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

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.

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.

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.

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.

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.

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.

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 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.

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.

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