Osteosarcoma Health Literacy: A Quantitative Assessment of the Understandability and Readability of Web-based Patient Education Material (Preprint)

2020 ◽  
Author(s):  
Trevor Gulbrandsen ◽  
Mary Kate Skalitzky ◽  
Alan Gregory Shamrock ◽  
Burke Gao ◽  
Obada Hasan ◽  
...  
Keyword(s):  
Patient Education ◽  
Grade Level ◽  
Assessment Tool ◽  
Statistical Significance ◽  
Reading Level ◽  
Online Resources ◽  
Search Term ◽  
Education Material ◽  
American Adult ◽  
The Mean

BACKGROUND Patients often turn to online resources following the diagnosis of osteosarcoma. To be fully understood by the average American adult, the American Medical Association (AMA) and National Institutes of Health (NIH) recommend online health information to be written at a 6th grade level or lower. Previous analyses of osteosarcoma resources have not measured whether text is written such that readers can process key information (understandability) or identify available actions to take (actionability). The Patient Education Materials Assessment Tool (PEMAT) is a validated measurement of understandability and actionability. OBJECTIVE The purpose of this study was to evaluate osteosarcoma online resources utilizing measures of readability, understandability, and actionability. METHODS Using the search term “osteosarcoma”, two independent searches (Google.com) were performed and the top 50 results were collected. Websites were included if directed at providing patient education on osteosarcoma. Readability was quantified using validated algorithms: Flesh-Kincaid Grade Ease (FKGE), Flesch-Kincaid Grade-Level (FKGL). A higher FKGE score represents the material is easier to read. All other readability scores represent the US school grade level. Two independent PEMAT assessments were performed with independent scores assigned for both understandability and actionability. A PEMAT score of 70% or below is considered poorly understandable and/or poorly actionable. Statistical significance was defined as p≤0.05. RESULTS Of 53 unique websites, 37 websites (69.8%) met inclusion criteria. The mean FKGE was 40.8±13.6. The mean FKGL grade level was 12.0±2.4. No (0%) websites scored within the acceptable NIH/AHA recommended reading level. Overall, only 10.8% (n=4) and 2.7% (n=1) met the acceptable understandability and actionability threshold. CONCLUSIONS Overall, osteosarcoma online patient educational materials scored poorly with respect to readability, understandability, and actionability. None of the online resources scored at the recommended reading level. Only four met the appropriate score to considered understandable by the general public. Future efforts should be made to improve online resources in order to support patient understanding.

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

Cardiology ◽  
2017 ◽  
Vol 138 (1) ◽  
pp. 36-40 ◽  
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.

scholarly journals Quality Assessment of Online Patient Information for Cosmetic Botulinum Toxin

2020 ◽  
Vol 40 (11) ◽  
pp. NP636-NP642 ◽  
Author(s):  
Eric Barbarite ◽  
David Shaye ◽  
Samuel Oyer ◽  
Linda N Lee
Keyword(s):  
Botulinum Toxin ◽  
Patient Education ◽  
Online Education ◽  
Grade Level ◽  
Assessment Tool ◽  
Botulinum Toxin Injection ◽  
Reading Level ◽  
Accuracy Score ◽  
Flesch Reading Ease

Abstract Background In an era of widespread Internet access, patients increasingly look online for health information. Given the frequency with which cosmetic botulinum toxin injection is performed, there is a need to provide patients with high-quality information about this procedure. Objectives The aim of this study was to examine the quality of printed online education materials (POEMs) about cosmetic botulinum toxin. Methods An Internet search was performed to identify 32 websites of various authorship types. Materials were evaluated for accuracy and inclusion of key content points. Readability was measured by Flesch Reading Ease and Flesch-Kincaid Grade Level. Understandability and actionability were assessed with the Patient Education Materials Assessment Tool for Printed Materials. The effect of authorship was measured by undertaking analysis of variance between groups. Results The mean [standard deviation] accuracy score among all POEMs was 4.2 [0.7], which represents an accuracy of 76% to 99%. Mean comprehensiveness was 47.0% [16.4%]. Mean Flesch-Kincaid Grade Level and Flesch Reading Ease scores were 10.7 [2.1] and 47.9 [10.0], respectively. Mean understandability and actionability were 62.8% [18.8%] and 36.2% [26.5%], respectively. There were no significant differences between accuracy (P &gt; 0.2), comprehensiveness (P &gt; 0.5), readability (P &gt; 0.1), understandability (P &gt; 0.3), or actionability (P &gt; 0.2) by authorship. Conclusions There is wide variability in the quality of cosmetic botulinum toxin POEMs regardless of authorship type. The majority of materials are written above the recommended reading level and fail to include important content points. It is critical that providers take an active role in the evaluation and endorsement of online patient education materials.

Search Trends and Quality of Online Resources Regarding Thyroidectomy

2020 ◽  
pp. 019459982096915
Author(s):  
Lena W. Chen ◽  
Vandra Chatrice Harris ◽  
Justin Lee Jia ◽  
Deborah Xingchun Xie ◽  
Ralph Patrick Tufano ◽  
...  
Keyword(s):  
Grade Level ◽  
Interrater Reliability ◽  
Assessment Tool ◽  
Neck Surgery ◽  
Reading Level ◽  
Online Resources ◽  
Cross Sectional ◽  
Flesch Reading Ease ◽  
Google Search

Objective Thyroidectomy is one of the most common procedures performed in head and neck surgery. The quality of online resources for thyroidectomy is unknown. We aim to evaluate search trends and online resource quality regarding thyroidectomy. Study Design Cross-sectional analysis. Setting Websites appearing on Google search. Methods The first 30 Google websites for thyroidectomy were reviewed, excluding research, video, and restricted sites. Search patterns were obtained with Google Trends. Quality was measured by readability (Flesch Reading Ease and Flesch-Kinkaid Grade Level), understandability and actionability (Patient Education Materials Assessment Tool), and clinical practice guideline (CPG) compatibility. Fleiss kappa interrater reliability analysis was performed for 2 raters. Results Twenty-one sites were evaluated. Search popularity for thyroidectomy has increased since 2004. Median reading ease was 42.2 (range, 15.4-62.7) on a scale from 1 to 100, with 100 indicating maximum readability. Median reading grade level was 12 (range, 7-16). Thyroidectomy resources were poorly understandable (median, 66%; range, 21%-88%) and actionable (median, 10%; range, 0%-60%). Median CPG compatibility was 4 out of 5 (range, 0-5). Interrater reliability ranged from substantial to moderate for understandability (0.78), actionability (0.57), and CPG compatibility (0.58), with P < .05 for all results. Conclusion Online resources about thyroidectomy vary in quality and reliability and are written at grade levels above the average reading level of the public. Providers should be aware of existing resources and work to create education resources that meet universal health literacy guidelines. The framework provided in this article may also serve as a guide and provide tangible steps that providers can take to help patients access care.

scholarly journals Readability of patient education materials related to radiation safety: What are the implications for patient-centred radiology care?

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Francis T. Delaney ◽  
Tiarnán Ó. Doinn ◽  
James M. Broderick ◽  
Emma Stanley
Keyword(s):  
Grade Level ◽  
Radiation Safety ◽  
Reading Level ◽  
Online Resources ◽  
Flesch Reading Ease ◽  
Reading Grade Level ◽  
8Th Grade ◽  
Ease Score ◽  
The Mean ◽  
Grade Reading Level

Abstract Background Increasing numbers of patients and carers rely on online resources for healthcare information. Radiation safety can be misunderstood by patients and clinicians and lead to patient anxiety. We aimed to assess the readability of online patient educational materials (PEMs) related to radiation safety. Methods A total of 84 articles pertaining to radiation safety from 14 well-known online resources were identified. PEMs were then analysed using Readability Studio Professional Edition Version 2019. Readability was assessed using eight different instruments: the Flesch-Kincaid Reading Grade Level, Raygor Estimate, SMOG, Coleman–Liau, Fry, FORCAST, Gunning Fog, and Flesch Reading Ease Score formula. The mean reading grade level (RGL) of each article was compared to the 6th and 8th grade reading level using 1-sample t-tests. Results The cumulative mean RGL for all 84 articles was 13.3 (range = 8.6–17.4), and none were written at or below the 6th or 8th grade level. The cumulative mean RGL exceeded the 6th grade reading level by an average of 7.3 levels (95% CI, 6.8–7.8; p < 0.001) and the 8th grade level by an average of 5.3 grade levels (95% CI, 4.8–5.8; p < 0.001). The mean Flesch Reading Ease Score was 39/100 (‘difficult’). Conclusion Currently available online PEMs related to radiation safety are still written at higher than recommended reading levels. Radiation safety is a topic in which the specialist training of radiologists is crucial in providing guidance to patients. Addressing the readability of online PEMs can improve radiology-patient communication and support the shift to a patient-centred model of practice.

scholarly journals Evaluation of the Quality, Accuracy, and Readability of Online Patient Resources for the Management of Articular Cartilage Defects

Cartilage ◽  
2016 ◽  
Vol 8 (2) ◽  
pp. 112-118 ◽  
Author(s):  
Dean Wang ◽  
Rohit G. Jayakar ◽  
Natalie L. Leong ◽  
Michael P. Leathers ◽  
Riley J. Williams ◽  
...  
Keyword(s):  
Articular Cartilage ◽  
Patient Education ◽  
Cartilage Defect ◽  
Grade Level ◽  
Cartilage Defects ◽  
Search Term ◽  
Patient Education Material ◽  
Education Material ◽  
Patient Resources ◽  
Articular Cartilage Defects

Objective Patients commonly use the Internet to obtain their health-related information. The purpose of this study was to investigate the quality, accuracy, and readability of online patient resources for the management of articular cartilage defects. Design Three search terms (“cartilage defect,” “cartilage damage,” “cartilage injury”) were entered into 3 Internet search engines (Google, Bing, Yahoo). The first 25 websites from each search were collected and reviewed. The quality and accuracy of online information were independently evaluated by 3 reviewers using predetermined scoring criteria. The readability was evaluated using the Flesch-Kincaid (FK) grade score. Results Fifty-three unique websites were evaluated. Quality ratings were significantly higher in websites with a FK score >11 compared to those with a score of ≤11 ( P = 0.021). Only 10 websites (19%) differentiated between focal cartilage defects and diffuse osteoarthritis. Of these, 7 (70%) were elicited using the search term “cartilage defect” ( P = 0.038). The average accuracy of the websites was high (11.7 out of maximum 12), and the average FK grade level (13.4) was several grades higher than the recommended level for readable patient education material (eighth grade level). Conclusions The quality and readability of online patient resources for articular cartilage defects favor those with a higher level of education. Additionally, the majority of these websites do not distinguish between focal chondral defects and diffuse osteoarthritis, which can fail to provide appropriate patient education and guidance for available treatment. Clinicians should help guide patients toward high-quality, accurate, and readable online patient education material.

Readability of Online Patient Education Materials Related to Lipoprotein(a): Systematic Review (Preprint)

2021 ◽  
Author(s):  
Keon Pearson ◽  
Summer Ngo ◽  
Eson Ekpo ◽  
Ashish Sarraju ◽  
Grayson Baird ◽  
...  
Keyword(s):  
Health Literacy ◽  
Patient Education ◽  
Grade Level ◽  
Lipid Fraction ◽  
Significant Risk ◽  
Reading Level ◽  
Search Term ◽  
Lipoprotein A ◽  
The Impact ◽  
Online Patient Education

BACKGROUND Lipoprotein (a) (Lp(a)) is a highly proatherogenic lipid fraction that is a clinically significant risk modifier. Patients wanting to learn more about Lp(a) are likely to use online patient educational materials (OPEM). However, the readability of OPEM may exceed the health literacy of the general public. OBJECTIVE This study aims to assess the readability of online patient education materials related to Lp(a). We hypothesized that the readability of these online materials would exceed the 6th grade level recommended by the American Medical Association (AMA). METHODS Using an online search engine, we queried the top 20 search results from 10 commonly used Lp(a)-related search terms to identify a total of 200 websites. We excluded duplicate websites, advertised results, research journal articles, or non-patient-directed materials, such as those intended only for health professionals or researchers. Grade-level readability was calculated using 5 standard readability metrics (Automated Readability Index, SMOG Index, Coleman Liau Index, Gunning Fog Score, Flesch Kincaid score) to produce robust point (mean) and interval (confidence interval) estimates of readability. Generalized estimating equations were used to model grade-level readability by each search term, with the 5 readability scores nested within each OPEM. RESULTS A total of 27 unique websites were identified for analysis. The average readability score for the aggregated results was 12.2 grade level (95% CI, 10.9798 - 13.3978). OPEM were grouped into 6 categories by primary source: industry, lay press, research foundation and non-profit organizations, university or government, clinic, and other. The most readable category was OPEM published by universities or government agencies (9.0, 95% CI 6.8-11.3). The least readable OPEM on average were the ones published by the lay press (13.0, 95% CI 11.2-14.8). All categories exceeded the 6th grade reading level recommended by the AMA. CONCLUSIONS Conclusions: Lack of access to readable OPEM may disproportionately affect patients with low health literacy. Ensuring that online content is understandable by broad audiences is a necessary component of increasing the impact of novel therapeutics and recommendations regarding Lp(a).

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.

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.

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

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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