Exploring Mechanisms of Measurement Discrepancy: Perceived Acceptability and Efficiency of Two Sexual Victimization Questionnaires

Background: Obtaining accurate prevalence rates of sexual violence is made difficult by discrepancies in self-reporting questionnaires. Thus, the current study sought to explore participants' perceptions of acceptability (i.e., perceived difficulty, readability, and preference) of questionnaires as an important psychometric indicator and a potential mechanism of discrepancy between different questionnaires assessing sexual victimization. Methods: Participants were 673 college students who completed the Sexual Experiences Survey-Short Form Victimization (SES-SFV) and the Post-Refusal Sexual Persistence Scales-Victimization (PRSPS-V). Participants then answered questions about each measure's perceived difficulty and their preference between the two. Flesch-Kincaid Reading Grade Level and efficiency (i.e., number of items: number of cases identified) were also analyzed. Results: Participants found the PRSPS-V easier to understand and preferred it 2.5 to1 over the SES-SFV. Preference was related to reporting; participants who preferred the PRSPS-V reported more instances of sexual victimization on the PRSPS-V. The PRSPS-V was objectively easier to comprehend according to Flesch-Kincaid levels and was two times more efficient than the SES-SFV in the number of cases detected per item administered. Conclusions: Our results indicate that acceptability impacts reported prevalence rates and is one mechanism for documented discrepancies between sexual violence questionnaires. Thus, it may behoove researchers to consider acceptability as a metric of interest when choosing sexual victimization questionnaires.

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

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.

1071 SUFE and the Internet: Are Healthcare Information Websites Accessible to Parents?

Background Slipped upper femoral epiphysis(SUFE) is an adolescent hip disorder requiring rapid surgical intervention. Faced with the prospect of their child undergoing surgery, many fearful parents will turn to the internet to provide information and reassurance. Previous studies have shown the orthopaedic information can be difficult to comprehend. Objective Assess the readability of healthcare websites regarding SUFE. Method The term Slipped Upper Femoral Epiphysis was searched in Google, Bing and Yahoo and evaluated using readability software with seven specialised readability tests. A Flesich Read Ease Score (FRES) score above 65 and a Reading Grade Level (RGL) of sixth grade and under was considered acceptable. Results 21 unique websites were assessed. The average FRES was 52.5 +/- 15.4. Only 3 websites scored 65 or higher (14%). There was a statistically significant difference between website scores based on affiliation, with physician websites having the overall highest mean(P = 0.004). The average RGL was 8.67 +/- 1.8. Only two websites met the accepted RGL criteria (9.5%) while five websites were marked as extremely difficult to understand (23.8%). Only five websites offered translations (23.8%). There was no statistically significant difference in readability scores between websites which offered translation and those which did not. One-way t-tests showed that both the RGL (p &lt; 0.001; CI: 1.83-3.49) and the FRES (P &lt; 0.001, CI: -19.4 to -5.4) scores were significantly different from the accepted standard. Conclusions Most websites reviewed were deemed inaccessible. Improving readability would enhance the internet’s usability as a healthcare tool for parents.

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

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.

Assessing the quality and readability of NHS urology webpages in England

Objective: To examine the readability of urology webpages to assess their suitability for the general population and their inclusivity for varied levels of health literacy. Methods: We accessed all urology department websites from NHS trusts in England. A standard framework was used to assess these for ease of navigation, availability and quality of urology-specific information. Text was analysed using Flesch–Kincaid Grade Level and Ease Score to measure readability. Results: From the 132 NHS trust websites investigated, 117 (88.6%) had a urology-specific webpage, a considerable increase from 98 trusts (68%) in 2010. However, a smaller proportion of websites explained their services and procedures, and only 23.9% explained common urological conditions. Websites still appeared outdated, 23.9% had spelling errors, and 75.2% made none or poor use of images. The mean reading grade level was 13.40, equivalent to a UK reading age above 18 years, and the mean reading ease score was 30.35, in the range of ‘difficult’ text. Conclusion: Our data suggest that urology-specific webpages are not providing useful content for patients and are too complex for the general population to understand. Improvement would allow patients to be able to utilise such resources to aid decision making and to navigate complex NHS pathways. Level of evidence: Not applicable

Evaluating the Quality and Readability of Online Resources for Covid-19 in Pregnancy: An Assessment of Web Based Information (Preprint)

BACKGROUND The internet is a source for inquiries and a way to distribute information. Pregnant women may look to the internet for information about COVID-19’s impact on pregnancy. As providers, it’s vital to provide patients with information that is both reliable and comprehendible. The purpose of this study is to evaluate the readability and quality of web-based information regarding Covid-19 in pregnancy. OBJECTIVE The primary aim of this study was to evaluate the quality, readability, and accuracy of web-based information regarding Covid-19 in pregnancy. METHODS The JAMA benchmark tool was used to evaluate the websites. Readability was assessed using Flesch-Kincaid reading ease and Flesch-Kincaid grade level. An interrater reliability analysis using the Kappa statistic was performed to determine consistency among raters. RESULTS The mean score using the JAMA tool was 3.53 (SD, 0.74). The majority of the websites came from news sites (37.8%). The median reading grade level was 11.9. The interrater reliability for the raters was found to be Kappa=0.363 (P<0.001). CONCLUSIONS Our study indicated that reliable information regarding Covid-19 in pregnancy was available online. An assessment of website content indicated that both grade levels and reading ease was higher than recommended. By guiding patients to reliable and accurate sources we can educate our patients while also guiding shared decision making.

Evaluating Readability Scores of Treatment Summaries and Cancer Survivorship Care Plans

PURPOSE: Treatment Summaries and Survivorship Care Plans (TS/SCPs) may be difficult for patients to comprehend because of readability, magnitude of information, and complex medical verbiage. METHODS: Readability scores were calculated for TS/SCP templates including ASCO, Oncolink, Journey Forward, and the authors' institution. The Simple Measure of Gobbledygook (SMOG) index, Flesch-Kincaid reading grade level, Coleman-Liau Index, and Gunning Fog index were used to assess readability. RESULTS: The Flesch-Kincaid reading ease scores for the blank ASCO templates ranged from 47.4 to 53.3, requiring a reading grade level of 10-12. Coleman-Liau and Gunning Fog scores showed that an 11th grade reading level is essential, and SMOG required a college education to comprehend the ASCO templates. For the colorectal case exemplar, Oncolink's template resulted in the lowest SMOG score (11.3; 11th grade), Flesch-Kincaid reading grade level (11; 11th grade), and Coleman-Liau score (12; 12th grade). Journey Forward's TS/SCP template scored the highest on the SMOG (21.2; college graduate), Flesch-Kincaid reading grade level (18.3; college graduate), and Gunning-Fog index (25.8; college graduate) compared with other TS/SCPs. CONCLUSION: The existing TS/SCP templates used by US cancer centers are written at a grade level beyond the comprehension of most adults. Cancer care teams should assess TS/SCP content for readability and use of plain language and reduce medical jargon.

Readability and Quality Assessment of Internet-Based Patient Education Materials Regarding Diabetic Foot Ulcers (Preprint)

BACKGROUND While diabetic foot ulcers are a common complication of diabetes, little is known about the content and readability of online patient education materials for diabetic foot ulcers. The recommended reading grade level for these materials is grade 6th - 8th. OBJECTIVE To evaluate the quality and readability of online patient education materials on diabetic foot ulcers. METHODS A Google search was performed using four different search terms related to DFUs. Six different tools were used to assess the readability of included patient education materials. These included the Flesch-Kincaid Grade Level, Flesch-Reading Ease Score, 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 Fourty-one online patient education materials were included. The average Flesch-Reading Ease score for all patient education materials was 63.43±14.21, indicating a standard difficulty level of reading. The average reading grade level was 9.33±2.6, which is higher than the recommended reading level for patient education materials. The mean DISCERN score was 45.66±3.34 and 27% (11/41) of articles had DISCERN scores less than 39, corresponding to poor or very poor quality. CONCLUSIONS The majority of online patient education materials on diabetic foot ulcers 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’ self-management.

An Evaluation of Readability of Information on the Internet Regarding Total Ankle Replacement

Background:Health literacy is defined as the ability to understand basic health information with such competence as to be able to use this information to enhance health. Lower health literacy is associated with increased post-operative complications, reduced satisfaction and compliance. To ensure accessibility and comprehension by the general public, many international health organisations suggest that health literature has a reading grade level equivalent to the American sixth grade. However, previous studies show that this rarely occurs.Total ankle replacement (TAR) technology has rapidly progressed with new prosthesis showing increasingly improving outcomes. However, TAR remains a complex procedure which may be challenging to explain to the patient. Thus, many patients will turn to the internet for more information and as a ‘quasi-second opinion’. If the health education materials provided on the internet is not accessible to patients, it can leave them overwhelmed and confused. The aim of the study is to evaluate the readability of information on the internet with regards to Total Ankle ReplacementMethods: 110 websites from the two main search engines (Google and Bing) were assessed using the terms ‘total ankle replacement’ and ‘total ankle arthroplasty’. Once duplicates had been removed and exclusion criteria were applied, 36 unique websites were categorised and underwent analysis using readability software (WEB FX readability tool). The websites were assessed for readability using the Fleisch Reading Ease Score (FRES) and the Reading Grade Level (RGL). A score of greater than 65 for FRES and an RGL of six or less were considered acceptable. Differential and Inferential statistical analysis was performed using SPSS.Results:The mean FRES score was 54.95 (SD: ± 13.2); this was significantly below the recognised acceptable standard score of 65 (P<.0001). An ANOVA conducted showed significant difference between FRES scores based on categories (P=.041) with post-hoc testing showing that the difference between commercial and non-physician scores was the most significant (P=.016; CI:3.84-61.66).The mean RGL was 8.31 (SD: ± 1.95). One-way t-tests showed that these scores were significantly higher than the acceptable standard (P<.0001; CI: 1.64-2.97). ANOVA testing showed a significant difference based on category (P=.028) with post hoc testing showing significant difference between non physician and commercial scores (P=.012, CI: 0.71-9.33).Conclusion:The majority of the websites pertaining to total ankle replacement are significantly beyond the comprehension levels of the general public. This will affect the patient’s ability to discern the complexities and potential complications of total ankle arthroplasty, with serious ramifications for consent as well as post-operative rehabilitation and compliance.Level of Evidence: not applicable

Dupuytren's Contracture: The Readability of Online Information

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.