grade ◽

Hand Fractures ◽

Tunnel Syndrome ◽

Grade Reading Level ◽

Google Search

Background: The American Medical Association (AMA) and National Institutes of Health (NIH) recommend that patient education materials be written at no higher than a sixth-grade reading level. Methods: We examined 100 online educational materials for the 10 hand conditions most commonly treated by hand surgeons, as reported by the American Society for Surgery of the Hand. The listed conditions were carpal tunnel syndrome, basal joint arthritis of the thumb, de Quervain syndrome, Dupuytren’s contracture, ganglion cysts, hand fractures, trigger finger, extensor tendon injuries, flexor tendon injuries, and mallet finger. Following a Google search for each condition, we analyzed the 10 most visited websites for each disorder utilizing the Flesch-Kincaid formula. Results: The average grade reading level of the 100 websites studied was 9.49 with a reading ease of 53.03 (“fairly difficult high school”). Only 29% of the websites were at or below the national average of an eighth-grade reading level. Carpal tunnel syndrome had the highest average grade reading level at 10.32 (standard deviation: 1.52), whereas hand fractures had the lowest at 8.14 (2.03). Every hand condition in this study had an average readability at or above the ninth-grade reading level. Conclusions: The most frequently accessed materials for common maladies of the hand exceed both the readability limits recommended by the AMA and NIH, and the average reading ability of most US adults. Therefore, the most commonly accessed websites pertaining to hand pathology may not be comprehended by the audience for which it is intended.

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Health Literacy: Readability of ACC/AHA Online Patient Education Material

Cardiology ◽

10.1159/000475881 ◽

2017 ◽

Vol 138 (1) ◽

pp. 36-40 ◽

Cited By ~ 7

Author(s):

Karan Kapoor ◽

Praveen George ◽

Matthew C. Evans ◽

Weldon J. Miller ◽

Stanley S. Liu

Keyword(s):

Patient Education ◽

Grade Level ◽

Heart Association ◽

Reading Level ◽

Patient Education Material ◽

Education Material ◽

Reading Grade Level ◽

8Th Grade ◽

The Mean ◽

Online Patient Education

Objectives: To determine whether the online patient education material offered by the American College of Cardiology (ACC) and the American Heart Association (AHA) is written at a higher level than the 6th-7th grade level recommended by the National Institute of Health (NIH). Methods: Online patient education material from each website was subjected to reading grade level (RGL) analysis using the Readability Studio Professional Edition. One-sample t testing was used to compare the mean RGLs obtained from 8 formulas to the NIH-recommended 6.5 grade level and 8th grade national mean. Results: In total, 372 articles from the ACC website and 82 from the AHA were studied. Mean (±SD) RGLs for the 454 articles were 9.6 ± 2.1, 11.2 ± 2.1, 11.9 ± 1.6, 10.8 ± 1.6, 9.7 ± 2.1, 10.8 ± 0.8, 10.5 ± 2.6, and 11.7 ± 3.5 according to the Flesch-Kincaid grade level (FKGL), Simple Measure of Gobbledygook (SMOG Index), Coleman-Liau Index (CLI), Gunning-Fog Index (GFI), New Dale-Chall reading level formula (NDC), FORCAST, Raygor Readability Estimate (RRE), and Fry Graph (Fry), respectively. All analyzed articles had significantly higher RGLs than both the NIH-recommended grade level of 6.5 and the national mean grade level of 8 (p < 0.00625). Conclusions: Patient education material provided on the ACC and AHA websites is written above the NIH-recommended 6.5 grade level and 8th grade national mean reading level. Additional studies are required to demonstrate whether lowering the RGL of this material improves outcomes among patients with cardiovascular disease.

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