Is the Readability of Spine-Related Patient Education Material Improving?: An Assessment of Subspecialty Websites.

PubMed

Eltorai, Adam E M; Cheatham, Morgan; Naqvi, Syed S; Marthi, Siddharth; Dang, Victor; Palumbo, Mark A; Daniels, Alan H

2016-06-01

Analysis of spine-related patient education materials (PEMs) from subspecialty websites. The aim of this study was to assess the readability of spine-related PEMs and compare to readability data from 2008. Many spine patients use the Internet for health information. Several agencies recommend that the readability of online PEMs should be no greater than a sixth-grade reading level, as health literacy predicts health-related quality of life outcomes. This study evaluated whether the North American Spine Society (NASS), American Association of Neurological Surgeons (AANS), and American Academy of Orthopaedic Surgeons (AAOS) online PEMs meet recommended readability guidelines for medical information. All publicly accessible spine-related entries within the patient education section of the NASS, AANS, and AAOS websites were analyzed for grade level readability using the Flesch-Kincaid formula. Readability scores were also compared with a similar 2008 analysis. Comparative statistics were performed. A total of 125 entries from the subspecialty websites were analyzed. The average (SD) readability of the online articles was grade level 10.7 (2.3). Of the articles, 117 (93.6%) had a readability score above the sixth-grade level. The readability of the articles exceeded the maximum recommended level by an average of 4.7 grade levels (95% CI, 4.292-5.103; P < 0.001). Compared with 2008, the three societies published more spine-related patient education articles (61 vs. 125, P = 0.045) and the average readability level improved from 11.5 to 10.7 (P = 0.018). Of three examined societies, only one showed significant improvement over time. Our findings suggest that the spine-related PEMs on the NASS, AAOS, and AANS websites have readability levels that may make comprehension difficult for a substantial portion of the patient population. Although some progress has been made in the readability of PEMs over the past 7 years, additional improvement is necessary. 2.

Readability, content, and quality of online patient education materials on preeclampsia.

PubMed

Lange, Elizabeth M S; Shah, Anuj M; Braithwaite, Brian A; You, Whitney B; Wong, Cynthia A; Grobman, William A; Toledo, Paloma

2015-01-01

The objective of this study was to evaluate the readability, content, and quality of patient education materials addressing preeclampsia. Websites of U.S. obstetrics and gynecology residency programs were searched for patient education materials. Readability, content, and quality were assessed. A one-sample t-test was used to evaluate mean readability level compared with the recommended 6th grade reading level. Mean readability levels were higher using all indices (p < 0.001). Content was variable with good website understandability, but poor actionability. The mean readability was above the recommended 6th grade reading level. The content, readability, and actionability of preeclampsia patient education materials should be improved.

The Readability of an Unreadable Text.

ERIC Educational Resources Information Center

Gordon, Robert M.

1980-01-01

The Dale-Chall Readability Formula and the Fry Readability Graph were used to analyze passages of Plato's "Parmenides," a notoriously difficult literary piece. The readability levels of the text ranged from fourth to eighth grade (Dale-Chall) and from sixth to tenth grade (Fry), indicating the limitations of the readability tests. (DF)

Readability Levels of Dental Patient Education Brochures.

PubMed

Boles, Catherine D; Liu, Ying; November-Rider, Debra

2016-02-01

The objective of this study was to evaluate dental patient education brochures produced since 2000 to determine if there is any change in the Flesch-Kincaid grade level readability. A convenience sample of 36 brochures was obtained for analysis of the readability of the patient education material on multiple dental topics. Readability was measured using the Flesch-Kincaid Grade Level through Microsoft Word. Pearson's correlation was used to describe the relationship among the factors of interest. Backward model selection of multiple linear regression model was used to investigate the relationship between Flesch-Kincaid Grade level and a set of predictors included in this study. A convenience sample (n=36) of dental education brochures produced from 2000 to 2014 showed a mean Flesch-Kincaid reading grade level of 9.15. Weak to moderate correlations existed between word count and grade level (r=0.40) and characters count and grade level (r=0.46); strong correlations were found between grade level and average words per sentence (r=0.70), average characters per word (r=0.85) and Flesch Reading Ease (r=-0.98). Only 1 brochure out of the sample met the recommended sixth grade reading level (Flesch-Kincaid Grade Level 5.7). Overall, the Flesch-Kincaid Grade Level of all brochures was significantly higher than the recommended sixth grade reading level (p<0.0001). The findings from this study demonstrated that there has generally been an improvement in the Flesch-Kincaid grade level readability of the brochures. However, the majority of the brochures analyzed are still testing above the recommended sixth grade reading level. Copyright © 2016 The American Dental Hygienists’ Association.

Readability of Self-Report Alcohol Misuse Measures

PubMed Central

McHugh, R Kathryn; Sugarman, Dawn E; Kaufman, Julia S; Park, Sara; Weiss, Roger D; Greenfield, Shelly F

2014-01-01

Objective: Self-report measures of alcohol misuse and alcohol use disorders are valuable assessment tools for both research and clinical practice settings. However, readability is often overlooked when establishing the validity of these measures, which may result in measures written at a reading-grade level that is higher than the ability level of many potential respondents. The aim of the current study was to estimate the reading-grade level of validated measures of alcohol misuse and associated problems. Method: A total of 45 measures were identified, and reading-grade level was calculated using three validated readability formulas. Results: The majority of measures were written above the recommended reading-grade level for patient materials (5th–6th grade), with particularly poor readability for measure instructions. Conclusions: Given that many self-report alcohol misuse measures are written at a high reading-grade level, the consideration of readability is important when selecting measures for use in research and practice settings. Moreover, the development or modification of measures to target low-literacy populations may facilitate the broader applicability of these instruments. PMID:24650827

MDA and AAEM informational brochures: can patients read them?

PubMed

Galloway, Gloria; Murphy, Peggy; Chesson, Andrew L; Martinez, Karen

2003-06-01

The purpose of this study was to assess patient literacy and the readability of patient education brochures from the American Academy of Electrodiagnostic Medicine and Muscular Dystrophy Association. Materials with the appropriate readability and suitability are more likely to provide instruction patients will understand. The readability of the brochure was assessed with Grammatik (Fry, 1977), the literacy of the participants with the Rapid Estimate of Adult Literacy (REALM) in Medicine test, and the suitability of the brochure was tested with the Suitability Assessment of Materials measure (Doak, Doak, & Root, 1993). The average REALM score for participation in this study correlated with a reading level of 7th-8th grade. All six brochures were found to be too difficult for many patients. Readability levels in four of the brochures were at 11th- or 12th-grade levels, one at 9th grade, and one at 10th grade. Materials with readability levels for 9th grade or higher should be rewritten to be understandable by most Americans, or supplemental instruction should be given. Readability and suitability assessments should be made to determine whether educational materials are appropriate for patients.

Readability of online patient education materials on adult reconstruction Web sites.

PubMed

Polishchuk, Daniil L; Hashem, Jenifer; Sabharwal, Sanjeev

2012-05-01

Recommended readability of patient education materials is sixth-grade level or lower. Readability of 212 patient education materials pertaining to adult reconstruction topics available from the American Academy of Orthopaedic Surgeons, American Association of Hip and Knee Surgeons, and 3 other specialty and private practitioner Web sites was assessed using the Flesch-Kincaid grade formula. The mean Flesch-Kincaid score was 11.1 (range, 3-26.5). Only 5 (2%) articles had a readability level of sixth grade or lower. Readability of most of the articles for patient education on adult reconstruction Web sites evaluated may be too advanced for a substantial portion of patients. Further studies are needed to assess the optimal readability level of health information on the Internet. Copyright © 2012 Elsevier Inc. All rights reserved.

Assessing readability formula differences with written health information materials: application, results, and recommendations.

PubMed

Wang, Lih-Wern; Miller, Michael J; Schmitt, Michael R; Wen, Frances K

2013-01-01

Readability formulas are often used to guide the development and evaluation of literacy-sensitive written health information. However, readability formula results may vary considerably as a result of differences in software processing algorithms and how each formula is applied. These variations complicate interpretations of reading grade level estimates, particularly without a uniform guideline for applying and interpreting readability formulas. This research sought to (1) identify commonly used readability formulas reported in the health care literature, (2) demonstrate the use of the most commonly used readability formulas on written health information, (3) compare and contrast the differences when applying common readability formulas to identical selections of written health information, and (4) provide recommendations for choosing an appropriate readability formula for written health-related materials to optimize their use. A literature search was conducted to identify the most commonly used readability formulas in health care literature. Each of the identified formulas was subsequently applied to word samples from 15 unique examples of written health information about the topic of depression and its treatment. Readability estimates from common readability formulas were compared based on text sample size, selection, formatting, software type, and/or hand calculations. Recommendations for their use were provided. The Flesch-Kincaid formula was most commonly used (57.42%). Readability formulas demonstrated variability up to 5 reading grade levels on the same text. The Simple Measure of Gobbledygook (SMOG) readability formula performed most consistently. Depending on the text sample size, selection, formatting, software, and/or hand calculations, the individual readability formula estimated up to 6 reading grade levels of variability. The SMOG formula appears best suited for health care applications because of its consistency of results, higher level of expected comprehension, use of more recent validation criteria for determining reading grade level estimates, and simplicity of use. To improve interpretation of readability results, reporting reading grade level estimates from any formula should be accompanied with information about word sample size, location of word sampling in the text, formatting, and method of calculation. Copyright © 2013 Elsevier Inc. All rights reserved.

Readability assessment of online patient education materials provided by the European Association of Urology.

PubMed

Betschart, Patrick; Zumstein, Valentin; Bentivoglio, Maico; Engeler, Daniel; Schmid, Hans-Peter; Abt, Dominik

2017-12-01

To assess the readability of the web-based patient education material provided by the European Association of Urology. English patient education materials (PEM) as available in May 2017 were obtained from the EAU website. Each topic was analyzed separately using six well-established readability assessment tools, including Flesch-Kincaid Grade Level (FKGL), SMOG Grade Level (SMOG), Coleman-Liau Index (CLI), Gunning Fog Index (GFI), Flesch Reading Ease Formula (FRE) and Fry Readability Graph (FRG). A total of 17 main topics were identified of which separate basic and in-depth information is provided for 14 topics. Calculation of grade levels (FKGL, SMOG, CLI, GFI) showed readability scores of 7th-13th grade for basic information, 8th-15th grade for in-depth information and 7th-15th grade for single PEM. Median FRE score was 54 points (range 45-65) for basic information and 56 points (41-64) for in-depth information. The FRG as a graphical assessment revealed only 13 valid results with an approximate 8th-17th grade level. The EAU provides carefully worked out PEM for 17 urological topics. Although improved readability compared to similar analyses was found, a simplification of certain chapters might be helpful to facilitate better patient understanding.

Readability assessment of patient education materials from the American Academy of Otolaryngology--Head and Neck Surgery Foundation.

PubMed

Kasabwala, Khushabu; Agarwal, Nitin; Hansberry, David R; Baredes, Soly; Eloy, Jean Anderson

2012-09-01

Americans are increasingly turning to the Internet as a source of health care information. These online resources should be written at a level readily understood by the average American. This study evaluates the readability of online patient education information available from the American Academy of Otolaryngology--Head and Neck Surgery Foundation (AAO-HNSF) professional Web site using 7 different assessment tools that analyze the materials for reading ease and grade level of its target audience. Analysis of Internet-based patient education material from the AAO-HNSF Web site. Online patient education material from the AAO-HNSF was downloaded in January 2012 and assessed for level of readability using the Flesch Reading Ease, Flesch-Kincaid Grade Level, SMOG grading, Coleman-Liau Index, Gunning-Fog Index, Raygor Readability Estimate graph, and Fry Readability graph. The text from each subsection was pasted as plain text into Microsoft Word document, and each subsection was subjected to readability analysis using the software package Readability Studio Professional Edition Version 2012.1. All health care education material assessed is written between an 11th grade and graduate reading level and is considered "difficult to read" by the assessment scales. Online patient education materials on the AAO-HNSF Web site are written above the recommended 6th grade level and may need to be revised to make them more easily understood by a broader audience.

Readability of spine-related patient education materials from subspecialty organization and spine practitioner websites.

PubMed

Vives, Michael; Young, Lyle; Sabharwal, Sanjeev

2009-12-01

Analysis of spine-related websites available to the general public. To assess the readability of spine-related patient educational materials available on professional society and individual surgeon or practice based websites. The Internet has become a valuable source of patient education material. A significant percentage of patients, however, find this Internet based information confusing. Healthcare experts recommend that the readability of patient education material be less than the sixth grade level. The Flesch-Kincaid grade level is the most widely used method to evaluate the readability score of textual material, with lower scores suggesting easier readability. We conducted an Internet search of all patient education documents on the North American Spine Society (NASS), American Association of Neurological Surgeons (AANS), the American Academy of Orthopaedic Surgeons (AAOS), and a sample of 10 individual surgeon or practice based websites. The Flesch-Kincaid grade level of each article was calculated using widely available Microsoft Office Word software. The mean grade level of articles on the various professional society and individual/practice based websites were compared. A total of 121 articles from the various websites were available and analyzed. All 4 categories of websites had mean Flesch-Kincaid grade levels greater than 10. Only 3 articles (2.5%) were found to be at or below the sixth grade level, the recommended readability level for adult patients in the United States. There were no significant differences among the mean Flesch-Kincaid grade levels from the AAOS, NASS, AANS, and practice-based web-sites (P = 0.065, ANOVA). Our findings suggest that most of the Spine-related patient education materials on professional society and practice-based websites have readability scores that may be too high, making comprehension difficult for a substantial portion of the United States adult population.

Readability of Patient Education Materials From the Web Sites of Orthopedic Implant Manufacturers.

PubMed

Yi, Meghan M; Yi, Paul H; Hussein, Khalil I; Cross, Michael B; Della Valle, Craig J

2017-12-01

Prior studies indicate that orthopedic patient education materials are written at a level that is too high for the average patient. The purpose of this study was to assess the readability of online patient education materials provided by orthopedic implant manufacturers. All patient education articles available in 2013 from the web sites of the 5 largest orthopedic implant manufacturers were identified. Each article was evaluated with the Flesch-Kincaid (FK) readability test. The number of articles with readability ≤ the eighth-grade level (average reading ability of US adults) and the sixth-grade level (recommended level for patient education materials) was determined. Mean readability levels of each company's articles were compared using analysis of variance (significance set at P < .05). A total of 581 articles were reviewed from the 5 largest implant manufacturers. The mean overall FK grade level was 10.9 (range, 3.8-16.1). Only 58 articles (10%) were written ≤ the eighth-grade level, and only 13 (2.2%) were ≤ the sixth-grade level. The mean FK grade level was significantly different among groups (Smith & Nephew = 12.0, Stryker = 11.6, Biomet = 11.3, DePuy = 10.6, Zimmer = 10.1; P < .0001). The majority of patient education materials from implant manufacturers are written at a level too high to be comprehended by the average patient. Future efforts should be made to improve the readability of orthopedic patient education materials. Copyright © 2017 Elsevier Inc. All rights reserved.

Readability of patient education materials from the American Academy of Orthopaedic Surgeons and Pediatric Orthopaedic Society of North America web sites.

PubMed

Badarudeen, Sameer; Sabharwal, Sanjeev

2008-01-01

While experts recommend that the readability of patient education materials should be less than the sixth grade level, the available information pertaining to orthopaedic diseases may be excessively complex for some to read and comprehend. The Flesch-Kincaid grade level is the most widely used tool to evaluate the readability score of a given text, with a lower grade level suggesting easier readability. The goal of our study was to assess the readability of pediatric orthopaedic patient education materials that were developed by the American Academy of Orthopaedic Surgeons (AAOS) and the Pediatric Orthopaedic Society of North America (POSNA) and were accessible to the general public through the Internet. All articles from the "Children" section of the patient education library, "Your Orthopaedic Connection," on the AAOS web site and the "Parent/Patient" section on the POSNA web site were identified. The Flesch-Kincaid grade level of each article was determined with use of Microsoft Office Word software. The mean grade levels of articles that were available in 2001 were compared with those accessible in 2007. Fifty-seven unique articles were available in 2007 on both web sites compared with twenty-five articles available in 2001. The readability score of only one (2%) of the currently available articles was less than sixth grade level. The mean Flesch-Kincaid grade level of the currently available articles was 8.9 compared with 8.7 for the articles available in 2001 (p = 0.71). Our findings suggest that most of the pediatric orthopaedic patient education materials available on the AAOS and POSNA web sites have readability scores that may be too high, making comprehension difficult for a substantial portion of the United States population.

Content, format, gender and grade level differences in elementary students' ability to read science materials as measured by the cloze procedure

NASA Astrophysics Data System (ADS)

Williams, Richard L.; Yore, Larry D.

Present instructional trends in science indicate a need to reexamine a traditional concern in science education: the readability of science textbooks. An area of reading research not well documented is the effect of color, visuals, and page layout on readability of science materials. Using the cloze readability method, the present study explored the relationships between page format, grade level, sex, content, and elementary school students ability to read science material. Significant relationships were found between cloze scores and both grade level and content, and there was a significant interaction effect between grade and sex in favor of older males. No significant relationships could be attributed to page format and sex. In the area of science content, biological materials were most difficult in terms of readability followed by earth science and physical science. Grade level data indicated that grade five materials were more difficult for that level than either grade four or grade six materials were for students at each respective level. In eight of nine cases, the science text materials would be classified at or near the frustration level of readability. The implications for textbook writers and publishers are that science reading materials need to be produced with greater attention to readability and known design principles regarding visual supplements. The implication for teachers is that students need direct instruction in using visual materials to increase their learning from text material. Present visual materials appear to neither help nor hinder the student to gain information from text material.

Readability Analysis of the Package Leaflets for Biological Medicines Available on the Internet Between 2007 and 2013: An Analytical Longitudinal Study

PubMed Central

2016-01-01

Background The package leaflet included in the packaging of all medicinal products plays an important role in the transmission of medicine-related information to patients. Therefore, in 2009, the European Commission published readability guidelines to try to ensure that the information contained in the package leaflet is understood by patients. Objective The main objective of this study was to calculate and compare the readability levels and length (number of words) of the package leaflets for biological medicines in 2007, 2010, and 2013. Methods The sample of this study included 36 biological medicine package leaflets that were downloaded from the European Medicines Agency website in three different years: 2007, 2010, and 2013. The readability of the selected package leaflets was obtained using the following readability formulas: SMOG grade, Flesch-Kincaid grade level, and Szigriszt’s perspicuity index. The length (number of words) of the package leaflets was also measured. Afterwards, the relationship between these quantitative variables (three readability indexes and length) and categorical (or qualitative) variables were analyzed. The categorical variables were the year when the package leaflet was downloaded, the package leaflet section, type of medicine, year of authorization of biological medicine, and marketing authorization holder. Results The readability values of all the package leaflets exceeded the sixth-grade reading level, which is the recommended value for health-related written materials. No statistically significant differences were found between the three years of study in the readability indexes, although differences were observed in the case of the length (P=.002), which increased over the study period. When the relationship between readability indexes and length and the other variables was analyzed, statistically significant differences were found between package leaflet sections (P<.001) and between the groups of medicine only with regard to the length over the three studied years (P=.002 in 2007, P=.007 in 2010, P=.009 in 2013). Linear correlation was observed between the readability indexes (SMOG grade and Flesch-Kincaid grade level: r2=.92; SMOG grade and Szigriszt’s perspicuity index: r2=.81; Flesch-Kincaid grade level and Szigriszt’s perspicuity index: r2=.95), but not between the readability indexes and the length (length and SMOG grade: r2=.05; length and Flesch-Kincaid grade level: r2=.03; length and Szigriszt’s perspicuity index: r2=.02). Conclusions There was no improvement in the readability of the package leaflets studied between 2007 and 2013 despite the European Commission’s 2009 guideline on the readability of package leaflets. The results obtained from the different readability formulas coincided from a qualitative point of view. Efforts to improve the readability of package leaflets for biological medicines are required to promote the understandability and accessibility of this online health information by patients and thereby contribute to the appropriate use of medicines and medicine safety. PMID:27226241

Readability Analysis of the Package Leaflets for Biological Medicines Available on the Internet Between 2007 and 2013: An Analytical Longitudinal Study.

PubMed

Piñero-López, María Ángeles; Modamio, Pilar; Lastra, Cecilia F; Mariño, Eduardo L

2016-05-25

The package leaflet included in the packaging of all medicinal products plays an important role in the transmission of medicine-related information to patients. Therefore, in 2009, the European Commission published readability guidelines to try to ensure that the information contained in the package leaflet is understood by patients. The main objective of this study was to calculate and compare the readability levels and length (number of words) of the package leaflets for biological medicines in 2007, 2010, and 2013. The sample of this study included 36 biological medicine package leaflets that were downloaded from the European Medicines Agency website in three different years: 2007, 2010, and 2013. The readability of the selected package leaflets was obtained using the following readability formulas: SMOG grade, Flesch-Kincaid grade level, and Szigriszt's perspicuity index. The length (number of words) of the package leaflets was also measured. Afterwards, the relationship between these quantitative variables (three readability indexes and length) and categorical (or qualitative) variables were analyzed. The categorical variables were the year when the package leaflet was downloaded, the package leaflet section, type of medicine, year of authorization of biological medicine, and marketing authorization holder. The readability values of all the package leaflets exceeded the sixth-grade reading level, which is the recommended value for health-related written materials. No statistically significant differences were found between the three years of study in the readability indexes, although differences were observed in the case of the length (P=.002), which increased over the study period. When the relationship between readability indexes and length and the other variables was analyzed, statistically significant differences were found between package leaflet sections (P<.001) and between the groups of medicine only with regard to the length over the three studied years (P=.002 in 2007, P=.007 in 2010, P=.009 in 2013). Linear correlation was observed between the readability indexes (SMOG grade and Flesch-Kincaid grade level: r(2)=.92; SMOG grade and Szigriszt's perspicuity index: r(2)=.81; Flesch-Kincaid grade level and Szigriszt's perspicuity index: r(2)=.95), but not between the readability indexes and the length (length and SMOG grade: r(2)=.05; length and Flesch-Kincaid grade level: r(2)=.03; length and Szigriszt's perspicuity index: r(2)=.02). There was no improvement in the readability of the package leaflets studied between 2007 and 2013 despite the European Commission's 2009 guideline on the readability of package leaflets. The results obtained from the different readability formulas coincided from a qualitative point of view. Efforts to improve the readability of package leaflets for biological medicines are required to promote the understandability and accessibility of this online health information by patients and thereby contribute to the appropriate use of medicines and medicine safety.

Readability of Spine-Related Patient Education Materials From Leading Orthopedic Academic Centers.

PubMed

Ryu, Justine H; Yi, Paul H

2016-05-01

Cross-sectional analysis of online spine-related patient education materials from leading academic centers. To assess the readability levels of spine surgery-related patient education materials available on the websites of academic orthopedic surgery departments. The Internet is becoming an increasingly popular resource for patient education. Yet many previous studies have found that Internet-based orthopedic-related patient education materials from subspecialty societies are written at a level too difficult for the average American; however, no prior study has assessed the readability of spine surgery-related patient educational materials from leading academic centers. All spine surgery-related articles from the online patient education libraries of the top five US News & World Report-ranked orthopedic institutions were assessed for readability using the Flesch-Kincaid (FK) readability test. Mean readability levels of articles amongst the five academic institutions and articles were compared. We also determined the number of articles with readability levels at or below the recommended sixth- or eight-grade levels. Intraobserver and interobserver reliability of readability assessment were assessed. A total of 122 articles were reviewed. The mean overall FK grade level was 11.4; the difference in mean FK grade level between each department varied significantly (range, 9.3-13.4; P < 0.0001). Twenty-three articles (18.9%) had a readability level at or below the eighth grade level, and only one (0.8%) was at or below the sixth grade level. Intraobserver and interobserver reliability were both excellent (intraclass correlation coefficient of 1 for both). Online patient education materials related to spine from academic orthopedic centers are written at a level too high for the average patient, consistent with spine surgery-related patient education materials provided by the American Academy of Orthopaedic Surgeons and spine subspecialty societies. This study highlights the potential difficulties patients might have in reading and comprehending the information in publicly available education materials related to spine. N/A.

Readability evaluation of Internet-based patient education materials related to the anesthesiology field.

PubMed

De Oliveira, Gildasio S; Jung, Michael; Mccaffery, Kirsten J; McCarthy, Robert J; Wolf, Michael S

2015-08-01

The main objective of the current investigation was to assess the readability of Internet-based patient education materials related to the field of anesthesiology. We hypothesized that the majority of patient education materials would not be written according to current recommended readability grade level. Online patient education materials describing procedures, risks, and management of anesthesia-related topics were identified using the search engine Google (available at www.google.com) using the terms anesthesia, anesthesiology, anesthesia risks, and anesthesia care. Cross-sectional evaluation. None. Assessments of content readability were performed using validated instruments (Flesch-Kincaid Grade Formulae, the Gunning Frequency of Gobbledygook, the New Dale-Chall Test, the Fry graph, and the Flesch Reading Ease score). Ninety-six Web sites containing Internet patient education materials (IPEMs) were evaluated. The median (interquartile range) readability grade level for all evaluated IPEMs was 13.5 (12.0-14.6). All the evaluated documents were classified at a greater readability level than the current recommended readability grade, P < .001. Readability grades were not significantly different among different IPEM sources. Assessment by the Flesch Reading Ease test classified all but 4 IPEMs as at least fairly difficult to read. Internet-based patient education materials related to the field of anesthesiology are currently written far above the recommended readability grade level. High complexity of written education materials likely limits access of information to millions of American patients. Redesign of online content of Web sites that provide patient education material regarding anesthesia could be an important step in improving access to information for patients with poor health literacy. Copyright © 2015 Elsevier Inc. All rights reserved.

Analyzing readability of medicines information material in Slovenia

PubMed Central

Kasesnik, Karin; Kline, Mihael

2011-01-01

Objective: Readability has been claimed to be an important factor for understanding texts describing health symptoms and medications. Such texts may be a factor which indirectly affects the health of the population. Despite the expertise of physicians, the readability of information sources may be important for acquiring essential treatment information. The aim of this study was to measure the readability level of medicines promotion material in Slovenia. Methods: The Flesch readability formula was modified to comply with Slovene texts. On the basis of determining the Slovene readability algorithm, the readability ease related to the readability grade level of different Slovene texts was established. In order to estimate an adjustment of the texts to the recommended readability grade level of the targeted population, readability values of English texts were set. One sample t-test and standard deviations from the arithmetic mean values were used as statistical tests. Results: The results of the research showed low readability scores of the Slovene texts. Difficult readability values were seen in different types of examined texts: in patient information leaflets, in the summaries of product characteristics, in promotional materials, while describing over-the-counter medications and in the materials for creating disease awareness. Especially low readability values were found within the texts belonging to promotional materials intended for the physicians. None of researched items, not even for the general public, were close to primary school grade readability levels and therefore could not be described as easily readable. Conclusion: This study provides an understanding of the level of readability of selected Slovene medicines information material. It was concluded that health-related texts were not compliant with general public or with healthcare professional needs. PMID:23093886

Assessment of online patient education materials from major ophthalmologic associations.

PubMed

Huang, Grace; Fang, Christina H; Agarwal, Nitin; Bhagat, Neelakshi; Eloy, Jean Anderson; Langer, Paul D

2015-04-01

Patients are increasingly using the Internet to supplement finding medical information, which can be complex and requires a high level of reading comprehension. Online ophthalmologic materials from major ophthalmologic associations should be written at an appropriate reading level. To assess ophthalmologic online patient education materials (PEMs) on ophthalmologic association websites and to determine whether they are above the reading level recommended by the American Medical Association and National Institutes of Health. Descriptive and correlational design. Patient education materials from major ophthalmology websites were downloaded from June 1, 2014, through June 30, 2014, and assessed for level of readability using 10 scales. The Flesch Reading Ease test, Flesch-Kincaid Grade Level, Simple Measure of Gobbledygook test, Coleman-Liau Index, Gunning Fog Index, New Fog Count, New Dale-Chall Readability Formula, FORCAST scale, Raygor Readability Estimate Graph, and Fry Readability Graph were used. Text from each article was pasted into Microsoft Word and analyzed using the software Readability Studio professional edition version 2012.1 for Windows. Flesch Reading Ease score, Flesch-Kincaid Grade Level, Simple Measure of Gobbledygook grade, Coleman-Liau Index score, Gunning Fog Index score, New Fog Count, New Dale-Chall Readability Formula score, FORCAST score, Raygor Readability Estimate Graph score, and Fry Readability Graph score. Three hundred thirty-nine online PEMs were assessed. The mean Flesch Reading Ease score was 40.7 (range, 17.0-51.0), which correlates with a difficult level of reading. The mean readability grade levels ranged as follows: 10.4 to 12.6 for the Flesch-Kincaid Grade Level; 12.9 to 17.7 for the Simple Measure of Gobbledygook test; 11.4 to 15.8 for the Coleman-Liau Index; 12.4 to 18.7 for the Gunning Fog Index; 8.2 to 16.0 for the New Fog Count; 11.2 to 16.0 for the New Dale-Chall Readability Formula; 10.9 to 12.5 for the FORCAST scale; 11.0 to 17.0 for the Raygor Readability Estimate Graph; and 12.0 to 17.0 for the Fry Readability Graph. Analysis of variance demonstrated a significant difference (P < .001) between the websites for each reading scale. Online PEMs on major ophthalmologic association websites are written well above the recommended reading level. Consideration should be given to revision of these materials to allow greater comprehension among a wider audience.

Readability of Orthopedic Trauma Patient Education Materials on the Internet.

PubMed

Mohan, Rohith; Yi, Paul H; Morshed, Saam

In this study, we used the Flesch-Kincaid Readability Scale to determine the readability levels of orthopedic trauma patient education materials on the American Academy of Orthopaedic Surgeons (AAOS) website and to examine how subspecialty coauthorship affects readability level. Included articles from the AAOS online patient education library and the AAOS OrthoPortal website were categorized as trauma or broken bones and injuries on the AAOS online library or were screened by study authors for relevance to orthopedic trauma. Subsequently, the Flesch-Kincaid scale was used to determine each article's readability level, which was reported as a grade level. Subspecialty coauthorship was noted for each article. A total of 115 articles from the AAOS website were included in the study and reviewed. Mean reading level was grade 9.1 for all articles reviewed. Nineteen articles (16.5%) were found to be at or below the eighth-grade level, and only 1 article was at or below the sixth-grade level. In addition, there was no statistically significant difference between articles coauthored by the various orthopedic subspecialties and those authored exclusively by AAOS. Orthopedic trauma readability materials on the AAOS website appear to be written at a reading comprehension level too high for the average patient to understand.

Readability of Online Materials for Rhinoplasty.

PubMed

Santos, Pauline Joy F; Daar, David A; Paydar, Keyianoosh Z; Wirth, Garrett A

2018-01-01

Rhinoplasty is a popular aesthetic and reconstructive surgical procedure. However, little is known about the content and readability of online materials for patient education. The recommended grade level for educational materials is 7th to 8th grade according to the National Institutes of Health (NIH). This study aims to assess the readability of online patient resources for rhinoplasty. The largest public search engine, Google, was queried using the term "rhinoplasty" on February 26, 2016. Location filters were disabled and sponsored results excluded to avoid any inadvertent search bias. The 10 most popular websites were identified and all relevant, patient-directed information within one click from the original site was downloaded and saved as plain text. Readability was analyzed using five established analyses (Readability-score.com, Added Bytes, Ltd., Sussex, UK). Analysis of ten websites demonstrates an average grade level of at least 12 th grade. No material was at the recommended 7 th to 8 th grade reading level (Flesch-Kincaid, 11.1; Gunning-Fog, 14.1; Coleman-Liau, 14.5; SMOG 10.4; Automated Readability, 10.7; Average Grade Level, 12.2). Overall Flesch-Kincaid Reading Ease Index was 43.5, which is rated as "difficult." Online materials available for rhinoplasty exceed NIH-recommended reading levels, which may prevent appropriate decision-making in patients considering these types of surgery. Outcomes of this study identify that Plastic Surgeons should be cognizant of available online patient materials and make efforts to develop and provide more appropriate materials. Readability results can also contribute to marketing strategy and attracting a more widespread interest in the procedure.

Readability of Online Materials for Rhinoplasty

PubMed Central

Santos, Pauline Joy F; Daar, David A; Paydar, Keyianoosh Z; Wirth, Garrett A

2018-01-01

BACKGROUND Rhinoplasty is a popular aesthetic and reconstructive surgical procedure. However, little is known about the content and readability of online materials for patient education. The recommended grade level for educational materials is 7th to 8th grade according to the National Institutes of Health (NIH). This study aims to assess the readability of online patient resources for rhinoplasty. METHODS The largest public search engine, Google, was queried using the term “rhinoplasty” on February 26, 2016. Location filters were disabled and sponsored results excluded to avoid any inadvertent search bias. The 10 most popular websites were identified and all relevant, patient-directed information within one click from the original site was downloaded and saved as plain text. Readability was analyzed using five established analyses (Readability-score.com, Added Bytes, Ltd., Sussex, UK). RESULTS Analysis of ten websites demonstrates an average grade level of at least 12th grade. No material was at the recommended 7th to 8th grade reading level (Flesch-Kincaid, 11.1; Gunning-Fog, 14.1; Coleman-Liau, 14.5; SMOG 10.4; Automated Readability, 10.7; Average Grade Level, 12.2). Overall Flesch-Kincaid Reading Ease Index was 43.5, which is rated as “difficult.” CONCLUSION Online materials available for rhinoplasty exceed NIH-recommended reading levels, which may prevent appropriate decision-making in patients considering these types of surgery. Outcomes of this study identify that Plastic Surgeons should be cognizant of available online patient materials and make efforts to develop and provide more appropriate materials. Readability results can also contribute to marketing strategy and attracting a more widespread interest in the procedure. PMID:29651397

Readability of arthroscopy-related patient education materials from the American Academy of Orthopaedic Surgeons and Arthroscopy Association of North America Web sites.

PubMed

Yi, Paul H; Ganta, Abhishek; Hussein, Khalil I; Frank, Rachel M; Jawa, Andrew

2013-06-01

We sought to assess the readability levels of arthroscopy-related patient education materials available on the Web sites of the American Academy of Orthopaedic Surgeons (AAOS) and the Arthroscopy Association of North America (AANA). We identified all articles related to arthroscopy available in 2012 from the online patient education libraries of AAOS and AANA. After performing follow-up editing, we assessed each article with the Flesch-Kincaid (FK) readability test. Mean readability levels of the articles from the AAOS Web site and the AANA Web site were compared. We also determined the number of articles with readability levels at or below the eighth-grade level (the average reading ability of the US adult population) and sixth-grade level (the widely recommended level for patient education materials). Intraobserver reliability and interobserver reliability of FK grade assessment were evaluated. A total of 62 articles were reviewed (43 from AAOS and 19 from AANA). The mean overall FK grade level was 10.2 (range, 5.2 to 12). The AAOS articles had a mean FK grade level of 9.6 (range, 5.2 to 12), whereas the AANA articles had a mean FK grade level of 11.4 (range, 8.7 to 12); the difference was significant (P < .0001). Only 3 articles had a readability level at or below the eighth-grade level and only 1 was at or below the sixth-grade level; all were from AAOS. Intraobserver reliability and interobserver reliability were excellent (intraclass correlation coefficient of 1 for both). Online patient education materials related to arthroscopy from AAOS and AANA may be written at a level too difficult for a large portion of the patient population to comprehend. Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Comparative Readability of Shoulder and Elbow Patient Education Materials within Orthopaedic Websites.

PubMed

Beutel, Bryan G; Danna, Natalie R; Melamed, Eitan; Capo, John T

2015-12-01

There is growing concern that the readability of online orthopaedic patient education materials are too difficult for the general public to fully understand. It is recommended that this information be at the sixth grade reading level or lower. This study compared the readability of shoulder and elbow education articles from the American Academy of Orthopaedic Surgeons (AAOS) and American Society for Surgery of the Hand (ASSH) websites. Seventy-six patient education articles from the AAOS and ASSH concerning shoulder and elbow disorders were evaluated. Each article was assessed for the number of years since its last update, word count, percentage of passive sentences, Flesch Reading Ease score, Flesch-Kincaid grade level, Simple Measure of Gobbledygook (SMOG) grade, and New Dale-Chall grade level. Only one article was at or below the sixth grade reading level. The AAOS and ASSH articles had the following respective scores: a mean Flesch Reading Ease score of 54.3 and 51.8, Flesch-Kincaid grade level of 9.4 and 10.3, SMOG grade of 8.5 and 9.4, and New Dale-Chall grade of 10.4 and 11.0. Articles from the AAOS were longer (p < 0.001), had a lower percentage of passive sentences (p < 0.001), and were more recently updated (p = 0.02) than their ASSH counterparts. Higher percentages of passive sentences were found to correlate with more difficult readability. Patient education materials regarding the shoulder and elbow on the AAOS and ASSH websites have readability scores above the recommended reading level. These may be too challenging for the majority of patients to read and consequently serve as a barrier to proper patient education. Reducing the percentage of passive sentences may serve as a novel target for improving readability.

Readability Level of Standardized Test Items and Student Performance: The Forgotten Validity Variable

ERIC Educational Resources Information Center

Hewitt, Margaret A.; Homan, Susan P.

2004-01-01

Test validity issues considered by test developers and school districts rarely include individual item readability levels. In this study, items from a major standardized test were examined for individual item readability level and item difficulty. The Homan-Hewitt Readability Formula was applied to items across three grade levels. Results of…

Readability of Orthopaedic Patient-reported Outcome Measures: Is There a Fundamental Failure to Communicate?

PubMed

Perez, Jorge L; Mosher, Zachary A; Watson, Shawna L; Sheppard, Evan D; Brabston, Eugene W; McGwin, Gerald; Ponce, Brent A

2017-08-01

Patient-reported outcome measures (PROMs) are increasingly used to quantify patients' perceptions of functional ability. The American Medical Association and NIH suggest patient materials be written at or below 6th to 8th grade reading levels, respectively, yet one recent study asserts that few PROMs comply with these recommendations, and suggests that the majority of PROMs are written at too high of a reading level for self-administered patient use. Notably, this study was limited in its use of only one readability algorithm, although there is no commonly accepted, standard readability algorithm for healthcare-related materials. Our study, using multiple readability equations and heeding equal weight to each, hopes to yield a broader, all-encompassing estimate of readability, thereby offering a more accurate assessment of the readability of orthopaedic PROMS. (1) What proportion of orthopaedic-related PROMs and orthopaedic-related portions of the NIH Patient Reported Outcomes Measurement Information System (PROMIS ® ) are written at or below the 6th and 8th grade levels? (2) Is there a correlation between the number of questions in the PROM and reading level? (3) Using systematic edits based on guidelines from the Centers for Medicare and Medicaid Services, what proportion of PROMs achieved American Medical Association and NIH-recommended reading levels? Eighty-six (86) independent, orthopaedic and general wellness PROMs, drawn from commonly referenced orthopaedic websites and prior studies, were chosen for analysis. Additionally, owing to their increasing use in orthopaedics, four relevant short forms, and 11 adult, physical health question banks from the PROMIS ® , were included for analysis. All documents were analyzed for reading grade levels using 19 unique readability algorithms. Descriptive statistics were performed using SPSS Version 22.0. The majority of the independent PROMs (64 of 86; 74%) were written at or below the 6th grade level, with 81 of 86 (94%) written at or below the 8th grade level. All item banks (11 of 11) and short forms (four of four) of the PROMIS ® were written below the 6th grade reading level. The median reading grade level of the 86 independent PROMs was 5.0 (interquartile range [IQR], 4.6-6.1). The PROMIS ® question banks had a median reading grade level of 4.1 (IQR, 3.5-4.8); the Adult Short Forms had a median reading grade level of 4.2 (IQR, 4.2-4.3) There was no correlation appreciated between the median reading grade level and the number of questions contained in a PROM (r = -0.081; p = 0.460). For PROMs above NIH-recommended levels, following edits, all (five of five) achieved NIH reading level goals and three (three of five) achieved American Medical Association goals. Editing of these PROMs improved readability by 4.3 median grade level (before, 8.9 [IQR, 8.4-9.1], after 4.6 [IQR, 4.6-6.4], difference of medians, 4.3; p = 0.008). Patient literacy has great influence on healthcare outcomes, and readability is an important consideration in all patient-directed written materials. Our study found that more than 70% of PROMs commonly used in orthopaedics, and all orthopaedic-related portions of the PROMIS ® are written at or below the most stringent recommendations (≤ 6th grade reading level), and more than 90% of independent PROMs and all PROMIS ® materials are written at or below an 8th grade level. Additionally, the use of the Centers for Medicare and Medicaid Services guidelines for editing high reading level PROMs yields satisfactory results. Fears of widely incomprehensible PROMs may be unfounded. Future research to identify the most appropriate readability algorithm for use in the healthcare sector, and revalidation of PROMs after readability-improving edits is warranted.

Readability assessment of Internet-based patient education materials related to endoscopic sinus surgery.

PubMed

Cherla, Deepa V; Sanghvi, Saurin; Choudhry, Osamah J; Liu, James K; Eloy, Jean Anderson

2012-08-01

Numerous professional societies, clinical practices, and hospitals provide Internet-based patient education materials (PEMs) to the general public, but not all of this information is written at a reading level appropriate for the average patient. The National Institutes of Health and the US Department of Health and Human Services recommend that PEMs be written at or below the sixth-grade level. Our purpose was to assess the readability of endoscopic sinus surgery (ESS)-related PEMs available on the Internet and compare readability levels of PEMs provided by three sources: professional societies, clinical practices, and hospitals. A descriptive and correlational design was used for this study. The readability of 31 ESS-related PEMs was assessed with four different readability indices: Flesch-Kincaid Grade Level (FKGL), Flesch Reading Ease Score (FRES), Simple Measure of Gobbledygook (SMOG), and Gunning Frequency of Gobbledygook (Gunning FOG). Averages were evaluated against national recommendations and between each source using analysis of variance and t tests. The majority of PEMs (96.8%) were written above the recommended sixth-grade reading level, based on FKGL (P < .001). Only one article (3.2%) had an FKGL at or below the sixth-grade level. The mean readability values were: FRES 47.1 ± 13.4, FKGL 10.7 ± 2.4, SMOG 13.7 ± 1.6, and Gunning FOG 12.4 ± 2.7. Current Internet-based PEMs related to ESS, regardless of source type, were written well above the recommended sixth-grade level. Materials from the hospitals/university-affiliated websites had lower readability scores, but were still above recommended levels. Web-based PEMs pertaining to ESS should be written with the average patient in mind. Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.

Readability of Healthcare Literature for Hepatitis B and C.

PubMed

Meillier, Andrew; Patel, Shyam; Al-Osaimi, Abdullah M S

2015-12-01

Patients increasingly use the Internet for educational material concerning health and diseases. This information can be utilized to teach the population of hepatitis B and C if properly written at the necessary grade level of the intended patient population. We explored the readability of online resources concerning hepatitis B and C. Google searches were performed for "Hepatitis B" and "Hepatitis C." The Internet resources that were intended for patient education were used with specific exclusions. Articles were taken from 19 and 23 different websites focusing on the symptoms, diagnosis, and treatment of hepatitis B and C, respectively. The articles were analyzed using Readability Studio Professional Edition (Oleander Solutions, Vandalia, OH) using 10 different readability scales. The results were compared and averaged to identify the anticipated academic grade level required to understand the information. The average readability scores of the 10 scales had ranges of 9.7-16.4 for hepatitis B and 9.2-16.4 for hepatitis C. The average academic reading grade level for hepatitis B was 12.6 ± 2.1 and for hepatitis C was 12.7 ± 2.1. There was no significant discrepancy between the hepatitis B and C Internet resource averaged grade levels. The resources accessed by patients are higher than the previously determined necessary grade level for patients to properly understand the intended information. The American Medical Association recommends material should be simplified to grade levels below the sixth grade level to benefit the ideal proportion of the patient population.

Readability analysis of healthcare-oriented education resources from the American Academy of Facial Plastic and Reconstructive Surgery.

PubMed

Misra, Poonam; Agarwal, Nitin; Kasabwala, Khushabu; Hansberry, David R; Setzen, Michael; Eloy, Jean Anderson

2013-01-01

Deficient health literacy remains a widespread public issue. As such, the National Institutes of Health (NIH) recommends that all patient resources should be written around a sixth-grade level. The authors evaluate healthcare-oriented resources specified for patient use on the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) Web site in order to identify potential areas of improvement and highlight those sections that may serve as paradigms for future revisions. Descriptive and correlational design. Seventeen healthcare-oriented resources specifically for patients were downloaded in February 2012 from the American Academy of Facial Plastic and Reconstructive Surgery Web site. Readability assessments of each article were performed using Readability Studio Professional Edition Version 2012.1. These tests included the Flesch Reading Ease, Flesch-Kincaid Grade Level, SMOG Grading, Coleman-Liau Index, Gunning-Fog Index, the New Fog Count, the New Dale-Chall Readability Formula, FORCAST formula, Raygor Readability Estimate, and the Fry Graph. Patient health education material found on the AAFPRS Web site has been found to be written at an average grade level of 12th grade using 10 different readability scales. Modifications of the patient education section of the AAFPRS Web site can increase the readability of the literature, and allow greater comprehension among a wider audience. Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.

Online patient information from radiation oncology departments is too complex for the general population.

PubMed

Rosenberg, Stephen A; Francis, David M; Hullet, Craig R; Morris, Zachary S; Brower, Jeffrey V; Anderson, Bethany M; Bradley, Kristin A; Bassetti, Michael F; Kimple, Randall J

Nearly two-thirds of cancer patients seek information about their diagnosis online. We assessed the readability of online patient education materials found on academic radiation oncology department Web sites to determine whether they adhered to guidelines suggesting that information be presented at a sixth-grade reading level. The Association of American Medical Colleges Web site was used to identify all academic radiation oncology departments in the United States. One-third of these department Web sites were selected for analysis using a random number generator. Both general information on radiation therapy and specific information regarding various radiation modalities were collected. To test the hypothesis that the readability of these online educational materials was written at the recommended grade level, a panel of 10 common readability tests was used. A composite grade level of readability was constructed using the 8 readability measures that provide a single grade-level output. A mean of 5605 words (range, 2058-12,837) from 30 department Web sites was collected. Using the composite grade level score, the overall mean readability level was determined to be 13.36 (12.83-13.89), corresponding to a collegiate reading level. This was significantly higher than the target sixth-grade reading level (middle school, t (29) = 27.41, P < .001). Online patient educational materials from academic radiation oncology Web sites are significantly more complex than recommended by the National Institutes of Health and the Department of Health and Human Services. To improve patients' comprehension of radiation therapy and its role in their treatment, our analysis suggests that the language used in online patient information should be simplified to communicate the information at a more appropriate level. Copyright © 2016 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

Readability Assessment of Online Patient Education Material on Congestive Heart Failure.

PubMed

Kher, Akhil; Johnson, Sandra; Griffith, Robert

2017-01-01

Online health information is being used more ubiquitously by the general population. However, this information typically favors only a small percentage of readers, which can result in suboptimal medical outcomes for patients. The readability of online patient education materials regarding the topic of congestive heart failure was assessed through six readability assessment tools. The search phrase "congestive heart failure" was employed into the search engine Google. Out of the first 100 websites, only 70 were included attending to compliance with selection and exclusion criteria. These were then assessed through six readability assessment tools. Only 5 out of 70 websites were within the limits of the recommended sixth-grade readability level. The mean readability scores were as follows: the Flesch-Kincaid Grade Level (9.79), Gunning-Fog Score (11.95), Coleman-Liau Index (15.17), Simple Measure of Gobbledygook (SMOG) index (11.39), and the Flesch Reading Ease (48.87). Most of the analyzed websites were found to be above the sixth-grade readability level recommendations. Efforts need to be made to better tailor online patient education materials to the general population.

Readability assessment of patient education materials on major otolaryngology association websites.

PubMed

Eloy, Jean Anderson; Li, Shawn; Kasabwala, Khushabu; Agarwal, Nitin; Hansberry, David R; Baredes, Soly; Setzen, Michael

2012-11-01

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. Analysis of patient education materials from 9 major otolaryngology association websites. 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. 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. The IPEMs found on all otolaryngology association websites exceed the recommended fourth- to sixth-grade reading level.

Readability of the Patient Education Section of the AOFAS Website.

PubMed

Bluman, Eric M; Foley, Ryan P; Chiodo, Christopher P

2009-04-01

One of the goals of the AOFAS website is to provide easily understandable information about orthopaedic foot and ankle conditions to the public. However, validation of this goal has not been conducted. Evaluation of text reading level is frequently performed using the Flesch-Kincaid formula (FKF). This study evaluated whether the patient information section of the AOFAS website meets recommended readability guidelines for medical information. Seventy-nine publicly accessible entries within the patient education section of the AOFAS website were analyzed for grade level readability using the FKF. Two entries were unable to be effectively evaluated using the FKF. The average grade reading level of all patient education entries was 8.3 (95% CI 7.8 to 8.9). Only 20.8% of entries were at or below a 6th grade reading level. Almost 30% were above the 8th grade level. The average grade levels of the constituent sections were: ;;Ailments and Conditions'', 8.7; ;;Steps to Recovery'', 7.1; ;;Adult Feet'', 8.3; ;;Children's Feet'', 7.5; ;;Foot Health and Fitness'', 7.8; ;;Shoes'', 8.5; and ;;Glossary'', 10.1. The percentage of entries within these sections below a 7th grade reading level were 13%, 30%, 0%, 0%, 43%, 24% and 0%, respectively. The percentage of entries at or below the recommended 6th grade reading level on the AOFAS website compared favorably with other orthopaedic organizations' websites. However, the majority still exceeds a recommended reading level. To enhance the readability of patient education materials, we believe use of computer aided readability assessment tools should be considered in future website revisions.

Readability Levels of the 1975 Third Grade Macmillan Basal Readers.

ERIC Educational Resources Information Center

McKinney, Ernestine Williams

1983-01-01

Analysis of third-grade books in the New Macmillan Reading Program reveals that the books exceeded the publisher's designation of readability and did not progress in difficulty from easy to more difficult. Findings suggest the need for more complete and reliable information from publishers concerning textbook readability. (FL)

Readability and Understandability of Online Vocal Cord Paralysis Materials.

PubMed

Balakrishnan, Vini; Chandy, Zachariah; Hseih, Amy; Bui, Thanh-Lan; Verma, Sunil P

2016-03-01

Patients use several online resources to learn about vocal cord paralysis (VCP). The objective of this study was to assess the readability and understandability of online VCP patient education materials (PEMs), with readability assessments and the Patient Education Materials Evaluation Tool (PEMAT), respectively. The relationship between readability and understandability was then analyzed. Descriptive and correlational design. Online PEMs were identified by performing a Google search with the term "vocal cord paralysis." After scientific webpages, news articles, and information for medical professionals were excluded, 29 articles from the first 50 search results were considered. Readability analysis was performed with 6 formulas. Four individuals with different educational backgrounds conducted understandability analysis with the PEMAT. Fleiss's Kappa interrater reliability analysis determined consistency among raters. Correlation between readability and understandability was determined with Pearson's correlation test. The reading level of the reviewed articles ranged from grades 9 to 17. Understandability ranged from 29% to 82%. Correlation analysis demonstrated a strong negative correlation between materials' readability and understandability (r = -0.462, P < .05). Online PEMs pertaining to VCP are written above the recommended reading levels. Overall, materials written at lower grade levels are more understandable. However, articles of identical grade levels had varying levels of understandability. The PEMAT may provide a more critical evaluation of the quality of a PEM when compared with readability formulas. Both readability and understandability should be used to evaluate PEMs. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

Readability assessment of internet-based patient education materials related to mammography for breast cancer screening.

PubMed

AlKhalili, Rend; Shukla, Pratik A; Patel, Ronak H; Sanghvi, Saurin; Hubbi, Basil

2015-03-01

The US Department of Health and Human Services (USDHHS) recommends that Internet-based patient education materials (IPEMs) be written below the sixth-grade reading level to target the average American adult. This study was designed to determine the readability of IPEMs regarding mammography for breast cancer screening. Three-hundred mammography-related Web sites were reviewed for IPEMs. Forty-two IPEMs that met the Health on the Net Foundation Code of Conduct were assessed for readability level with four readability indices that use existing algorithms based on word and sentence length to quantitatively analyze Internet sources for language intricacy including the following: Flesch-Kincaid Grade Level (FKGL), Flesch Reading Ease Score (FRES), Simple Measure of Gobbledygook (SMOG), and Gunning Frequency of Gobbledygook (Gunning FOG; GFOG). Results were compared to national recommendations, and intergroup analysis was performed. No IPEMs (0%) regarding mammography were written at or below the sixth-grade reading level, based on FKGL. The mean readability scores were as follows: FRES, 49.04 ± 10.62; FKGL, 10.71 ± 2.01; SMOG, 13.33 ± 1.67; and Gunning FOG, 14.32 ± 2.18. These scores indicate that the readability of mammography IPEMs is written at a "difficult" level, significantly above the recommended sixth-grade reading level (P < .05) determined by the USDHHS. IPEMs related to mammography are written well above the recommended sixth-grade level and likely reflect other IPEMs in diagnostic radiology. Copyright © 2015 AUR. Published by Elsevier Inc. All rights reserved.

A Framework for Readability Research.

ERIC Educational Resources Information Center

Harris, Albert J.; Jacobson, Milton D.

There is a need for basic readability research and for an easily applied and accurate new readability formula. Two steps taken toward the development of such a formula are the revision of a vocabulary list for primary grades and the combination of reading exercises given at different grade levels into a single scale of ascending difficulty. Much…

Assessing the Readability of Online Information About Hip Arthroscopy.

PubMed

Mehta, Manish P; Swindell, Hasani W; Westermann, Robert W; Rosneck, James T; Lynch, T Sean

2018-04-06

To investigate the current readability of online information pertaining to hip arthroscopy. The terms "hip arthroscopy" and "hip scope" were entered into the advanced search functions of Google, Yahoo!, and Bing on March 25, 2017, and results from the first 3 pages were analyzed. Results were required to be unique, accessible websites with information about hip arthroscopy conveyed primarily via analyzable text. Two reviewers applied inclusion criteria to the initial 97 results, discussing to reach consensus in cases of disagreement. Overall, 60 unique results were reviewed with 48 meeting inclusion criteria. Websites were categorized as physician-sponsored, academic, commercial, governmental and nonprofit organization (NPO), or unspecified. Readability was measured via 6 different indices: the Flesch-Kincaid grade level (FKGL), Flesch Reading Ease (FRE), Gunning Fog Score, SMOG Index, Coleman-Liau Index (CLI), and Automated Readability Index (ARI) along with an average grade level and readability classification score. Forty-eight unique websites were assessed for readability, with physician-sponsored webpages composing the majority (47.92%) followed by academic sources (35.42%). The webpages' average grade level, incorporating information from all 6 metrics, was 12.79 ± 1.98. The current readability of online information pertaining to hip arthroscopy is at an inappropriately high reading level compared with the sixth-grade level recommended by the American Medical Association and National Institutes of Health, thus introducing significant barriers to understanding for many patients. Online materials should be edited to reduce word and sentence length and complexity, use simpler terms, and minimize use of passive voice to facilitate patient knowledge acquisition and understanding of online information about hip arthroscopy. This study shows that the current readability of online information on hip arthroscopy exceeds the suggested sixth-grade reading level. It also emphasizes the need for simplifying written materials and offers specific suggestions on doing so to increase accessibility of information for patients. Copyright © 2018 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Readability Level of Spanish-Language Patient-Reported Outcome Measures in Audiology and Otolaryngology

PubMed Central

Coco, Laura; Colina, Sonia; Atcherson, Samuel R.

2017-01-01

Purpose The purpose of this study was to examine the readability level of the Spanish versions of several audiology- and otolaryngology-related patient-reported outcome measures (PROMs) and include a readability analysis of 2 translation approaches when available—the published version and a “functionalist” version—using a team-based collaborative approach including community members. Method Readability levels were calculated using the Fry Graph adapted for Spanish, as well as the Fernandez-Huerta and the Spaulding formulae for several commonly used audiology- and otolaryngology-related PROMs. Results Readability calculations agreed with previous studies analyzing audiology-related PROMs in English and demonstrated many Spanish-language PROMs were beyond the 5th grade reading level suggested for health-related materials written for the average population. In addition, the functionalist versions of the PROMs yielded lower grade-level (improved) readability levels than the published versions. Conclusion Our results suggest many of the Spanish-language PROMs evaluated here are beyond the recommended readability levels and may be influenced by the approach to translation. Moreover, improved readability may be possible using a functionalist approach to translation. Future analysis of the suitability of outcome measures and the quality of their translations should move beyond readability and include an evaluation of the individual's comprehension of the written text. PMID:28892821

Readability analysis of online resources related to lung cancer.

PubMed

Weiss, Kathleen D; Vargas, Christina R; Ho, Olivia A; Chuang, Danielle J; Weiss, Jonathan; Lee, Bernard T

2016-11-01

Patients seeking health information commonly use the Internet as the first source for material. Studies show that well-informed patients have increased involvement, satisfaction, and healthcare outcomes. As one-third of Americans have only basic or below basic health literacy, the National Institutes of Health and American Medical Association recommend patient-directed health resources be written at a sixth-grade reading level. This study evaluates the readability of commonly accessed online resources on lung cancer. A search for "lung cancer" was performed using Google and Bing, and the top 10 websites were identified. Location services were disabled, and sponsored sites were excluded. Relevant articles (n = 109) with patient-directed content available directly from the main sites were downloaded. Readability was assessed using 10 established methods and analyzed with articles grouped by parent website. The average reading grade level across all sites was 11.2, with a range from 8.8 (New Fog Count) to 12.2 (Simple Measure of Gobbledygook). The average Flesch Reading Ease score was 52, corresponding with fairly difficult to read text. The readability varied when compared by individual website, ranging in grade level from 9.2 to 15.2. Only 10 articles (9%) were written below a sixth-grade level and these tended to discuss simpler topics. Patient-directed online information about lung cancer exceeds the recommended sixth-grade reading level. Readability varies between individual websites, allowing physicians to direct patients according to level of health literacy. Modifications to existing materials can significantly improve readability while maintaining content for patients with low health literacy. Copyright © 2016 Elsevier Inc. All rights reserved.

Readability Assessment of Online Patient Education Material on Congestive Heart Failure

PubMed Central

2017-01-01

Background Online health information is being used more ubiquitously by the general population. However, this information typically favors only a small percentage of readers, which can result in suboptimal medical outcomes for patients. Objective The readability of online patient education materials regarding the topic of congestive heart failure was assessed through six readability assessment tools. Methods The search phrase “congestive heart failure” was employed into the search engine Google. Out of the first 100 websites, only 70 were included attending to compliance with selection and exclusion criteria. These were then assessed through six readability assessment tools. Results Only 5 out of 70 websites were within the limits of the recommended sixth-grade readability level. The mean readability scores were as follows: the Flesch-Kincaid Grade Level (9.79), Gunning-Fog Score (11.95), Coleman-Liau Index (15.17), Simple Measure of Gobbledygook (SMOG) index (11.39), and the Flesch Reading Ease (48.87). Conclusion Most of the analyzed websites were found to be above the sixth-grade readability level recommendations. Efforts need to be made to better tailor online patient education materials to the general population. PMID:28656111

An exploratory study of older adults' comprehension of printed cancer information: is readability a key factor?

PubMed

Friedman, Daniela B; Hoffman-Goetz, Laurie

2007-01-01

Printed cancer information often is written at or beyond high school reading levels, despite lower average literacy abilities of the public. The objectives of this exploratory study were twofold: (1) to evaluate older adults' comprehension of breast (BC), prostate (PC), and colorectal (CC) cancer information; and (2) to determine if comprehension of BC, PC, and CC information varies according to text readability. Comprehension of printed cancer resources was evaluated with 44 community-dwelling older adults using the Cloze procedure and recall questions. Participants' comprehension scores were compared with Simple Measure of Gobbledegook (SMOG) readability scores (

The Development and Validation of a Formula for Measuring Single-Sentence Test Item Readability.

ERIC Educational Resources Information Center

Homan, Susan; And Others

1994-01-01

A study was conducted with 782 elementary school students to determine whether the Homan-Hewitt Readability Formula could identify the readability of a single-sentence test item. Results indicate that a relationship exists between students' reading grade levels and responses to test items written at higher readability levels. (SLD)

Readability levels of health pamphlets distributed in hospitals and health centres in Athens, Greece.

PubMed

Kondilis, B K; Akrivos, P D; Sardi, T A; Soteriades, E S; Falagas, M E

2010-10-01

Health literacy is important in the medical and social sciences due to its impact on behavioural and health outcomes. Nevertheless, little is known about it in Greece, including patients' level of understanding health brochures and pamphlets distributed in Greek hospitals and clinics. Observational study in the greater metropolitan area of Athens, Greece. Pamphlets and brochures written in the Greek language were collected from 17 hospitals and healthcare centres between the spring and autumn of 2006. Readability of pamphlets using the Flesch-Kincaid, Simple Measure of Gobbledygook (SMOG) and Fog methods was calculated based on a Greek readability software. Out of 70 pamphlets collected from 17 hospitals, 37 pamphlets met the criteria for the study. The average readability level of all scanned pamphlets was ninth to 10th grade, corresponding to a readability level of 'average'. A highly significant difference (P<0.001) was found between private and public hospitals using the Flesch-Kincaid and SMOG readability scales. Pamphlets from private hospitals were one grade more difficult than those from public hospitals. Approximately 43.7% of the Greek population aged ≥20 years would not be able to comprehend the available pamphlets, which were found to have an average readability level of ninth to 10th grade. Further research examining readability levels in the context of health literacy in Greece is warranted. This effort paves the way for additional research in the field of readability levels of health pamphlets in the Greek language, the sources of health information, and the level of understanding of key health messages by the population. Copyright © 2010 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Readability of sports medicine-related patient education materials from the American Academy of Orthopaedic Surgeons and the American Orthopaedic Society for Sports Medicine.

PubMed

Ganta, Abhishek; Yi, Paul H; Hussein, Khalil; Frank, Rachel M

2014-04-01

Although studies have revealed high readability levels of orthopedic patient education materials, no study has evaluated sports medicine-related patient education materials. We conducted a study to assess the readability of sports medicine-related patient education materials from the American Academy of Orthopaedic Surgeons (AAOS) and the American Orthopaedic Society for Sports Medicine (AOSSM). All sports medicine patient education articles available online in 2012 from the AAOS and the AOSSM, including the Stop Sports Injuries Campaign (STOP), were identified, and their readability was assessed with the Flesch-Kinkaid (FK) readability test. Mean overall FK grade level of the 170 articles reviewed (104 from AAOS, 36 from AOSSM, 30 from STOP) was 10.2. Mean FK levels for the 3 sources were 9.5 (AAOS), 11.0 (AOSSM), and 11.5 (STOP) (P = .16). Fifteen (8.8%) of the 170 articles had a readability level at or below eighth grade (average reading level of US adults); only 2 (1.2%) of the 170 articles were at or below the recommended sixth-grade level. The majority of sports medicine-related patient education materials from AAOS and AOSSM had reading levels higher than recommended, indicating that the majority of the patient population may find it difficult to comprehend these articles.

Readability assessment of internet-based patient education materials related to facial fractures.

PubMed

Sanghvi, Saurin; Cherla, Deepa V; Shukla, Pratik A; Eloy, Jean Anderson

2012-09-01

Various professional societies, clinical practices, hospitals, and health care-related Web sites provide Internet-based patient education material (IPEMs) to the general public. However, this information may be written above the 6th-grade reading level recommended by the US Department of Health and Human Services. The purpose of this study is to assess the readability of facial fracture (FF)-related IPEMs and compare readability levels of IPEMs provided by four sources: professional societies, clinical practices, hospitals, and miscellaneous sources. Analysis of IPEMs on FFs available on Google.com. The readability of 41 FF-related IPEMs was assessed with four readability indices: Flesch-Kincaid Grade Level (FKGL), Flesch Reading Ease Score (FRES), Simple Measure of Gobbledygook (SMOG), and Gunning Frequency of Gobbledygook (Gunning FOG). Averages were evaluated against national recommendations and between each source using analysis of variance and t tests. Only 4.9% of IPEMs were written at or below the 6th-grade reading level, based on FKGL. The mean readability scores were: FRES 54.10, FKGL 9.89, SMOG 12.73, and Gunning FOG 12.98, translating into FF-related IPEMs being written at a "difficult" writing level, which is above the level of reading understanding of the average American adult. IPEMs related to FFs are written above the recommended 6th-grade reading level. Consequently, this information would be difficult to understand by the average US patient. Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.

How readable are Australian paediatric oral health education materials?

PubMed

Arora, Amit; Lam, Andy S F; Karami, Zahra; Do, Loc Giang; Harris, Mark Fort

2014-09-02

The objective of this study was to analyse the readability of paediatric oral health education leaflets available in Australia. Forty paediatric oral health education materials were analysed for general readability according to the following parameters: Thoroughness; Textual framework; Terminology; and Readability (Flesch-Kincaid grade level (FKGL), Gunning Fog index (Fog) and Simplified Measure of Gobbledygook (SMOG)). Leaflets produced by the industry were among the hardest to read with an average readability at the 8th grade (8.4 ± 0.1). The readability of leaflets produced by the commercial sector was at the 7th grade (7.1 ± 1.7) and the government at the 6th grade (6.3 ± 1.9). The FKGL consistently yielded readabilities 2 grades below the Fog and SMOG indexes. In the content analyses, 14 essential paediatric oral health topics were noted and Early Childhood Caries (ECC) was identified as the most commonly used jargon term. Paediatric oral health education materials are readily available, yet their quality and readability vary widely and may be difficult to read for disadvantaged populations in Australia. A redesign of these leaflets while taking literacy into consideration is suggested.

Evaluation of the Readability of Dermatological Postoperative Patient Information Leaflets Across England.

PubMed

Hunt, William T N; McGrath, Emily J

2016-06-01

Postoperative patient information leaflets (PILs) provide important guidance to patients after skin surgery. Readability is a method of evaluating information for text comprehension. The recommended level for PIL readability is US grade ≤6. To evaluate the readability of public English dermatological postoperative PILs. All dermatology departments in England were requested to provide their postoperative PILs. Patient information leaflets were evaluated using Readability Studio (Oleander Software, Vandalia, OH). Two preselected parameters were also noted: whether the PIL was doctor or nurse-written, and whether the PIL was Information Standard hallmarked. Eighty-five of one hundred thirty (65.4%) of PILs were evaluated. Only 29.4% of the PILs were grade level ≤6 with Flesch-Kincaid. The mean readability levels were 7.8 for Flesch-Kincaid, 67 for Flesch reading ease, 10.5 for Simple Measure of Gobbledygook (SMOG), 9.4 for Gunning-Fog, 8 for Fry, and 9.8 for FORCAST. No instruments demonstrated a significant difference between doctor (6) and nurse-written (7) PILs. Two instruments found that the 3 Information Standard hallmarked PILs had a higher (harder) readability than ordinary PILs (n = 82) (Gunning-Fog, p = .029*; SMOG p = .049*). Most English postoperative dermatological PILs' readability levels exceed recommendations (US grade ≤6). Departmental PILs should be reviewed to ensure that they are comprehensible to their patients.

Readability of patient information and consent documents in rheumatological studies.

PubMed

Hamnes, Bente; van Eijk-Hustings, Yvonne; Primdahl, Jette

2016-07-16

Before participation in medical research an informed consent must be obtained. This study investigates whether the readability of patient information and consent documents (PICDs) corresponds to the average educational level of participants in rheumatological studies in the Netherlands, Denmark, and Norway. 24 PICDs from studies were collected and readability was assessed independently using the Gunning's Fog Index (FOG) and Simple Measure of Gobbledygook (SMOG) grading. The mean score for the FOG and SMOG grades were 14.2 (9.0-19.0) and 14.2 (12-17) respectively. The mean FOG and SMOG grades were 12.7 and 13.3 in the Dutch studies, 15.0 and 14.9 in the Danish studies, and 14.6 and 14.3 in the Norwegian studies, respectively. Out of the 2865 participants, more than 57 % had a lower educational level than the highest readability score calculated in the individual study. As the readability level of the PICDs did not match the participants' educational level, consent may not have been valid, as the participants may have had a limited understanding of what they agreed to participate in. There should be more focus on the readability of PICDs. National guidelines for how to write clear and unambiguous PICDs in simple and easily understandable language could increase the focus on the readability of PICD.

Readability of patient education materials in ophthalmology: a single-institution study and systematic review.

PubMed

Williams, Andrew M; Muir, Kelly W; Rosdahl, Jullia A

2016-08-03

Patient education materials should be written at a level that is understandable for patients with low health literacy. The aims of this study are (1) to review the literature on readability of ophthalmic patient education materials and (2) to evaluate and revise our institution's patient education materials about glaucoma using evidence-based guidelines on writing for patients with low health literacy. A systematic search was conducted on the PubMed/MEDLINE database for studies that have evaluated readability level of ophthalmic patient education materials, and the reported readability scores were assessed. Additionally, we collected evidence-based guidelines for writing easy-to-read patient education materials, and these recommendations were applied to revise 12 patient education handouts on various glaucoma topics at our institution. Readability measures, including Flesch-Kincaid Grade Level (FKGL), and word count were calculated for the original and revised documents. The original and revised versions of the handouts were then scored in random order by two glaucoma specialists using the Suitability Assessment of Materials (SAM) instrument, a grading scale used to evaluate suitability of health information materials for patients. Paired t test was used to analyze changes in readability measures, word count, and SAM score between original and revised handouts. Finally, five glaucoma patients were interviewed to discuss the revised materials, and patient feedback was analyzed qualitatively. Our literature search included 13 studies that evaluated a total of 950 educational materials. Among the mean FKGL readability scores reported in these studies, the median was 11 (representing an eleventh-grade reading level). At our institution, handouts' readability averaged a tenth-grade reading level (FKGL = 10.0 ± 1.6), but revising the handouts improved their readability to a sixth-grade reading level (FKGL = 6.4 ± 1.2) (p < 0.001). Additionally, the mean SAM score of our institution's handouts improved from 60 ± 7 % (adequate) for the original versions to 88 ± 4 % (superior) for the revised handouts (p < 0.001). Our systematic review of the literature reveals that ophthalmic patient education materials are consistently written at a level that is too high for many patients to understand. Our institution's experience suggests that applying guidelines on writing easy-to-understand material can improve the readability and suitability of educational materials for patients with low health literacy.

A Comparison of the Readability of Selected Instructions, Publications and Forms Commonly Used by Adults and the Minimum Literacy Level as Defined by the United States Office of Education.

ERIC Educational Resources Information Center

Beris, Carole

The Fry Readability Graph was used to assess the approximate readability level of each of 23 selected instructions, publications, and forms commonly used by adults in order to compare their readability levels with the minimum literacy level as defined by the United States Office of Education (approximately the eighth grade level). The results…

The Readability Levels of the 1981 Scott, Foresman and Co. Basal Texts and Their Comparison with the 1978 Edition.

ERIC Educational Resources Information Center

Ackerman, Bonnie

Fry's Readability Graph was used to determine the readability levels of the 1981 Scott, Foresman and Co. basal textbook series for grades one through six. The readability levels were then compared to those established for the 1978 edition. In the 1981 edition, all stories were handscored. Poems, skill lessons, and plays were not examined in order…

Readability analysis of patient information on the American Academy of Otolaryngology-Head and Neck Surgery website.

PubMed

Greywoode, Jewel; Bluman, Eric; Spiegel, Joseph; Boon, Maurits

2009-11-01

To evaluate the readability of patient-oriented online health information (OHI) presented on the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) website. Review of the Flesch-Kincaid (FK) grade level for 104 articles on the AAO-HNS website. The FK grade level for 104 articles was determined using the readability calculator available within Microsoft Office Word 2003. The interobserver reliability for the FK grade level was determined by calculating the intraclass correlation coefficient (ICC) for 52 entries. The average FK grade reading level of the articles was 10.8 (range 6.3-16.7; 95% CI, 10.4-11.2). Eighty-one percent of the articles were written at a ninth grade level or higher. The intraclass correlation was good (r = 0.83) for the 52 articles that were independently reviewed. This analysis has shown that the average reading level for each article on the AAO-HNS site was higher than the recommended sixth grade reading level. Although the AAO-HNS site is written at a higher level than that suggested for the general public, it is important to realize that readability is just one consideration in the evaluation of OHI comprehension. Physicians need to be cognizant of their patients' ability to read and comprehend written information and tailor their educational material appropriately.

Evaluation of online consumer medication information.

PubMed

Kim, Karissa Y; Metzger, Anne; Wigle, Patricia R; Choe, Pearl J

2011-06-01

Millions of Americans search the Internet for health-related information; however, the readability and comprehensiveness of consumer medication information (CMI) on the Internet has not been widely studied. The purpose of this study was to evaluate the readability and comprehensiveness of online CMI. The readability and comprehensiveness of consumer drug information found on 3 well-known Web sites (Medline Plus, Yahoo Health, and WebMD) was evaluated; in particular, information related to 10 commonly prescribed medications. Readability was assessed using the Simple Measure of Gobbledygook (SMOG) and Fry Readability Graph (FRG) tools; comprehensiveness of information was evaluated using the Keystone action plan criteria. Using SMOG, the mean reading level of each Web site was 13th grade level or higher. Using the FRG, the mean reading level was 10th grade or higher. Out of the 24 points in the Keystone action plan criteria, information found on each of the Web sites was deemed accurate with mean score of 21, 21, and 19 for Medline Plus, Yahoo Health, and WebMD, respectively. For the medications reviewed, CMI found on Web sites was accurate when assessed using the Keystone action plan criteria. The readability levels were higher than the recommended sixth grade level. Copyright © 2011 Elsevier Inc. All rights reserved.

Are Online Zenker's Diverticulum Materials Readable and Understandable?

PubMed

Balakrishnan, Vini; Chandy, Zachariah; Verma, Sunil P

2016-11-01

Patients use a multitude of resources to learn about Zenker's diverticulum (ZD). The objectives of this study were to assess the readability and understandability of online materials on ZD, evaluate them against the existing criteria, and investigate the relationship between readability and understandability. The first 50 webpages from an online search for ZD were analyzed. Twenty-one webpages had materials intended for patients and were included in the study. The patient education materials (PEMs) were analyzed using 6 readability tools. Four individuals used the Patient Education Materials Evaluation Tool (PEMAT) to assess the understandability. Fleiss κ interrater reliability analysis determined consistency among the raters. Finally, Pearson correlation coefficient analyzed the relationship between readability and understandability. The reading grade level of the materials reviewed ranged from 10th to 16th grade while the understandability ranged from 31% to 74%. Correlation analysis demonstrated a strong negative correlation between readability and understandability (r = -0.62, P < .05). Fleiss' κ interrater reliability for the raters demonstrated substantial agreement between the 4 raters (κ = 0.64). Online PEMs pertaining to ZD are written well above the recommended reading level. Materials written at a lower reading level are more understandable. A wide range of understandability exists among materials with identical reading grade levels. Health care providers need to create new PEMs for ZD that are available online that are both readable and understandable. The PEMAT and readability formulas can provide a framework for authors to create these materials. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

Readability of Patient Education Materials in Hand Surgery and Health Literacy Best Practices for Improvement.

PubMed

Hadden, Kristie; Prince, Latrina Y; Schnaekel, Asa; Couch, Cory G; Stephenson, John M; Wyrick, Theresa O

2016-08-01

This study aimed to update a portion of a 2008 study of patient education materials from the American Society for Surgery of the Hand Web site with new readability results, to compare the results to health literacy best practices, and to make recommendations to the field for improvement. A sample of 77 patient education documents were downloaded from the American Society for Surgery of the Hand Web site, handcare.org, and assessed for readability using 4 readability tools. Mean readability grade-level scores were derived. Best practices for plain language for written health materials were compiled from 3 government agency sources. The mean readability of the 77 patient education documents in the study was 9.3 grade level. This reading level is reduced from the previous study in 2008 in which the overall mean was 10.6; however, the current sample grade level still exceeds recommended readability according to best practices. Despite a small body of literature on the readability of patient education materials related to hand surgery and other orthopedic issues over the last 7 years, readability was not dramatically improved in our current sample. Using health literacy as a framework, improvements in hand surgery patient education may result in better understanding and better outcomes for patients seeing hand surgeons. Improved understanding of patient education materials related to hand surgery may improve preventable negative outcomes that are clinically significant as well as contribute to improved quality of life for patients. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

The Quality and Readability of Information Available on the Internet Regarding Lumbar Fusion

PubMed Central

Zhang, Dafang; Schumacher, Charles; Harris, Mitchel B.; Bono, Christopher M.

2015-01-01

Study Design An Internet-based evaluation of Web sites regarding lumbar fusion. Objective The Internet has become a major resource for patients; however, the quality and readability of Internet information regarding lumbar fusion is unclear. The objective of this study is to evaluate the quality and readability of Internet information regarding lumbar fusion and to determine whether these measures changed with Web site modality, complexity of the search term, or Health on the Net Code of Conduct certification. Methods Using five search engines and three different search terms of varying complexity (“low back fusion,” “lumbar fusion,” and “lumbar arthrodesis”), we identified and reviewed 153 unique Web site hits for information quality and readability. Web sites were specifically analyzed by search term and Web site modality. Information quality was evaluated on a 5-point scale. Information readability was assessed using the Flesch-Kincaid score for reading grade level. Results The average quality score was low. The average reading grade level was nearly six grade levels above that recommended by National Work Group on Literacy and Health. The quality and readability of Internet information was significantly dependent on Web site modality. The use of more complex search terms yielded information of higher reading grade level but not higher quality. Conclusions Higher-quality information about lumbar fusion conveyed using language that is more readable by the general public is needed on the Internet. It is important for health care providers to be aware of the information accessible to patients, as it likely influences their decision making regarding care. PMID:26933614

The Quality and Readability of Information Available on the Internet Regarding Lumbar Fusion.

PubMed

Zhang, Dafang; Schumacher, Charles; Harris, Mitchel B; Bono, Christopher M

2016-03-01

Study Design An Internet-based evaluation of Web sites regarding lumbar fusion. Objective The Internet has become a major resource for patients; however, the quality and readability of Internet information regarding lumbar fusion is unclear. The objective of this study is to evaluate the quality and readability of Internet information regarding lumbar fusion and to determine whether these measures changed with Web site modality, complexity of the search term, or Health on the Net Code of Conduct certification. Methods Using five search engines and three different search terms of varying complexity ("low back fusion," "lumbar fusion," and "lumbar arthrodesis"), we identified and reviewed 153 unique Web site hits for information quality and readability. Web sites were specifically analyzed by search term and Web site modality. Information quality was evaluated on a 5-point scale. Information readability was assessed using the Flesch-Kincaid score for reading grade level. Results The average quality score was low. The average reading grade level was nearly six grade levels above that recommended by National Work Group on Literacy and Health. The quality and readability of Internet information was significantly dependent on Web site modality. The use of more complex search terms yielded information of higher reading grade level but not higher quality. Conclusions Higher-quality information about lumbar fusion conveyed using language that is more readable by the general public is needed on the Internet. It is important for health care providers to be aware of the information accessible to patients, as it likely influences their decision making regarding care.

Nuclear Medicine and Resources for Patients: How Complex are Online Patient Educational Materials?

PubMed

Hansberry, David R; Shah, Kush; Agarwal, Nitin; Kim, Sung M; Intenzo, Charles M

2018-02-02

The Internet is a major source of healthcare information for patients. The American Medical Association and National Institutes of Health recommend that consumer healthcare websites be written between a 3rd and 7th grade level. The purpose of this study is to evaluate the level of readability of patient education websites pertaining to nuclear medicine. Methods: Ten search terms were Googled and the top 10 links for each term were collected and analyzed for their level of readability using 10 well-established readability scales. Results: Collectively the 99 articles were written at an 11.8 grade level (standard deviation of 3.4). Only 5 of the 99 articles were written at the NIH and AMA recommended 3rd to 7th grade. Conclusion: There is a clear discordance between the readability level of nuclear medicine related imaging terms with the NIH and AMA guidelines. This disconnect may negatively impact patient understanding contributing to poor health outcomes. Copyright © 2018 by the Society of Nuclear Medicine and Molecular Imaging, Inc.

Assessing the content, presentation, and readability of dental informed consents.

PubMed

Glick, Aaron; Taylor, David; Valenza, John A; Walji, Muhammad F

2010-08-01

Informed consents are important aids in helping patients make optimal decisions. Little knowledge exists about the quality of dental informed consents. Fifty-two informed consents used throughout the University of Texas Health Science Center at Houston Dental Branch were evaluated based on the quality of their content, readability, and presentation. Content quality was judged on four basic elements: description of procedure, risk, benefits, and alternatives. Of the clinical consents, 26 percent of forms contained all four of the basic content elements, 48 percent contained three of four elements, 16 percent contained two of four elements, and 10 percent contained one of four elements. Presentation quality was judged on twelve criteria items. The average clinical consent included seven out of twelve presentation items, and the average nonclinical consent included eight out of twelve items. Readability was judged using three standard instruments for rating readability: Flesch Reading Ease, Flesch-Kincaid Grade-Level, and Simple Measure of Gobbledygook (SMOG) grading. Average Flesch-Kincaid Grade-Level was 12.7 (range, 7.4 to 19.1), significantly higher than the recommended ninth grade level (p<.001). The results suggest that many existing dental informed consents may be improved by 1) increasing the comprehensiveness of the content, 2) improving the design and layout, and 3) reducing the readability levels for patient comprehension.

Readability of Questionnaires Assessing Listening Difficulties Associated with (Central) Auditory Processing Disorders

ERIC Educational Resources Information Center

Atcherson, Samuel R.; Richburg, Cynthia M.; Zraick, Richard I.; George, Cassandra M.

2013-01-01

Purpose: Eight English-language, student- or parent proxy-administered questionnaires for (central) auditory processing disorders, or (C)APD, were analyzed for readability. For student questionnaires, readability levels were checked against the approximate reading grade levels by intended administration age per the questionnaires' developers. For…

Mobile applications and patient education: Are currently available GERD mobile apps sufficient?

PubMed

Bobian, Michael; Kandinov, Aron; El-Kashlan, Nour; Svider, Peter F; Folbe, Adam J; Mayerhoff, Ross; Eloy, Jean Anderson; Raza, S Naweed

2017-08-01

Despite the increasing role of mobile applications (apps) in patient education, there has been little inquiry evaluating the quality of these resources. Because poor health literacy has been associated with inferior health outcomes, evaluating the quality of patient education materials takes on great importance. Our objective was to employ validated readability tools for the evaluation of gastroesophageal reflux (GERD) mobile apps. GERD-specific apps found in the Apple App Store (Apple Inc., Cupertino CA) were evaluated using the Readability Studio Professional Version 2015 for Windows (Oleander Software, Ltd, Vandalia, OH). All text was evaluated using nine validated algorithms measuring readability including Flesch-Kincaid Grade Level, Simple Measure of Gobbledygook grading, Gunning Fog index, Coleman-Liau, New Fog Count formula, Raygor Readability Estimate, FORCAST, Fry graph, and Flesch Reading Ease score. Average reading grade levels for individual GERD apps ranged from 9.6 to 12.9 (interquartile range 10.3-12). The average reading grade level for all apps analyzed was 11.1 ± 0.2 standard error of the mean (SEM), with an average Flesch Reading Ease score for all mobile apps analyzed of 51 ± 2.05 (SEM), falling into the "fairly difficult" category given by this measure. Raygor Readability estimates that most mobile apps have a reading grade level between 10 and 12, with the majority of this outcome due to long words. This analysis demonstrates the feasibility of assessing readability of mobile health apps. Our findings suggest significant gaps in potential comprehension between the apps analyzed and the average reader, diminishing the utility of these resources. We hope our findings influence future mobile health-related app development and thereby improve patient outcomes in GERD and other chronic diseases. NA. Laryngoscope, 127:1775-1779, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Readability analysis of online health information about overactive bladder.

PubMed

Koo, Kevin; Shee, Kevin; Yap, Ronald L

2017-09-01

Despite the prevalence of overactive bladder (OAB) and the widespread accessibility of patient education information on the Internet, the readability of this information and its potential impact on patient decision-making are not known. This study evaluates the readability of OAB material online in the context of website ownership and the Health on the Net standard for information reliability. Three Internet search platforms were queried daily with OAB-related keywords for 30 days. Readability analysis was performed using the SMOG test, Dale-Chall readability formula, and Fry readability graph. Websites were stratified by ownership type and Health on the Net certification to compare readability metrics. After 270 total searches, 57 websites were analyzed. Mean SMOG reading grade was 10.7 (SD = 1.6) and 10.1 in an adjusted calculation to reduce overestimation from medical jargon. Mean Dale-Chall score was 9.2 (SD = 0.9), or grade 13-15. Mean Fry graph coordinates (177 syllables, 5.9 sentences) corresponded to grade 15. Only seven sites (12%) were predicted to be readable by the average adult with an eighth-grade reading level. Mean reading grades were not significantly different between academic versus commercial sites and Health on the Net-certified versus non-certified sites. A large majority of online information about OAB treatment exceeds the reading ability of most adults. Neither websites sponsored by academic institutions nor those certified by the Health on the Net standard have easier readability. The readability of health information online may be distinct from reliability in the context of urological literacy. © 2017 Wiley Periodicals, Inc.

Readability assessment of package inserts of biological medicinal products from the European medicines agency website.

PubMed

Piñero-López, Ma Ángeles; Modamio, Pilar; Lastra, Cecilia F; Mariño, Eduardo L

2014-07-01

Package inserts that accompany medicines are a common source of information aimed at patients and should match patient abilities in terms of readability. Our objective was to determine the degree of readability of the package inserts for biological medicinal products commercially available in 2007 and compare them with the readability of the same package inserts in 2010. A total of 33 package inserts were selected and classified into five groups according to the type of medicine: monoclonal antibody-based products, cytokines, therapeutic enzymes, recombinant blood factors and other blood-related products, and recombinant hormones. The package inserts were downloaded from the European Medicines Agency website in 2007 and 2010. Readability was evaluated for the entire text of five of the six sections of the package inserts and for the 'Annex' when there was one. Three readability formulas were used: SMOG (Simple Measure of Gobbledygook) grade, Flesh-Kincaid grade level, and Szigriszt's perspicuity index. No significant differences were found between the readability results for the 2007 package inserts and those from 2010 according to any of the three readability indices studied (p>0.05). However, there were significant differences (p<0.05) between the readability scores of the sections of the package inserts in both 2007 and 2010. The readability of the package inserts was above the recommended sixth grade reading level (ages 11-12) and may lead to difficulties of understanding for people with limited literacy. All the sections should be easy to read and, therefore, the readability of the medicine package inserts studied should be improved.

Readability and suitability assessment of patient education materials in rheumatic diseases.

PubMed

Rhee, Rennie L; Von Feldt, Joan M; Schumacher, H Ralph; Merkel, Peter A

2013-10-01

Web-based patient education materials and printed pamphlets are frequently used by providers to inform patients about their rheumatic disease. Little attention has been given to the readability and appropriateness of patient materials. The objective of this study was to examine the readability and suitability of commonly used patient education materials for osteoarthritis (OA), rheumatoid arthritis, systemic lupus erythematosus, and vasculitis. Five or 6 popular patient resources for each disease were chosen for evaluation. Readability was measured using the Flesch-Kincaid reading grade level and suitability was determined by the Suitability Assessment of Materials (SAM), a score that considers characteristics such as content, graphics, layout/topography, and cultural appropriateness. Three different reviewers rated the SAM score and means were used in the analysis. Twenty-three resources written on the 4 diseases were evaluated. The education material for all 4 diseases studied had readability above the eighth-grade level and readability did not differ among the diseases. Only 5 of the 23 resources received superior suitability scores, and 3 of these 5 resources were written for OA. All 4 diseases received adequate suitability scores, with OA having the highest mean suitability score. Most patient education materials for rheumatic diseases are written at readability levels above the recommended sixth-grade reading level and have only adequate suitability. Developing more appropriate educational resources for patients with rheumatic diseases may improve patient comprehension. Copyright © 2013 by the American College of Rheumatology.

An analysis of the readability characteristics of oral health information literature available to the public in Tasmania, Australia.

PubMed

Barnett, Tony; Hoang, Ha; Furlan, Ashlea

2016-03-17

The effectiveness of print-based health promotion materials is dependent on their readability. This study aimed to assess the characteristics of print-based oral health information literature publically available in Tasmania, Australia. Oral health education brochures were collected from 11 dental clinics across Tasmania and assessed for structure and format, content and readability. Reading level was calculated using three widely-used measures: Flesch-Kincaid Grade Level (FKGL), Flesch Reading Ease, and Simple Measure of Gobbledygook (SMOG) reading grade level. The FKGL of the 67 brochures sampled ranged from grade 3 to 13. The grade level for government health department brochures (n = 14) ranged from grade 4 to 11 (5.6 ± 1.8). Reading levels for materials produced by commercial sources (n = 22) ranged from 3 to 13 (8.3 ± 2.1), those from professional associations (n = 22) ranged from grade 7 to 11 (8.9 ± 0.9) and brochures produced by other sources (n = 9) ranged from 5 to 10 (7.6 ± 1.5). The SMOG test was positively correlated with the FKGL (rs = 0.92, p < 0.001) though consistently rated materials 2-3 grades higher. The reading level required to comprehend brochures published by government sources were, on average, lower than those from commercial, professional and other sources. Government materials were also more likely to contain fewer words and professional jargon terms than brochures from the other sources. A range of oral health information brochures were publically available for patients in both public and private dental clinics. However, their readability characteristics differed. Many brochures required a reading skill level higher than that suited to a large proportion of the Tasmanian population. Readability and other characteristics of oral health education materials should be assessed to ensure their suitability for use with patients, especially those suspected of having low literacy skills.

Readability of Online Patient Education Materials Related to IR.

PubMed

McEnteggart, Gregory E; Naeem, Muhammad; Skierkowski, Dorothy; Baird, Grayson L; Ahn, Sun H; Soares, Gregory

2015-08-01

To assess the readability of online patient education materials (OPEM) related to common diseases treated by and procedures performed by interventional radiology (IR). The following websites were chosen based on their average Google search return for each IR OPEM content area examined in this study: Society of Interventional Radiology (SIR), Cardiovascular and Interventional Radiological Society of Europe (CIRSE), National Library of Medicine, RadiologyInfo, Mayo Clinic, WebMD, and Wikipedia. IR OPEM content area was assessed for the following: peripheral arterial disease, central venous catheter, varicocele, uterine artery embolization, vertebroplasty, transjugular intrahepatic portosystemic shunt, and deep vein thrombosis. The following algorithms were used to estimate and compare readability levels: Flesch-Kincaid Grade Formula, Flesch Reading Ease Score, Gunning Frequency of Gobbledygook, Simple Measure of Gobbledygook, and Coleman-Liau Index. Data were analyzed using general mixed modeling. On average, online sources that required beyond high school grade-level readability were Wikipedia (15.0), SIR (14.2), and RadiologyInfo (12.4); sources that required high school grade-level readability were CIRSE (11.3), Mayo Clinic (11.0), WebMD (10.6), and National Library of Medicine (9.0). On average, OPEM on uterine artery embolization, vertebroplasty, varicocele, and peripheral arterial disease required the highest level of readability (12.5, 12.3, 12.3, and 12.2, respectively). The IR OPEM assessed in this study were written above the recommended sixth-grade reading level and the health literacy level of the average American adult. Many patients in the general public may not have the ability to read and understand health information in IR OPEM. Copyright © 2015 SIR. Published by Elsevier Inc. All rights reserved.

The Relationship between Readability Level of Mississippi's Middle Schools' Websites and Seventh Grade Language Arts MCT2 Scores

ERIC Educational Resources Information Center

Pickard, Anna Marlene Graves

2011-01-01

Today's educators face the unprecedented challenge of increasing achievement for all students. One response has been to increase and improve parent involvement and school-to-home communication through the use of school websites. The quantitative section of this study analyzed the readability grade level of the website as it relates to state test…

Readability assessment of online urology patient education materials.

PubMed

Colaco, Marc; Svider, Peter F; Agarwal, Nitin; Eloy, Jean Anderson; Jackson, Imani M

2013-03-01

The National Institutes of Health, American Medical Association, and United States Department of Health and Human Services recommend that patient education materials be written at a fourth to sixth grade reading level to facilitate comprehension. We examined and compared the readability and difficulty of online patient education materials from the American Urological Association and academic urology departments in the Northeastern United States. We assessed the online patient education materials for difficulty level with 10 commonly used readability assessment tools, including the Flesch Reading Ease Score, Flesch-Kincaid Grade Level, Simple Measure of Gobbledygook, Gunning Frequency of Gobbledygook, New Dale-Chall Test, Coleman-Liau index, New Fog Count, Raygor Readability Estimate, FORCAST test and Fry score. Most patient education materials on the websites of these programs were written at or above the eleventh grade reading level. Urological online patient education materials are written above the recommended reading level. They may need to be simplified to facilitate better patient understanding of urological topics. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Readability assessment of online patient education materials from academic otolaryngology-head and neck surgery departments.

PubMed

Svider, Peter F; Agarwal, Nitin; Choudhry, Osamah J; Hajart, Aaron F; Baredes, Soly; Liu, James K; Eloy, Jean Anderson

2013-01-01

The aim of this study was to compare the readability of online patient education materials among academic otolaryngology departments in the mid-Atlantic region, with the purpose of determining whether these commonly used online resources were written at a level readily understood by the average American. A readability analysis of online patient education materials was performed using several commonly used readability assessments including the Flesch Reading Ease Score, the Flesch-Kincaid Grade Level, Simple Measure of Gobbledygook, Gunning Frequency of Gobbledygook, the New Dale-Chall Test, the Coleman-Liau Index, the New Fog Count, the Raygor Readability Estimate, the FORCAST test, and the Fry Graph. Most patient education materials from these programs were written at or above an 11th grade reading level, considerably above National Institutes of Health guidelines for recommended difficulty. Patient educational materials from academic otolaryngology Web sites are written at too difficult a reading level for a significant portion of patients and can be simplified. Copyright © 2013 Elsevier Inc. All rights reserved.

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

PubMed

Wang, Dean; Jayakar, Rohit G; Leong, Natalie L; Leathers, Michael P; Williams, Riley J; Jones, Kristofer J

2017-04-01

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.

Analysis of the readability of patient education materials from surgical subspecialties.

PubMed

Hansberry, David R; Agarwal, Nitin; Shah, Ravi; Schmitt, Paul J; Baredes, Soly; Setzen, Michael; Carmel, Peter W; Prestigiacomo, Charles J; Liu, James K; Eloy, Jean Anderson

2014-02-01

Patients are increasingly using the Internet as a source of information on medical conditions. Because the average American adult reads at a 7th- to 8th-grade level, the National Institutes of Health recommend that patient education material be written between a 4th- and 6th-grade level. In this study, we assess and compare the readability of patient education materials on major surgical subspecialty Web sites relative to otolaryngology. Descriptive and correlational design. Patient education materials from 14 major surgical subspecialty Web sites (American Society of Colon and Rectal Surgeons, American Association of Endocrine Surgeons, American Society of General Surgeons, American Society for Metabolic and Bariatric Surgery, American Association of Neurological Surgeons, American Congress of Obstetricians and Gynecologists, American Academy of Ophthalmology, American Academy of Orthopedic Surgeons, American Academy of Otolaryngology-Head and Neck Surgery, American Pediatric Surgical Association, American Society of Plastic Surgeons, Society for Thoracic Surgeons, and American Urological Association) were downloaded and assessed for their level of readability using 10 widely accepted readability scales. The readability level of patient education material from all surgical subspecialties was uniformly too high. Average readability levels across all subspecialties ranged from the 10th- to 15th-grade level. Otolaryngology and other surgical subspecialties Web sites have patient education material written at an education level that the average American may not be able to understand. To reach a broader population of patients, it might be necessary to rewrite patient education material at a more appropriate level. N/A. © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

Sense and readability: participant information sheets for research studies.

PubMed

Ennis, Liam; Wykes, Til

2016-02-01

Informed consent in research is partly achieved through the use of information sheets. There is a perception however that these information sheets are long and complex. The recommended reading level for patient information is grade 6, or 11-12 years old. To investigate whether the readability of participant information sheets has changed over time, whether particular study characteristics are related to poorer readability and whether readability and other study characteristics are related to successful study recruitment. Method: We obtained 522 information sheets from the UK National Institute for Health Research Clinical Research Network: Mental Health portfolio database and study principal investigators. Readability was assessed with the Flesch reading index and the Grade level test. Information sheets increased in length over the study period. The mean grade level across all information sheets was 9.8, or 15-16 years old. A high level of patient involvement was associated with more recruitment success and studies involving pharmaceutical or device interventions were the least successful. The complexity of information sheets had little bearing on successful recruitment. Information sheets are far more complex than the recommended reading level of grade 6 for patient information. The disparity may be exacerbated by an increasing focus on legal content. Researchers would benefit from clear guidance from ethics committees on writing succinctly and accessibly and how to balance the competing legal issues with the ability of participants to understand what a study entails. © The Royal College of Psychiatrists 2016.

Sense and readability: participant information sheets for research studies

PubMed Central

Ennis, Liam; Wykes, Til

2016-01-01

Background Informed consent in research is partly achieved through the use of information sheets. There is a perception however that these information sheets are long and complex. The recommended reading level for patient information is grade 6, or 11–12 years old. Aims To investigate whether the readability of participant information sheets has changed over time, whether particular study characteristics are related to poorer readability and whether readability and other study characteristics are related to successful study recruitment. Method We obtained 522 information sheets from the UK National Institute for Health Research Clinical Research Network: Mental Health portfolio database and study principal investigators. Readability was assessed with the Flesch reading index and the Grade level test. Results Information sheets increased in length over the study period. The mean grade level across all information sheets was 9.8, or 15–16 years old. A high level of patient involvement was associated with more recruitment success and studies involving pharmaceutical or device interventions were the least successful. The complexity of information sheets had little bearing on successful recruitment. Conclusions Information sheets are far more complex than the recommended reading level of grade 6 for patient information. The disparity may be exacerbated by an increasing focus on legal content. Researchers would benefit from clear guidance from ethics committees on writing succinctly and accessibly and how to balance the competing legal issues with the ability of participants to understand what a study entails. PMID:26382948

Readability of American online patient education materials in urologic oncology: a need for simple communication.

PubMed

Pruthi, Amanda; Nielsen, Matthew E; Raynor, Mathew C; Woods, Michael E; Wallen, Eric M; Smith, Angela B

2015-02-01

To determine the readability levels of reputable cancer and urologic Web sites addressing bladder, prostate, kidney, and testicular cancers. Online patient education materials (PEMs) for bladder, prostate, kidney, and testicular malignancies were evaluated from the American Cancer Society, American Society of Clinical Oncology, National Cancer Institute, Urology Care Foundation, Bladder Cancer Advocacy Network, Prostate Cancer Foundation, Kidney Cancer Association, and Testicular Cancer Resource Center. Grade level was determined using several readability indices, and analyses were performed on the basis of cancer type, Web site, and content area (general, causes, risk factors and prevention, diagnosis and staging, treatment, and post-treatment). Estimated grade level of online PEMs ranged from 9.2 to 14.2 with an overall mean of 11.7. Web sites for kidney cancer had the least difficult readability (11.3) and prostate cancer had the most difficult readability (12.1). Among specific Web sites, the most difficult readability levels were noted for the Urology Care Foundation Web site for bladder and prostate cancer and the Kidney Cancer Association and Testicular Cancer Resource Center for kidney and testes cancer. Readability levels within content areas varied on the basis of the disease and Web site. Online PEMs in urologic oncology are written at a level above the average American reader. Simplification of these resources is necessary to improve patient understanding of urologic malignancy. Copyright © 2015 Elsevier Inc. All rights reserved.

Assessing the reading level of online sarcoma patient education materials.

PubMed

Patel, Shaan S; Sheppard, Evan D; Siegel, Herrick J; Ponce, Brent A

2015-01-01

Cancer patients rely on patient education materials (PEMs) to gather information regarding their disease. Patients who are better informed about their illness have better health outcomes. The National Institutes of Health (NIH) recommends that PEMs be written at a sixth- to seventh-grade reading level. The purpose of this study was to evaluate the readability of online PEMs of bone and soft-tissue sarcomas and related conditions. We identified relevant online PEMs from the following websites: American Academy of Orthopaedic Surgeons, academic training centers, sarcoma specialists, Google search hits, Bonetumor.org, Sarcoma Alliance, Sarcoma Foundation of America, and Medscape. We used 10 different readability instruments to evaluate the reading level of each website's PEMs. In assessing 72 websites and 774 articles, we found that none of the websites had a mean readability score at or below 7 (seventh grade). Collectively, all websites had a mean readability score of 11.4, and the range of scores was grade level 8.9 to 15.5. None of the PEMs in this study of bone and soft-tissue sarcomas and related conditions met the NIH recommendation for PEM reading levels. Concerted efforts to improve the reading level of orthopedic oncologic PEMs are necessary.

Evaluation of the Informational Content, Readability and Comprehensibility of Online Health Information on Monogenic Diabetes.

PubMed

Guan, Yue; Maloney, Kristin A; Roter, Debra L; Pollin, Toni I

2018-06-01

The purpose of this study was to assess the informational content, readability, suitability and comprehensibility of websites offering educational information about monogenic diabetes available to patients. The top 20 results from 15 queries in four search engines were screened. Content analysis was performed by two independent coders. Readability was determined using Flesch-Kincaid grade level (FKGL) and Simplified Measure of Goobledygook (SMOG). The Comprehensibility Assessment of Materials (SAM + CAM) scale was utilized to evaluate website suitability and comprehensibility. Only 2% (N = 29) of 1200 screened websites met inclusion criteria. Content analysis showed that 16 websites presented information on at least the most common forms of MODY (1, 2 and 3), four addressed the utility of genetic counseling, and none included support resources for patients. All websites exceeded the consensus readability level (6th grade) as assessed by FKGL (10.1 grade) and SMOG (12.8 ± 1.5 grades). Although the majority (N = 20) of websites had an overall "adequate" to "superior" quality score (SAM + CAM score > = 40%), more than one-third scored "not suitable" in categories of content, literacy demand, graphics, and learning motivation. The online educational resources for monogenic diabetes have a high readability level and require improvement in ease of use and comprehensibility for patients with diabetes.

Online Patient Resources for Liposuction: A Comparative Analysis of Readability.

PubMed

Vargas, Christina R; Ricci, Joseph A; Chuang, Danielle J; Lee, Bernard T

2016-03-01

As patients strive to become informed about health care, inadequate functional health literacy is a significant barrier. Nearly half of American adults have poor or marginal health literacy skills and the National Institutes of Health and American Medical Association have recommended that patient information should be written at a sixth grade level. The aim of this study is to identify the most commonly used online patient information about liposuction and to evaluate its readability relative to average American literacy. An internet search of "liposuction" was performed and the 10 most popular websites identified. User and location data were disabled and sponsored results excluded. All relevant, patient-directed articles were downloaded and formatted into plain text. Articles were then analyzed using 10 established readability tests. A comparison group was constructed to identify the most popular online consumer information about tattooing. Mean readability scores and specific article characteristics were compared. A total of 80 articles were collected from websites about liposuction. Readability analysis revealed an overall 13.6 grade reading level (range, 10-16 grade); all articles exceeded the target sixth grade level. Consumer websites about tattooing were significantly easier to read, with a mean 7.8 grade level. These sites contained significantly fewer characters per word and words per sentence, as well as a smaller proportion of complex, long, and unfamiliar words. Online patient resources about liposuction are potentially too difficult for a large number of Americans to understand. Liposuction websites are significantly harder to read than consumer websites about tattooing. Aesthetic surgeons are advised to discuss with patients resources they use and guide patients to appropriate information for their skill level.

Evaluation of internet-based patient education materials from internal medicine subspecialty organizations: will patients understand them?

PubMed

Hansberry, David R; Agarwal, Nitin; John, Elizabeth S; John, Ann M; Agarwal, Prateek; Reynolds, James C; Baker, Stephen R

2017-06-01

The majority of Americans use the Internet daily, if not more often, and many search online for health information to better understand a diagnosis they have been given or to research treatment options. The average American reads at an eighth-grade level. The purpose of this study is to evaluate the readability of online patient education materials on the websites of 14 professional organizations representing the major internal medicine subspecialties. We used ten well-established quantitative readability scales to assess written text from patient education materials published on the websites of the major professional organizations representing the following subspecialty groups: allergy and immunology, cardiology, endocrinology, gastroenterology, geriatrics, hematology, hospice and palliative care, infectious disease, nephrology, oncology, pulmonology and critical care, rheumatology, sleep medicine, and sports medicine. Collectively the 540 articles analyzed were written at an 11th-grade level (SD 1.4 grade levels). The sleep medicine and nephrology websites had the most readable materials, written at an academic grade level of 8.5 ± 1.5 and 9.0 ± 0.2, respectively. Material at the infectious disease site was written at the most difficult level, with average readability corresponding to grades 13.9 ± 0.3. None of the patient education materials we reviewed conformed to the American Medical Association (AMA) and the National Institutes of Health (NIH) guidelines requiring that patient education articles be written at a third- to seventh-grade reading level. If these online resources were rewritten, it is likely that more patients would derive benefit from reading them.

Readability of Educational Materials to Support Parent Sexual Communication With Their Children and Adolescents.

PubMed

Ballonoff Suleiman, Ahna; Lin, Jessica S; Constantine, Norman A

2016-05-01

Sexual communication is a principal means of transmitting sexual values, expectations, and knowledge from parents to their children and adolescents. Many parents seek information and guidance to support talking with their children about sex and sexuality. Parent education materials can deliver this guidance but must use appropriate readability levels to facilitate comprehension and motivation. This study appraised the readability of educational materials to support parent sexual communication with their children. Fifty brochures, pamphlets, and booklets were analyzed using the Flesch-Kincaid, Gunning Fog, and Simple Measure of Gobbledygook (SMOG) index methods. Mean readability grade-level scores were 8.3 (range = 4.5-12.8), 9.7 (range = 5.5-14.9), and 10.1 (range = 6.7-13.9), respectively. Informed by National Institutes of Health-recommended 6th to 7th grade levels and American Medical Association-recommended 5th to 6th grade levels, percentages falling at or below the 7.0 grade level were calculated as 38%, 12%, and 2% and those falling at or below the 6.0 grade level were calculated as 12%, 2%, and 0% based on the Flesch-Kincaid, Gunning Fog, and SMOG methods, respectively. These analyses indicate that the majority of educational materials available online to support parents' communication with their children about sex and sexuality do not meet the needs of many or most parents. Efforts to improve the accessibility of these materials are warranted.

Readability of Healthcare Literature for Gastroparesis and Evaluation of Medical Terminology in Reading Difficulty.

PubMed

Meillier, Andrew; Patel, Shyam

2017-02-01

Gastroparesis is a chronic condition that can be further enhanced with patient understanding. Patients' education resources on the Internet have become increasingly important in improving healthcare literacy. We evaluated the readability of online resources for gastroparesis and the influence by medical terminology. Google searches were performed for "gastroparesis", "gastroparesis patient education material" and "gastroparesis patient information". Following, all medical terminology was determined if included on Taber's Medical Dictionary 22nd Edition. The medical terminology was replaced independently with "help" and "helping". Web resources were analyzed with the Readability Studio Professional Edition (Oleander Solutions, Vandalia, OH) using 10 different readability scales. The average of the 26 patient education resources was 12.7 ± 1.8 grade levels. The edited "help" group had 6.6 ± 1.0 and "helping" group had 10.4 ± 2.1 reading levels. In comparing the three groups, the "help" and "helping" groups had significantly lower readability levels (P < 0.001). The "help" group was significantly less than the "helping" group (P < 0.001). The web resources for gastroparesis were higher than the recommended reading level by the American Medical Association. Medical terminology was shown to be the cause for this elevated readability level with all, but four resources within the recommended grade levels following word replacement.

A comparative analysis of minimally invasive and open spine surgery patient education resources.

PubMed

Agarwal, Nitin; Feghhi, Daniel P; Gupta, Raghav; Hansberry, David R; Quinn, John C; Heary, Robert F; Goldstein, Ira M

2014-09-01

The Internet has become a widespread source for disseminating health information to large numbers of people. Such is the case for spine surgery as well. Given the complexity of spinal surgeries, an important point to consider is whether these resources are easily read and understood by most Americans. The average national reading grade level has been estimated to be at about the 7th grade. In the present study the authors strove to assess the readability of open spine surgery resources and minimally invasive spine surgery resources to offer suggestions to help improve the readability of patient resources. Online patient education resources were downloaded in 2013 from 50 resources representing either traditional open back surgery or minimally invasive spine surgery. Each resource was assessed using 10 scales from Readability Studio Professional Edition version 2012.1. Patient education resources representing traditional open back surgery or minimally invasive spine surgery were all found to be written at a level well above the recommended 6th grade level. In general, minimally invasive spine surgery materials were written at a higher grade level. The readability of patient education resources from spine surgery websites exceeds the average reading ability of an American adult. Revisions may be warranted to increase quality and patient comprehension of these resources to effectively reach a greater patient population.

Readability and comprehensibility of patient education material in hand-related web sites.

PubMed

Wang, Steve W; Capo, John T; Orillaza, Nathaniel

2009-09-01

As patients are more frequently referring to the Internet for information on their musculoskeletal problems, the readability and comprehensibility of these educational materials becomes increasingly more important to most of the lay public. In this study, we investigated the readability of the currently available web sites of the American Society for Surgery of the Hand (ASSH) and the American Academy of Orthopaedic Surgeons (AAOS) that pertain to hand and wrist problems, to assess their usefulness as a source for patient information. We analyzed all articles available in 2008 from the AAOS web site within the Patient Education Library under the heading, "Hand & Wrist" and from the ASSH web site under the heading, "Hand Conditions." A total of 83 articles were identified for hand conditions. Each article was analyzed by the Flesch-Kincaid program available in Microsoft Office Word software and the Dale-Chall grade-level assessor. These program models analyze all words in the specified text and return a grade level that corresponds to the difficulty level of the text. The AAOS web sites contained 34 articles with a mean Flesch-Kincaid grade level of 8.5 and a mean Dale-Chall grade level of 8.8. The ASSH web site contained 49 articles showing a mean Flesch-Kincaid grade level of 10.4 and a mean Dale-Chall grade level of 10.8. Our results suggest that the patient education materials found on the AAOS and ASSH web sites have readability scores that are higher than the recommended reading levels and thus may be too difficult to be understood by a substantial portion of the U.S. population.

Improving the readability of online foot and ankle patient education materials.

PubMed

Sheppard, Evan D; Hyde, Zane; Florence, Mason N; McGwin, Gerald; Kirchner, John S; Ponce, Brent A

2014-12-01

Previous studies have shown the need for improving the readability of many patient education materials to increase patient comprehension. This study's purpose was to determine the readability of foot and ankle patient education materials and to determine the extent readability can be improved. We hypothesized that the reading levels would be above the recommended guidelines and that decreasing the sentence length would also decrease the reading level of these patient educational materials. Patient education materials from online public sources were collected. The readability of these articles was assessed by a readability software program. The detailed instructions provided by the National Institutes of Health (NIH) were then used as a guideline for performing edits to help improve the readability of selected articles. The most quantitative guideline, lowering all sentences to less than 15 words, was chosen to show the effect of following the NIH recommendations. The reading levels of the sampled articles were above the sixth to seventh grade recommendations of the NIH. The MedlinePlus website, which is a part of the NIH website, had the lowest reading level (8.1). The articles edited had an average reduction of 1.41 grade levels, with the lowest reduction in the Medline articles of 0.65. Providing detailed instructions to the authors writing these patient education articles and implementing editing techniques based on previous recommendations could lead to an improvement in the readability of patient education materials. This study provides authors of patient education materials with simple editing techniques that will allow for the improvement in the readability of online patient educational materials. The improvement in readability will provide patients with more comprehendible education materials that can strengthen patient awareness of medical problems and treatments. © The Author(s) 2014.

Readability of informed consent forms in clinical trials conducted in a skin research center

PubMed Central

Samadi, Aniseh; Asghari, Fariba

2016-01-01

Obtaining informed consents is one of the most fundamental principles in conducting a clinical trial. In order for the consent to be informed, the patient must receive and comprehend the information appropriately. Complexity of the consent form is a common problem that has been shown to be a major barrier to comprehension for many patients. The objective of this study was to assess the readability of different templates of informed consent forms (ICFs) used in clinical trials in the Center for Research and Training in Skin Diseases and Leprosy (CRTSDL), Tehran, Iran. This study was conducted on ICFs of 45 clinical trials of the CRTSDL affiliated with Tehran University of Medical Sciences. ICFs were tested for reading difficulty, using the readability assessments formula adjusted for the Persian language including the Flesch–Kincaid reading ease score, Flesch–Kincaid grade level, and Gunning fog index. Mean readability score of the whole text of ICFs as well as their 7 main information parts were calculated. The mean ± SD Flesch Reading Ease score for all ICFs was 31.96 ± 5.62 that is in the difficult range. The mean ± SD grade level was calculated as 10.71 ± 1.8 (8.23–14.09) using the Flesch–Kincaid formula and 14.64 ± 1.22 (12.67–18.27) using the Gunning fog index. These results indicate that the text is expected to be understandable for an average student in the 11th grade, while the ethics committee recommend grade level 8 as the standard readability level for ICFs. The results showed that the readability scores of ICFs assessed in our study were not in the acceptable range. This means they were too complex to be understood by the general population. Ethics committees must examine the simplicity and readability of ICFs used in clinical trials. PMID:27471590

Varying Readability of Science-Based Text in Elementary Readers: Challenges for Teachers

ERIC Educational Resources Information Center

Gallagher, Tiffany L.; Fazio, Xavier; Gunning, Thomas G.

2012-01-01

This investigation compared readability formulae to publishers' identified reading levels in science-based elementary readers. Nine well-established readability indices were calculated and comparisons were made with the publishers' identified grade designations and between different genres of text. Results revealed considerable variance among the…

Are we effectively informing patients? A quantitative analysis of on-line patient education resources from the American Society of Neuroradiology.

PubMed

Hansberry, D R; Agarwal, N; Gonzales, S F; Baker, S R

2014-07-01

The ubiquitous use of the Internet by the public in an attempt to better understand their health care requires the on-line resources written at an appropriate level to maximize comprehension for the average user. The National Institutes of Health and the American Medical Association recommend on-line patient education resources written at a third-to-seventh grade level. We evaluated the readability of the patient education resources provided on the Web site of the American Society of Neuroradiology (http://www.asnr.org/patientinfo/). All patient education material from the ASNR Web site and the Society of Neurointerventional Surgery Web site were downloaded and evaluated with the computer software, Readability Studio Professional Edition, by using 10 quantitative readability scales: the Flesch Reading Ease, Flesch-Kincaid Grade Level, Simple Measure of Gobbledygook, Coleman-Liau Index, Gunning Fog Index, New Dale-Chall, FORCAST Formula, Fry Graph, Raygor Reading Estimate, and New Fog Count. An unpaired t test was used to compare the readability level of resources available on the American Society of Neuroradiology and the Society of Neurointerventional Surgery Web sites. The 20 individual patient education articles were written at a 13.9 ± 1.4 grade level with only 5% written at <11th grade level. There was no statistical difference between the level of readability of the resources on the American Society of Neuroradiology and Society of Neurointerventional Surgery Web sites. The patient education resources on these Web sites fail to meet the guidelines of the National Institutes of Health and American Medical Association. Members of the public may fail to fully understand these resources and would benefit from revisions that result in more comprehensible information cast in simpler language. © 2014 by American Journal of Neuroradiology.

Readability and quality of wikipedia pages on neurosurgical topics.

PubMed

Modiri, Omeed; Guha, Daipayan; Alotaibi, Naif M; Ibrahim, George M; Lipsman, Nir; Fallah, Aria

2018-03-01

Wikipedia is the largest online encyclopedia with over 40 million articles, and generating 500 million visits per month. The aim of this study is to assess the readability and quality of Wikipedia pages on neurosurgical related topics. We selected the neurosurgical related Wikipedia pages based on the series of online patient information articles that are published by the American Association of Neurological Surgeons (AANS). We assessed readability of Wikipedia pages using five different readability scales (Flesch Reading Ease, Flesch Kincaid Grade Level, Gunning Fog Index, SMOG) Grade level, and Coleman-Liau Index). We used the Center for Disease Control (CDC) Clear Communication Index as well as the DISCERN Instrument to evaluate the quality of each Wikipedia article. We identified a total of fifty-five Wikipedia articles that corresponded with patient information articles published by the AANS. This constitutes 77.46% of the AANS topics. The mean Flesch Kincaid reading ease score for all of the Wikipedia articles we analyzed is 31.10, which indicates that a college-level education is necessary to understand them. In comparison to the readability analysis for the AANS articles, the Wikipedia articles were more difficult to read across every scale. None of the Wikipedia articles meet the CDC criterion for clear communications. Our analyses demonstrated that Wikipedia articles related to neurosurgical topics are associated with higher grade levels for reading and also below the expected levels of clear communications for patients. Collaborative efforts from the neurosurgical community are needed to enhance the readability and quality of Wikipedia pages related to neurosurgery. Copyright © 2018 Elsevier B.V. All rights reserved.

Readability Formulas and User Perceptions of Electronic Health Records Difficulty: A Corpus Study

PubMed Central

Yu, Hong

2017-01-01

Background Electronic health records (EHRs) are a rich resource for developing applications to engage patients and foster patient activation, thus holding a strong potential to enhance patient-centered care. Studies have shown that providing patients with access to their own EHR notes may improve the understanding of their own clinical conditions and treatments, leading to improved health care outcomes. However, the highly technical language in EHR notes impedes patients’ comprehension. Numerous studies have evaluated the difficulty of health-related text using readability formulas such as Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG), and Gunning-Fog Index (GFI). They conclude that the materials are often written at a grade level higher than common recommendations. Objective The objective of our study was to explore the relationship between the aforementioned readability formulas and the laypeople’s perceived difficulty on 2 genres of text: general health information and EHR notes. We also validated the formulas’ appropriateness and generalizability on predicting difficulty levels of highly complex technical documents. Methods We collected 140 Wikipedia articles on diabetes and 242 EHR notes with diabetes International Classification of Diseases, Ninth Revision code. We recruited 15 Amazon Mechanical Turk (AMT) users to rate difficulty levels of the documents. Correlations between laypeople’s perceived difficulty levels and readability formula scores were measured, and their difference was tested. We also compared word usage and the impact of medical concepts of the 2 genres of text. Results The distributions of both readability formulas’ scores (P<.001) and laypeople’s perceptions (P=.002) on the 2 genres were different. Correlations of readability predictions and laypeople’s perceptions were weak. Furthermore, despite being graded at similar levels, documents of different genres were still perceived with different difficulty (P<.001). Word usage in the 2 related genres still differed significantly (P<.001). Conclusions Our findings suggested that the readability formulas’ predictions did not align with perceived difficulty in either text genre. The widely used readability formulas were highly correlated with each other but did not show adequate correlation with readers’ perceived difficulty. Therefore, they were not appropriate to assess the readability of EHR notes. PMID:28254738

Quality and readability of information materials for people with brain tumours and their families.

PubMed

Langbecker, Danette; Janda, Monika

2012-12-01

Written information is commonly used to inform patients about their disease and treatment but must be evidence-based and understandable to be useful. This study assessed the quality of the content and the readability of information brochures for people affected by brain tumours. We randomly selected 18 publicly available brochures. Brochures were assessed by criteria to assess the quality of content using the DISCERN instrument. Readability was tested using three commonly used formulas, which yield the reading grade level required to comprehend the brochure (sixth grade level recommended). The mean overall DISCERN score was 3.17 out of a maximum of 5 (moderate quality); only one achieved a rating greater than 4 (high quality). Only one brochure met the sixth grade readability criteria. Although brochures may have accurate content, few satisfied all of the recommended criteria to evaluate their content. Existing brochures need to be critically reviewed and simplified and consumer-focused brochures, produced.

Health literacy and the Internet: a study on the readability of Australian online health information.

PubMed

Cheng, Christina; Dunn, Matthew

2015-08-01

Almost 80% of Australian Internet users seek out health information online so the readability of this information is important. This study aimed to evaluate the readability of Australian online health information and determine if it matches the average reading level of Australians. Two hundred and fifty-one web pages with information on 12 common health conditions were identified across sectors. Readability was assessed by the Flesch-Kincaid (F-K), Simple Measure of Gobbledygook (SMOG) and Flesch Reading Ease (FRE) formulas, with grade 8 adopted as the average Australian reading level. The average reading grade measured by F-K and SMOG was 10.54 and 12.12 respectively. The mean FRE was 47.54, a 'difficult-to-read' score. Only 0.4% of web pages were written at or below grade 8 according to SMOG. Information on dementia was the most difficult to read overall, while obesity was the most difficult among government websites. The findings suggest that the readability of Australian health websites is above the average Australian levels of reading. A quantifiable guideline is needed to ensure online health information accommodates the reading needs of the general public to effectively use the Internet as an enabler of health literacy. © 2015 Public Health Association of Australia.

Are we failing to communicate? Internet-based patient education materials and radiation safety.

PubMed

Hansberry, David R; Ramchand, Tekchand; Patel, Shyam; Kraus, Carl; Jung, Jin; Agarwal, Nitin; Gonzales, Sharon F; Baker, Stephen R

2014-09-01

Patients frequently turn to the Internet when seeking answers to healthcare related inquiries including questions about the effects of radiation when undergoing radiologic studies. We investigate the readability of online patient education materials concerning radiation safety from multiple Internet resources. Patient education material regarding radiation safety was downloaded from 8 different websites encompassing: (1) the Centers for Disease Control and Prevention, (2) the Environmental Protection Agency, (3) the European Society of Radiology, (4) the Food and Drug Administration, (5) the Mayo Clinic, (6) MedlinePlus, (7) the Nuclear Regulatory Commission, and (8) the Society of Pediatric Radiology. From these 8 resources, a total of 45 articles were analyzed for their level of readability using 10 different readability scales. The 45 articles had a level of readability ranging from 9.4 to the 17.2 grade level. Only 3/45 (6.7%) were written below the 10th grade level. No statistical difference was seen between the readability level of the 8 different websites. All 45 articles from all 8 websites failed to meet the recommendations set forth by the National Institutes of Health and American Medical Association that patient education resources be written between the 3rd and 7th grade level. Rewriting the patient education resources on radiation safety from each of these 8 websites would help many consumers of healthcare information adequately comprehend such material. Copyright © 2014. Published by Elsevier Ireland Ltd.

Evaluating the complexity of online patient education materials about brain aneurysms published by major academic institutions.

PubMed

Gupta, Raghav; Adeeb, Nimer; Griessenauer, Christoph J; Moore, Justin M; Patel, Apar S; Kim, Christopher; Thomas, Ajith J; Ogilvy, Christopher S

2017-08-01

OBJECTIVE Health care education resources are increasingly available on the Internet. A majority of people reference these resources at one point or another. A threshold literacy level is needed to comprehend the information presented within these materials. A key component of health literacy is the readability of educational resources. The National Institutes of Health (NIH) and the American Medical Association have recommended that patient education materials be written between a 4th- and a 6th-grade education level. The authors assessed the readability of online patient education materials about brain aneurysms that have been published by several academic institutions across the US. METHODS Online patient education materials about brain aneurysms were downloaded from the websites of 20 academic institutions. The materials were assessed via 8 readability scales using Readability Studio software (Oleander Software Solutions), and then were statistically analyzed. RESULTS None of the patient education materials were written at or below the NIH's recommended 6th-grade reading level. The average educational level required to comprehend the texts across all institutions, as assessed by 7 of the readability scales, was 12.4 ± 2.5 (mean ± SD). The Flesch Reading Ease Scale classified the materials as "difficult" to understand, correlating with a college-level education or higher. An ANOVA test found that there were no significant differences in readability among the materials from the institutions (p = 0.215). CONCLUSIONS Brain aneurysms affect 3.2% of adults 50 years or older across the world and can cause significant patient anxiety and uncertainty. Current patient education materials are not written at or below the NIH's recommended 4th- to 6th-grade education level.

Readability of Spanish language online information for the initial treatment of burns.

PubMed

Votta, Kaitlyn; Metivier, Meghan; Romo, Stephanie; Garrigan, Hannah; Drexler, Alana; Nodoushani, Ariana; Sheridan, Robert

2018-06-01

This study's aim is to identify the most popular online resources for burn treatment information available in the Spanish language, and to evaluate the readability of this information. The phrase "tratamiento de quemaduras" (burn treatment) was entered into search engines Google and Bing on 9/15/2014 and 9/13/2017. The top 12 Spanish web results on each site were identified and analyzed using Readability Studio Professional Edition v2012.1. The software generated a "mean grade reading level" for each article, or the grade of students that could be expected to understand the article's language. 21 distinct articles were identified at T1 and 17 at T2, with seven overlapping between T1 and T2. The average grade reading level of all the websites ranged from 7.8 to 13.8 at T1 (approximately 8th grade to sophomore year of college) and 7.8 to 12.2 at T2. No websites were within 1 standard deviation of the American Medical Association recommended 6th grade reading level. With readability showing little improvement during the past three years, providers should be aware of the complexity of online literature, and the potential complications this presents to patients. Additionally, burn centers should prioritize generating more accessible information for the Spanish speaking public. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

A Comparison of Readability in Science-Based Texts: Implications for Elementary Teachers

ERIC Educational Resources Information Center

Gallagher, Tiffany; Fazio, Xavier; Ciampa, Katia

2017-01-01

Science curriculum standards were mapped onto various texts (literacy readers, trade books, online articles). Statistical analyses highlighted the inconsistencies among readability formulae for Grades 2-6 levels of the standards. There was a lack of correlation among the readability measures, and also when comparing different text sources. Online…

Can Readability Formulas Be Used to Successfully Gauge Difficulty of Reading Materials?

ERIC Educational Resources Information Center

Begeny, John C.; Greene, Diana J.

2014-01-01

A grade level of reading material is commonly estimated using one or more readability formulas, which purport to measure text difficulty based on specified text characteristics. However, there is limited direction for teachers and publishers regarding which readability formulas (if any) are appropriate indicators of actual text difficulty. Because…

Readability of Brochures Produced by State of Florida.

ERIC Educational Resources Information Center

Christ, William G.; Pharr, Paula

1980-01-01

A study of the readability of governmental pamphlets produced by the State of Florida, based on the use of the Flesch Reading Ease Formula and the Dale-Chall Formula, suggests that if a seventh or eighth grade readability level is considered an appropriate standard for public information brochures, the brochures tested may be too complex…

Assessing Online Patient Education Readability for Spine Surgery Procedures.

PubMed

Long, William W; Modi, Krishna D; Haws, Brittany E; Khechen, Benjamin; Massel, Dustin H; Mayo, Benjamin C; Singh, Kern

2018-03-01

Increased patient reliance on Internet-based health information has amplified the need for comprehensible online patient education articles. As suggested by the American Medical Association and National Institute of Health, spine fusion articles should be written for a 4th-6th-grade reading level to increase patient comprehension, which may improve postoperative outcomes. The purpose of this study is to determine the readability of online health care education information relating to anterior cervical discectomy and fusion (ACDF) and lumbar fusion procedures. Online health-education resource qualitative analysis. Three search engines were utilized to access patient education articles for common cervical and lumbar spine procedures. Relevant articles were analyzed for readability using Readability Studio Professional Edition software (Oleander Software Ltd). Articles were stratified by organization type as follows: General Medical Websites (GMW), Healthcare Network/Academic Institutions (HNAI), and Private Practices (PP). Thirteen common readability tests were performed with the mean readability of each compared between subgroups using analysis of variance. ACDF and lumbar fusion articles were determined to have a mean readability of 10.7±1.5 and 11.3±1.6, respectively. GMW, HNAI, and PP subgroups had a mean readability of 10.9±2.9, 10.7±2.8, and 10.7±2.5 for ACDF and 10.9±3.0, 10.8±2.9, and 11.6±2.7 for lumbar fusion articles. Of 310 total articles, only 6 (3 ACDF and 3 lumbar fusion) were written for comprehension below a 7th-grade reading level. Current online literature from medical websites containing information regarding ACDF and lumbar fusion procedures are written at a grade level higher than the suggested guidelines. Therefore, current patient education articles should be revised to accommodate the average reading level in the United States and may result in improved patient comprehension and postoperative outcomes.

Readability of HIV/AIDS educational materials: the role of the medium of communication, target audience, and producer characteristics.

PubMed

Wells, J A

1994-12-01

The reading difficulty of many HIV/AIDS brochures and pamphlets limits their effectiveness. This analysis addresses correlates of readability in 136 HIV/AIDS educational items. Readability is measured using the SMOG Index. The medium of communication is significantly related to readability: comic books and brochures are, on average, more readable than books and pamphlets (10.9 versus 11.9). The target audience also differentiates readability. Materials for HIV antibody test seekers, the general community, and sexually active adults have a more difficult reading grade, averaging 12.1, whereas materials for ethnic minorities average a more readable 9.2. The producer organization's type and location are unrelated to readability, but an AIDS-specific organizational focus correlates with better readability (grade 10.8 vs. 11.8). These findings remain significant in multivariate analysis. The results indicate that brochures and comics are more likely to be comprehended by low-literacy populations, that an understanding of the literacy of target audiences is needed to produce materials with appropriate reading levels, and that policies to influence producer organizations may result in the creation of more readable materials.

Readability assessment of internet-based patient education materials related to uterine artery embolization.

PubMed

Shukla, Pratik; Sanghvi, Saurin P; Lelkes, Valdis M; Kumar, Abhishek; Contractor, Sohail

2013-04-01

To determine the readability of Internet-based patient education materials (IPEMs) created by United States hospitals and universities and clinical practices and miscellaneous health care-associated Web sites regarding uterine artery embolization (UAE) as a marker for IPEMs in general. Two hundred unique Web sites were evaluated for patient-related articles on UAE. Web sites produced by US hospitals and universities and clinical practices, as well as miscellaneous health care-associated Web sites meeting the Health on the Net Foundation Code of Conduct criteria were included in the database. By using mathematical regression algorithms based on word and sentence length to quantitatively analyze reading materials for language intricacy, readability of 40 UAE-related IPEMs was assessed with four indices: Flesch-Kincaid Grade Level (FKGL), Flesch Reading Ease Score (FRES), Simple Measure of Gobbledygook (SMOG), and Gunning Frequency of Gobbledygook (GFOG). Scores were evaluated against national recommendations, and intergroup analysis was performed. None of the IPEMs were written at or below the sixth-grade reading level, based on FKGL. The mean readability scores were as follows: FRES, 43.98; FKGL, 10.76; SMOG, 13.63; and GFOG, 14.55. These scores indicate that the readability of UAE IPEMs is written at an advanced level, significantly above the recommended 6th grade reading level (P<.05) determined by the United States Department of Health and Human Services. IPEMs related to UAE generated by hospitals, clinical practices, and miscellaneous health care-associated Web sites are written above the recommended sixth grade level. IPEMs for other disease entities may also reflect similar results. Copyright © 2013 SIR. Published by Elsevier Inc. All rights reserved.

Literacy assessment of family health history tools for public health prevention.

PubMed

Wang, C; Gallo, R E; Fleisher, L; Miller, S M

2011-01-01

This study aimed to systematically identify and evaluate the readability and document complexity of currently available family history tools for the general public. Three steps were undertaken to identify family history tools for evaluation: (a) Internet searches, (b) expert consultation, and (c) literature searches. Tools identified were assessed for readability using the Simple Measure of Gobbledygook (SMOG) readability formula. The complexity of documents (i.e., forms collecting family history information) was assessed using the PMOSE/IKIRSCH document readability formula. A total of 78 tools were identified, 47 of which met the criteria for inclusion. SMOG reading grade levels for multimedia-based tools ranged from 10.1 to 18.3, with an average score of 13.6. For print-based tools, SMOG ranged from 8.7 to 14.1, with an average score of 12.0. Document complexity ranged from very low complexity (level 1 proficiency) to high complexity (level 4 proficiency). The majority of tools are written at a reading grade level that is beyond the 8th grade average reading level in the United States. The lack of family history tools that are easy to read or use may compromise their potential effectiveness in identifying individuals at increased risk for chronic diseases in the general population. Copyright © 2010 S. Karger AG, Basel.

A readability assessment of online stroke information.

PubMed

Sharma, Nikhil; Tridimas, Andreas; Fitzsimmons, Paul R

2014-07-01

Patients and carers increasingly access the Internet as a source of health information. Poor health literacy is extremely common and frequently limits patient's comprehension of health care information literature. We aimed to assess the readability of online consumer-orientated stroke information using 2 validated readability measures. The 100 highest Google ranked consumer-oriented stroke Web pages were assessed for reading difficulty using the Flesch-Kincaid and Simple Measure of Gobbledygook (SMOG) formulae. None of the included Web pages complied with the current readability guidelines when readability was measured using the gold standard SMOG formula. Mean Flesch-Kincaid grade level was 10.4 (95% confidence interval [CI] 9.97-10.9) and mean SMOG grade 12.1 (95% CI 11.7-12.4). Over half of the Web pages were produced at graduate reading levels or above. Not-for-profit Web pages were significantly easier to read (P=.0006). The Flesch-Kincaid formula significantly underestimated reading difficulty, with a mean underestimation of 1.65 grades (95% CI 1.49-1.81), P<.0001. Most consumer-orientated stroke information Web sites require major text revision to comply with readability guidelines and to be comprehensible to the average patient. The Flesch-Kincaid formula significantly underestimates reading difficulty, and SMOG should be used as the measure of choice. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

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

PubMed

Kapoor, Karan; George, Praveen; Evans, Matthew C; Miller, Weldon J; Liu, Stanley S

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). 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. 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). 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. © 2017 S. Karger AG, Basel.

Accuracy and Readability of Websites on Kidney and Bladder Cancers.

PubMed

Azer, Samy A; Alghofaili, Maha M; Alsultan, Rana M; Alrumaih, Najla S

2017-03-09

The aim of this study was to assess the scientific accuracy and the readability level of websites on kidney and bladder cancers. The search engines Google™, Yahoo™ and Bing™ were searched independently by assessors in November 2014 using the following keywords: "bladder cancer", "kidney cancer", "patient bladder cancer", "patient kidney cancer" and "bladder and kidney cancer". Only English-language websites were selected on the bases of predetermined inclusion and exclusion criteria. Assessors independently reviewed the findings and evaluated the accuracy and quality of each website by using the DISCERN and the LIDA instruments. The readability of the websites was calculated using the Flesch-Kincaid Grade Level Index and the Coleman-Liau Readability Index. Sixty-two websites were finally included in the study. The overall accuracy scores varied; for the DISCERN, the range was 28 to 76; out of 80 (mean ± SD, 47.1 ± 12.1; median = 46.0, interquartile range (IQR) = 19.2), and for the LIDA, the range was 52 to 125; out of 144 (mean ± SD, 101.9 ± 15.2; median, 103; IQR, 16.5). The creators of these websites were universities and research centres (n = 25, 40%), foundations and associations (n = 10, 16%), commercial and pharmaceutical companies (n = 13, 21%), charities and volunteer work (n = 4, 6%) and non-university educational bodies (n = 10, 16%). The readability scores (mean ± SD) were 11.2 ± 2.2 for the Flesch-Kincaid Grade Level Index and 11.2 ± 1.6 for the Coleman-Liau Readability Index. The accuracy and the quality of the websites on kidney and bladder cancers varied. In most websites, there were deficiencies in clarity of aims, presenting symptoms, investigations and treatment options. The readability matched grades 10-11 literacy levels-a level above the public readability level. The study highlights the needs for further improvement of the online information created for public and patients with kidney and bladder cancers.

Unsuitable readability levels of patient information pertaining to dementia and related diseases: a comparative analysis.

PubMed

Weih, Markus; Reinhold, Angelika; Richter-Schmidinger, Tanja; Sulimma, Anne-Kathrin; Klein, Harald; Kornhuber, Johannes

2008-12-01

Our study investigated the readability of printed material about dementia that is offered to patients and caregivers. Comparisons of various brochures (at least three standard pages in length) on dementia and related disorders were made using automated measuring by the SMOG readability index grade. 118 brochures were assessed (25 in English, 93 in German), for which the mean readability was found to be high school/college level as measured by the SMOG readability index (grade 13.6 +/- 1.8). No differences in readability were observed between materials produced by pharmaceutical companies and other sources. Furthermore, recently published brochures were not more readable than older ones. Shorter brochures, English brochures and those containing medical facts were easier to read than longer ones, those written in German or brochures primarily addressing psychosocial care/social issues. The sentence length was above the 20 word recommendation in 25% of the brochures. The average font size of the brochure texts was small (mean font size 11.1 +/- 1.6 point) with only 25% of brochures having a font size of 12 or more, as recommended. Written patient information and educational material of more than three standard pages is often published at unsuitably high readability levels using small fonts. Information material about dementia should be designed and tested prior to distribution among patients and caregivers. Future studies should address material shorter than three pages and material for younger caregivers.

Examining the Reading Level of Internet Medical Information for Common Internal Medicine Diagnoses.

PubMed

Hutchinson, Nora; Baird, Grayson L; Garg, Megha

2016-06-01

The National Institutes of Health (NIH) recommend that health materials be written at a grade 6-7 reading level, which has generally not been achieved in online reading materials. Up to the present time, there have not been any assessments focused on the reading level of online educational materials across the most popular consumer Web sites for common internal medicine diagnoses. In this study, we examined the readability of open-access online health information for 9 common internal medicine diagnoses. Nine of the most frequently encountered inpatient and ambulatory internal medicine diagnoses were selected for analysis. In November and December 2014, these diagnoses were used as search terms in Google, and the top 5 Web sites across all diagnoses and a diagnosis-specific site were analyzed across 5 validated reading indices. On average, the lowest reading grade-level content was provided by the NIH (10.7), followed by WebMD (10.9), Mayo Clinic (11.3), and diagnosis-specific Web sites (11.5). Conversely, Wikipedia provided content that required the highest grade-level readability (14.6). The diagnoses with the lowest reading grade levels were chronic obstructive pulmonary disease (10.8), followed by diabetes (10.9), congestive heart failure (11.7), osteoporosis (11.7) and hypertension (11.7). Depression had the highest grade-level readability (13.8). Despite recommendations for patient health information to be written at a grade 6-7 reading level, our examination of online educational materials pertaining to 9 common internal medicine diagnoses revealed reading levels significantly above the NIH recommendation. This was seen across both diagnosis-specific and general Web sites. There is a need to improve the readability of online educational materials made available to patients. These improvements have the potential to greatly enhance patient awareness, engagement, and physician-patient communication. Published by Elsevier Inc.

Are condom instructions readable? Results of a readability study.

PubMed Central

Richwald, G A; Wamsley, M A; Coulson, A H; Morisky, D E

1988-01-01

The use of condoms has assumed a central position in the current strategy to prevent sexual transmission of the human immunodeficiency virus. The effectiveness of condoms in disease prophylaxis is dependent, to a degree, on their correct use. Condom manufacturers routinely include information on condom use either printed on the actual package or in an enclosed package insert. With the use of three readability formulas, the reading grade level was determined for 14 different sets of instructions included with 25 brands of condoms manufactured by 7 domestic and 1 overseas manufacturer. The readability formulas, when applied to instructions for condom use, estimated that, conservatively, 8 of the 14 instructions required at least reading at the level of a high school graduate and none required less than a 10th grade level. Clearly written instructions and simple concepts could assist current and future condom users in the correct use of condoms and improve the effectiveness of condoms in the prevention of AIDS and other sexually transmitted diseases. PMID:3136494

Readability assessment of online thyroid surgery patient education materials.

PubMed

Patel, Chirag R; Cherla, Deepa V; Sanghvi, Saurin; Baredes, Soly; Eloy, Jean Anderson

2013-10-01

Published guidelines recommend written health information be written at or below the sixth-grade level. We evaluate the readability of online materials related to thyroid surgery. Thyroid surgery materials were evaluated using Flesch Reading Ease Score (FRES), Flesch Kincaid Grade Level (FKGL), Gunning Frequency of Gobbledygook (GFOG), and Simple Measure of Gobbledygook (SMOG). Thirty-one documents were evaluated. FRES scores ranged from 29.3 to 67.8 (possible range = 0 to 100), and averaged 50.5. FKGL ranged from 6.9 to 14.9 (possible range = 3 to 12), and averaged 10.4. SMOG scores ranged from 11.8 to 14.5 (possible range = 3 to 19), and averaged 13.0. GFOG scores ranged from 10.6 to 18.0 (possible range = 3 to 19), and averaged 13.5. Readability scores for online thyroid surgery materials are higher (i.e., more difficult) than the recommended levels. However, readability is only one aspect of comprehension. Written information should be designed with that fact in mind. Copyright © 2013 Wiley Periodicals, Inc.

Readability Formulas and User Perceptions of Electronic Health Records Difficulty: A Corpus Study.

PubMed

Zheng, Jiaping; Yu, Hong

2017-03-02

Electronic health records (EHRs) are a rich resource for developing applications to engage patients and foster patient activation, thus holding a strong potential to enhance patient-centered care. Studies have shown that providing patients with access to their own EHR notes may improve the understanding of their own clinical conditions and treatments, leading to improved health care outcomes. However, the highly technical language in EHR notes impedes patients' comprehension. Numerous studies have evaluated the difficulty of health-related text using readability formulas such as Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG), and Gunning-Fog Index (GFI). They conclude that the materials are often written at a grade level higher than common recommendations. The objective of our study was to explore the relationship between the aforementioned readability formulas and the laypeople's perceived difficulty on 2 genres of text: general health information and EHR notes. We also validated the formulas' appropriateness and generalizability on predicting difficulty levels of highly complex technical documents. We collected 140 Wikipedia articles on diabetes and 242 EHR notes with diabetes International Classification of Diseases, Ninth Revision code. We recruited 15 Amazon Mechanical Turk (AMT) users to rate difficulty levels of the documents. Correlations between laypeople's perceived difficulty levels and readability formula scores were measured, and their difference was tested. We also compared word usage and the impact of medical concepts of the 2 genres of text. The distributions of both readability formulas' scores (P<.001) and laypeople's perceptions (P=.002) on the 2 genres were different. Correlations of readability predictions and laypeople's perceptions were weak. Furthermore, despite being graded at similar levels, documents of different genres were still perceived with different difficulty (P<.001). Word usage in the 2 related genres still differed significantly (P<.001). Our findings suggested that the readability formulas' predictions did not align with perceived difficulty in either text genre. The widely used readability formulas were highly correlated with each other but did not show adequate correlation with readers' perceived difficulty. Therefore, they were not appropriate to assess the readability of EHR notes. ©Jiaping Zheng, Hong Yu. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 02.03.2017.

Readability Assessment of Online Patient Abdominoplasty Resources.

PubMed

Phillips, Nicole A; Vargas, Christina R; Chuang, Danielle J; Lee, Bernard T

2015-02-01

Limited functional health literacy is recognized as an important contributor to health disparities in the United States. As internet access becomes more universal, there is increasing concern about whether patients with poor or marginal literacy can access understandable healthcare information. As such, the National Institutes of Health and American Medical Association recommend that patient information be written at a sixth grade level. This study identifies the most popular online resources for patient information about abdominoplasty and evaluates their readability in the context of average American literacy. The two largest internet search engines were queried for "tummy tuck surgery" to simulate a patient search in lay terms. The ten most popular sites common to both search engines were identified, and all relevant articles from the main sites were downloaded. Sponsored results were excluded. Readability analysis of the articles was performed using ten established tests. Online information about abdominoplasty from the ten most popular publically available websites had an overall average readability of 12th grade. Mean reading grade level scores among tests were: Coleman-Liau 11.9, Flesch-Kincaid 11.4, FORCAST 11.1, Fry 13, Gunning Fog 13.5, New Dale-Chall 11.8, New Fog Count 9.9, Raygor Estimate 12, and SMOG 13.4; Flesch Reading Ease index score was 46. Online patient resources about abdominoplasty are uniformly above the recommended target readability level and are likely too difficult for many patients to understand. A range of readability identified among websites could allow surgeons to guide patients to more appropriate resources for their literacy skills.

What parents are reading about laryngomalacia: Quality and readability of internet resources on laryngomalacia.

PubMed

Corredera, Erica; Davis, Kara S; Simons, Jeffrey P; Jabbour, Noel

2018-05-01

The goal of this study is to measure the quality and readability of websites related to laryngomalacia, and to compare the quality and readability scores for the sites accessed through the most popular search engines. Laryngomalacia is a common diagnosis in children but is often difficult for parents to comprehend. As information available on the internet is unregulated, the quality and readability of this information may vary. An advanced search on Google, Yahoo, and Bing was conducted using the terms "laryngomalacia" OR "soft larynx" OR "floppy voice box." The first ten websites meeting inclusion and exclusion criteria were evaluated, for each search engine. Quality and readability were assessed using the DISCERN criteria and the Flesch reading ease scoring (FRES) and Flesch-Kincaid grade level (FKGL) tests, respectively. The top 10 hits on each search engine yielded 15 unique web pages. The median DISCERN score (out of a possible high-score of 80) was 48.5 (SD 12.6). The median USA grade-level estimated by the FKGL was 11.3 (SD 1.4). Only one website (6.7%), had a readability score in the optimal range of 6th to 8th grade reading level. DISCERN scores did not correlate with FKGL scores (r = 0.10). Online information discussing laryngomalacia often varies in quality and may not be easily comprehensible to the public. It is important for healthcare professionals to understand the quality of health information accessible to patients as it may influence medical decision-making by patient families. Copyright © 2018 Elsevier B.V. All rights reserved.

Readability, complexity, and suitability of online resources for mastectomy and lumpectomy.

PubMed

Tran, Bao Ngoc N; Singh, Mansher; Singhal, Dhruv; Rudd, Rima; Lee, Bernard T

2017-05-15

Nearly half of American adults have low or marginal health literacy. This negatively affects patients' participation, decision-making, satisfaction, and overall outcomes especially when there is a mismatch between information provided and the skills of the intended audience. Recommendations that patient information be written below the sixth grade level have been made for over three decades. This study compares online resources for mastectomy versus lumpectomy using expanded metrics including readability level, complexity, and density of data and overall suitability for public consumption. The 10 highest ranked Web sites for mastectomy and lumpectomy were identified using the largest Internet engine (Google). Each Web site was assessed for readability (Simple Measure of Gobbledygook), complexity (PMOSE/iKIRSCH), and suitability (Suitability Assessment of Materials). Scores were analyzed by each Web site and overall. Readability analysis showed a significant reading grade level difference between mastectomy and lumpectomy online information (15.4 and 13.9, P = 0.04, respectively). Complexity analysis via PMOSE/iKIRSCH revealed a mean score of 6.5 for mastectomy materials corresponding to "low" complexity and eighth to 12 th grade education. Lumpectomy literature had a lower PMOSE/iKIRSCH score of 5.8 corresponding to a "very low" complexity and fourth to eighth grade education (P = 0.05). Suitability assessment showed mean values of 41% and 46% (P = 0.83) labeled as the lowest level of "adequacy" for mastectomy and lumpectomy materials, respectively. Inter-rater reliability was high for both complexity and suitability analysis. Online resources for the surgical treatment of breast cancer are above the recommended reading grade level. The suitability level is barely adequate indicating a need for revision. Online resources for mastectomy have a higher reading grade level than do materials for lumpectomy and tend to be more complex. Copyright © 2017 Elsevier Inc. All rights reserved.

Evaluation of Quality and Readability of Health Information Websites Identified through India's Major Search Engines.

PubMed

Raj, S; Sharma, V L; Singh, A J; Goel, S

2016-01-01

Background. The available health information on websites should be reliable and accurate in order to make informed decisions by community. This study was done to assess the quality and readability of health information websites on World Wide Web in India. Methods. This cross-sectional study was carried out in June 2014. The key words "Health" and "Information" were used on search engines "Google" and "Yahoo." Out of 50 websites (25 from each search engines), after exclusion, 32 websites were evaluated. LIDA tool was used to assess the quality whereas the readability was assessed using Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), and SMOG. Results. Forty percent of websites (n = 13) were sponsored by government. Health On the Net Code of Conduct (HONcode) certification was present on 50% (n = 16) of websites. The mean LIDA score (74.31) was average. Only 3 websites scored high on LIDA score. Only five had readability scores at recommended sixth-grade level. Conclusion. Most health information websites had average quality especially in terms of usability and reliability and were written at high readability levels. Efforts are needed to develop the health information websites which can help general population in informed decision making.

Comparative analysis of online patient education material pertaining to hepatitis and its complications.

PubMed

Gulati, Rishabh; Nawaz, Mohammad; Pyrsopoulos, Nikolaos T

2016-05-01

Approximately 50% of patients leave the doctor's office with a poor understanding of their diagnosis. Online patient education websites are becoming a major source of information for many of the patients. Here, we determine the reading grade level of online patient education materials on hepatitis B, hepatitis C, cirrhosis, and hepatocellular cancer and compare it with the National Institutes of Health-recommended reading grade level of sixth to seventh grade or under. A Google search was performed to retrieve patient reading materials. Text was modified to remove medical terms that were defined within the article. Documents were then divided into categories of introduction, risk factors, symptoms, diagnosis, treatment, and prevention. Each document was then analyzed using six validated readability tests to determine the grade level and complexity on the basis of the number of words, syllables, or number of uncommon words. Modified documents had a mean readability score of 10.23, although the recommended score is less than 7.0. Cirrhosis had the highest reading grade level, with a median of 11.3, whereas hepatitis B and hepatocellular carcinoma had the easiest readability, with a median of 9.5. Furthermore, treatment subsection was the most difficult, with a median score of 10.8. Patient reading materials reviewed in this study were written well above the recommended reading grade level. These findings suggest review of patient education materials in an effort to close the gap between the average reading level and the reading materials.

Readability assessment of online tracheostomy care resources.

PubMed

Kong, Keonho Albert; Hu, Amanda

2015-02-01

To assess the readability of online tracheostomy care resources. Cross-sectional study. Academic center. A Google search was performed for "tracheostomy care" in January 2014. The top 50 results were categorized into major versus minor websites and patient-oriented versus professional-oriented resources. These websites were evaluated with the following readability tools: Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG), and Gunning Frequency of Gobbledygook (GFOG). Readability scores for the websites were FRES 57.21 ± 16.71 (possible range = 0-100), FKGL 8.33 ± 2.84 (possible range = 3-12), SMOG 11.25 ± 2.49 (possible range = 3-19), and GFOG 11.43 ± 4.07 (possible range = 3-19). There was no significant difference in all 4 readability scores between major (n = 41) and minor (n = 9) websites. Professional-oriented websites (n = 19) had the following readability scores: FRES 40.77 ± 11.69, FKGL 10.93 ± 2.48, SMOG 13.29 ± 2.32, and GFOG 14.91 ± 3.98. Patient-oriented websites (n = 31) had the following readability scores: FRES 67.29 ± 9.91, FKGL 6.73 ± 1.61, SMOG 10.01 ± 1.64, and GFOG 9.30 ± 2.27. Professional-oriented websites had more difficult readability scores than patient-oriented websites for FRES (P < .00), FKGL (P < .00), SMOG (P < .00), and GFOG (P < .00). Online tracheostomy care resources were written at a level more difficult than the recommended fourth- to sixth-grade level for written health information. There was no significant difference in readability between major and minor websites. Professional-oriented websites were more difficult to read than patient-oriented websites. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.

The readability of pediatric patient education materials on the World Wide Web.

PubMed

D'Alessandro, D M; Kingsley, P; Johnson-West, J

2001-07-01

Literacy is a national and international problem. Studies have shown the readability of adult and pediatric patient education materials to be too high for average adults. Materials should be written at the 8th-grade level or lower. To determine the general readability of pediatric patient education materials designed for adults on the World Wide Web (WWW). GeneralPediatrics.com (http://www.generalpediatrics.com) is a digital library serving the medical information needs of pediatric health care providers, patients, and families. Documents from 100 different authoritative Web sites designed for laypersons were evaluated using a built-in computer software readability formula (Flesch Reading Ease and Flesch-Kincaid reading levels) and hand calculation methods (Fry Formula and SMOG methods). Analysis of variance and paired t tests determined significance. Eighty-nine documents constituted the final sample; they covered a wide spectrum of pediatric topics. The overall Flesch Reading Ease score was 57.0. The overall mean Fry Formula was 12.0 (12th grade, 0 months of schooling) and SMOG was 12.2. The overall Flesch-Kincaid grade level was significantly lower (P<.0001), at a mean of 7.1, when compared with the other 2 methods. All author and institution groups had an average reading level above 10.6 by the Fry Formula and SMOG methods. Pediatric patient education materials on the WWW are not written at an appropriate reading level for the average adult. We propose that a practical reading level and how it was determined be included on all patient education materials on the WWW for general guidance in material selection. We discuss suggestions for improved readability of patient education materials.

How Readable Is BPH Treatment Information on the Internet? Assessing Barriers to Literacy in Prostate Health

PubMed Central

Koo, Kevin; Yap, Ronald L.

2016-01-01

Information about benign prostatic hyperplasia (BPH) has become increasingly accessible on the Internet. Though the ability to find such material is encouraging, its readability and impact on informing patient decision making are not known. To evaluate the readability of Internet-based information about BPH in the context of website ownership and Health on the Net certification, three search engines were queried daily for 1 month with BPH-related keywords. Website ownership data and Health on the Net certification status were verified. Three readability analyses were performed: SMOG test, Dale–Chall readability formula, and Fry readability graph. An adjusted SMOG calculation was performed to reduce overestimation from medical jargon. After a total of 270 searches, 52 websites met inclusion criteria. Mean SMOG grade was 10.6 (SD = 1.4) and 10.2 after adjustment. Mean Dale–Chall score was 9.1 (SD = 0.6), or Grades 13 to 15. Mean Fry graph coordinates (173 syllables, 5.1 sentences) corresponded to Grade 15. Seven sites (13%) were at or below the average adult reading level based on SMOG; none of the sites qualified based on the other tests. Readability was significantly poorer for academic versus commercial sites and for Health on the Net-certified versus noncertified sites. In conclusion, online information about BPH treatment markedly exceeds the reading comprehension of most U.S. adults. Websites maintained by academic institutions and certified by the Health on the Net standard have more difficult readability. Efforts to improve literacy with respect to urological health should target content readability independent of reliability. PMID:27903952

How Readable Is BPH Treatment Information on the Internet? Assessing Barriers to Literacy in Prostate Health.

PubMed

Koo, Kevin; Yap, Ronald L

2017-03-01

Information about benign prostatic hyperplasia (BPH) has become increasingly accessible on the Internet. Though the ability to find such material is encouraging, its readability and impact on informing patient decision making are not known. To evaluate the readability of Internet-based information about BPH in the context of website ownership and Health on the Net certification, three search engines were queried daily for 1 month with BPH-related keywords. Website ownership data and Health on the Net certification status were verified. Three readability analyses were performed: SMOG test, Dale-Chall readability formula, and Fry readability graph. An adjusted SMOG calculation was performed to reduce overestimation from medical jargon. After a total of 270 searches, 52 websites met inclusion criteria. Mean SMOG grade was 10.6 ( SD = 1.4) and 10.2 after adjustment. Mean Dale-Chall score was 9.1 ( SD = 0.6), or Grades 13 to 15. Mean Fry graph coordinates (173 syllables, 5.1 sentences) corresponded to Grade 15. Seven sites (13%) were at or below the average adult reading level based on SMOG; none of the sites qualified based on the other tests. Readability was significantly poorer for academic versus commercial sites and for Health on the Net-certified versus noncertified sites. In conclusion, online information about BPH treatment markedly exceeds the reading comprehension of most U.S. adults. Websites maintained by academic institutions and certified by the Health on the Net standard have more difficult readability. Efforts to improve literacy with respect to urological health should target content readability independent of reliability.

Assessment of readability, understandability, and completeness of pediatric hospital medicine discharge instructions.

PubMed

Unaka, Ndidi I; Statile, Angela; Haney, Julianne; Beck, Andrew F; Brady, Patrick W; Jerardi, Karen E

2017-02-01

The average American adult reads at an 8th-grade level. Discharge instructions written above this level might increase the risk of adverse outcomes for children as they transition from hospital to home. We conducted a cross-sectional study at a large urban academic children's hospital to describe readability levels, understandability scores, and completeness of written instructions given to families at hospital discharge. Two hundred charts for patients discharged from the hospital medicine service were randomly selected for review. Written discharge instructions were extracted and scored for readability (Fry Readability Scale [FRS]), understandability (Patient Education Materials Assessment Tool [PEMAT]), and completeness (5 criteria determined by consensus). Descriptive statistics enumerated the distribution of readability, understandability, and completeness of written discharge instructions. Of the patients included in the study, 51% were publicly insured. Median age was 3.1 years, and median length of stay was 2.0 days. The median readability score corresponded to a 10th-grade reading level (interquartile range, 8-12; range, 1-13). Median PEMAT score was 73% (interquartile range, 64%-82%; range, 45%-100%); 36% of instructions scored below 70%, correlating with suboptimal understandability. The diagnosis was described in only 33% of the instructions. Although explicit warning signs were listed in most instructions, 38% of the instructions did not include information on the person to contact if warning signs developed. Overall, the readability, understandability, and completeness of discharge instructions were subpar. Efforts to improve the content of discharge instructions may promote safe and effective transitions home. Journal of Hospital Medicine 2017;12:98-101. © 2017 Society of Hospital Medicine.

The quality and readability of internet information regarding clavicle fractures.

PubMed

Zhang, Dafang; Schumacher, Charles; Harris, Mitchel Byron

2016-03-01

The internet has become a major source of health information for patients. However, there has been little scrutiny of health information available on the internet to the public. Our objectives were to evaluate the quality and readability of information available on the internet regarding clavicle fractures and whether they changed with academic affiliation of the website or with complexity of the search term. Through a prospective evaluation of 3 search engines using 3 different search terms of varying complexity ("broken collarbone," "collarbone fracture," and "clavicle fracture"), we evaluated 91 website hits for quality and readability. Websites were specifically analyzed by search term and by website type. Information quality was evaluated on a four-point scale, and information readability was assessed using the Flesch-Kincaid score for reading grade level. The average quality score for our website hits was low, and the average reading grade level was far above the recommended level. Academic websites offered significantly higher quality information, whereas commercial websites offered significantly lower quality information. The use of more complex search terms yielded information of higher reading grade level but not higher quality. Current internet information regarding clavicle fractures is of low quality and low readability. Higher quality information utilizing more accessible language on clavicle fractures is needed on the internet. It is important to be aware of the information accessible to patients prior to their presentation to our clinics. Patients should be advised to visit websites with academic affiliations and to avoid commercial websites. Copyright © 2015 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

Readability of Orthopaedic Oncology-related Patient Education Materials Available on the Internet.

PubMed

Shah, Akash K; Yi, Paul H; Stein, Andrew

2015-12-01

A person's health literacy is one of the most important indicators of a patient's health status. According to national recommendations, patient education materials should be written at no higher than the sixth- to eighth-grade reading level. The purpose of our study was to assess the readability of online patient education materials related to orthopaedic oncology on the websites of the American Academy of Orthopaedic Surgeons (AAOS), American Cancer Society (ACS), Bone and Cancer Foundation (BCF), and National Cancer Institute (NCI). We searched the online patient education libraries of the AAOS, ACS, BCF, and NCI for all articles related to orthopaedic oncology. The Flesch-Kincaid (FK) readability score was calculated for each article and compared between sources. A total of 227 articles were identified with an overall mean FK grade level of 9.8. Stratified by source, the mean FK grade levels were 10.1, 9.6, 11.1, and 9.5 for the AAOS, ACS, BCF, and NCI, respectively (P < 0.003). Only 31 articles (14%) and 1 article (0.4%) were at or below the recommended eighth- and sixth-grade levels, respectively. Online patient education materials related to orthopaedic oncology appear to be written at a level above the comprehension ability of the average patient. Copyright 2015 by the American Academy of Orthopaedic Surgeons.

Enhancing the Radiologist-Patient Relationship through Improved Communication: A Quantitative Readability Analysis in Spine Radiology.

PubMed

Hansberry, D R; Donovan, A L; Prabhu, A V; Agarwal, N; Cox, M; Flanders, A E

2017-06-01

More than 75 million Americans have less than adequate health literacy skills according to the National Center for Education Statistics. Readability scores are used as a measure of how well populations read and understand patient education materials. The purpose of this study was to assess the readability of Web sites dedicated to patient education for radiologic spine imaging and interventions. Eleven search terms relevant to radiologic spine imaging were searched on the public Internet, and the top 10 links for each term were collected and analyzed to determine readability scores by using 10 well-validated quantitative readability assessments from patient-centered education Web sites. The search terms included the following: x-ray spine, CT spine, MR imaging spine, lumbar puncture, kyphoplasty, vertebroplasty, discogram, myelogram, cervical spine, thoracic spine, and lumbar spine. Collectively, the 110 articles were written at an 11.3 grade level (grade range, 7.1-16.9). None of the articles were written at the American Medical Association and National Institutes of Health recommended 3rd-to-7th grade reading levels. The vertebroplasty articles were written at a statistically significant ( P < .05) more advanced level than the articles for x-ray spine, CT spine, and MR imaging spine. Increasing use of the Internet to obtain health information has made it imperative that on-line patient education be written for easy comprehension by the average American. However, given the discordance between readability scores of the articles and the American Medical Association and National Institutes of Health recommended guidelines, it is likely that many patients do not fully benefit from these resources. © 2017 by American Journal of Neuroradiology.

Critical Analysis of the Quality, Readability, and Technical Aspects of Online Information Provided for Neck-Lifts.

PubMed

Rayess, Hani; Zuliani, Giancarlo F; Gupta, Amar; Svider, Peter F; Folbe, Adam J; Eloy, Jean Anderson; Carron, Michael A

2017-03-01

The number of patients using the internet to obtain health information is growing. This material is unregulated and heterogeneous and can influence patient decisions. To compare the quality, readability, and technical aspects of online information about neck-lifts provided by private practice websites vs academic medical centers and reference sources. In this cross-sectional analysis conducted between November 2015 and January 2016, a Google search of the term neck-lift was performed, and the first 45 websites were evaluated. The websites were categorized as private practice vs other. Private websites (PWs) included sites created by private practice physicians. Other websites (OWs) were created by academic medical centers or reference sources. Quality, readability, and technical aspects of online websites related to neck-lifts. Quality was assessed using the DISCERN criteria and the Health on the Net principles (HONcode). Readability was assessed using 7 validated and widely used criteria. Consensus US reading grade level readability was provided by a website (readabilityformulas.com). Twelve technical aspects were evaluated based on criteria specified by medical website creators. Forty-five websites (8 OWs [18%] and 37 PWs [82%]) were analyzed. There was a significant difference in quality between OWs and PWs based on the DISCERN criteria and HONcode principles. The DISCERN overall mean (SD) scores were 2.3 (0.5) for OWs and 1.3 (0.3) for PWs (P < .001). Of a total possible score of 14 using the HONcode analysis, the mean (SD) was 8.6 (1.8) (range, 5-11) for OW, and the mean (SD) was 5.8 (1.7) (range, 2-9) for PW. The mean (SD) readability consensus reading grade level scores were 11.7 (1.9) for OWs and 10.6 (1.9) for PWs. Of a total possible score of 12, the mean (SD) technical scores were 6.3 (1.8) (range, 4-9) for OWs and 6.4 (1.5) (range, 3-9) for PWs. Compared with PWs, OWs had a significantly higher quality score based on both the DISCERN criteria and HONcode principles. The mean readability for OWs and PWs was grade 11 and grade 10, respectively, significantly higher than the grade 7 level recommended by the National Institutes of Health. Assessment of technical criteria demonstrated room for improvement in providing links to social media and blogs and reducing advertisements. Improving the quality and readability of online information may result in increased patient understanding, more active patient involvement, and ultimately better outcomes. Enhancing the technical aspects of websites may increase website traffic and patient volume. NA.

Reading and Readability Affect on E-Learning Success in a Fortune 100 Company: A Correlational Study

ERIC Educational Resources Information Center

Finnegan, Denis Michael Thomas

2010-01-01

The purpose of this quantitative correlational study was to examine the relationship between employees' reading skills, E-learning readability, student learning, and student satisfaction. The Tests of Adult Basic Education (TABE) form 10 Level A instrument evaluated student-reading skills. The Flesch-Kincaid Grade Level Index course assessed…

The Reading Level of Government and Voluntary Health Organization Smoking Cessation Websites: A Descriptive Analysis

ERIC Educational Resources Information Center

Seitz, Christopher M.; Shiplo, Samantha; Filippini, Taylor; Kabir, Zubair; Lennon, Jeffrey L.; Fowler, Donald

2017-01-01

Background: The U.S. Department of Health & Human Services (USDHHS) recommends that health material be written at or below a sixth-grade reading level to ensure readability. Purpose: The aim of this study was to investigate the readability of online smoking cessation materials from several government and voluntary health organizations.…

Inflammatory bowel disease: An evaluation of health information on the internet.

PubMed

Azer, Samy A; AlOlayan, Thekra I; AlGhamdi, Malak A; AlSanea, Malak A

2017-03-07

To evaluate the quality and accuracy of websites written to the public on inflammatory bowel disease (IBD) (Crohn's disease and ulcerative colitis) and assess their readability level. Google™, Bing™, and Yahoo™ search engines were searched independently by three researchers in December 2014. Only English-language websites were selected on the basis of predetermined inclusion and exclusion criteria. Researchers independently evaluated the quality of each website by using the DISCERN and the HONcode instruments. The readability levels were calculated using two formulas; the Flesch-Kincaid Grade Level Index, and the Coleman-Liau Readability Index. The agreement between the evaluators was calculated using Cohen kappa coefficient. Eighty-four websites were finally identified. Scores varied from a minimum DISCERN score of 18 to a maximum of 68 [mean ± SD, 42.2 ± 10.7; median = 41.5, interquartile range, interquartile range (IQR) = 15.8] and a minimum score of HONcode of 0.14 and a maximum of 0.95 (mean ± SD, 0.16 ± 0.19; median = 0.45, IQR = 0.29). Most of these websites were reviewed in 2014 and 2015 ( n = 51). The creators of these websites were: universities and research centers ( n = 25, 30%), foundations and associations ( n = 15, 18%), commercial and pharmaceutical companies ( n = 25, 30%), charities and volunteer work ( n = 9, 10%), and non-university educational bodies ( n = 10, 12%). The Flesch-Kincaid Grade Level readability score (mean ± SD) was 11.9 ± 2.4 and the Coleman-Liau Readability Index score was 12.6 ± 1.5. Significant correlation was found between the two readability scores (R 2 = 0.509, P = 0.001). The overall agreement between evaluators measured by Cohen kappa coefficient was in the range of 0.804-0.876; rated as "Good". The DISCERN and the HONcode scores of websites varied and the readability levels of most websites were above the public readability level. The study highlights the areas that need further improvement and development in patient education online materials about IBD.

High Interest - Low Vocabulary Science Books, Reading Level Grades 1-4 (Prepared for the Remedial Reading Teacher).

ERIC Educational Resources Information Center

Gott, Margaret E., Comp.; Wailes, James R., Comp.

This booklist is intended for elementary school science students with high interest and low vocabulary skills. The Spache Readability Scale, Dale-Chall formula, sentence structure, paragraph flow, illustration, and diagram analysis or publishers stated grade level were used to determine grade level designations. The included interest level varies…

Evaluation of Quality and Readability of Health Information Websites Identified through India's Major Search Engines

PubMed Central

Raj, S.; Sharma, V. L.; Singh, A. J.; Goel, S.

2016-01-01

Background. The available health information on websites should be reliable and accurate in order to make informed decisions by community. This study was done to assess the quality and readability of health information websites on World Wide Web in India. Methods. This cross-sectional study was carried out in June 2014. The key words “Health” and “Information” were used on search engines “Google” and “Yahoo.” Out of 50 websites (25 from each search engines), after exclusion, 32 websites were evaluated. LIDA tool was used to assess the quality whereas the readability was assessed using Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), and SMOG. Results. Forty percent of websites (n = 13) were sponsored by government. Health On the Net Code of Conduct (HONcode) certification was present on 50% (n = 16) of websites. The mean LIDA score (74.31) was average. Only 3 websites scored high on LIDA score. Only five had readability scores at recommended sixth-grade level. Conclusion. Most health information websites had average quality especially in terms of usability and reliability and were written at high readability levels. Efforts are needed to develop the health information websites which can help general population in informed decision making. PMID:27119025

The readability of psychosocial wellness patient resources: improving surgical outcomes.

PubMed

Kugar, Meredith A; Cohen, Adam C; Wooden, William; Tholpady, Sunil S; Chu, Michael W

2017-10-01

Patient education is increasingly accessed with online resources and is essential for patient satisfaction and clinical outcomes. The average American adult reads at a seventh grade level, and the National Institute of Health (NIH) and the American Medical Association (AMA) recommend that information be written at a sixth-grade reading level. Health literacy plays an important role in the disease course and outcomes of all patients, including those with depression and likely other psychiatric disorders, although this is an area in need of further study. The purpose of this study was to collect and analyze written, online mental health resources on the Veterans Health Administration (VA) website, and other websites, using readability assessment instruments. An internet search was performed to identify written patient education information regarding mental health from the VA (the VA Mental Health Website) and top-rated psychiatric hospitals. Seven mental health topics were included in the analysis: generalized anxiety disorder, bipolar, major depressive disorder, posttraumatic stress disorder, schizophrenia, substance abuse, and suicide. Readability analyses were performed using the Gunning Fog Index, the Flesch-Kincaid Grade Level, the Coleman-Liau Index, the SMOG Readability Formula, and the Automated Readability Index. These scores were then combined into a Readability Consensus score. A two-tailed t-test was used to compare the mean values, and statistical significance was set at P < 0.05. Twelve of the best hospitals for psychiatry 2016-2017 were identified. Nine had educational material. Six of the nine cited the same resource, The StayWell Company, LLC (StayWell Company, LLC; Yardley, PA), for at least one of the mental health topics analyzed. The VA mental health website (http://www.mentalhealth.va.gov) had a significantly higher readability consensus than six of the top psychiatric hospitals (P < 0.05, P = 0.0067, P = 0.019, P = 0.041, P = 0.0093, P = 0.0054, and P = 0.0093). The overall average readability consensus for mental health information on all websites analyzed was 9.52. Online resources for mental health disorders are more complex than recommended by the NIH and AMA. Efforts to improve readability of mental health and psychosocial wellness resources could benefit patient understanding and outcomes, especially in patients with lower literacy. Surgical outcomes are correlated with patient mental health and psychosocial wellness and thus can be improved with more appropriate levels of readability of psychosocial wellness resources. Copyright © 2017 Elsevier Inc. All rights reserved.

An evaluation of the readability of drinking water quality reports: a national assessment.

PubMed

Roy, Siddhartha; Phetxumphou, Katherine; Dietrich, Andrea M; Estabrooks, Paul A; You, Wen; Davy, Brenda M

2015-09-01

The United States Environmental Protection Agency mandates that community water systems (or water utilities) provide annual consumer confidence reports (CCRs)--water quality reports--to their consumers. These reports encapsulate information regarding sources of water, detected contaminants, regulatory compliance, and educational material. These reports have excellent potential for providing the public with accurate information on the safety of tap water, but there is a lack of research on the degree to which the information can be understood by a large proportion of the population. This study evaluated the readability of a nationally representative sample of 30 CCRs, released between 2011 and 2013. Readability (or 'comprehension difficulty') was evaluated using Flesch-Kincaid readability tests. The analysis revealed that CCRs were written at the 11th-14th grade level, which is well above the recommended 6th-7th grade level for public health communications. The CCR readability ease was found to be equivalent to that of the Harvard Law Review journal. These findings expose a wide chasm that exists between current water quality reports and their effectiveness toward being understandable to US residents. Suggestions for reorienting language and scientific information in CCRs to be easily comprehensible to the public are offered.

Online Tonsillectomy Resources: Are Parents Getting Consistent and Readable Recommendations?

PubMed

Wozney, Lori; Chorney, Jill; Huguet, Anna; Song, Jin Soo; Boss, Emily F; Hong, Paul

2017-05-01

Objective Parents frequently refer to information on the Internet to confirm or broaden their understanding of surgical procedures and to research postoperative care practices. Our study evaluated the readability, comprehensiveness, and consistency around online recommendations directed at parents of children undergoing tonsillectomy. Study Design A cross-sectional study design was employed. Setting Thirty English-language Internet websites. Subjects and Methods Three validated measures of readability were applied and content analysis was employed to evaluate the comprehensiveness of information in domains of perioperative education. Frequency effect sizes and percentile ranks were calculated to measure dispersion of recommendations across sites. Results The mean readability level of all sites was above a grade 10 level with fewer than half of the sites (n = 14, 47%) scoring at or below the eight-grade level. Provided information was often incomplete with a noted lack of psychosocial support and skills-training recommendations. Content analysis showed 67 unique recommendations spanning the full perioperative period. Most recommendations had low consensus, being reported in 5 or fewer sites (frequency effect size <16%). Conclusion Many online parent-focused resources do not meet readability recommendations, portray incomplete education about perioperative care and expectations, and provide recommendations with low levels of consensus. Up-to-date mapping of the research evidence around recommendations is needed as well as improved efforts to make online information easier to read.

Readability and Comprehension of Self-Report Binge Eating Measures

PubMed Central

Richards, Lauren K.; McHugh, R. Kathryn; Pratt, Elizabeth M.; Thompson-Brenner, Heather

2013-01-01

The validity of self-report binge eating instruments among individuals with limited literacy is uncertain. This study aims to evaluate reading grade level and multiple domains of comprehension of 13 commonly used self-report assessments of binge eating for use in low-literacy populations. We evaluated self-report binge eating measures with respect to reading grade levels, measure length, formatting and linguistic problems. Results: All measures were written at a reading grade level higher than is recommended for patient materials (above the 5th to 6th grade level), and contained several challenging elements related to comprehension. Correlational analyses suggested that readability and comprehension elements were distinct contributors to measure difficulty. Individuals with binge eating who have low levels of educational attainment or limited literacy are often underrepresented in measure validation studies. Validity of measures and accurate assessment of symptoms depends on an individual's ability to read and comprehend instructions and items, and these may be compromised in populations with lower levels of literacy. PMID:23557814

Readability and comprehension of self-report binge eating measures.

PubMed

Richards, Lauren K; McHugh, R Kathryn; Pratt, Elizabeth M; Thompson-Brenner, Heather

2013-04-01

The validity of self-report binge eating instruments among individuals with limited literacy is uncertain. This study aims to evaluate reading grade level and multiple domains of comprehension of 13 commonly used self-report assessments of binge eating for use in low-literacy populations. We evaluated self-report binge eating measures with respect to reading grade levels, measure length, formatting and linguistic problems. All measures were written at a reading grade level higher than is recommended for patient materials (above the 5th to 6th grade level), and contained several challenging elements related to comprehension. Correlational analyses suggested that readability and comprehension elements were distinct contributors to measure difficulty. Individuals with binge eating who have low levels of educational attainment or limited literacy are often underrepresented in measure validation studies. Validity of measures and accurate assessment of symptoms depend on an individual's ability to read and comprehend instructions and items, and these may be compromised in populations with lower levels of literacy. Copyright © 2013 Elsevier Ltd. All rights reserved.

Can Patients Comprehend the Educational Materials that Hospitals Provide about Common IR Procedures?

PubMed

Sadigh, Gelareh; Hawkins, C Matthew; O'Keefe, John J; Khan, Ramsha; Duszak, Richard

2015-08-01

To assess the readability of online education materials offered by hospitals describing commonly performed interventional radiology (IR) procedures. Online patient education materials from 402 hospitals selected from the Medicare Hospital Compare database were assessed. The presence of an IR service was determined by representation in the Society of Interventional Radiology physician finder directory. Patient online education materials about (i) uterine artery embolization for fibroid tumors, (ii) liver cancer embolization, (iii) varicose vein treatment, (iv) central venous access, (v) inferior vena cava (IVC) filter placement, (vi) nephrostomy tube insertion, (vii) gastrostomy tube placement, and (viii) vertebral augmentation were targeted and assessed by using six validated readability scoring systems. Of 402 hospitals sampled, 156 (39%) were presumed to offer IR services. Of these, 119 (76%) offered online patient education material for one or more of the eight service lines. The average readability scores corresponding to grade varied between the ninth- and 12th-grade levels. All were higher than the recommended seventh-grade level (P < .05) except for nephrostomy and gastrostomy tube placement. Average Flesch-Kincaid Reading Ease scores ranged from 42 to 69, corresponding with fairly difficult to difficult readability for all service lines except IVC filter and gastrostomy tube placement, which corresponded with standard readability. A majority of hospitals offering IR services provide at least some online patient education material. Most, however, are written significantly above the reading comprehension level of most Americans. More attention to health literacy by hospitals and IR physicians is warranted. Copyright © 2015 SIR. Published by Elsevier Inc. All rights reserved.

The Evaluation of High School Geography 9 and High School Geography 11 Text Books with Some Formulas of Readability

ERIC Educational Resources Information Center

Gecit, Yilmaz

2010-01-01

The purpose of this study is to evaluate readability of 9th and 11th grade geography text-books currently used in schools. As known, one of the most fundamental features in a text-book is the readability of the text by students. In addition, it is also very important that the fluency and suitability of books match age level. In this study, the…

Factors Influencing the Readability of Student-Generated Texts.

ERIC Educational Resources Information Center

Allen, JoBeth

An investigation examined student-generated texts in terms of both traditional and more theoretically valid readability to determine what factors influence comprehension when children read their own, peer, and adult-written texts. Seventy dictated stories created in an earlier study, along with 4 first-grade level stories from the "Reader's…

Online palliative care and oncology patient education resources through Google: Do they meet national health literacy recommendations?

PubMed

Prabhu, Arpan V; Crihalmeanu, Tudor; Hansberry, David R; Agarwal, Nitin; Glaser, Christine; Clump, David A; Heron, Dwight E; Beriwal, Sushil

The Google search engine is a resource commonly used by patients to access health-related patient education information. The American Medical Association and National Institutes of Health recommend that patient education resources be written at a level between the third and seventh grade reading levels. We assessed the readability levels of online palliative care patient education resources using 10 readability algorithms widely accepted in the medical literature. In October 2016, searches were conducted for 10 individual terms pertaining to palliative care and oncology using the Google search engine; the first 10 articles written for the public for each term were downloaded for a total of 100 articles. The terms included palliative care, hospice, advance directive, cancer pain management, treatment of metastatic disease, treatment of brain metastasis, treatment of bone metastasis, palliative radiation therapy, palliative chemotherapy, and end-of-life care. We determined the average reading level of the articles by readability scale and Web site domain. Nine readability assessments with scores equivalent to academic grade level found that the 100 palliative care education articles were collectively written at a 12.1 reading level (standard deviation, 2.1; range, 7.6-17.3). Zero articles were written below a seventh grade level. Forty-nine (49%) articles were written above a high school graduate reading level. The Flesch Reading Ease scale classified the articles as "difficult" to read with a score of 45.6 of 100. The articles were collected from 62 Web site domains. Seven domains were accessed 3 or more times; among these, www.mskcc.org had the highest average reading level at a 14.5 grade level (standard deviation, 1.4; range, 13.4-16.1). Most palliative care education articles readily available on Google are written above national health literacy recommendations. There is need to revise these resources to allow patients and their families to derive the most benefit from these materials. Copyright © 2017 729. Published by Elsevier Inc. All rights reserved.

How reliable is computerized assessment of readability?

PubMed

Mailloux, S L; Johnson, M E; Fisher, D G; Pettibone, T J

1995-01-01

To assess the consistency and comparability of readability software programs, four software programs (Corporate Voice, Grammatix IV, Microsoft Word for Windows, and RightWriter) were compared. Standard materials included 28 pieces of printed educational materials on human immunodeficiency virus/acquired immunodeficiency syndrome distributed nationally and the Gettysburg Address. Statistical analyses for the educational materials revealed that each of the three formulas assessed (Flesch-Kincaid, Flesch Reading Ease, and Gunning Fog Index) provided significantly different grade equivalent scores and that the Microsoft Word program provided significantly lower grade levels and was more inconsistent in the scores provided. For the Gettysburg Address, considerable variation was revealed among formulas, with the discrepancy being up to two grade levels. When averaging across formulas, there was a variation of 1.3 grade levels between the four software programs. Given the variation between formulas and programs, implications for decisions based on results of these software programs are provided.

The Readability of Online Patient Information About Mohs Micrographic Surgery.

PubMed

Vargas, Christina R; DePry, Jennifer; Lee, Bernard T; Bordeaux, Jeremy S

2016-10-01

Mohs micrographic surgery has become increasingly used in the treatment of cutaneous malignancies over the past decade. Concurrently, more patients are using the Internet as a resource for medical information than ever before. The average American adult reads at an eighth grade level. The American Medical Association and National Institutes of Health have recommended a sixth grade target reading level for patient health materials. This study evaluates the readability of currently available online information about Mohs micrographic surgery in the context of these recommendations. An Internet search for the term "Mohs surgery" was performed and the first 10 results were identified. Patient information from each primary site was downloaded and formatted into plain text. Readability was assessed using 9 established tests; text was analyzed both overall and by Web site for comparison. A total of 101 articles were collected from the first 10 Web site search results; the overall average reading level was 14.4. All articles exceeded the recommended sixth grade reading level. Online resources about Mohs micrographic surgery are too difficult for many patients to read. The paucity of appropriately written patient information available on the Internet may hinder informed decision-making, participation, and subsequent postoperative satisfaction.

Mammography Patient Information at Hospital Websites: Most Neither Comprehensible Nor Guideline Supported.

PubMed

Sadigh, Gelareh; Singh, Kush; Gilbert, Kirven; Khan, Ramsha; Duszak, Abigail M; Duszak, Richard

2016-11-01

Ongoing controversy regarding screening mammography guidelines has created confusion for many patients. Given recommendations that patient educational material be prepared at or below the 7th grade reading level of average Americans, the purpose of this study was to assess the readability of online mammography information offered by hospitals nationwide. During 2015, online mammography patient educational materials were identified for all Medicare-recognized hospitals nationwide for which screening mammography metrics were publicly available. Patient educational materials were assessed using six validated readability score algorithms. All references to official screening guidelines were captured. Of 4105 hospitals nationwide, 3252 had websites and confirmable screening mammography services. Of those, 1753 (54%) offered mammography information material online. Only 919 (28%) referenced any professional society guidelines. After excluding information not formatted in HTML and shorter than 100 words (to improve algorithm reliability), 1524 hospital mammography webpages were assessed for grade level scores. Nationally, the mean of each readability score for all hospitals varied between the 10th and 14th grade levels, all higher than the recommended 7th grade level (p < 0.001). At the individual hospital level, only 14 hospitals (0.4%) had mean scores at or below the 7th grade level. Of U.S. hospitals that offer screening mammography and have websites, only 54% provide online mammography educational material. Of those, only 0.4% present information at a reading level comprehensible to average Americans, and only 28% offer specific information to help patients reconcile conflicting guidelines. Health systems offering mammography should strive to better meet women's health information and literacy needs.

Quantitative analysis of the level of readability of online emergency radiology-based patient education resources.

PubMed

Hansberry, David R; D'Angelo, Michael; White, Michael D; Prabhu, Arpan V; Cox, Mougnyan; Agarwal, Nitin; Deshmukh, Sandeep

2018-04-01

The vast amount of information found on the internet, combined with its accessibility, makes it a widely utilized resource for Americans to find information pertaining to medical information. The field of radiology is no exception. In this paper, we assess the readability level of websites pertaining specifically to emergency radiology. Using Google, 23 terms were searched, and the top 10 results were recorded. Each link was evaluated for its readability level using a set of ten reputable readability scales. The search terms included the following: abdominal ultrasound, abdominal aortic aneurysm, aortic dissection, appendicitis, cord compression, CT abdomen, cholecystitis, CT chest, diverticulitis, ectopic pregnancy, epidural hematoma, dural venous thrombosis, head CT, MRI brain, MR angiography, MRI spine, ovarian torsion, pancreatitis, pelvic ultrasound, pneumoperitoneum, pulmonary embolism, subarachnoid hemorrhage, and subdural hematoma. Any content that was not written for patients was excluded. The 230 articles that were assessed were written, on average, at a 12.1 grade level. Only 2 of the 230 articles (1%) were written at the third to seventh grade recommended reading level set forth by the National Institutes of Health (NIH) and American Medical Association (AMA). Fifty-two percent of the 230 articles were written so as to require a minimum of a high school education (at least a 12th grade level). Additionally, 17 of the 230 articles (7.3%) were written at a level that exceeded an undergraduate education (at least a 16th grade level). The majority of websites with emergency radiology-related patient education materials are not adhering to the NIH and AMA's recommended reading levels, and it is likely that the average reader is not benefiting fully from these information outlets. With the link between health literacy and poor health outcomes, it is important to address the online content in this area of radiology, allowing for patient to more fully benefit from their online searches.

Readability assessment of online ophthalmic patient information.

PubMed

Edmunds, Matthew R; Barry, Robert J; Denniston, Alastair K

2013-12-01

Patients increasingly use the Internet to access information related to their disease, but poor health literacy is known to impact negatively on medical outcomes. Multiple agencies have recommended that patient-oriented literature be written at a fourth- to sixth-grade (9-12 years of age) reading level to assist understanding. The readability of online patient-oriented materials related to ophthalmic diagnoses is not yet known. To assess the readability of online literature specifically for a range of ophthalmic conditions. Body text of the top 10 patient-oriented websites for 16 different ophthalmic diagnoses, covering the full range of ophthalmic subspecialties, was analyzed for readability, source (United Kingdom vs non-United Kingdom, not for profit vs commercial), and appropriateness for sight-impaired readers. Four validated readability formulas were used: Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG), and Gunning Fog Index (GFOG). Data were compared with the Mann-Whitney test (for 2 groups) and Kruskal-Wallis test (for more than 2 groups) and correlation was assessed by the Spearman r. None of the 160 webpages had readability scores within published guidelines, with 83% assessed as being of "difficult" readability. Not-for-profit webpages were of significantly greater length than commercial webpages (P = .02) and UK-based webpages had slightly superior readability scores compared with those of non-UK webpages (P = .004 to P < .001, depending on the readability formula used). Of all webpages evaluated, only 34% included facility to adjust text size to assist visually impaired readers. To our knowledge, this is the first study to assess readability of patient-focused webpages specifically for a range of ophthalmic diagnoses. In keeping with previous studies in other medical conditions, we determined that readability scores were inferior to those recommended, irrespective of the measure used. Although readability is only one aspect of how well a patient-oriented webpage may be comprehended, we recommend the use of readability scoring when producing such resources in the future. Minimum readability policies and inclusion of facilities within webpages to maximize viewing potential for visually impaired readers are important to ensure that online ophthalmic patient information is accessible to the broadest audience possible.

A Study of the Measured Readability Level of Selected Intermediate Grade Social Studies Textbooks.

ERIC Educational Resources Information Center

DuVall, Charles R.

It was the purpose of this study to determine the readability level of all social studies textbooks authorized for purchase in the adoption made by the Textbook Commission of the Indiana State Board of Education on December 12, 1968 for five years beginning July 1, 1969. A thorough search of the literature and research did not reveal that their…

Assessing reading levels of health information: uses and limitations of flesch formula.

PubMed

Jindal, Pranay; MacDermid, Joy C

2017-01-01

Written health information is commonly used by health-care professionals (HCPs) to inform and assess patients in clinical practice. With growing self-management of many health conditions and increased information seeking behavior among patients, there is a greater stress on HCPs and researchers to develop and implement readable and understandable health information. Readability formulas such as Flesch Reading Ease (FRE) and Flesch-Kincaid Reading Grade Level (FKRGL) are commonly used by researchers and HCPs to assess if health information is reading grade appropriate for patients. In this article, we critically analyze the role and credibility of Flesch formula in assessing the reading level of written health information. FRE and FKRGL assign a grade level by measuring semantic and syntactic difficulty. They serve as a simple tool that provides some information about the potential literacy difficulty of written health information. However, health information documents often involve complex medical words and may incorporate pictures and tables to improve the legibility. In their assessments, FRE and FKRGL do not take into account (1) document factors (layout, pictures and charts, color, font, spacing, legibility, and grammar), (2) person factors (education level, comprehension, health literacy, motivation, prior knowledge, information needs, anxiety levels), and (3) style of writing (cultural sensitivity, comprehensiveness, and appropriateness), and thus, inadequately assess reading level. New readability measures incorporate pictures and use complex algorithms to assess reading level but are only moderately used in health-care research and not in clinical practice. Future research needs to develop generic and disease-specific readability measures to evaluate comprehension of a written document based on individuals' literacy levels, cultural background, and knowledge of disease.

Creating a Gold Standard for the Readability Measurement of Health Texts

PubMed Central

Kandula, Sasikiran; Zeng-Treitler, Qing

2008-01-01

Developing easy-to-read health texts for consumers continues to be a challenge in health communication. Though readability formulae such as Flesch-Kincaid Grade Level have been used in many studies, they were found to be inadequate to estimate the difficulty of some types of health texts. One impediment to the development of new readability assessment techniques is the absence of a gold standard that can be used to validate them. To overcome this deficiency, we have compiled a corpus of 324 health documents consisting of six different types of texts. These documents were manually reviewed and assigned a readability level (1-7 Likert scale) by a panel of five health literacy experts. The expert assigned ratings were found to be highly correlated with a patient representative’s readability ratings (r = 0.81, p<0.0001). PMID:18999150

THE READABILITY OF SCIENCE TEXTBOOKS FOR ELEMENTARY SCHOOL.

ERIC Educational Resources Information Center

NEWPORT, JOHN F.

AN INVESTIGATION WAS MADE OF THE READABILITY LEVELS OF NINE CONTINUOUS SERIES OF ELEMENTARY SCHOOL SCIENCE TEXTBOOKS, GRADES 1-6. THE FOLLOWING SCIENCE SERIES WERE EVALUATED--ALLYN AND BACON, AMERICAN BOOK COMPANY, GINN, HARPER AND ROW, HEATH, LYONS AND CARNAHAN, MACMILLAN, SINGER, AND WINSTON. THE SPACHE FORMULA (SAFIER METHOD) WAS APPLIED TO…

Readability of menopause web sites: a cross-sectional study.

PubMed

Charbonneau, Deborah H

2012-01-01

More women are frequently referring to the Internet for health information, yet the readability of information about menopause on the Internet has not been widely studied. To address this gap, this study examined the readability of information about menopause on 25 Internet Web sites. Findings included that information on the Web sites had a reading level higher than the recommended sixth-grade level, and culturally appropriate health information was lacking. Health educators and practitioners are in a pivotal role to help women understand information useful for healthcare decisions. Several criteria are discussed to help practitioners evaluate Web sites.

Inflammatory bowel disease: An evaluation of health information on the internet

PubMed Central

Azer, Samy A; AlOlayan, Thekra I; AlGhamdi, Malak A; AlSanea, Malak A

2017-01-01

AIM To evaluate the quality and accuracy of websites written to the public on inflammatory bowel disease (IBD) (Crohn's disease and ulcerative colitis) and assess their readability level. METHODS Google™, Bing™, and Yahoo™ search engines were searched independently by three researchers in December 2014. Only English-language websites were selected on the basis of predetermined inclusion and exclusion criteria. Researchers independently evaluated the quality of each website by using the DISCERN and the HONcode instruments. The readability levels were calculated using two formulas; the Flesch-Kincaid Grade Level Index, and the Coleman-Liau Readability Index. The agreement between the evaluators was calculated using Cohen kappa coefficient. RESULTS Eighty-four websites were finally identified. Scores varied from a minimum DISCERN score of 18 to a maximum of 68 [mean ± SD, 42.2 ± 10.7; median = 41.5, interquartile range, interquartile range (IQR) = 15.8] and a minimum score of HONcode of 0.14 and a maximum of 0.95 (mean ± SD, 0.16 ± 0.19; median = 0.45, IQR = 0.29). Most of these websites were reviewed in 2014 and 2015 (n = 51). The creators of these websites were: universities and research centers (n = 25, 30%), foundations and associations (n = 15, 18%), commercial and pharmaceutical companies (n = 25, 30%), charities and volunteer work (n = 9, 10%), and non-university educational bodies (n = 10, 12%). The Flesch-Kincaid Grade Level readability score (mean ± SD) was 11.9 ± 2.4 and the Coleman-Liau Readability Index score was 12.6 ± 1.5. Significant correlation was found between the two readability scores (R2 = 0.509, P = 0.001). The overall agreement between evaluators measured by Cohen kappa coefficient was in the range of 0.804-0.876; rated as "Good". CONCLUSION The DISCERN and the HONcode scores of websites varied and the readability levels of most websites were above the public readability level. The study highlights the areas that need further improvement and development in patient education online materials about IBD. PMID:28321169

Readability Assessment of Internet-Based Patient Education Materials Related to Parathyroid Surgery.

PubMed

Patel, Chirag R; Sanghvi, Saurin; Cherla, Deepa V; Baredes, Soly; Eloy, Jean Anderson

2015-07-01

Patient education is critical in obtaining informed consent and reducing preoperative anxiety. Written patient education material (PEM) can supplement verbal communication to improve understanding and satisfaction. Published guidelines recommend that health information be presented at or below a sixth-grade reading level to facilitate comprehension. We investigate the grade level of online PEMs regarding parathyroid surgery. A popular internet search engine was used to identify PEM discussing parathyroid surgery. Four formulas were used to calculate readability scores: Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (FKGL), Gunning Frequency of Gobbledygook (GFOG), and Simple Measure of Gobbledygook (SMOG). Thirty web-based articles discussing parathyroid surgery were identified. The average FRE score was 42.8 (±1 standard deviation [SD] 16.3; 95% confidence interval [CI], 36.6-48.8; range, 6.1-71.3). The average FKGL score was 11.7 (±1 SD 3.3; 95% CI, 10.5-12.9; range, 6.1-19.0). The SMOG scores averaged 14.2 (±1 SD 2.6; 95% CI, 13.2-15.2; range, 10.7-21.9), and the GFOG scores averaged 15.0 (±1 SD 3.5; 95% CI, 13.7-16.3; range, 10.6-24.8). Online PEM on parathyroid surgery is written above the recommended sixth-grade reading level. Improving readability of PEM may promote better health education and compliance. © The Author(s) 2015.

Radiation Oncology and Online Patient Education Materials: Deviating From NIH and AMA Recommendations.

PubMed

Prabhu, Arpan V; Hansberry, David R; Agarwal, Nitin; Clump, David A; Heron, Dwight E

2016-11-01

Physicians encourage patients to be informed about their health care options, but much of the online health care-related resources can be beneficial only if patients are capable of comprehending it. This study's aim was to assess the readability level of online patient education resources for radiation oncology to conclude whether they meet the general public's health literacy needs as determined by the guidelines of the United States National Institutes of Health (NIH) and the American Medical Association (AMA). Radiation oncology-related internet-based patient education materials were downloaded from 5 major professional websites (American Society for Radiation Oncology, American Association of Physicists in Medicine, American Brachytherapy Society, RadiologyInfo.org, and Radiation Therapy Oncology Group). Additional patient education documents were downloaded by searching for key radiation oncology phrases using Google. A total of 135 articles were downloaded and assessed for their readability level using 10 quantitative readability scales that are widely accepted in the medical literature. When all 10 assessment tools for readability were taken into account, the 135 online patient education articles were written at an average grade level of 13.7 ± 2.0. One hundred nine of the 135 articles (80.7%) required a high school graduate's comprehension level (12th-grade level or higher). Only 1 of the 135 articles (0.74%) met the AMA and NIH recommendations for patient education resources to be written between the third-grade and seventh-grade levels. Radiation oncology websites have patient education material written at an educational level above the NIH and AMA recommendations; as a result, average American patients may not be able to fully understand them. Rewriting radiation oncology patient education resources would likely contribute to the patients' understanding of their health and treatment options, making each physician-patient interaction more productive and efficient. Copyright © 2016 Elsevier Inc. All rights reserved.

Radiation Oncology and Online Patient Education Materials: Deviating From NIH and AMA Recommendations

DOE Office of Scientific and Technical Information (OSTI.GOV)

Prabhu, Arpan V.; Hansberry, David R.; Agarwal, Nitin

Purpose: Physicians encourage patients to be informed about their health care options, but much of the online health care–related resources can be beneficial only if patients are capable of comprehending it. This study's aim was to assess the readability level of online patient education resources for radiation oncology to conclude whether they meet the general public's health literacy needs as determined by the guidelines of the United States National Institutes of Health (NIH) and the American Medical Association (AMA). Methods: Radiation oncology–related internet-based patient education materials were downloaded from 5 major professional websites (American Society for Radiation Oncology, American Associationmore » of Physicists in Medicine, American Brachytherapy Society, (RadiologyInfo.org), and Radiation Therapy Oncology Group). Additional patient education documents were downloaded by searching for key radiation oncology phrases using Google. A total of 135 articles were downloaded and assessed for their readability level using 10 quantitative readability scales that are widely accepted in the medical literature. Results: When all 10 assessment tools for readability were taken into account, the 135 online patient education articles were written at an average grade level of 13.7 ± 2.0. One hundred nine of the 135 articles (80.7%) required a high school graduate's comprehension level (12th-grade level or higher). Only 1 of the 135 articles (0.74%) met the AMA and NIH recommendations for patient education resources to be written between the third-grade and seventh-grade levels. Conclusion: Radiation oncology websites have patient education material written at an educational level above the NIH and AMA recommendations; as a result, average American patients may not be able to fully understand them. Rewriting radiation oncology patient education resources would likely contribute to the patients' understanding of their health and treatment options, making each physician-patient interaction more productive and efficient.« less

Readability of Hospice Materials to Prepare Families for Caregiving at the Time of Death

PubMed Central

Kehl, Karen A.; McCarty, Kayla N.

2012-01-01

Many health care materials are not written at levels that can be understood by most lay people. In this descriptive study, we examined the readability of documents used by hospices to prepare families for caregiving at the time of death. We used two common formulae to examine the documents. The mean Flesch-Kincaid grade level was 8.95 (SD 1.80). The mean Simple Measure of Gobbledygook grade level was 11.06 (SD 1.36). When we used the Colors Label Ease for Adult Readers instrument, it became evident that medical terminology was the primary reason for the high grade levels. Most documents (78%) included medical terms that were directly (46.2%) or indirectly (25.6%) explained in the text. Modification of hospice materials could improve families’ comprehension of information important for optimal end-of-life care. PMID:22492500

Uterine Artery Embolization: An Analysis of Online Patient Information Quality and Readability with Historical Comparison.

PubMed

Murray, Timothy E; Mansoor, Tayyaub; Bowden, Dermot J; O'Neill, Damien C; Lee, Michael J

2018-05-01

Investigators aimed to assess online information describing uterine artery embolization (UAE) to examine the quality and readability of websites patients are accessing. A list of applicable, commonly used searchable terms was generated, including "Uterine Artery Embolization," "Fibroid Embolization," "Uterine Fibroid Embolization," and "Uterine Artery Embolisation." Each possible term was assessed across the five most-used English language search engines to determine the most commonly used term. The most common term was then investigated across each search engine, with the first 25 pages returned by each engine included for analysis. Duplicate pages, nontext content such as video or audio, and pages behind paywalls were excluded. Pages were analyzed for quality and readability using validated tools including DISCERN score, JAMA Benchmark Criteria, HONcode Certification, Flesch Reading Ease Score, Flesch-Kincaid Grade Level, and Gunning-Fog Index. Secondary features such as age, rank, author, and publisher were recorded. The most common applicable term was "Uterine Artery Embolization" (492,900 results). Mean DISCERN quality of information provided by UAE websites is "fair"; however, it has declined since comparative 2012 studies. Adherence to JAMA Benchmark Criteria has reduced to 6.7%. UAE website readability remains more difficult than the World Health Organization-recommended 7-8th grade reading levels. HONcode-certified websites (35.6%) demonstrated significantly higher quality than noncertified websites. Quality of online UAE information remains "fair." Adherence to JAMA benchmark criteria is poor. Readability is above recommended 7-8th grade levels. HONcode certification was predictive of higher website quality, a useful guide to patients requesting additional information. Copyright © 2018 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

Quality and readability of websites for patient information on tonsillectomy and sleep apnea.

PubMed

Chi, Ethan; Jabbour, Noel; Aaronson, Nicole Leigh

2017-07-01

Tonsillectomy is a common treatment for obstructive sleep apnea (OSA). The Internet allows patients direct access to medical information. Since information on the Internet is largely unregulated, quality and readability are variable. This study evaluates the quality and readability of the most likely visited websites presenting information on sleep apnea and tonsillectomy. The three most popular search engines (Google, Bing, Yahoo) were queried with the phrase "sleep apnea AND tonsillectomy." The DISCERN instrument was used to assess quality of information. Readability was evaluated using the Flesch-Kincaid Reading Grade Level (FKGL) and Flesch Reading Ease Score (FRES). Out of the maximum of 80, the average DISCERN quality score for the websites was 55.1 (SD- 12.3, Median- 60.5). The mean score for FRES was 42.3 (SD- 15.9, Median- 45.5), which falls in the range defined as difficult. No website was above the optimal score of 65. The mean score for the FKGL was US grade-level of 10.7 (SD- 1.6, Median- 11.6). Only 4(27%) websites were in the optimal range of 6-8. There was very weak correlation between FRES and DISCERN (r = 0.07) and FKGL and DISCERN (r = 0.21). Tonsillectomy is one of the most common surgeries in the US. However, the internet information readily available to patients varies in quality. Additionally, much of the information is above the recommended grade level for comprehension by the public. By being aware of what information patients are reading online, physicians can better explain treatments and address misunderstandings. Physicians may consider using similar methods to test the readability for their own resources for patient education. Copyright © 2017 Elsevier B.V. All rights reserved.

Radiology Online Patient Education Materials Provided by Major University Hospitals: Do They Conform to NIH and AMA Guidelines?

PubMed

Prabhu, Arpan V; Donovan, Ashley L; Crihalmeanu, Tudor; Hansberry, David R; Agarwal, Nitin; Beriwal, Sushil; Kale, Hrishikesh; Heller, Matthew

The internet creates opportunities for Americans to access medical information about imaging tests and modalities to guide them in their medical decision-making. Owing to health literacy variations in the general population, the American Medical Association and National Institutes of Health recommend patient education resources to be written between the third and seventh grade levels. Our purpose is to quantitatively assess the readability levels of online radiology educational materials, written for the public, in 20 major university hospitals. In September and October 2016, we identified 20 major university hospitals with radiology residency-affiliated hospital systems. On each hospital׳s website, we downloaded all radiology-related articles written for patient use. A total of 375 articles were analyzed for readability level using 9 quantitative readability scales that are well validated in the medical literature. The 375 articles from 20 hospital systems were collectively written at an 11.4 ± 3.0 grade level (range: 8.4-17.1). Only 11 (2.9%) articles were written at the recommended third to seventh grade levels. Overall, 126 (33.6%) were written above a full high-school reading level. University of Washington Medical Center׳s articles were the most readable with a reading level corresponding to 7.9 ± 0.9. The vast majority of websites at major academic hospitals with radiology residencies designed to provide patients with information about imaging were written above the nationally recommended health literacy guidelines to meet the needs of the average American. This may limit the benefit that patients can derive from these educational materials. Copyright © 2018 Elsevier Inc. All rights reserved.

Printed health information materials: evaluation of readability and suitability.

PubMed

Shieh, Carol; Hosei, Barbara

2008-01-01

This study examined readability and suitability of printed health information materials colleted from multiple sources. In phase I, nursing students used Simple Measure of Gobbledygook (SMOG; McLaughlin, 1969) to assess the readability of 21 materials collected from the community. In phases II and III, nursing students and registered nurses used SMOG and the Suitability Assessment of Materials (SAM; Doak, Doak, & Root, 1996) to evaluate 15 prenatal materials from a Healthy Start program. SMOG assigns a reading grade level based on the number of words with 3 or more syllables. SAM has 22 items in 6 evaluation areas: content, literacy demand, graphics, layout and typography, learning stimulation and motivation, and cultural appropriateness. Major findings included that 53% to 86% of the printed materials had a reading level at or higher than 9th grade; materials lacked summary, interaction, and modeled behaviors, and registered nurses rated more materials as not suitable and fewer as superior for suitability qualities than students. Improving printed materials to have lower reading levels and better suitability qualities are indicated.

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

PubMed

Akinleye, Sheriff D; Garofolo-Gonzalez, Garret; Montuori, Michael; Culbertson, Maya Deza; Hashem, Jennifer; Edelstein, David Marc

2017-08-01

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. 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. 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. 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.

Colorectal cancer screening patient education materials-how effective is online health information?

PubMed

John, Elizabeth Sheena; John, Ann M; Hansberry, David R; Thomas, Prashant J; Agarwal, Prateek; Deitch, Christopher; Chokhavatia, Sita

2016-12-01

Patients screened for colorectal cancer (CRC) frequently turn to the Internet to improve their understanding of tests used for detection, including colonoscopy, flexible sigmoidoscopy, fecal occult blood test (FOBT), and CT colonography. It was of interest to determine the quality and readability levels of online health information. The screening tools were googled, and the top 20 results of each test were analyzed for readability, accessibility, usability, and reliability. The 80 articles excluded scientific literature and blogs. We used ten validated readability scales to measure grade levels, and one-way ANOVA and Tukey's honestly statistical different (HSD) post hoc analyses to determine any statistically significant differences among the four diagnostic tests. The LIDA tool assessed overall quality by measuring accessibility, usability, and reliability. The 80 articles were written at an 11.7 grade level, with CT colonography articles written at significantly higher levels than FOBT articles, F(3, 75) = 3.07, p = 0.033. LIDA showed moderate percentages in accessibility (83.9 %), usability (73.0 %), and reliability (75.9 %). Online health information about CRC screening tools are written at higher levels than the National Institute of Health (NIH) and American Medical Association (AMA) recommended third to seventh grade levels. More patients could benefit from this modality of information if it were written at a level and quality that would better facilitate understanding.

Health literacy and the readability of written information for hormone therapies.

PubMed

Charbonneau, Deborah H

2013-01-01

Health education and counseling are important elements of the care provided by clinicians. Counseling efforts may involve helping women to understand their options for symptom management related to various reproductive life transitions. In light of this, the need for information during the menopausal transition is critical for assisting women with their health care decisions. Yet the Institute of Medicine estimates that approximately half the adult population in the United States has difficulty understanding and using health information. The US Food and Drug Administration (FDA) mandates the distribution of written information for estrogen-containing products; however, the readability of information for these pharmaceutical products has not been widely studied. To address this gap, this study examined the readability of written information for FDA-approved prescription menopausal hormone therapies (N = 31). Readability of the written information about hormone therapies from 31 hormone therapy products was assessed using the Flesch Reading Ease and Flesch-Kincaid Grade Level formulas. The reading level ranged from 6.70 to 12.30, with an average grade level of 9.33 (ninth-grade reading level). All but one of the hormone therapy products evaluated in this study exceeded the recommended sixth-grade reading level for written health information. In addition, only 48% of the written information instructions in the study sample (n = 15) included illustrations. Assessment of written information about menopausal hormone therapies showed that the majority of the materials are written at a high reading level. These findings have implications for health literacy and counseling efforts when helping women to understand their options for menopausal symptom management. Midwives, nurses, and other health care providers may need to supplement written information with additional consumer-friendly written information, utilize illustrations, and use verbal instructions more frequently to help support women in evaluating their treatment options. © 2013 by the American College of Nurse-Midwives.

How Effective Are Patient Education Materials in Educating Patients?

PubMed

Keçeci, Ayla; Toprak, Sadiye; Kiliç, Seçil

2017-11-01

The aim of this research was to evaluate the patient education materials prepared and published by nurses and physicians in terms of the qualitative properties of these materials, including readability, understandability, and actionability. A total of 38 patient education materials prepared by nurses and physicians in a university hospital in Turkey were evaluated. The readability of the materials was assessed using the formulas proposed by Atesman and Cetinkaya. The Patient Education Materials Assessment Tool (PEMAT) form was used for estimating the understandability and actionability. Data were analyzed using the percentile and mean values, and the Kendall's Tau-c and correlation tests were used for interobserver agreement. According to the assessments based on the readability formulas, 55.3% of the materials were moderately difficult, while 81.6% had instructional-level readability (U.S. Grades 8 and 9) with a moderate to low level of understandability and actionability. Consequently, the patient education materials evaluated in our study had a moderate level of readability, understandability, and actionability.

Assessing the readability of thirty-nine behavior-modification training manuals and primers

PubMed Central

Andrasik, Frank; Murphy, William D.

1977-01-01

Thirty-nine behavior-modification training manuals and primers, sampling various topical areas, were subjected to a readability analysis. Reading-ease scores were computed by the formula developed by Flesch. The texts sampled ranged from very difficult (appropriate for college graduates) to fairly easy (appropriate for readers at the seventh-grade level). PMID:16795559

Readability of Magazines of Interest to Reading-Deficit Students.

ERIC Educational Resources Information Center

Miller, Maurice; And Others

The reading abilities of low achieving high school students at two schools were compared to the readability levels of the magazines in which they showed interest. The median tested reading ability of these students was reported as third/fourth grade by their reading teachers. The reading specialist at one high school reported that boys had an…

Assessing Readability and Reliability of Online Patient Information Regarding Vestibular Schwannoma.

PubMed

Spiers, Harry; Amin, Nikul; Lakhani, Raj; Martin, Andrew J; Patel, Parag M

2017-12-01

The aim of this study is to objectively assess the quality and readability of websites related to vestibular schwannomas. Patients are increasingly seeking information on confirmed or suspected diagnoses through the Internet. Clinicians are often concerned regarding the accuracy, quality, and readability of web-based sites. Online information relating to vestibular schwannoma was searched using the three most popular search engines. The terms "acoustic neuroma" and "vestibular schwannoma" were used. The top 50 results from each site were assessed for readability using the Flesch-Kincaid Grade Level, Flesch Reading Ease Score, and the Gunning-Fog Index. Quality of website information was scored using the DISCERN tool. Of 300 search results analyzed, 58 separate appropriate websites were identified. The mean readability score using Flesch-Kincaid Grade Level was 10.27 (95% confidence interval [CI] 9.84-10.70). The mean Flesch Reading Ease Score was 48.75 (95% CI 46.57-50.92). The Gunning-Fog Index was 13.40 (95% CI 12.92-13.89). These scores equate to someone finishing secondary school/first year university student. DISCERN scores were highly variable but consistently demonstrated great variability in quality of information. Online patient information on vestibular schwannoma is highly variable in quality. Although there are a wide range of different websites easily available to patients on their condition and its treatment options, the information is written at a difficult level which may exceed the understanding level of many patients as it is written at a higher than average level of expected reading ability.

National Survey of Patients’ Bill of Rights Statutes

PubMed Central

Jacob, Dan M.; Hochhauser, Mark; Parker, Ruth M.

2009-01-01

BACKGROUND Despite vigorous national debate between 1999–2001 the federal patients’ bill of rights (PBOR) was not enacted. However, states have enacted legislation and the Joint Commission defined an accreditation standard to present patients with their rights. Because such initiatives can be undermined by overly complex language, we surveyed the readability of hospital PBOR documents as well as texts mandated by state law. METHODS State Web sites and codes were searched to identify PBOR statutes for general patient populations. The rights addressed were compared with the 12 themes presented in the American Hospital Association’s (AHA) PBOR text of 2002. In addition, we obtained PBOR texts from a sample of hospitals in each state. Readability was evaluated using Prose, a software program which reports an average of eight readability formulas. RESULTS Of 23 states with a PBOR statute for the general public, all establish a grievance policy, four protect a private right of action, and one stipulates fines for violations. These laws address an average of 7.4 of the 12 AHA themes. Nine states’ statutes specify PBOR text for distribution to patients. These documents have an average readability of 15th grade (range, 11.6, New York, to 17.0, Minnesota). PBOR documents from 240 US hospitals have an average readability of 14th grade (range, 8.2 to 17.0). CONCLUSIONS While the average U.S. adult reads at an 8th grade reading level, an advanced college reading level is routinely required to read PBOR documents. Patients are not likely to learn about their rights from documents they cannot read. PMID:19189192

Readability of Wikipedia Pages on Autoimmune Disorders: Systematic Quantitative Assessment

PubMed Central

Bragazzi, Nicola Luigi; Brigo, Francesco; Sharif, Kassem; Amital, Howard; McGonagle, Dennis; Shoenfeld, Yehuda; Adawi, Mohammad

2017-01-01

Background In the era of new information and communication technologies, the Internet is being increasingly accessed for health-related information. Indeed, recently published patient surveys of people with autoimmune disorders confirmed that the Internet was reported as one of the most important health information sources. Wikipedia, a free online encyclopedia launched in 2001, is generally one of the most visited websites worldwide and is often consulted for health-related information. Objective The main objective of this investigation was to quantitatively assess whether the Wikipedia pages related to autoimmune disorders can be easily accessed by patients and their families, in terms of readability. Methods We obtained and downloaded a list of autoimmune disorders from the American Autoimmune Related Diseases Association (AARDA) website. We analyzed Wikipedia articles for their overall level of readability with 6 different quantitative readability scales: (1) the Flesch Reading Ease, (2) the Gunning Fog Index, (3) the Coleman-Liau Index, (4) the Flesch-Kincaid Grade Level, (5) the Automated Readability Index (ARI), and (6) the Simple Measure of Gobbledygook (SMOG). Further, we investigated the correlation between readability and clinical, pathological, and epidemiological parameters. Moreover, each Wikipedia analysis was assessed according to its content, breaking down the readability indices by main topic of each part (namely, pathogenesis, treatment, diagnosis, and prognosis plus a section containing paragraphs not falling into any of the previous categories). Results We retrieved 134 diseases from the AARDA website. The Flesch Reading Ease yielded a mean score of 24.34 (SD 10.73), indicating that the sites were very difficult to read and best understood by university graduates, while mean Gunning Fog Index and ARI scores were 16.87 (SD 2.03) and 14.06 (SD 2.12), respectively. The Coleman-Liau Index and the Flesch-Kincaid Grade Level yielded mean scores of 14.48 (SD 1.57) and 14.86 (1.95), respectively, while the mean SMOG score was 15.38 (SD 1.37). All the readability indices confirmed that the sites were suitable for a university graduate reading level. We found no correlation between readability and clinical, pathological, and epidemiological parameters. Differences among the different sections of the Wikipedia pages were statistically significant. Conclusions Wikipedia pages related to autoimmune disorders are characterized by a low level of readability. The onus is, therefore, on physicians and health authorities to improve the health literacy skills of patients and their families and to create, together with patients themselves, disease-specific readable sites, disseminating highly accessible health-related online information, in terms of both clarity and conciseness. PMID:28720555

The Appropriateness of Language Found in Research Consent Form Templates: A Computational Linguistic Analysis.

PubMed

Villafranca, Alexander; Kereliuk, Stephanie; Hamlin, Colin; Johnson, Andrea; Jacobsohn, Eric

2017-01-01

To facilitate informed consent, consent forms should use language below the grade eight level. Research Ethics Boards (REBs) provide consent form templates to facilitate this goal. Templates with inappropriate language could promote consent forms that participants find difficult to understand. However, a linguistic analysis of templates is lacking. We reviewed the websites of 124 REBs for their templates. These included English language medical school REBs in Australia/New Zealand (n = 23), Canada (n = 14), South Africa (n = 8), the United Kingdom (n = 34), and a geographically-stratified sample from the United States (n = 45). Template language was analyzed using Coh-Metrix linguistic software (v.3.0, Memphis, USA). We evaluated the proportion of REBs with five key linguistic outcomes at or below grade eight. Additionally, we compared quantitative readability to the REBs' own readability standards. To determine if the template's country of origin or the presence of a local REB readability standard influenced the linguistic variables, we used a MANOVA model. Of the REBs who provided templates, 0/94 (0%, 95% CI = 0-3.9%) provided templates with all linguistic variables at or below the grade eight level. Relaxing the standard to a grade 12 level did not increase this proportion. Further, only 2/22 (9.1%, 95% CI = 2.5-27.8) REBs met their own readability standard. The country of origin (DF = 20, 177.5, F = 1.97, p = 0.01), but not the presence of an REB-specific standard (DF = 5, 84, F = 0.73, p = 0.60), influenced the linguistic variables. Inappropriate language in templates is an international problem. Templates use words that are long, abstract, and unfamiliar. This could undermine the validity of participant informed consent. REBs should set a policy of screening templates with linguistic software.

Cauda equina syndrome: assessing the readability and quality of patient information on the Internet.

PubMed

O'Neill, Shane Ciaran; Baker, Joseph Frederick; Fitzgerald, Conall; Fleming, Christina; Rowan, Fiachra; Byrne, Damien; Synnott, Keith

2014-05-01

A readability and quality control Internet-based study using recognized quality scoring systems. To assess the readability and quality of Internet information relating to cauda equina syndrome accessed through common search engines. Access to health-related Internet information has increased dramatically during the past decade. A significant proportion of this information has been demonstrated to be set at too high a level for general comprehension. Despite this, searching for health-related information is now the third most popular online activity. A total of 125 cauda equina syndrome Web sites were analyzed from the 5 most popular Internet search engines: Google, Bing, Yahoo, Ask, and AOL. Web site authorship was classified: academic, physician, medico-legal, commercial, or discussion/social media. Readability of each Web site was assessed using the Flesch Reading Ease score, the Flesch-Kincaid grade level, and the Gunning Fog Index. Quality was calculated using the DISCERN instrument and The Journal of the American Medical Association benchmark criteria. The presence of HON-code certification was also assessed. Fifty-two individual Web sites were identified and assessed. The majority of Web sites were academic or physician compiled (53.8%; 28/52); however, a significant minority of Web sites were medico-legal related (19.2%; 10/52). Just 13.5% (7/52) of Web sites were at or below the recommended sixth-grade readability level. HON-code certified Web sites achieved significantly greater DISCERN (P = 0.0006) and The Journal of the American Medical Association (P = 0.0002) scores. Internet information relating to cauda equina syndrome is of variable quality and largely set at an inappropriate readability level. Given this variability in quality, health care providers should direct patients to known sources of reliable, readable online information. Identification of reliable sources may be aided by known markers of quality such as HON-code certification.

A critical review of the readability of online patient education resources from RadiologyInfo.Org.

PubMed

Hansberry, David R; John, Ann; John, Elizabeth; Agarwal, Nitin; Gonzales, Sharon F; Baker, Stephen R

2014-03-01

Health consumers and their families rely on the Internet as a source of authoritative information regarding the procedures used to reach a diagnosis, effect treatment, and influence prognosis. In radiology, online materials can be a means by which to offer patients comprehensible explanations of the capabilities, the risks and rewards, and the techniques under our purview. Consequently, estimations of health literacy should take into account the reading level of the average American when composing and transmitting such information to the lay public without the mediation of a referring physician. In December 2012, patient education reports from the files of RadiologyInfo.org, a jointly sponsored website of the American College of Radiology and the Radiological Society of North America, were downloaded to assess their textual sophistication. All 138 patient education articles including the glossary were analyzed for their respective level of "readability" using the following 10 evaluative scales: Flesch Reading Ease, Flesch-Kincaid Grade Level, Simple Measure of Gobbledygook Grading, Coleman-Liau Index, Gunning Fog Index, New Dale-Chall scale, FORCAST, Fry graph, Raygor Readability Estimate, and New Fog Count. The 138 online patient education articles were written, on average, between the 10th and 14th grade levels, which exceeds both the American Medical Association and the National Institutes of Health recommendations that patient education resources be comprehensible to those who read no higher than the seventh grade level. Patients may accrue a greater benefit from written articles available on RadiologyInfo.org if the texts were revised to be in compliance with the National Institutes of Health and American Medical Association grade level recommendations. This could lead to a broadened appreciation of the capabilities of radiology's role in general and enhanced understanding of imaging techniques and their application to clinical practice.

Forensic scientists' conclusions: how readable are they for non-scientist report-users?

PubMed

Howes, Loene M; Kirkbride, K Paul; Kelty, Sally F; Julian, Roberta; Kemp, Nenagh

2013-09-10

Scientists have an ethical responsibility to assist non-scientists to understand their findings and expert opinions before they are used as decision-aids within the criminal justice system. The communication of scientific expert opinion to non-scientist audiences (e.g., police, lawyers, and judges) through expert reports is an important but under-researched issue. Readability statistics were used to assess 111 conclusions from a proficiency test in forensic glass analysis. The conclusions were written using an average of 23 words per sentence, and approximately half of the conclusions were expressed using the active voice. At an average Flesch-Kincaid Grade level of university undergraduate (Grade 13), and Flesch Reading Ease score of difficult (42), the conclusions were written at a level suitable for people with some tertiary education in science, suggesting that the intended non-scientist readers would find them difficult to read. To further analyse the readability of conclusions, descriptive features of text were used: text structure; sentence structure; vocabulary; elaboration; and coherence and unity. Descriptive analysis supported the finding that texts were written at a level difficult for non-scientists to read. Specific aspects of conclusions that may pose difficulties for non-scientists were located. Suggestions are included to assist scientists to write conclusions with increased readability for non-scientist readers, while retaining scientific integrity. In the next stage of research, the readability of expert reports in their entirety is to be explored. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Quality of patient education materials for rehabilitation after neurological surgery.

PubMed

Agarwal, Nitin; Sarris, Christina; Hansberry, David R; Lin, Matthew J; Barrese, James C; Prestigiacomo, Charles J

2013-01-01

To evaluate the quality of online patient education materials for rehabilitation following neurological surgery. Materials were obtained from the National Institute of Neurological Disorders and Stroke (NINDS), U.S. National Library of Medicine (NLM), American Occupational Therapy Association (AOTA), and the American Academy of Orthopaedic Surgeons (AAOS). After removing unnecessary formatting, the readability of each site was assessed using the Flesch Reading Ease and Flesch-Kincaid Grade Level evaluations with Microsoft Office Word software. The average values of the Flesch Reading Ease and Flesch-Kincaid Grade Level were 41.5 and 11.8, respectively, which are well outside the recommended reading levels for the average American. Moreover, no online section was written below a ninth grade reading level. Evaluations of several websites from the NINDS, NLM, AOTA, and AAOS demonstrated that their reading levels were higher than that of the average American. Improved readability might be beneficial for patient education. Ultimately, increased patient comprehension may correlate to positive clinical outcomes.

South Carolina Word List, Grades 1-12. Basic Skills Assessment Program.

ERIC Educational Resources Information Center

Instructional Objectives Exchange, Los Angeles, CA.

Designed as a resource for reading teachers who are attempting to enhance their students' fundamental reading skills and to permit the more rigorous determination of readability levels for both instructional materials and testing devices, this word list provides a grade-by-grade set of key words students need to master for grades 1 through 12 The…

Consent information leaflets – readable or unreadable?

PubMed Central

Graham, Caroline; Reynard, John M; Turney, Benjamin W

2016-01-01

Objective The objective of this article is to assess the readability of leaflets about urological procedures provided by the British Association of Urological Surgeons (BAUS) to evaluate their suitability for providing information. Methods Information leaflets were assessed using three measures of readability: Flesch Reading Ease, Flesch-Kincaid and Simple Measure of Gobbledygook (SMOG) grade formulae. The scores were compared with national literacy statistics. Results Relatively good readability was demonstrated using the Flesch Reading Ease (53.4–60.1) and Flesch-Kincaid Grade Level (6.5–7.6) methods. However, the average SMOG index (14.0–15.0) for each category suggests that the majority of the leaflets are written above the reading level of an 18-year-old. Using national literacy statistics, at least 43% of the population will have significant difficultly understanding the majority of these leaflets. Conclusions The results suggest that comprehension of the leaflets provided by the BAUS is likely to be poor. These leaflets may be used as an adjunct to discussion but it is essential to ensure that all the information necessary to make an informed decision has been conveyed in a way that can be understood by the patient. PMID:27867520

Readability of the Most Commonly Accessed Arthroscopy-Related Online Patient Education Materials.

PubMed

Akinleye, Sheriff D; Krochak, Ryan; Richardson, Nicholas; Garofolo, Garret; Culbertson, Maya Deza; Erez, Orry

2018-04-01

To assess the readability and comprehension of written text by the most commonly visited websites containing patient education materials on common conditions that can be treated arthroscopically. We examined 50 websites, assessed independently by 2 orthopaedic surgery residents (S.A. and G.G.), with educational materials on 5 common conditions treated by arthroscopic surgeons: anterior cruciate ligament (ACL) tear, meniscus tear, hip labral tear, shoulder labral tear, and rotator cuff tear. Following a Google search for each condition, we analyzed the 10 most visited websites for each disorder using a widely used and validated tool for assessing the reading levels of written materials (Flesch-Kincaid formula). The average grade reading level of the 50 websites studied was 9.90 with a reading ease of 52.14 ("fairly difficult, high school"). Only 26% of the websites were at or below the national average of an eighth-grade reading level. Of the 5 conditions treated by arthroscopic surgery, ACL tear had the highest average grade reading level at 10.73 ± 1.54, whereas meniscus tear had the lowest at 9.31 ± 1.81. Every condition in this study had an average readability at or above the ninth-grade reading level. The most frequently accessed materials for patients with injuries requiring arthroscopic surgery exceeds the readability recommendations of the American Medical Association and National Institutes of Health, as well as the average reading ability of US adults. Given the fact that these are the most commonly visited websites by the lay public, there needs to be a greater emphasis on tailoring written information to the literacy levels of the patient population. This study emphasizes the discrepancy between the recommended versus the measured reading levels of online patient education materials related to conditions treated by arthroscopic surgeons. The subject matter of these conditions is inherently complex; thus, relying solely on text to inform patients increases the likelihood that the reading level of the material exceeds that of the majority of the lay public. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

The Índice Flesch-Szigriszt and Spanish Lexile Analyzer to evaluate Spanish patient education materials in otolaryngology.

PubMed

Nassif, Samih J; Wong, Kevin; Levi, Jessica R

2018-01-01

Evaluate the reading difficulty of Spanish patient education materials using the validated Índice Flesch-Szigriszt (INFLESZ) and Spanish Lexile Analyzer, and to identify relationships between English and Spanish readability formulas. Cross-sectional analysis. All otolaryngology-related patient education articles written in Spanish from the health libraries of the top 10 US News & World Report-ranked hospitals, top 10 Doximity-ranked otolaryngology residencies, the American Academy of Otolaryngology-Head and Neck Surgery website, and the US National Library of Medicine online section on ears, nose and throat were collected. Reading difficulty was assessed using the INFLESZ and Spanish Lexile Analyzer. Additional readability assessments included the traditional English tools: Flesch-Kincaid Grade Level, Flesch Reading Ease Score, and the Simple Measure of Gobbledygook score. A total of 497 articles were reviewed. The average INFLESZ score for all articles was 57.75, which is considered normal and requires the reading ability of a student who finished Escuela Secundaria Obligatoria or 10th grade equivalent in the United States. The average Spanish Lexile measure for all articles was 1062L, equivalent to a reading level between the 6th and 12th grade. English readability tools calculated a more difficult reading level compared to Spanish tools when performed on the same text. Current Spanish patient education materials in otolaryngology may be too difficult for the average Spanish-speaking reader to understand. Future improvements may be warranted to improve the readability of educational materials and increase health literacy. NA. Laryngoscope, 128:E21-E26, 2018. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

Determining the efficacy of the chronic disease self-management programme and readability of 'living a healthy life with chronic conditions' in a New Zealand setting.

PubMed

Cheng, J J-Y; Arenhold, F; Braakhuis, A J

2016-11-01

Self-management programmes are an increasingly popular way of treating chronic diseases. This study aims to determine the efficacy of the Stanford Chronic Disease Self-Management Programme (CDSMP) in a New Zealand context by assessing course outcomes and readability of the accompanying reference guide Living a Healthy Life with Chronic Conditions, 4th Edition. This is a cross-sectional pre-post study conducted in Auckland between August 2009 and September 2015, using CDSMP participants' baseline and follow-up Health Education Intervention Questionnaire (heiQ TM ) data. Readability of the guide was assessed using the Gunning Fog Index, Coleman Liau, Flesch Reading Ease, Flesch Kincaid Grade Level and Simplified Measure of Gobbledygook scores. Significant evidence of improvement (P ≤ 0.001) was observed in seven of the eight domains measured by the heiQ TM (Deakin University, Centre for Population Health Research, Melbourne, Vic., Australia). The greatest improvements were seen in skill and technique acquisition (mean change score 0.25, P ≤ 0.001) and self-monitoring and insight (0.18, P ≤ 0.001). There was little evidence of improvement in health service navigation (0.04, P = 0.17). Readability analyses indicate that a person needs to be reading at a minimum of U.S. 8th grade level in order to understand the text, and possibly up to 11th grade. The CDSMP is effective for improving patient self-efficacy in the New Zealand setting. However, adaptation of the programme to support better health service navigation is warranted. The readability of the reference guide is not suitable for this setting and requires further improvement. © 2016 Royal Australasian College of Physicians.

Diabetes websites accredited by the Health On the Net Foundation Code of Conduct: readable or not?

PubMed

Kusec, Sanja; Brborovic, Ognjen; Schillinger, Dean

2003-01-01

Health information posted on the Internet has become a popular mode of communication with the population at large because millions of people now use the Internet to gather health information. Many studies on readability have shown that patient education information is frequently written at the reading level too high for the average population to understand, and the same holds true for health information on the Internet. The aim of this study was to determine the readability levels of health information found on diabetes-related websites displaying HONcode logo, which indicates to high quality of the information provided. The 99 websites tested for readability using the Flesch Reading Ease formula and Flesch-Kincaid level showed FRE score 2.1 to 79.6, with the mean 41.7 (10th grade, 8th month Flesch-Kincaid level), which indicates that 86.9% of these materials would be too difficult to read for the average adult population. It is suggested that the readability level, and the name of the formula used, be used on the websites themselves to help the Internet users decide which sites could be of the greatest benefit to them.

Quality and readability assessment of websites related to recurrent respiratory papillomatosis

PubMed Central

de Groot, Olivier S.D.; Dikkers, Frederik G.

2017-01-01

Objective Recurrent respiratory papillomatosis (RRP) is a rare disease for which a limited number of information sources for patients exist. The role of the Internet in the patient–physician relationship is increasing. More and more patients search for online health information, which should be of good quality and easy readable. The study aim was to investigate the quality and readability of English online health information about RRP. Study Design Quality and readability assessment of online information. Methods Relevant information was collected using three different search engines and seven different search terms. Quality was assessed with the DISCERN instrument. The Flesch Reading Ease Score (FRES) and average grade level (AGL) were determined to measure readability of the English websites. Results Fifty‐one English websites were included. The mean DISCERN score of the websites is 28.1 ± 9.7 (poor quality); the mean FRES is 41.3 ± 14.9 (difficult to read); and the mean AGL is 12.6 ± 2.3. Conclusion The quality and readability of English websites about RRP is alarmingly poor. Level of Evidence NA. Laryngoscope, 127:2293–2297, 2017 PMID:28233911

Readability of Written Materials for CKD Patients: A Systematic Review.

PubMed

Morony, Suzanne; Flynn, Michaela; McCaffery, Kirsten J; Jansen, Jesse; Webster, Angela C

2015-06-01

The "average" patient has a literacy level of US grade 8 (age 13-14 years), but this may be lower for people with chronic kidney disease (CKD). Current guidelines suggest that patient education materials should be pitched at a literacy level of around 5th grade (age 10-11 years). This study aims to evaluate the readability of written materials targeted at patients with CKD. Systematic review. Patient information materials aimed at adults with CKD and written in English. Patient education materials designed to be printed and read, sourced from practices in Australia and online at all known websites run by relevant international CKD organizations during March 2014. Quantitative analysis of readability using Lexile Analyzer and Flesch-Kincaid tools. We analyzed 80 materials. Both Lexile Analyzer and Flesch-Kincaid analyses suggested that most materials required a minimum of grade 9 (age 14-15 years) schooling to read them. Only 5% of materials were pitched at the recommended level (grade 5). Readability formulas have inherent limitations and do not account for visual information. We did not consider other media through which patients with CKD may access information. Although the study covered materials from the United States, United Kingdom, and Australia, all non-Internet materials were sourced locally, and it is possible that some international paper-based materials were missed. Generalizability may be limited due to exclusion of non-English materials. These findings suggest that patient information materials aimed at patients with CKD are pitched above the average patient's literacy level. This issue is compounded by cognitive decline in patients with CKD, who may have lower literacy than the average patient. It suggests that information providers need to consider their audience more carefully when preparing patient information materials, including user testing with a low-literacy patient population. Copyright © 2015 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

A Systematic Assessment of Google Search Queries and Readability of Online Gynecologic Oncology Patient Education Materials.

PubMed

Martin, Alexandra; Stewart, J Ryan; Gaskins, Jeremy; Medlin, Erin

2018-01-20

The Internet is a major source of health information for gynecologic cancer patients. In this study, we systematically explore common Google search terms related to gynecologic cancer and calculate readability of top resulting websites. We used Google AdWords Keyword Planner to generate a list of commonly searched keywords related to gynecologic oncology, which were sorted into five groups (cervical cancer, ovarian cancer, uterine cancer, vulvar cancer, vaginal cancer) using five patient education websites from sgo.org . Each keyword was Google searched to create a list of top websites. The Python programming language (version 3.5.1) was used to describe frequencies of keywords, top-level domains (TLDs), domains, and readability of top websites using four validated formulae. Of the estimated 1,846,950 monthly searches resulting in 62,227 websites, the most common was cancer.org . The most common TLD was *.com. Most websites were above the eighth-grade reading level recommended by the American Medical Association (AMA) and the National Institute of Health (NIH). The SMOG Index was the most reliable formula. The mean grade level readability for all sites using SMOG was 9.4 ± 2.3, with 23.9% of sites falling at or below the eighth-grade reading level. The first ten results for each Google keyword were easiest to read with results beyond the first page of Google being consistently more difficult. Keywords related to gynecologic malignancies are Google-searched frequently. Most websites are difficult to read without a high school education. This knowledge may help gynecologic oncology providers adequately meet the needs of their patients.

Readability Trends of Online Information by the American Academy of Otolaryngology-Head and Neck Surgery Foundation.

PubMed

Wong, Kevin; Levi, Jessica R

2017-01-01

Objective Previous studies have shown that patient education materials published by the American Academy of Otolaryngology-Head and Neck Surgery Foundation may be too difficult for the average reader to understand. The purpose of this study was to determine if current educational materials show improvements in readability. Study Design Cross-sectional analysis. Setting The Patient Health Information section of the American Academy of Otolaryngology-Head and Neck Surgery Foundation website. Subjects and Methods All patient education articles were extracted in plain text. Webpage navigation, references, author information, appointment information, acknowledgments, and disclaimers were removed. Follow-up editing was also performed to remove paragraph breaks, colons, semicolons, numbers, percentages, and bullets. Readability grade was calculated with the Flesch-Kincaid Grade Level, Flesch Reading Ease, Gunning-Fog Index, Coleman-Liau Index, Automated Readability Index, and Simple Measure of Gobbledygook. Intra- and interobserver reliability were assessed. Results A total of 126 articles from 7 topics were analyzed. Readability levels across all 6 tools showed that the difficulty of patient education materials exceeded the abilities of an average American. As compared with previous studies, current educational materials by the American Academy of Otolaryngology-Head and Neck Surgery Foundation have shown a decrease in difficulty. Intra- and interobserver reliability were both excellent, with intraclass coefficients of 0.99 and 0.96, respectively. Conclusion Improvements in readability is an encouraging finding and one that is consistent with recent trends toward improved health literacy. Nevertheless, online patient educational material is still too difficult for the average reader. Revisions may be necessary for current materials to benefit a larger readership.

Quality assessment of online patient education resources for peripheral neuropathy.

PubMed

Hansberry, David R; Suresh, Ragha; Agarwal, Nitin; Heary, Robert F; Goldstein, Ira M

2013-03-01

Given its practicality, the internet is a primary resource for patients afflicted with diseases like peripheral neuropathy. Therefore, it is important that the readily available online resources on peripheral neuropathy are tailored to the general public, particularly concerning readability. Patient education resources were downloaded from the US National Library of Medicine, Mayo Clinic, National Institute of Neurological Disorders and Stroke, Neuropathy.org, GBS/CIDP Foundation International, Hereditary Neuropathy Foundation, Charcot-Marie-Tooth Association, Foundation for Peripheral Neuropathy, and Neuropathy Action Foundation websites. All patient education material related to peripheral neuropathy was evaluated for its level of readability using the Flesch Reading Ease (FRE) and Flesch-Kincaid Grade Level. The FRE scores averaged 43.4 with only the US National Library of Medicine scoring above 60 (76.5). The Flesch-Kincaid Grade Level scores averaged 11.0. All scores were above a seventh-grade level except the US National Library of Medicine, which had a score of a fifth-grade reading level. Most Americans may not fully benefit from patient education resources concerning peripheral neuropathy education on many of the websites. Only the US National Library of Medicine, which is written at a fifth-grade level, is likely to benefit the average American. © 2013 Peripheral Nerve Society.

Readability of Wikipedia Pages on Autoimmune Disorders: Systematic Quantitative Assessment.

PubMed

Watad, Abdulla; Bragazzi, Nicola Luigi; Brigo, Francesco; Sharif, Kassem; Amital, Howard; McGonagle, Dennis; Shoenfeld, Yehuda; Adawi, Mohammad

2017-07-18

In the era of new information and communication technologies, the Internet is being increasingly accessed for health-related information. Indeed, recently published patient surveys of people with autoimmune disorders confirmed that the Internet was reported as one of the most important health information sources. Wikipedia, a free online encyclopedia launched in 2001, is generally one of the most visited websites worldwide and is often consulted for health-related information. The main objective of this investigation was to quantitatively assess whether the Wikipedia pages related to autoimmune disorders can be easily accessed by patients and their families, in terms of readability. We obtained and downloaded a list of autoimmune disorders from the American Autoimmune Related Diseases Association (AARDA) website. We analyzed Wikipedia articles for their overall level of readability with 6 different quantitative readability scales: (1) the Flesch Reading Ease, (2) the Gunning Fog Index, (3) the Coleman-Liau Index, (4) the Flesch-Kincaid Grade Level, (5) the Automated Readability Index (ARI), and (6) the Simple Measure of Gobbledygook (SMOG). Further, we investigated the correlation between readability and clinical, pathological, and epidemiological parameters. Moreover, each Wikipedia analysis was assessed according to its content, breaking down the readability indices by main topic of each part (namely, pathogenesis, treatment, diagnosis, and prognosis plus a section containing paragraphs not falling into any of the previous categories). We retrieved 134 diseases from the AARDA website. The Flesch Reading Ease yielded a mean score of 24.34 (SD 10.73), indicating that the sites were very difficult to read and best understood by university graduates, while mean Gunning Fog Index and ARI scores were 16.87 (SD 2.03) and 14.06 (SD 2.12), respectively. The Coleman-Liau Index and the Flesch-Kincaid Grade Level yielded mean scores of 14.48 (SD 1.57) and 14.86 (1.95), respectively, while the mean SMOG score was 15.38 (SD 1.37). All the readability indices confirmed that the sites were suitable for a university graduate reading level. We found no correlation between readability and clinical, pathological, and epidemiological parameters. Differences among the different sections of the Wikipedia pages were statistically significant. Wikipedia pages related to autoimmune disorders are characterized by a low level of readability. The onus is, therefore, on physicians and health authorities to improve the health literacy skills of patients and their families and to create, together with patients themselves, disease-specific readable sites, disseminating highly accessible health-related online information, in terms of both clarity and conciseness. ©Abdulla Watad, Nicola Luigi Bragazzi, Francesco Brigo, Kassem Sharif, Howard Amital, Dennis McGonagle, Yehuda Shoenfeld, Mohammad Adawi. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 18.07.2017.

Readability, suitability, and health content assessment of web-based patient education materials on colorectal cancer screening.

PubMed

Tian, Chenlu; Champlin, Sara; Mackert, Michael; Lazard, Allison; Agrawal, Deepak

2014-08-01

Colorectal cancer (CRC) screening rates in the Unites States are still below target level. Web-based patient education materials are used by patients and providers to provide supplemental information on CRC screening. Low literacy levels and patient perceptions are significant barriers to screening. There are little data on the quality of these online materials from a health literacy standpoint or whether they address patients' perceptions. To evaluate the readability, suitability, and health content of web-based patient education materials on colon cancer screening. Descriptive study. Web-based patient materials. Twelve reputable and popular online patient education materials were evaluated. Readability was measured by using the Flesch-Kincaid Reading Grade Level, and suitability was determined by the Suitability Assessment of Materials, a scale that considers characteristics such as content, graphics, layout/typography, and learning stimulation. Health content was evaluated within the framework of the Health Belief Model, a behavioral model that relates patients' perceptions of susceptibility to disease, severity, and benefits and barriers to their medical decisions. Each material was scored independently by 3 reviewers. Flesch-Kincaid Reading Grade Level score, Suitability Assessment of Materials score, health content score. Readability for 10 of 12 materials surpassed the maximum recommended sixth-grade reading level. Five were 10th grade level and above. Only 1 of 12 materials received a superior suitability score; 3 materials received inadequate scores. Health content analysis revealed that only 50% of the resources discussed CRC risk in the general population and <25% specifically addressed patients at high risk, such as African Americans, smokers, patients with diabetes, and obese patients. For perceived barriers to screening, only 8.3% of resources discussed embarrassment, 25% discussed pain with colonoscopy, 25% addressed cost of colonoscopy, and none specifically mentioned the need to get colonoscopy when no symptoms are present. No material discussed the social benefits of screening. Descriptive design. Most online patient education materials for CRC screening are written beyond the recommended sixth-grade reading level, with suboptimal suitability. Health content is lacking in addressing key perceived risks, barriers, and benefits to CRC screening. Developing more appropriate and targeted patient education resources on CRC may improve patient understanding and promote screening. Copyright © 2014 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

Improving readability of informed consents for research at an academic medical institution.

PubMed

Hadden, Kristie B; Prince, Latrina Y; Moore, Tina D; James, Laura P; Holland, Jennifer R; Trudeau, Christopher R

2017-12-01

The final rule for the protection of human subjects requires that informed consent be "in language understandable to the subject" and mandates that "the informed consent must be organized in such a way that facilitates comprehension." This study assessed the readability of Institutional Review Board-approved informed consent forms at our institution, implemented an intervention to improve the readability of consent forms, and measured the first year impact of the intervention. Readability assessment was conducted on a sample of 217 Institutional Review Board-approved informed consents from 2013 to 2015. A plain language informed consent template was developed and implemented and readability was assessed again after 1 year. The mean readability of the baseline sample was 10th grade. The mean readability of the post-intervention sample (n=82) was seventh grade. Providing investigators with a plain language informed consent template and training can promote improved readability of informed consents for research.

Availability and Readability of Online Patient Education Materials Regarding Regional Anesthesia Techniques for Perioperative Pain Management.

PubMed

Kumar, Gunjan; Howard, Steven K; Kou, Alex; Kim, T Edward; Butwick, Alexander J; Mariano, Edward R

2017-10-01

Patient education materials (PEM) should be written at a sixth-grade reading level or lower. We evaluated the availability and readability of online PEM related to regional anesthesia and compared the readability and content of online PEM produced by fellowship and nonfellowship institutions. With IRB exemption, we constructed a cohort of online regional anesthesia PEM by searching Websites from North American academic medical centers supporting a regional anesthesiology and acute pain medicine fellowships and used a standardized Internet search engine protocol to identify additional nonfellowship Websites with regional anesthesia PEM based on relevant keywords. Readability metrics were calculated from PEM using the TextStat 0.1.4 textual analysis package for Python 2.7 and compared between institutions with and without a fellowship program. The presence of specific descriptive PEM elements related to regional anesthesia was also compared between groups. PEM from 17 fellowship and 15 nonfellowship institutions were included in analyses. The mean (SD) Flesch-Kincaid Grade Level for PEM from the fellowship group was 13.8 (2.9) vs 10.8 (2.0) for the nonfellowship group (p = 0.002). We observed no other differences in readability metrics between fellowship and nonfellowship institutions. Fellowship-based PEM less commonly included descriptions of the following risks: local anesthetic systemic toxicity (p = 0.033) and injury due to an insensate extremity (p = 0.003). Available online PEM related to regional anesthesia are well above the recommended reading level. Further, fellowship-based PEM posted are at a higher reading level than PEM posted by nonfellowship institutions and are more likely to omit certain risk descriptions. 2016 American Academy of Pain Medicine. This work is written by US Government employees and is in the public domain in the US.

Junior High Basals: Effective Hi/Lo Materials for Remedial High School Readers.

ERIC Educational Resources Information Center

Alvermann, Donna E.

1981-01-01

Discusses the results of an analysis of the appropriateness of eighth-grade basal reading materials for remedial instruction of ninth- and tenth-grade students who read two to three years below grade level. Readability, interest appeal, and representation of content areas are considered. Three data tables and a 14-item reference list are included.…

The readability and suitability of sexual health promotion leaflets.

PubMed

Corcoran, Nova; Ahmad, Fatuma

2016-02-01

To investigate the readability and suitability of sexual health promotion leaflets. Application of SMOG, FRY and SAM tests to assess the readability and suitability of a selection of sexual health leaflets. SMOG and FRY scores illustrate an average reading level of grade 9. SAM scores indicate that 59% of leaflets are superior in design and 41% are average in design. Leaflets generally perform well in the categories of content, literacy demand, typography and layout. They perform poorly in use of graphics, learning stimulation/motivation and cultural appropriateness. Sexual health leaflets have a reading level that is too high. Leaflets perform well on the suitability scores indicating they are reasonably suitable. There are a number of areas where sexual health leaflets could improve their design. Numerous practical techniques are suggested for improving the readability and suitability of sexual health leaflets. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Readability analysis of internet-based patient information regarding skull base tumors.

PubMed

Misra, Poonam; Kasabwala, Khushabu; Agarwal, Nitin; Eloy, Jean Anderson; Liu, James K

2012-09-01

Readability is an important consideration in assessing healthcare-related literature. In order for a source of information to be the most beneficial to patients, it should be written at a level appropriate for the audience. The National Institute of Health recommends that health literature be written at a maximum level of sixth grade. This is not uniformly found in current health literature, putting patients with lower reading levels at a disadvantage. In February 2012, healthcare-oriented education resources were retrieved from websites obtained using the Google search phrase skull base tumors. Of the first 25 consecutive, unique website hits, 18 websites were found to contain information for patients. Ten different assessment scales were utilized to assess the readability of the patient-specific web pages. Patient-oriented material found online for skull base tumors was written at a significantly higher level than the reading level of the average US patient. The average reading level of this material was found to be at a minimum of eleventh grade across all ten scales. Health related material related to skull base tumors available through the internet can be improved to reach a larger audience without sacrificing the necessary information. Revisions of this material can provide significant benefit for average patients and improve their health care.

Variation in the Readability of Items Within Surveys

PubMed Central

Calderón, José L.; Morales, Leo S.; Liu, Honghu; Hays, Ron D.

2006-01-01

The objective of this study was to estimate the variation in the readability of survey items within 2 widely used health-related quality-of-life surveys: the National Eye Institute Visual Functioning Questionnaire–25 (VFQ-25) and the Short Form Health Survey, version 2 (SF-36v2). Flesch-Kincaid and Flesch Reading Ease formulas were used to estimate readability. Individual survey item scores and descriptive statistics for each survey were calculated. Variation of individual item scores from the mean survey score was graphically depicted for each survey. The mean reading grade level and reading ease estimates for the VFQ-25 and SF-36v2 were 7.8 (fairly easy) and 6.4 (easy), respectively. Both surveys had notable variation in item readability; individual item readability scores ranged from 3.7 to 12.0 (very easy to difficult) for the VFQ-25 and 2.2 to 12.0 (very easy to difficult) for the SF-36v2. Because survey respondents may not comprehend items with readability scores that exceed their reading ability, estimating the readability of each survey item is an important component of evaluating survey readability. Standards for measuring the readability of surveys are needed. PMID:16401705

Readability, suitability, and characteristics of asthma action plans: examination of factors that may impair understanding.

PubMed

Yin, H Shonna; Gupta, Ruchi S; Tomopoulos, Suzy; Wolf, Michael S; Mendelsohn, Alan L; Antler, Lauren; Sanchez, Dayana C; Lau, Claudia Hillam; Dreyer, Benard P

2013-01-01

Recognition of the complexity of asthma management has led to the development of asthma treatment guidelines that include the recommendation that all pediatric asthma patients receive a written asthma action plan. We assessed the readability, suitability, and characteristics of asthma action plans, elements that contribute to the effectiveness of action plan use, particularly for those with limited literacy. This was a descriptive study of 30 asthma action plans (27 state Department of Health (DOH)-endorsed, 3 national action plans endorsed by 6 states). (1) readability (as assessed by Flesch Reading Ease, Flesch-Kincaid, Gunning Fog, Simple Measure of Gobbledygook, Forcast), (2) suitability (Suitability Assessment of Materials [SAM], adequate: ≥ 0.4; unsuitable: <0.4), (3) action plan characteristics (peak flow vs symptom-based, symptoms, recommended actions). Mean (SD) overall readability grade level was 7.2 (1.1) (range = 5.7-9.8); 70.0% were above a sixth-grade level. Mean (SD) suitability score was 0.74 (0.14). Overall, all action plans were found to be adequate, although 40.0% had an unsuitable score in at least 1 factor. The highest percent of unsuitable scores were found in the categories of layout/typography (30.0%), learning stimulation/motivation (26.7%), and graphics (13.3%). There were no statistically significant differences between the average grade level or SAM score of state DOH developed action plans and those from or adapted from national organizations. Plans varied with respect to terms used, symptoms included, and recommended actions. Specific improvements in asthma action plans could maximize patient and parent understanding of appropriate asthma management and could particularly benefit individuals with limited literacy skills.

Constructing and validating readability models: the method of integrating multilevel linguistic features with machine learning.

PubMed

Sung, Yao-Ting; Chen, Ju-Ling; Cha, Ji-Her; Tseng, Hou-Chiang; Chang, Tao-Hsing; Chang, Kuo-En

2015-06-01

Multilevel linguistic features have been proposed for discourse analysis, but there have been few applications of multilevel linguistic features to readability models and also few validations of such models. Most traditional readability formulae are based on generalized linear models (GLMs; e.g., discriminant analysis and multiple regression), but these models have to comply with certain statistical assumptions about data properties and include all of the data in formulae construction without pruning the outliers in advance. The use of such readability formulae tends to produce a low text classification accuracy, while using a support vector machine (SVM) in machine learning can enhance the classification outcome. The present study constructed readability models by integrating multilevel linguistic features with SVM, which is more appropriate for text classification. Taking the Chinese language as an example, this study developed 31 linguistic features as the predicting variables at the word, semantic, syntax, and cohesion levels, with grade levels of texts as the criterion variable. The study compared four types of readability models by integrating unilevel and multilevel linguistic features with GLMs and an SVM. The results indicate that adopting a multilevel approach in readability analysis provides a better representation of the complexities of both texts and the reading comprehension process.

Reading Level and Length of Written Research Consent Forms

PubMed Central

Foe, Gabriella; Lally, Rachel

2015-01-01

Abstract In 100 Institutional Review Board approved consent forms (CFs), we assessed pages, reading levels, and whether they included essential elements. CF page numbers ranged from 3 to 28 (mean, 10.3) and readability ranged from grades 5.6 to 28.9 (mean, 11.6). The CF mean score for including essential elements was 90.8% (range: 63.5–100%). There were no significant differences by specialty in number of pages (p = 0.053), but surgical specialties had the highest readability (mean, 13.1), and pediatrics the lowest (10.5), p = 0.008. While approved CFs generally included the Office for Human Research Protections recommended essential elements, they were very long, and even pediatric forms, which had the lowest reading levels, were written on average at a tenth grade level. Researchers need guidance to resolve pressure between regulatory mandates and guidelines and “keeping it simple and clear.” PMID:25580939

An Effectiveness Evaluation Between Manual and Automated Readability Counting Techniques. CNETS Report 5-75.

ERIC Educational Resources Information Center

Bunde, Gary R.

A statistical comparison was made between two automated devices which were used to count data points (words, sentences, and syllables) needed in the Flesch Reading Ease Score to determine the reading grade level of written material. Determination of grade level of all Rate Training Manuals and Non-Resident Career Courses had been requested by the…

Are patients comprehending? A critical assessment of online patient educational materials.

PubMed

Bui, Thanh-Lan; Silva-Hirschberg, Catalina; Torres, Josefina; Armstrong, April W

2018-05-01

The primary aim of this study was to evaluate the readability, understandability, suitability and actionability of online psoriasis patient educational materials. A secondary aim was to identify areas for improvement. We conducted an evaluation study to assess online psoriasis patient educational materials from the American Academy of Dermatology and National Psoriasis Foundation available in July 2017. We used two validated assessment tools specific to online healthcare materials. Outcomes were expressed as percentages, where higher percentages corresponded to higher quality materials. Overall, the educational materials had a mean understandability score (72.7%) that was understandable; a suitability score (58.8%) that was adequate; a reading grade level (10.5) that was not readable; and an actionability score (54.7%) that was not actionable. Areas of improvement include reading grade level, visual aids, word choice, specific steps for actions and cultural appropriateness. Online psoriasis patient educational materials are understandable and suitable, but they are written above the American Medical Association and National Institutes of Health's recommended 6th-8th grade reading level and are not actionable. Materials can benefit from decreasing reading grade level, including more visual elements, incorporating more actionable items and being culturally inclusive.

Readability of neurosurgery-related patient education materials provided by the American Association of Neurological Surgeons and the National Library of Medicine and National Institutes of Health.

PubMed

Schmitt, Paul J; Prestigiacomo, Charles J

2013-11-01

Most professional organizations now provide patient information material, and not all of this material is appropriate for the average American adult to comprehend. The National Institutes of Health (NIH) and the United States Department of Health and Human Services recommend that patient education materials be written at the sixth-grade level. Our aim was to assess the readability of neurosurgery-related patient education material and compare it with The American Medical Association, NIH, and United States Department of Health and Human Services recommendations. Materials provided by the American Association of Neurologic Surgeons (AANS) and the U.S. National Library of Medicine (NLM) and National Institutes of Health were assessed with the Flesch-Kincaid grade level and Flesch Reading Ease score with Microsoft Office Word software. None of the articles had Flesch-Kincaid grade levels at or below the sixth-grade level. All articles on the AANS Conditions and Treatments section were written at or above the ninth-grade level; three of the AANS Camera-Ready Fact Sheets and four of the NIH/NLM articles were written between the seventh- and eighth-grade levels. Current patient education material provided by the AANS is written well above the recommended level. Material from the NLM and NIH performed better, but was still above the recommended sixth-grade level. Education materials should contain information relevant to patients' conditions, be accurate in the information they present, and be written with the average patient in mind. Copyright © 2013 Elsevier Inc. All rights reserved.

A quantitative readability analysis of patient education resources from gastroenterology society websites.

PubMed

Hansberry, David R; Patel, Sahil R; Agarwal, Prateek; Agarwal, Nitin; John, Elizabeth S; John, Ann M; Reynolds, James C

2017-06-01

The lay public frequently access and rely on online information as a source of their medical knowledge. Many medical societies are unaware of national patient education material guidelines and subsequently fail to meet them. The goal of the present study was to evaluate the readability of patient education materials within the medical field of gastroenterology. Two hundred fourteen articles pertaining to patient education materials were evaluated with ten well-established readability scales. The articles were available on the websites for the American College of Gastroenterology (ACG), the American Gastroenterological Association (AGA), the American Society of Gastrointestinal Endoscopy (ASGE), the British Society of Gastroenterology (BSG), and the NIH section National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). One-way analysis of variance (ANOVA) and Tukey's honest significant difference (HSD) post hoc analysis were conducted to determine any differences in level of readability between websites. The 214 articles were written at an 11.8 ± 2.1 grade level with a range of 8.0 to 16.0 grade level. A one-way ANOVA and Tukey's HSD post hoc analysis determined the ACG was written at a significantly (p < 0.05) more difficult level when compared to the AGA, the BSG, and the NIDDK websites. No differences were noted when comparing the ASGE website. None of the patient education materials were written at a level that met national guidelines. If the materials are redrafted, the general American public will likely have a greater understanding of the gastroenterology content.

The Gobbledygook in Online Parent-Focused Information about Child and Adolescent Mental Health.

PubMed

Wozney, Lori; Radomski, Ashley D; Newton, Amanda S

2018-06-01

Online parent-focused informational resources play a vital step in parent decision-making about initiating child and adolescent mental health care, but their usefulness may depend on how easily the resource content can be understood. The purpose of this cross-sectional study was to examine the readability and reliability of parent-focused mental health resources provided on Canadian websites. After meeting inclusion criteria, 50 documents retrieved during the search in September 2016 from websites using online health information searching strategies that would be typically employed by parents underwent analysis. Document readability was assessed using Health Canada recommended instruments: Simple Measure of Gobbledygook (SMOG), Flesch-Kincaid Grade Level, and the Flesch Reading-Ease scale. Reliability was assessed using Health on the Net Foundation Code of Conduct (HONcode). Our analysis revealed that all included documents exceeded the 8th grade reading level. The mean ± SD readability scores were SMOG 11.65 ± 1.10 and FKGL 10.03 ± 1.49. Reading-ease scores showed that 42% (n = 21) of the documents were "Difficult" to read. Factorial ANOVA revealed no significant difference in readability across mental health topic areas or organizational sectors (p = > 0.05). Twenty-four percent of documents came from sites with HONcode certification. Findings suggest that almost all child and adolescent mental health information that would typically be found online by parents in Canada had readability scores that were too high for average parents to read and exceeded Health Canada recommended reading levels. Being able to locate resources online can be significantly precluded if a parent cannot understand and use information to mobilize them to accessing mental health care for their families.

An online readability analysis of pathology-related patient education articles: an opportunity for pathologists to educate patients.

PubMed

Prabhu, Arpan V; Kim, Christopher; Crihalmeanu, Tudor; Hansberry, David R; Agarwal, Nitin; DeFrances, Marie C; Trejo Bittar, Humberto E

2017-07-01

Information for patients regarding their clinical conditions and treatment options is widely available online. The American Medical Association and National Institutes of Health recommend that online patient-oriented materials be written at no higher than a seventh-grade reading level to ensure full comprehension by the average American. This study sought to determine whether online patient-oriented materials explaining common pathology procedures are written at appropriate reading levels. Ten pathology procedures that patients would likely research were queried into Google search, and plain text from the first 10 Web sites containing patient education materials for each procedure was analyzed using 10 validated readability scales. We determined mean reading levels of materials grouped by readability scale, procedure, and Web site domain, the overall average reading level of all resources, and popular Web site domains. One hundred Web sites were accessed; one was omitted for short length (<100 words). The average reading grade level of the 99 materials, none of which met national health literacy guidelines (range, 7.3-17.4), was 10.9. Twenty-nine articles (29%) required a high school education for full comprehension, and 4 (4%) required an undergraduate college education. Most frequently accessed Web site domains included medlineplus.gov, webmd.com (both accessed 7 times), and labtestsonline.org (accessed 6 times). Average reading levels of the 11 most commonly accessed Web sites ranged from 8.25 (patient.info) to 12.25 (mayoclinic.org). Readability levels of most online pathology-related patient education materials exceeded those recommended by national health literacy guidelines. These patient education materials should be revised to help patients fully understand them. Copyright © 2017 Elsevier Inc. All rights reserved.

Assessing the Readability of Medical Documents: A Ranking Approach.

PubMed

Zheng, Jiaping; Yu, Hong

2018-03-23

The use of electronic health record (EHR) systems with patient engagement capabilities, including viewing, downloading, and transmitting health information, has recently grown tremendously. However, using these resources to engage patients in managing their own health remains challenging due to the complex and technical nature of the EHR narratives. Our objective was to develop a machine learning-based system to assess readability levels of complex documents such as EHR notes. We collected difficulty ratings of EHR notes and Wikipedia articles using crowdsourcing from 90 readers. We built a supervised model to assess readability based on relative orders of text difficulty using both surface text features and word embeddings. We evaluated system performance using the Kendall coefficient of concordance against human ratings. Our system achieved significantly higher concordance (.734) with human annotators than did a baseline using the Flesch-Kincaid Grade Level, a widely adopted readability formula (.531). The improvement was also consistent across different disease topics. This method's concordance with an individual human user's ratings was also higher than the concordance between different human annotators (.658). We explored methods to automatically assess the readability levels of clinical narratives. Our ranking-based system using simple textual features and easy-to-learn word embeddings outperformed a widely used readability formula. Our ranking-based method can predict relative difficulties of medical documents. It is not constrained to a predefined set of readability levels, a common design in many machine learning-based systems. Furthermore, the feature set does not rely on complex processing of the documents. One potential application of our readability ranking is personalization, allowing patients to better accommodate their own background knowledge. ©Jiaping Zheng, Hong Yu. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 23.03.2018.

Readability and quality assessment of websites related to microtia and aural atresia.

PubMed

Alamoudi, Uthman; Hong, Paul

2015-02-01

Many parents and children utilize the Internet for health-related information, but the quality of these websites can vary. The objective of this study was to assess the quality and readability of microtia and aural atresia related websites. The search engine Google was queried with the terms 'microtia' and 'aural atresia.' The first 30 results were evaluated, and those websites containing original information written in English were reviewed. Quality of content was assessed with the DISCERN instrument, and readability was assessed with the Flesch-Kincaid Reading Grade Level (FKGL) and the Flesch Reading Ease Score (FRES) tests. Each website was also reviewed for ownership and the date of last update. Sixteen microtia and 14 aural atresia websites were included for full review. The mean DISCERN score for microtia websites was 54.4 (SD=8.3), and for aural atresia websites it was 47.6 (SD=10.7), which indicates 'good' and 'fair' quality of content, respectively. Readability assessments showed an average reading level requiring a grade 10 education on FKGL, and only one microtia (6.3%) and one aural atresia (7.1%) websites were deemed to be at 'reasonable' reading level on FRES. High-quality websites that are considered easily comprehensible to the general public were lacking. Since parents and children may use websites when making treatment decisions, physicians should be aware of the quality of health information pertaining to their area of expertise available on the Internet. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Quality and readability of information pamphlets on hearing and paediatric hearing loss in the Gauteng Province, South Africa.

PubMed

Joubert, Karin; Githinji, Esther

2014-02-01

The implementation of early hearing detection and intervention (EHDI) programmes is necessary in order to facilitate the early identification of hearing loss. An important component of EHDI is parental education. International and national guidelines stipulating that comprehensive, unbiased and appropriate information pamphlets should be provided to parents as part of EHDI programmes, however little is known about the availability and readability of such materials in South Africa. The objectives of this study were therefore to determine the availability of information pamphlets on hearing and hearing loss in children at public hospitals in the Gauteng Province of South Africa. In addition, the quality and readability levels of these pamphlets were determined. A non-experimental, descriptive research design was employed for this study. Information on the availability of leaflets at public health hospitals was obtained through a telephonic survey. Twenty-one information pamphlets available at these hospitals were then evaluated to determine the quality and readability levels. It was found that 73% of audiology departments at public hospitals in Gauteng had information pamphlets available on hearing and hearing loss in children. Of the pamphlets evaluated, the majority were rated to 'present with serious problems' questioning the quality of the content included. In addition, it was found that on average the readability level of these pamphlets were at a sixth-grade level, much higher that the recommended fourth-grade reading level. The need for development of quality educational material focused on providing parents with unbiased, comprehensive and appropriate information on hearing and hearing loss in children has been highlighted. Proposed guidelines were recommended to assist audiologists in this endeavour. The importance of providing appropriate parental educational materials for the success of EHDI in South Africa should not be underestimated. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

The quality and accuracy of internet information on the subject of ear tubes.

PubMed

McKearney, Thomas C; McKearney, Richard M

2013-06-01

The World Wide Web is a commonly used source of health information for patients. The objective of this study is to assess the quality and accuracy of information on the internet regarding ear tubes and their insertion. Websites were identified from Google, Yahoo and MSN using the search terms 'myringotomy', 'tympanostomy', 'grommet' and 'ear tubes'. The first 40 consecutive websites from each search engine using each search term were potentially eligible for the study. Quality of information was assessed using the DISCERN instrument and readability using the Flesch Readability Formula and Flesch-Kincaid Grade Level Readability Formula. As the DISCERN instrument is subjective, both authors rated each website. Specific facts related to ear tubes were identified from each website such as the indications for and complications of ear tubes which were evaluated for accuracy and consistency. Of the 480 potentially eligible websites, 84 were included in the study. The mean DISCERN score for all websites was 38.5 (range 18-64) and the mean readability score was 49.4 (range 5.7-71.6). The mean Flesch-Kincaid Grade level was 10.1 (range 6.6-12). Key facts quoted on websites regarding ear tube information such as indications for insertion and complications are very variable. Overall, internet information regarding ear tubes is of mixed quality and the readability is generally low. Certain topics such as the number of patients that require repeat ear tube insertion and advice on bathing and showering with ear tubes were poorly described. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Availability and Readability of Emergency Preparedness Materials for Deaf and Hard-of-Hearing and Older Adult Populations: Issues and Assessments

PubMed Central

Neuhauser, Linda; Ivey, Susan L.; Huang, Debbie; Engelman, Alina; Tseng, Winston; Dahrouge, Donna; Gurung, Sidhanta; Kealey, Melissa

2013-01-01

A major public health challenge is to communicate effectively with vulnerable populations about preparing for disasters and other health emergencies. People who are Deaf or Hard of Hearing (Deaf/HH) and older adults are particularly vulnerable during health emergencies and require communications that are accessible and understandable. Although health literacy studies indicate that the readability of health communication materials often exceeds people’s literacy levels, we could find no research about the readability of emergency preparedness materials (EPM) intended for Deaf/HH and older adult populations. The objective of this study was to explore issues related to EPM for Deaf/HH and older adult populations, to assess the availability and readability of materials for these populations, and to recommend improvements. In two California counties, we interviewed staff at 14 community-based organizations (CBOs) serving Deaf/HH clients and 20 CBOs serving older adults selected from a stratified, random sample of 227 CBOs. We collected 40 EPM from 10 CBOs and 2 public health departments and 40 EPM from 14 local and national websites with EPM for the public. We used computerized assessments to test the U.S. grade reading levels of the 16 eligible CBO and health department EPM, and the 18 eligible website materials. Results showed that less than half of CBOs had EPM for their clients. All EPM intended for clients of Deaf/HH-serving CBOs tested above the recommended 4th grade reading level, and 91% of the materials intended for clients of older adult-serving CBOs scored above the recommended 6th grade level. EPM for these populations should be widely available through CBOs and public health departments, adhere to health literacy principles, and be accessible in alternative formats including American Sign Language. Developers should engage the intended users of EPM as co-designers and testers. This study adds to the limited literature about EPM for these populations. PMID:23451029

Availability and readability of emergency preparedness materials for deaf and hard-of-hearing and older adult populations: issues and assessments.

PubMed

Neuhauser, Linda; Ivey, Susan L; Huang, Debbie; Engelman, Alina; Tseng, Winston; Dahrouge, Donna; Gurung, Sidhanta; Kealey, Melissa

2013-01-01

A major public health challenge is to communicate effectively with vulnerable populations about preparing for disasters and other health emergencies. People who are Deaf or Hard of Hearing (Deaf/HH) and older adults are particularly vulnerable during health emergencies and require communications that are accessible and understandable. Although health literacy studies indicate that the readability of health communication materials often exceeds people's literacy levels, we could find no research about the readability of emergency preparedness materials (EPM) intended for Deaf/HH and older adult populations. The objective of this study was to explore issues related to EPM for Deaf/HH and older adult populations, to assess the availability and readability of materials for these populations, and to recommend improvements. In two California counties, we interviewed staff at 14 community-based organizations (CBOs) serving Deaf/HH clients and 20 CBOs serving older adults selected from a stratified, random sample of 227 CBOs. We collected 40 EPM from 10 CBOs and 2 public health departments and 40 EPM from 14 local and national websites with EPM for the public. We used computerized assessments to test the U.S. grade reading levels of the 16 eligible CBO and health department EPM, and the 18 eligible website materials. Results showed that less than half of CBOs had EPM for their clients. All EPM intended for clients of Deaf/HH-serving CBOs tested above the recommended 4(th) grade reading level, and 91% of the materials intended for clients of older adult-serving CBOs scored above the recommended 6(th) grade level. EPM for these populations should be widely available through CBOs and public health departments, adhere to health literacy principles, and be accessible in alternative formats including American Sign Language. Developers should engage the intended users of EPM as co-designers and testers. This study adds to the limited literature about EPM for these populations.

Readability Assessment of Patient Information about Lymphedema and Its Treatment.

PubMed

Seth, Akhil K; Vargas, Christina R; Chuang, Danielle J; Lee, Bernard T

2016-02-01

Patient use of online resources for health information is increasing, and access to appropriately written information has been associated with improved patient satisfaction and overall outcomes. The American Medical Association and the National Institutes of Health recommend that patient materials be written at a sixth-grade reading level. In this study, the authors simulated a patient search of online educational content for lymphedema and evaluated readability. An online search for the term "lymphedema" was performed, and the first 12 hits were identified. User and location filters were disabled and sponsored results were excluded. Patient information from each site was downloaded and formatted into plain text. Readability was assessed using established tests: Coleman-Liau, Flesch-Kincaid, Flesch Reading Ease Index, FORCAST Readability Formula, Fry Graph, Gunning Fog Index, New Dale-Chall Formula, New Fog Count, Raygor Readability Estimate, and Simple Measure of Gobbledygook Readability Formula. There were 152 patient articles downloaded; the overall mean reading level was 12.6. Individual website reading levels ranged from 9.4 (cancer.org) to 16.7 (wikipedia.org). There were 36 articles dedicated to conservative treatments for lymphedema; surgical treatment was mentioned in nine articles across four sites. The average reading level for conservative management was 12.7, compared with 15.6 for surgery (p < 0.001). Patient information found through an Internet search for lymphedema is too difficult for many American adults to read. Websites queried had a range of readability, and surgeons should direct patients to sites appropriate for their level. There is limited information about surgical treatment available on the most popular sites; this information is significantly harder to read than sections on conservative measures.

Readability of websites containing information about prostate cancer treatment options.

PubMed

Ellimoottil, Chandy; Polcari, Anthony; Kadlec, Adam; Gupta, Gopal

2012-12-01

Approximately 90 million American adults have literacy skills that test below a high school reading level. Websites written above this level can pose a challenge for those seeking online information about prostate cancer treatment options. In this study we determine the readability of selected websites using a systematic search process and validated readability formulas. We identified the 3 most popular keywords from 513 terms related to prostate cancer treatment options. We then systematically collected 270 websites from the top 3 search engines, and excluded from study those that were nonEnglish, not primarily text, irrelevant and/or duplicated. We used the Flesch-Kincaid grade level and Flesch Reading Ease to determine scores for each site. A total of 62 unique websites were analyzed. Median Flesch-Kincaid grade level was 12.0 (range 8.0 to 12.0) and median Flesch Reading Ease score was 38.1 (range 0.0 to 65.5). Only 3 sites (4.8%) were written below a high school reading level (less than 9.0). Few websites with discussions on prostate cancer treatment options are written below a high school reading level. This is problematic for a third of Americans who seek to further educate themselves using online resources. Clinicians can use this information to guide their patients to appropriate websites. Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Are English-language pedometer instructions readable?

PubMed

Wallace, Lorraine S; Bielak, Kenneth; Linn, Brian

2010-05-01

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

Evaluating asthma websites using the Brief DISCERN instrument.

PubMed

Banasiak, Nancy Cantey; Meadows-Oliver, Mikki

2017-01-01

The primary purpose of this study was to examine the quality of sponsored and unsponsored asthma websites using the Brief DISCERN instrument and to evaluate whether the Health On the Net Code of Conduct (HONcode) logo was present, thereby indicating that the site met the criteria. The Internet is an important source of health information for patients and their families. The primary purpose of this study was to examine the quality of sponsored and unsupported asthma websites. A secondary aim was to determine the readability and reading ease of the materials for each website along with the grade level. We queried seven Internet search engines using the keyword "asthma." The websites were evaluated using the six-item Brief DISCERN instrument and by ascertaining whether the HONcode quality label was present. The websites were also evaluated for readability employing Flesch-Kincaid grade level and Flesch reading ease tools using Microsoft Office Word 2013 software. A total of 22 unique websites were included in the study. Approximately 68% of the websites reviewed had a Brief DISCERN cutoff score of ≥16. The overall Brief DISCERN scores ranged from 6 to 30, and the mean score was 17.32 (SD =6.71). The Flesch-Kincaid grade level scores ranged from 2.9 to 15.4, and the average reading grade score was 9.49 (SD =2.7). The Flesch reading ease scores ranged from 17 to 82.7, with a mean reading ease score of 53.57 (SD =15.03). Sites with a HONcode quality label had significantly higher Brief DISCERN scores than those without one ( t =2.3795; df =20; p =0.02). Brief DISCERN scores revealed that there is quality asthma information for children and their families available on the Internet. The grade level ranged between 2.9 and 15.4 among the websites. However, the mean grade level scores were 9.3-9.89, which is high for the average consumer. Access to accurate information via the Internet, with appropriate readability, may enable pediatric asthma patients and their caregivers to better control and manage asthma.

Evaluating asthma websites using the Brief DISCERN instrument

PubMed Central

Banasiak, Nancy Cantey; Meadows-Oliver, Mikki

2017-01-01

Purpose The primary purpose of this study was to examine the quality of sponsored and unsponsored asthma websites using the Brief DISCERN instrument and to evaluate whether the Health On the Net Code of Conduct (HONcode) logo was present, thereby indicating that the site met the criteria. The Internet is an important source of health information for patients and their families. The primary purpose of this study was to examine the quality of sponsored and unsupported asthma websites. A secondary aim was to determine the readability and reading ease of the materials for each website along with the grade level. Methods We queried seven Internet search engines using the keyword “asthma.” The websites were evaluated using the six-item Brief DISCERN instrument and by ascertaining whether the HONcode quality label was present. The websites were also evaluated for readability employing Flesch-Kincaid grade level and Flesch reading ease tools using Microsoft Office Word 2013 software. Results A total of 22 unique websites were included in the study. Approximately 68% of the websites reviewed had a Brief DISCERN cutoff score of ≥16. The overall Brief DISCERN scores ranged from 6 to 30, and the mean score was 17.32 (SD =6.71). The Flesch-Kincaid grade level scores ranged from 2.9 to 15.4, and the average reading grade score was 9.49 (SD =2.7). The Flesch reading ease scores ranged from 17 to 82.7, with a mean reading ease score of 53.57 (SD =15.03). Sites with a HONcode quality label had significantly higher Brief DISCERN scores than those without one (t=2.3795; df=20; p=0.02). Conclusion Brief DISCERN scores revealed that there is quality asthma information for children and their families available on the Internet. The grade level ranged between 2.9 and 15.4 among the websites. However, the mean grade level scores were 9.3–9.89, which is high for the average consumer. Access to accurate information via the Internet, with appropriate readability, may enable pediatric asthma patients and their caregivers to better control and manage asthma. PMID:28670135

Readability, complexity, and suitability analysis of online lymphedema resources.

PubMed

Tran, Bao Ngoc N; Singh, Mansher; Lee, Bernard T; Rudd, Rima; Singhal, Dhruv

2017-06-01

Over 72% of Americans use online health information to assist in health care decision-making. Previous studies of lymphedema literature have focused only on reading level of patient-oriented materials online. Findings indicate they are too advanced for most patients to comprehend. This, more comprehensive study, expands the previous analysis to include critical elements of health materials beyond readability using assessment tools to report on the complexity and density of data as well as text design, vocabulary, and organization. The top 10 highest ranked websites on lymphedema were identified using the most popular search engine (Google). Website content was analyzed for readability, complexity, and suitability using Simple Measure of Gobbledygook, PMOSE/iKIRSCH, and Suitability Assessment of Materials (SAM), respectively. PMOSE/iKIRSCH and SAM were performed by two independent raters. Fleiss' kappa score was calculated to ensure inter-rater reliability. Online lymphedema literature had a reading grade level of 14.0 (SMOG). Overall complexity score was 6.7 (PMOSE/iKIRSCH) corresponding to "low" complexity and requiring a 8th-12th grade education. Fleiss' kappa score was 80% (P = 0.04, "substantial" agreement). Overall suitability score was 45% (SAM) correlating to the lowest level of "adequate" suitability. Fleiss' kappa score was 76% (P = 0.06, "substantial" agreement). Online resources for lymphedema are above the recommended levels for readability and complexity. The suitability level is barely adequate for the intended audience. Overall, these materials are too sophisticated for the average American adult, whose literacy skills are well documented. Further efforts to revise these materials are needed to improve patient comprehension and understanding. Copyright © 2017 Elsevier Inc. All rights reserved.

A comparison of the readability of two patient-reported outcome measures used to evaluate foot surgery.

PubMed

Alvey, James; Palmer, Simon; Otter, Simon

2012-01-01

Measuring the outcome of surgical intervention is an integral part of modern-day healthcare provision. The increasing requirement to monitor patient-reported outcomes highlights the need for patients to be able to read and understand health outcomes questionnaires. The present study compared the readability of 2 commonly used, validated, foot surgery outcome questionnaires (the Foot Health Status Questionnaire and the Manchester-Oxford Foot Questionnaire) using the Flesch Reading Ease score and the Flesch-Kincaid grade level score. The Manchester-Oxford Foot Questionnaire had a significantly greater (p < .003) score for reading ease and a significantly lower reading grade score (p < .005) than the Foot Health Status Questionnaire. These findings suggest the Manchester-Oxford Foot Questionnaire is a more suitable instrument in terms of readability and comprehension for a greater proportion of the population undergoing hallux valgus surgery. Copyright © 2012 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Hearing aid user guides: suitability for older adults.

PubMed

Caposecco, Andrea; Hickson, Louise; Meyer, Carly

2014-02-01

The aim of this study was to analyse the content, design, and readability of printed hearing aid user guides to determine their suitability for older adults, who are the main users of hearing aids. Hearing aid user guides were assessed using four readability formulae and a standardized tool to assess content and design (SAM - Suitability Assessment of Materials). A sample of 36 hearing aid user guides (four user guides from nine different hearing aid manufacturers) were analysed. Sixty nine percent of user guides were rated 'not suitable' and 31% were rated 'adequate' for their suitability. Many scored poorly for scope, vocabulary, aspects of layout and typography, and learning stimulation and motivation. The mean reading grade level for all user guides was grade 9.6 which is too high for older adults. The content, design, and readability of hearing aid user guides are not optimal for older adults and thus may serve as a barrier to successful hearing aid outcomes for this population.

Separating the Wheat From the Chaff: An Evaluation of Readability, Quality, and Accuracy of Online Health Information for Treatment of Peyronie Disease.

PubMed

Bompastore, Nicholas J; Cisu, Theodore; Holoch, Peter

2018-04-30

To characterize available information about Peyronie disease online and evaluate its readability, quality, accuracy, and respective associations with HONcode certification and website category. The search term "Peyronie disease" was queried on 3 major search engines (Google, Bing, and Yahoo) and the first 50 search results on each search engine were assessed. All websites were categorized as institutional or reference, commercial, charitable, personal or patient support, or alternative medicine, and cross-referenced with the Health on the Net (HON) Foundation. Websites that met the inclusion criteria were analyzed for readability using 3 validated algorithms, for quality using the DISCERN instrument, and for accuracy by a fellowship-trained urologist. On average, online health information about treatment of Peyronie disease is written at or above the 11th grade level, exceeding the current reading guidelines of 6th-8th grade. The mean total DISCERN score for all website categories was 50.44 (standard deviation [SD] 11.94), the upper range of "fair" quality. The mean accuracy score of all online Peyronie treatment information was 2.76 (SD 1.23), corresponding to only 25%-50% accurate information. Both institutional or reference and HONcode-certified websites were of "good" quality (53.44, SD 11.64 and 60.86, SD 8.74, respectively). Institutional or reference websites were 50%-75% accurate (3.13, SD 1.20). Most of the online Peyronie disease treatment information is of mediocre quality and accuracy. The information from institutional or reference websites is of better quality and accuracy, and the information from HONcode-certified websites is of better quality. The mean readability of all websites exceeds the reading ability of most US adults by several grade levels. Copyright © 2018 Elsevier Inc. All rights reserved.

A text comprehension approach to questionnaire readability: An example using gambling disorder measures.

PubMed

Peter, Samuel C; Whelan, James P; Pfund, Rory A; Meyers, Andrew W

2018-06-14

Although readability has been traditionally operationalized and even become synonymous with the concept of word and sentence length, modern text analysis theory and technology have shifted toward multidimensional comprehension-based analytic techniques. In an effort to make use of these advancements and demonstrate their general utility, 6 commonly used measures of gambling disorder were submitted to readability analyses using 2 of these advanced approaches, Coh-Metrix and Question Understanding Aid (QUAID), and one traditional approach, the Flesch-Kincaid Grade Level. As hypothesized, significant variation was found across measures, with some questionnaires emerging as more appropriate than others for use in samples that may include individuals with low literacy. Recommendations are made for the use of these modern approaches to readability to inform decisions on measure selection and development. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Further issues in determining the readability of self-report items: comment on McHugh and Behar (2009).

PubMed

Schinka, John A

2012-10-01

Issues regarding the readability of self-report assessment instruments, methods for establishing the reading ability level of respondents, and guidelines for development of scales designed for marginal readers have been inconsistently addressed in the literature. A recent study by McHugh and Behar (2009) provided new findings relevant to these issues. McHugh and Behar calculated indices of readability separately for the instructions and the item sets of 105 self-report measures of anxiety and depression. Results revealed substantial variability in readability among the measures, with most measures being written at or above the mean reading grade level in the United States. These results were consistent with those reported previously by Schinka and Borum (1993, 1994) in analyses of the readability of commonly used self-report psychopathology and personality inventories. In their discussion, McHugh and Behar addressed implications of their findings for clinical assessment and for scale development. I expand on their comments by addressing the failure to consider vocabulary difficulty, a major shortcoming of readability indices that examine only text complexity. I demonstrate how vocabulary difficulty influences readability and discuss additional considerations and possible solutions for addressing the gap between scale readability and the reading skill level of the self-report respondent. The work of McHugh and Behar clearly demonstrates that the issues of reading ability that arise in collecting self-report data are neither simple nor straightforward. Comments are offered to focus attention on the problems identified by their work. These problems will require additional effort on the part of researchers and clinicians in order to obtain reliable, valid estimates of clinical status. (PsycINFO Database Record (c) 2012 APA, all rights reserved).

MyPyramid.gov: assessment of literacy, cultural and linguistic factors in the USDA food pyramid web site.

PubMed

Neuhauser, Linda; Rothschild, Rebeccah; Rodríguez, Fátima M

2007-01-01

MyPyramid.gov, a major national Web site about healthful eating and physical activity, was analyzed for literacy, cultural, and linguistic factors relevant to consumers. The assessment used 4 standardized readability tests, 1 navigational test, availability of non-English content, and new criteria for cultural factors. Readability scores averaged between grade levels 8.8 and 10.8, and half the navigation criteria were met. The Web site was available in Spanish, but it had little cultural tailoring for English speakers. It is recommended that MyPyramid's readability, navigation, and cultural tailoring be improved. References are provided to help educators learn more about assessing and using Internet communication with diverse audiences.

Information about oral cancer on the Internet: our patients cannot understand it.

PubMed

Varela-Centelles, P; Ledesma-Ludi, Y; Seoane-Romero, J M; Seoane, J

2015-04-01

Although information about cancer on the Internet can be beneficial to patients and physicians, to our knowledge, comprehension by patients has not been investigated. We used 3 search engines to select websites on oral cancer then assessed their readability using the Flesch-Kinkaid Reading Grade Level, Flesch Reading Ease Score, Gunning Fog Index, Coleman-Liau Index, Automated Readability Index, and the Simple Measure of Gobbledygook Index (SMOG). The mean scores for readability were within the range of "difficult to read" (FRES=36.04 (14.87)) with high educational requirements (FKRGL=11.44 (3.27)). This could hamper comprehension and is particularly worrying given the high percentage of people who have poor levels of literacy. Copyright © 2015 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Internet-Based Resources Frequently Provide Inaccurate and Out-of-Date Recommendations on Preoperative Fasting: A Systematic Review.

PubMed

Roughead, Taren; Sewell, Darreul; Ryerson, Christopher J; Fisher, Jolene H; Flexman, Alana M

2016-12-01

Preoperative fasting is important to avoid morbidity and surgery delays, yet recommendations available on the Internet may be inaccurate. Our objectives were to describe the characteristics and recommendations of Internet resources on preoperative fasting and assess the quality and readability of these websites. We searched the Internet for common search terms on preoperative fasting using Google® search engines from 4 English-speaking countries (Canada, the United States, Australia, and the United Kingdom). We screened the first 30 websites from each search and extracted data from unique websites that provided recommendations on preoperative fasting. Website quality was assessed using validated tools (JAMA Benchmark criteria, DISCERN score, and Health on the Net Foundation code [HONcode] certification). Readability was scored using the Flesch Reading Ease score and Flesch-Kincaid Grade Level. A total of 87 websites were included in the analysis. A total of 48 websites (55%) provided at least 1 recommendation that contradicted established guidelines. Websites from health care institutions were most likely to make inaccurate recommendations (61%). Only 17% of websites encouraged preoperative hydration. Quality and readability were poor, with a median JAMA Benchmark score of 1 (interquartile range 0-3), mean DISCERN score 39.8 (SD 12.5), mean reading ease score 49 (SD 15), and mean grade level of 10.6 (SD 2.7). HONcode certification was infrequent (10%). Anesthesia society websites and scientific articles had higher DISCERN scores but worse readability compared with websites from health care institutions. Online fasting recommendations are frequently inconsistent with current guidelines, particularly among health care institution websites. The poor quality and readability of Internet resources on preoperative fasting may confuse patients.

How are we communicating about clinical trials?: an assessment of the content and readability of recruitment resources.

PubMed

Friedman, Daniela B; Kim, Sei-Hill; Tanner, Andrea; Bergeron, Caroline D; Foster, Caroline; General, Kevin

2014-07-01

Clinical trials (CTs) are important for advancing public health and medical research, however, CT recruitment is challenging. The high reading level of CT information and the technical language of providers or researchers can serve as barriers to recruitment. Prior studies on the informed consent process found that consent documents often contain complicated terms. Limited research has examined resources specifically used to recruit individuals into CTs. The purpose of this study was to examine the content and readability of CT recruitment education resources in one U.S. state. Convenience sampling was employed for the collection of CT recruitment materials. A codebook was developed based on previous content analyses and emergent themes from statewide focus groups about CTs. A total of 127 materials were collected and analyzed (37.8% print; 62.2% Web). Most content was focused on treatment-related CTs (60.6%). Inclusion criteria related to specific disease conditions (88.9%) and age (73.6%) were described most often. Only 30% of resources had an explicit call to action. Overall mean readability level was Grade 11.7. Web-based materials were significantly more likely to be written at a higher grade level than print materials (p ≤ .0001). Readability also differed significantly according to resource distributor/creator, CT type, person quoted, and presence or absence of inclusion criteria and an explicit call to action. Our study provides insight into the content and difficulty level of recruitment materials intended to provide initial information about a CT. Future studies should examine individuals' comprehension of recruitment materials and how participation intentions are associated with recruitment messages. Copyright © 2014 Elsevier Inc. All rights reserved.

How Readable are Spanish-Language Medicaid Applications?

PubMed Central

Hansen, Julie S.; DeVoe, Jennifer E.

2015-01-01

Nationally, Hispanics comprise nearly one-quarter of all non-elderly Medicaid recipients. We evaluated readability, layout characteristics, and document complexity of state-issued Spanish-language Medicaid enrollment applications. We located and analyzed Internet-based Spanish enrollment applications from 37 states and the District of Columbia. We calculated the readability of each Medicaid enrollment application “Signature” page using the Spanish Lexile Analyzer. We assessed application layout characteristics utilizing the User-Friendliness Tool, and we evaluated document complexity using the PMOSE/IKIRSCH scale. The average Lexile score estimated an 11th–12th grade reading level (M = 1184, SD = 192) for “Signature” pages of enrollment applications. Most applications used small font size and lacked adequate white space. Document complexity ranged from level 3 (moderate) to level 5 (very high); the majority of applications ranked at level 4 (high). Spanish-language Medicaid enrollment applications should be revised to adhere to low-literacy guidelines, which may improve the accessibility of Medicaid coverage for eligible Spanish-speaking families. PMID:21213122

The Readability of Online Resources for Mastopexy Surgery.

PubMed

Vargas, Christina R; Chuang, Danielle J; Lee, Bernard T

2016-01-01

As more patients use Internet resources for health information, there is increasing interest in evaluating the readability of available online materials. The National Institutes of Health and American Medical Association recommend that patient educational content be written at a sixth-grade reading level. This study evaluates the most popular online resources for information about mastopexy relative to average adult literacy in the United States. The 12 most popular sites returned by the largest Internet search engine were identified using the search term "breast lift surgery." Relevant articles from the main sites were downloaded and formatted into text documents. Pictures, captions, links, and references were excluded. The readability of these 100 articles was analyzed overall and subsequently by site using 10 established readability tests. Subgroup analysis was performed for articles discussing the benefits of surgery and those focusing on risks. The overall average readability of online patient information was 13.3 (range, 11.1-15). There was a range of average readability scores overall across the 12 sites from 8.9 to 16.1, suggesting that some may be more appropriate than others for patient demographics with different health literacy levels. Subgroup analysis revealed that articles discussing the risks of mastopexy were significantly harder to read (mean, 14.1) than articles about benefits (11.6). Patient-directed articles from the most popular online resources for mastopexy information are uniformly above the recommended reading level and likely too difficult to be understood by a large number of patients in the United States.

Evaluating the quality and readability of Internet information sources regarding the treatment of swallowing disorders.

PubMed

O'Connell Ferster, Ashley P; Hu, Amanda

2017-03-01

The Internet has become a popular resource for patient education. The information it provides, however, is rarely peer-reviewed, and its quality may be a concern. Since the average American reads at an 8th grade level, the American Medical Association and the National Institutes of Health have recommended that health information be written at a 4th to 6th grade level. We performed a study to assess the quality and readability of online information regarding the treatment of swallowing disorders. A Google search for "swallowing treatment" was conducted. We studied the first 50 websites that appeared on the search engine's results with the use of the DISCERN quality index tool, the Flesch Ease of Reading Score (FRES), and the Flesch-Kincaid Grade Level (FKGL) readability test. DISCERN is a validated 16-item questionnaire used to assess the quality of written health information; FRES and FKGL are used to assess readability. We classified the websites as either patient-targeted or professional-targeted sites, as well as either major or minor. The overall DISCERN score was 1.61 ± 0.61 (range: 1 to 5), the overall FRES was 39.1 ± 19.0 (range: 1 to 100), and the overall FKGL was 11.8 ± 3.4 (range: 3 to 12). As would be expected, patient-targeted websites had significantly higher FRES and significantly lower FKGL scores than did the professional-targeted websites (p = 0.01 and p = 0.04, respectively); there was no significant difference between the two in DISCERN scores. The major websites had significantly higher DISCERN scores than did the minor sites (p = 0.002); there were no significant differences in FRES and FKGL scores. We conclude that online information sources regarding the treatment of swallowing disorders were of suboptimal quality in that information was written at a level too difficult for the average American to easily understand. Also, the patient-targeted websites were written at a lower reading level, and the major websites contained a higher quality of information.

Facial Plastic Surgery Patient Resources Exceed National Institute Recommendations.

PubMed

Chu, Michael W; Cook, Julia A; Tholpady, Sunil S; Schmalbach, Cecelia E; Momeni, Arash

2017-05-01

Patient education is essential in enhancing the physician-patient therapeutic alliance, patient satisfaction, and clinical outcomes. The American Medical Association and National Institute of Health recommend that information be written at a 6th-grade reading level, but online resources often exceed patient literacy. The purpose of this study is to assess readability of online material for facial plastics procedures presented on academic plastic surgery and otolaryngology websites.An Internet search was performed of all academic institutions that had both plastic surgery and otolaryngology training programs who offered patient information on facial plastic surgery procedures. National society websites for both plastic surgery and otolaryngology were also analyzed. All procedural information was compiled and readability analyses were performed. A 2-tailed Z-test was used to compare scores, and statistical significance was set at P < 0.05.Sixty-three programs were identified; 42 had educational material. The overall average readability for all information was at a 10th-grade reading level. The national plastic surgery website had a significantly higher word count and number of syllables per word compared to the national otolaryngology website (P < 0.001, P = 0.04).The complexity of written resources represents an obstacle to online patient education and efforts to improve readability could benefit patients seeking medical information online. Current online education materials are a potential hindrance to patient education, satisfaction, and decision making. Healthcare institutions should consider writing new materials with simpler language that would be accessible to patients.

Readability of patient discharge instructions with and without the use of electronically available disease-specific templates.

PubMed

Mueller, Stephanie K; Giannelli, Kyla; Boxer, Robert; Schnipper, Jeffrey L

2015-07-01

Low health literacy is common, leading to patient vulnerability during hospital discharge, when patients rely on written health instructions. We aimed to examine the impact of the use of electronic, patient-friendly, templated discharge instructions on the readability of discharge instructions provided to patients at discharge. We performed a retrospective cohort study of 233 patients discharged from a large tertiary care hospital to their homes following the implementation of a web-based "discharge module," which included the optional use of diagnosis-specific templated discharge instructions. We compared the readability of discharge instructions, as measured by the Flesch Reading Ease Level test (FREL, on a 0-100 scale, with higher scores indicating greater readability) and the Flesch-Kincaid Grade Level test (FKGL, measured in grade levels), between discharges that used templated instructions (with or without modification) versus discharges that used clinician-generated instructions (with or without available templated instructions for the specific discharge diagnosis). Templated discharge instructions were provided to patients in 45% of discharges. Of the 55% of patients that received clinician-generated discharge instructions, the majority (78.1%) had no available templated instruction for the specific discharge diagnosis. Templated discharge instructions had higher FREL scores (71 vs. 57, P < .001) and lower FKGL scores (5.6 vs. 7.6, P < .001), compared to clinician-generated discharge instructions. The use of electronically available templated discharge instructions was associated with better readability (a higher FREL score and a lower FKGL score) than the use of clinician-generated discharge instructions. The main reason for clinicians to create discharge instructions was the lack of available templates for the patient's specific discharge diagnosis. Use of electronically available templated discharge instructions may be a viable option to improve the readability of written material provided to patients at discharge, although the library of available templates requires expansion. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Readability and Item Difficulty of the Texas Assessment of Knowledge and Skills Fifth-Grade Science Tests

ERIC Educational Resources Information Center

Thomas, Conn; Carpenter, Clint

2008-01-01

The development of the Texas Assessment of Knowledge and Skills test involves input from educators across the state. The development process attempts to create an assessment that reflects the skills and content understanding of students at the tested grade level. This study attempts to determine other factors that can affect student performance on…

The development of a test of biodiversity knowledge of high school students

NASA Astrophysics Data System (ADS)

Ajayi, Olabisi Modupe

2002-09-01

The primary purpose of this study was to develop a valid and reliable test of the knowledge of biodiversity of high school students. The test differentiated students' knowledge on three levels of biodiversity: species, ecosystem and genetics. A secondary purpose was to examine how biodiversity scores were affected by gender, grade point average, and families' socioeconomic status. The initial phase of the instrument development involved the construction of 60 dichotomous items (true/false). To establish content validity, a panel of biodiversity experts reviewed the items for appropriateness and clarity. The items were checked for readability using Flesch-Kincaid Readability Index and the readability was at the fifth grade level. The instrument was subjected to factor analysis. As a result, the final instrument was compiled and named the Ajayi Biodiversity Instrument (ABI). The reliability of ABI was .87. The mean score on the 25-item test was 79%. No significant difference at >0.05 was found in the score of students on each of the three subtests for genetics, species, and ecosystem. No significant difference was found in the score of students relative to their family's socioeconomic status. There was a significant correlation between grade point average and participation in extracurricular activities that related to biodiversity concepts and scores on ABI. Gender differences emerged at the ecosystem level, females scoring higher than males. Differences among ethnic groups also emerged. Anglo-Americans scored significantly higher on the test of knowledge of biodiversity for high school students than the rest of the ethnic groups combined.

Readability and Reading Ease Revisited: State-Adopted Science Textbooks.

ERIC Educational Resources Information Center

Chavkin, Laura

1997-01-01

Examines if the reading levels of state-adopted science textbooks at the high-school level are consistent with their intended reader levels. Finds that four of five chemistry textbooks had reading levels beyond high school, while biology textbooks fared better but not as well as the physics and physical science textbooks, which were on grade level…

Readability and quality assessment of internet-based patient education materials related to laryngeal cancer.

PubMed

Narwani, Vishal; Nalamada, Keerthana; Lee, Michael; Kothari, Prasad; Lakhani, Raj

2016-04-01

Patients are increasingly using the internet to access health-related information. The purpose of this study was to assess the readability and quality of laryngeal cancer-related websites. Patient education materials were identified by performing an internet search using 3 search engines. Readability was assessed using Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), and Gunning Fog Index (GFI). The DISCERN instrument was utilized to assess quality of health information. A total of 54 websites were included in the analysis. The mean readability scores were as follows: FRES, 48.2 (95% confidence interval [CI] = 44.8-51.6); FKGL, 10.9 (95% CI = 10.3-11.5); and GFI, 13.8 (95% CI = 11.3-16.3). These scores suggest that, on average, online information about patients with laryngeal cancer is written at an advanced level. The mean DISCERN score was 49.8 (95% CI = 45.4-54.2), suggesting that online information is of variable quality. Our study suggests much of the laryngeal cancer information available online is of suboptimal quality and written at a level too difficult for the average adult to read comfortably. © 2015 Wiley Periodicals, Inc.

Patient-oriented methotrexate information sites on the Internet: a review of completeness, accuracy, format, reliability, credibility, and readability.

PubMed

Thompson, Andrew E; Graydon, Sara L

2009-01-01

With continuing use of the Internet, rheumatologists are referring patients to various websites to gain information about medications and diseases. Our goal was to develop and evaluate a Medication Website Assessment Tool (MWAT) for use by health professionals, and to explore the overall quality of methotrexate information presented on common English-language websites. Identification of websites was performed using a search strategy on the search engine Google. The first 250 hits were screened. Inclusion criteria included those English-language websites from authoritative sources, trusted medical, physicians', and common health-related websites. Websites from pharmaceutical companies, online pharmacies, and where the purpose seemed to be primarily advertisements were also included. Product monographs or technical-based web pages and web pages where the information was clearly directed at patients with cancer were excluded. Two reviewers independently scored each included web page for completeness and accuracy, format, readability, reliability, and credibility. An overall ranking was provided for each methotrexate information page. Twenty-eight web pages were included in the analysis. The average score for completeness and accuracy was 15.48+/-3.70 (maximum 24) with 10 out of 28 pages scoring 18 (75%) or higher. The average format score was 6.00+/-1.46 (maximum 8). The Flesch-Kincaid Grade Level revealed an average grade level of 10.07+/-1.84, with 5 out of 28 websites written at a reading level less than grade 8; however, no web page scored at a grade 5 to 6 level. An overall ranking was calculated identifying 8 web pages as appropriate sources of accurate and reliable methotrexate information. With the enormous amount of information available on the Internet, it is important to direct patients to web pages that are complete, accurate, readable, and credible sources of information. We identified web pages that may serve the interests of both rheumatologists and patients.

An analysis of the readability of patient information and consent forms used in research studies in anaesthesia in Australia and New Zealand.

PubMed

Taylor, H E; Bramley, D E P

2012-11-01

The provision of written information is a component of the informed consent process for research participants. We conducted a readability analysis to test the hypothesis that the language used in patient information and consent forms in anaesthesia research in Australia and New Zealand does not meet the readability standards or expectations of the Good Clinical Practice Guidelines, the National Health and Medical Research Council in Australia and the Health Research Council of New Zealand. We calculated readability scores for 40 patient information and consent forms using the Simple Measure of Gobbledygook and Flesch-Kincaid formulas. The mean grade level of patient information and consent forms when using the Simple Measure of Gobbledygook and Flesch-Kincaid readability formulas was 12.9 (standard deviation of 0.8, 95% confidence interval 12.6 to 13.1) and 11.9 (standard deviation 1.1, 95% confidence interval 11.6 to 12.3), respectively. This exceeds the average literacy and comprehension of the general population in Australia and New Zealand. Complex language decreases readability and negatively impacts on the informed consent process. Care should be exercised when providing written information to research participants to ensure language and readability is appropriate for the audience.

The effect of search term on the quality and accuracy of online information regarding distal radius fractures.

PubMed

Dy, Christopher J; Taylor, Samuel A; Patel, Ronak M; Kitay, Alison; Roberts, Timothy R; Daluiski, Aaron

2012-09-01

Recent emphasis on shared decision making and patient-centered research has increased the importance of patient education and health literacy. The internet is rapidly growing as a source of self-education for patients. However, concern exists over the quality, accuracy, and readability of the information. Our objective was to determine whether the quality, accuracy, and readability of information online about distal radius fractures vary with the search term. This was a prospective evaluation of 3 search engines using 3 different search terms of varying sophistication ("distal radius fracture," "wrist fracture," and "broken wrist"). We evaluated 70 unique Web sites for quality, accuracy, and readability. We used comparative statistics to determine whether the search term affected the quality, accuracy, and readability of the Web sites found. Three orthopedic surgeons independently gauged quality and accuracy of information using a set of predetermined scoring criteria. We evaluated the readability of the Web site using the Fleisch-Kincaid score for reading grade level. There were significant differences in the quality, accuracy, and readability of information found, depending on the search term. We found higher quality and accuracy resulted from the search term "distal radius fracture," particularly compared with Web sites resulting from the term "broken wrist." The reading level was higher than recommended in 65 of the 70 Web sites and was significantly higher when searching with "distal radius fracture" than "wrist fracture" or "broken wrist." There was no correlation between Web site reading level and quality or accuracy. The readability of information about distal radius fractures in most Web sites was higher than the recommended reading level for the general public. The quality and accuracy of the information found significantly varied with the sophistication of the search term used. Physicians, professional societies, and search engines should consider efforts to improve internet access to high-quality information at an understandable level. Copyright © 2012 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

A comparative analysis of neurosurgical online education materials to assess patient comprehension.

PubMed

Agarwal, Nitin; Chaudhari, Amit; Hansberry, David R; Tomei, Krystal L; Prestigiacomo, Charles J

2013-10-01

Americans have increasingly utilized the internet as a first-line resource for a variety of information, including healthcare-oriented materials. Therefore, these online resources should be written at a level the average American can understand. Patient education resources specifically written for and available to the public were downloaded from the American Association of Neurological Surgeons website and assessed for their level of readability using the Flesch Reading Ease, Flesch-Kincaid Grade Level, Simple Measure of Gobbledygook Grading, Coleman-Liau Index, and Gunning-Fog Index. A total of 71 subsections from different neurosurgical specialties were reviewed, including Cerebrovascular, Spine and Peripheral Nerves, Neurotrauma and Critical Care, Pain, Pediatric, Stereotactic and Functional, and Tumor material. All neurosurgical subspecialty education material provided on the American Association of Neurological Surgeons website was uniformly written at a level that was too high, as assessed by all modalities. In order to reach a larger patient population, patient education materials on the American Association of Neurological Surgeons website should be revised with the goal of simplifying readability. Copyright © 2013 Elsevier Ltd. All rights reserved.

Health literacy in vascular and interventional radiology: a comparative analysis of online patient education resources.

PubMed

Hansberry, David R; Kraus, Carl; Agarwal, Nitin; Baker, Stephen R; Gonzales, Sharon F

2014-08-01

The Internet is frequently accessed by patients as a resource for medical knowledge. However, the provided material is typically written at a level well above the recommended 7th grade level. A clear understanding of the capabilities, limitations, risks, and benefits of interventional radiology by patients, both current and prospective, is hindered when the textual information offered to the public is pitched at a level of sophistication too high for general comprehension. In January 2013, all 25 patient education resources from the Cardiovascular and Interventional Radiology Society of Europe (CIRSE) Web site ( http://www.cirse.org ) and all 31 resources from the Society of Interventional Radiology (SIR) Web site ( http://www.sirweb.org ) were analyzed for their specific level of readability using ten quantitative scales: Flesch Reading Ease, Flesch-Kincaid Grade Level, Simple Measure of Gobbledygook, Gunning fog index, New Fog Count, Coleman-Liau index, FORCAST formula, Fry graph, Raygor Readability Estimate, and New Dale-Chall. Collectively, the patient education resources on the CIRSE Web site are written at the 12.3 grade level, while the resources on the SIR Web site are written at the 14.5 grade level. Educational health care materials available on both the CIRSE and the SIR Web sites are presented in language in the aggregate that could be too difficult for many lay people to fully understand. Given the complex nature of vascular and interventional radiology, it may be advantageous to rewrite these educational resources at a lower reading level to increase comprehension.

Readability, credibility and quality of patient information for hypogonadism and testosterone replacement therapy on the Internet.

PubMed

McBride, J A; Carson, C C; Coward, R M

2017-05-01

The incidence of hypogonadism and use of testosterone replacement therapy (TRT) are rising, while data evaluating the complexity and quality of health-care information available to patients on the Internet for hypogonadism or TRT are lacking. This study focuses on characterizing the readability, credibility and quality of patient-centered information for hypogonadism on the Internet. A Google search was performed to identify top-ranked websites offering patient-centered information on hypogonadism and TRT. Readability was quantified by reading grade level using several validated instruments. Credibility and quality were determined by several additional criteria, including authorship, references, health-care information quality certification and breadth of topic discussion. Twenty of 75 total sites identified (27%) met the inclusion and exclusion criteria and were evaluated. The mean reading grade level was 13.1 (interquartile range 11.7-15.1), with all websites demonstrating reading levels significantly above recommended levels. Less than half (45%) of the sites were neither authored nor reviewed by a physician, 60% contained at least one reference and 40% were certified for displaying quality health-care information. Over half (55%) did not comprehensively discuss management of hypogonadism or mention treatment-associated risks. In conclusion, the majority of patient-centered information available on the Internet regarding hypogonadism or TRT is of poor quality and too complex for the average patient to comprehend. These results highlight a critical shortage in easily accessible, high-quality, comprehensible online patient health-care information on hypogonadism and TRT.

Readability of online patient education materials for velopharyngeal insufficiency.

PubMed

Xie, Deborah X; Wang, Ray Y; Chinnadurai, Sivakumar

2018-01-01

Evaluate the readability of online and mobile application health information about velopharyngeal insufficiency (VPI). Top website and mobile application results for search terms "velopharyngeal insufficiency", "velopharyngeal dysfunction", "VPI", and "VPD" were analyzed. Readability was determined using 10 algorithms with Readability Studio Professional Edition (Oleander Software Ltd; Vandalia, OH). Subgroup analysis was performed based on search term and article source - academic hospital, general online resource, peer-reviewed journal, or professional organization. 18 unique articles were identified. Overall mean reading grade level was a 12.89 ± 2.9. The highest reading level among these articles was 15.47-approximately the level of a college senior. Articles from "velopharyngeal dysfunction" had the highest mean reading level (13.73 ± 2.11), above "velopharyngeal insufficiency" (12.30 ± 1.56) and "VPI" (11.66 ± 1.70). Articles from peer-reviewed journals had the highest mean reading level (15.35 ± 2.79), while articles from academic hospitals had the lowest (12.81 ± 1.66). There were statistically significant differences in reading levels between the different search terms (P < 0.01) and article source types (P < 0.05). Only one mobile application was identified with VPI information, with a readability of 10.68. Despite published reading level guidelines, online patient education materials for VPI are disseminated with language too complex for most readers. There is also a lack of VPI-related mobile application data available for patients. Patients will benefit if future updates to websites and disseminated patient information are undertaken with health literacy in mind. Future studies will investigate patient comprehension of these materials. Copyright © 2017 Elsevier B.V. All rights reserved.

Accuracy and readability of cardiovascular entries on Wikipedia: are they reliable learning resources for medical students?

PubMed Central

Azer, Samy A; AlSwaidan, Nourah M; Alshwairikh, Lama A; AlShammari, Jumana M

2015-01-01

Objective To evaluate accuracy of content and readability level of English Wikipedia articles on cardiovascular diseases, using quality and readability tools. Methods Wikipedia was searched on the 6 October 2013 for articles on cardiovascular diseases. Using a modified DISCERN (DISCERN is an instrument widely used in assessing online resources), articles were independently scored by three assessors. The readability was calculated using Flesch-Kincaid Grade Level. The inter-rater agreement between evaluators was calculated using the Fleiss κ scale. Results This study was based on 47 English Wikipedia entries on cardiovascular diseases. The DISCERN scores had a median=33 (IQR=6). Four articles (8.5%) were of good quality (DISCERN score 40–50), 39 (83%) moderate (DISCERN 30–39) and 4 (8.5%) were poor (DISCERN 10–29). Although the entries covered the aetiology and the clinical picture, there were deficiencies in the pathophysiology of diseases, signs and symptoms, diagnostic approaches and treatment. The number of references varied from 1 to 127 references; 25.9±29.4 (mean±SD). Several problems were identified in the list of references and citations made in the articles. The readability of articles was 14.3±1.7 (mean±SD); consistent with the readability level for college students. In comparison, Harrison’s Principles of Internal Medicine 18th edition had more tables, less references and no significant difference in number of graphs, images, illustrations or readability level. The overall agreement between the evaluators was good (Fleiss κ 0.718 (95% CI 0.57 to 0.83). Conclusions The Wikipedia entries are not aimed at a medical audience and should not be used as a substitute to recommended medical resources. Course designers and students should be aware that Wikipedia entries on cardiovascular diseases lack accuracy, predominantly due to errors of omission. Further improvement of the Wikipedia content of cardiovascular entries would be needed before they could be considered a supplementary resource. PMID:26443650

Assessment of Online Patient Education Materials from Major Dermatologic Associations

PubMed Central

John, Ann M.; John, Elizabeth S.; Hansberry, David R.

2016-01-01

Objective: Patients increasingly use the internet to find medical information regarding their conditions and treatments. Physicians often supplement visits with written education materials. Online patient education materials from major dermatologic associations should be written at appropriate reading levels to optimize utility for patients. The purpose of this study is to assess online patient education materials from major dermatologic associations and determine if they are written at the fourth to sixth grade level recommended by the American Medical Association and National Institutes of Health. Design: This is a descriptive and correlational design. Setting: Academic institution. Participants/measurements: Patient education materials from eight major dermatology websites were downloaded and assessed using 10 readability scales. A one-way analysis of variance and Tukey’s Honestly Statistically Different post hoc analysis were performed to determine the difference in readability levels between websites. Results: Two hundred and sixty patient education materials were assessed. Collectively, patient education materials were written at a mean grade level of 11.13, with 65.8 percent of articles written above a tenth grade level and no articles written at the American Medical Association/National Institutes of Health recommended grade levels. Analysis of variance demonstrated a significant difference between websites for each reading scale (p<0.001), which was confirmed with Tukey’s Honestly Statistically Different post hoc analysis. Conclusion: Online patient education materials from major dermatologic association websites are written well above recommended reading levels. Associations should consider revising patient education materials to allow more effective patient comprehension. (J ClinAesthet Dermatol. 2016;9(9):23–28.) PMID:27878059

Assessment of Online Patient Education Materials from Major Dermatologic Associations.

PubMed

John, Ann M; John, Elizabeth S; Hansberry, David R; Lambert, William Clark

2016-09-01

Objective: Patients increasingly use the internet to find medical information regarding their conditions and treatments. Physicians often supplement visits with written education materials. Online patient education materials from major dermatologic associations should be written at appropriate reading levels to optimize utility for patients. The purpose of this study is to assess online patient education materials from major dermatologic associations and determine if they are written at the fourth to sixth grade level recommended by the American Medical Association and National Institutes of Health. Design: This is a descriptive and correlational design. Setting: Academic institution. Participants/measurements: Patient education materials from eight major dermatology websites were downloaded and assessed using 10 readability scales. A one-way analysis of variance and Tukey's Honestly Statistically Different post hoc analysis were performed to determine the difference in readability levels between websites. Results: Two hundred and sixty patient education materials were assessed. Collectively, patient education materials were written at a mean grade level of 11.13, with 65.8 percent of articles written above a tenth grade level and no articles written at the American Medical Association/National Institutes of Health recommended grade levels. Analysis of variance demonstrated a significant difference between websites for each reading scale (p<0.001), which was confirmed with Tukey's Honestly Statistically Different post hoc analysis. Conclusion: Online patient education materials from major dermatologic association websites are written well above recommended reading levels. Associations should consider revising patient education materials to allow more effective patient comprehension. (J ClinAesthet Dermatol. 2016;9(9):23-28.).

A Polio Immunization Pamphlet with Increased Appeal and Simplified Language Does Not Improve Comprehension to an Acceptable Level.

ERIC Educational Resources Information Center

Davis, Terry C.; Fredrickson, Doren D.; Arnold, Connie; Murphy, Peggy W.; Herbst, Melissa; Bocchini, Joseph A.

1998-01-01

Two polio-vaccine pamphlets written on a sixth-grade level were compared for readability, comprehension, and preference among a broad range of parents. The easy-to-read version was widely preferred, and comprehension was significantly higher. However, the use of instructional graphics was required to achieve an acceptable level of comprehension.…

Constructing post-surgical discharge instructions through a Delphi consensus methodology.

PubMed

Scott, Aaron R; Sanderson, Cody J; Rush, Augustus J; Alore, Elizabeth A; Naik, Aanand D; Berger, David H; Suliburk, James W

2018-05-01

Patient education materials are a crucial part of physician-patient communication. We hypothesize that available discharge instructions are difficult to read and fail to address necessary topics. Our objective is to evaluate readability and content of surgical discharge instructions using thyroidectomy to develop standardized discharge materials. Thyroidectomy discharge materials were analyzed for readability and assessed for content. Fifteen endocrine surgeons participated in a modified Delphi consensus panel to select necessary topics. Using readability best practices, we created standardized discharge instructions which included all selected topics. The panel evaluated 40 topics, selected 23, deemed 4 inappropriate, consolidated 5, and did not reach consensus on 8 topics after 4 rounds. The evaluated instructions' reading levels ranged from grade 6.5 to 13.2; none contained all consensus topics. Current post surgical thyroidectomy discharge instructions are more difficult to read than recommended by literacy standards and omit consensus warning signs of major complications. Our easy-to-read discharge instructions cover pertinent topics and may enhance patient education. Delphi methodology is useful for developing post-surgical instructions. Patient education materials need appropriate readability levels and content. We recommend the Delphi method to select content using consensus expert opinion whenever higher level data is lacking. Copyright © 2017 Elsevier B.V. All rights reserved.

Quality and readability assessment of websites related to recurrent respiratory papillomatosis.

PubMed

San Giorgi, Michel R M; de Groot, Olivier S D; Dikkers, Frederik G

2017-10-01

Recurrent respiratory papillomatosis (RRP) is a rare disease for which a limited number of information sources for patients exist. The role of the Internet in the patient-physician relationship is increasing. More and more patients search for online health information, which should be of good quality and easy readable. The study aim was to investigate the quality and readability of English online health information about RRP. Quality and readability assessment of online information. Relevant information was collected using three different search engines and seven different search terms. Quality was assessed with the DISCERN instrument. The Flesch Reading Ease Score (FRES) and average grade level (AGL) were determined to measure readability of the English websites. Fifty-one English websites were included. The mean DISCERN score of the websites is 28.1 ± 9.7 (poor quality); the mean FRES is 41.3 ± 14.9 (difficult to read); and the mean AGL is 12.6 ± 2.3. The quality and readability of English websites about RRP is alarmingly poor. NA. Laryngoscope, 127:2293-2297, 2017. © 2017 The Authors The Laryngoscope published by Wiley Periodicals, Inc. on behalf of American Laryngological, Rhinological and Otological Society Inc, “The Triological Society” and American Laryngological Association (ALA).

Health Literacy Demands of Patient-Reported Evaluation Tools in Orthopedics: A Mixed-Methods Case Study.

PubMed

Hadden, Kristie; Prince, Latrina Y; Barnes, C Lowry

In response to an assessment of organizational health literacy practices at a major academic health center, this case study evaluated the health literacy demands of patient-reported outcome measures commonly used in orthopedic surgery practices to identify areas for improvement. A mixed-methods approach was used to analyze the readability and patient feedback of orthopedic patient-reported outcome materials. Qualitative results were derived from focus group notes, observations, recordings, and consensus documents. Results were combined to formulate recommendations for quality improvement. Readability results indicated that narrative portions of sample patient outcome tools were written within or below the recommended eighth-grade reading level (= 5.9). However, document literacy results were higher than the recommended reading level (= 9.8). Focus group results revealed that participants had consensus on 8 of 12 plain language best practices, including use of bullet lists and jargon or technical words in both instruments. Although the typical readability of both instruments was not exceedingly high, appropriate readability formula and assessment methods gave a more comprehensive assessment of true readability. In addition, participant feedback revealed the need to reduce jargon and improve formatting to lessen the health literacy demands on patients. As clinicians turn more toward patient-reported measures to assess health care quality, it is important to consider the health literacy demands that are inherent in the instruments they are given in our health systems.

Readability Assessment of Online Uveitis Patient Education Materials.

PubMed

Ayoub, Samantha; Tsui, Edmund; Mohammed, Taariq; Tseng, Joseph

2017-12-29

To evaluate the readability of online uveitis patient education materials. A Google search in November 2016 was completed using search term "uveitis" and "uveitis inflammation." The top 50 websites with patient-centered information were selected and analyzed for readability using the Flesch-Kincaid Grade Level (FKGL), Flesch Reading Ease Score (FRES), Gunning FOG Index (GFI), and Simple Measure of Gobbledygook (SMOG). Statistical analysis was performed with two-tailed t-tests. The mean word count of the top 50 websites was 1162.7 words, and averaged 16.2 words per sentence. For these websites, the mean FRES was 38.0 (range 4-66, SD = 12.0), mean FKGL was 12.3 (range 6.8-19, SD = 2.4), mean SMOG score was 14.4 (range 9.8-19, SD = 1.8), and the mean Gunning FOG index was 14.0 (range 8.6-19, SD = 2.0). The majority of online patient directed uveitis materials are at a higher reading level than that of the average American adult.

Web-based information on oral dysplasia and precancer of the mouth - Quality and readability.

PubMed

Alsoghier, Abdullah; Ni Riordain, Richeal; Fedele, Stefano; Porter, Stephen

2018-07-01

The numbers of individuals with oral cancer are increasing. This cancer is preceded by oral epithelial dysplasia (OED). There remains no detailed study of the online information presently available for patients with OED or indeed what information such patients may require to be appropriately informed regarding their condition. Hence, the aim of the present study is to assess the patient-oriented web content with respect to OED. The first 100 websites yielded from nine searches performed using different search terms and engines were considered. These were assessed for content, quality (DISCERN instrument, Journal of the American Medical Association benchmarks, and Health on Net seal) and readability (Flesch Reading Ease Score and Flesch-Kincaid Grade Level). There was a general scarcity of OED content across the identified websites. Information about authors, sources used to compile the publication, treatment, and shared decision were limited or absent. Only 6% and 27% of the websites achieved all the four JAMA benchmarks and HON seal, respectively. The average readability level was at 10th grade (US schools), which far exceeds the recommended levels of written health information. At present patients seeking information on OED are likely to have difficulty in finding reliable information from the Web about this disorder and its possible impact upon their life. Further work is thus required to develop a web-based resource regarding OED that addresses the shortfalls demonstrated by the current study. Crown Copyright © 2018. Published by Elsevier Ltd. All rights reserved.

Analysis of online patient education materials in pediatric ophthalmology.

PubMed

John, Ann M; John, Elizabeth S; Hansberry, David R; Thomas, Prashant J; Guo, Suqin

2015-10-01

Patients increasingly consult online resources for healthcare information. The American Medical Association (AMA) and National Institutes of Health (NIH) recommend that online education resources be written between a 3rd- and 7th-grade level. This study assesses whether online health information abides by these guidelines. Ten pediatric ophthalmology conditions were entered into a commonly used search engine, Google.com, and analyzed using 10 validated readability scales. Scientific articles and articles written on patient forums were excluded. The 10 conditions--amblyopia, cataract, conjunctivitis, corneal abrasion, nystagmus, retinoblastoma, retinopathy of prematurity, strabismus, stye, and glaucoma--were also searched and analyzed separately from widely used websites, including Wikipedia and WebMD, as well as those of professional societies, including the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) and the American Optometric Association (AOA). The majority of articles were written above recommended guidelines. All scales showed that the 100 articles were written at a mean grade-level of 11.75 ± 2.72. Only 12% of articles were written below a 9th-grade level and only 3% met recommended criteria. The articles accrued separately from Wikipedia, WebMD, AAPOS, and AOA also had average grade levels above the recommended guidelines. The readability of online patient education material exceeds NIH and AMA guidelines. This disparity can adversely affect caregiver comprehension of such resources and contribute to poor decision making. Pediatric ophthalmology online articles are generally written at a level too high for average caregiver comprehension. Revision of articles can increase satisfaction, improve outcomes, and facilitate the patient-ophthalmologist relationship. Published by Elsevier Inc.

Lung Cancer Screening Guidelines: How Readable Are Internet-Based Patient Education Resources?

PubMed

Hansberry, David Richard; White, Michael D; D'Angelo, Michael; Prabhu, Arpan V; Kamel, Sarah; Lakhani, Paras; Sundaram, Baskaran

2018-04-30

Following the findings of the National Lung Screening Trial, several national societies from multiple disciplines have endorsed the use of low-dose chest CT to screen for lung cancer. Online patient education materials are an important tool to disseminate information to the general public regarding the proven health benefits of lung cancer screening. This study aims to evaluate the reading level at which these materials related to lung cancer screening are written. The four terms "pulmonary nodule," "radiation," "low-dose CT," and "lung cancer screening" were searched on Google, and the first 20 online resources for each term were downloaded, converted into plain text, and analyzed using 10 well-established readability scales. If the websites were not written specifically for patients, they were excluded. The 80 articles were written at a 12.6 ± 2.7 (mean ± SD) grade level, with grade levels ranging from 4.0 to 19.0. Of the 80 articles, 62.5% required a high school education to comprehend, and 22.6% required a college degree or higher (≥ 16th grade) to comprehend. Only 2.5% of the analyzed articles adhered to the recommendations of the National Institutes of Health and American Medical Association that patient education materials be written at a 3rd- to 7th-grade reading level. Commonly visited online lung cancer screening-related patient education materials are written at a level beyond the general patient population's ability to comprehend and may be contributing to a knowledge gap that is inhibiting patients from improving their health literacy.

Readability of ASPS and ASAPS educational web sites: an analysis of consumer impact.

PubMed

Aliu, Oluseyi; Chung, Kevin C

2010-04-01

Patients use the Internet to educate themselves about health-related topics, and learning about plastic surgery is a common activity for enthusiastic consumers in the United States. How to educate consumers regarding plastic surgical procedures is a continued concern for plastic surgeons when faced with the growing portion of the American population having relatively low health care literacy. The usefulness of health-related education materials on the Internet depends largely on their comprehensibility and understandability for all who visit the Web sites. The authors studied the readability of patient education materials related to common plastic surgery procedures from the American Society of Plastic Surgeons (ASPS) and the American Society for Aesthetic Plastic Surgery (ASAPS) Web sites and compared them with materials on similar topics from 10 popular health information-providing sites. The authors found that all analyzed documents on the ASPS and ASAPS Web sites targeted to the consumers were rated to be more difficult than the recommended reading grade level for most American adults, and these documents were consistently among the most difficult to read when compared with the other health information Web sites. The Internet is an increasingly popular avenue for patients to educate themselves about plastic surgery procedures. Patient education material provided on ASPS and ASAPS Web sites should be written at recommended reading grade levels to ensure that it is readable and comprehensible to the targeted audience.

Evaluating the Quality, Accuracy, and Readability of Online Resources Pertaining to Hallux Valgus.

PubMed

Tartaglione, Jason P; Rosenbaum, Andrew J; Abousayed, Mostafa; Hushmendy, Shazaan F; DiPreta, John A

2016-02-01

The Internet is one of the most widely utilized resources for health-related information. Evaluation of the medical literature suggests that the quality and accuracy of these resources are poor and written at inappropriately high reading levels. The purpose of our study was to evaluate the quality, accuracy, and readability of online resources pertaining to hallux valgus. Two search terms ("hallux valgus" and "bunion") were entered into Google, Yahoo, and Bing. With the use of scoring criteria specific to hallux valgus, the quality and accuracy of online information related to hallux valgus was evaluated by 3 reviewers. The Flesch-Kincaid score was used to determine readability. Statistical analysis was performed with t tests and significance was determined by P values <.05. Sixty-two unique websites were evaluated. Quality was significantly higher with use of the search term "bunion" as compared to "hallux valgus" (P = .045). Quality and accuracy were significantly higher in resources authored by physicians as compared to nonphysicians (quality, P = .04; accuracy, P < .001) and websites without commercial bias (quality, P = .038; accuracy, P = .011). However, the reading level was significantly more advanced for websites authored by physicians (P = .035). Websites written above an eighth-grade reading level were significantly more accurate than those written at or below an eighth-grade reading level (P = .032). The overall quality of online information related to hallux valgus is poor and written at inappropriate reading levels. Furthermore, the search term used, authorship, and presence of commercial bias influence the value of these materials. It is important for orthopaedic surgeons to become familiar with patient education materials, so that appropriate recommendations can be made regarding valuable resources. Level IV. © 2015 The Author(s).

Assessment of newborn screening parent education materials.

PubMed

Arnold, Connie L; Davis, Terry C; Frempong, Janet Ohene; Humiston, Sharon G; Bocchini, Anna; Kennen, Estela M; Lloyd-Puryear, Michele

2006-05-01

The purpose of this study was to measure the readability and user-friendliness (clarity, complexity, organization, appearance, and cultural appropriateness of materials) of parent education brochures on newborn screening. We studied English-language versions of the brochures that state newborn screening programs prepare and distribute. We obtained brochures from 48 states and Puerto Rico. We evaluated each brochure for readability with the Flesch reading ease formula. User-friendliness of the brochures was assessed with an instrument we created that contained 22 specific criteria grouped into 5 categories, ie, layout, illustrations, message, manageable information, and cultural appropriateness. Most current newborn screening brochures should be revised to make them more readable and user-friendly for parents. Ninety-two percent of brochures were written at a reading level that is higher than the average reading level of US adults (eighth-grade level). In most brochures, the essential information for parents was buried. Although all brochures were brief and focused on the newborn screening tests being performed, 81% needed improvement in getting to the point quickly and making it easy for parents to identify what they needed to know or to do. None of the brochures scored high in all 22 criteria on the user-friendliness checklist. Parent education materials about newborn screening should be revised to be easier to read and more user-friendly, by lowering the reading difficulty to eighth-grade level and focusing on issues such as layout, illustrations, message, information, and cultural appropriateness. It is important that state newborn screening programs and organizations work with parents to develop and to evaluate materials to ensure that they are user-friendly.

Readability of internet-sourced patient education material related to "labour analgesia".

PubMed

Boztas, Nilay; Omur, Dilek; Ozbılgın, Sule; Altuntas, Gözde; Piskin, Ersan; Ozkardesler, Sevda; Hanci, Volkan

2017-11-01

We evaluated the readability of Internet-sourced patient education materials (PEMs) related to "labour analgesia." In addition to assessing the readability of websites, we aimed to compare commercial, personal, and academic websites.We used the most popular search engine (http://www.google.com) in our study. The first 100 websites in English that resulted from a search for the key words "labour analgesia" were scanned. Websites that were not in English, graphs, pictures, videos, tables, figures and list formats in the text, all punctuation, the number of words in the text is less than 100 words, feedback forms not related to education, (Uniform Resource Locator) URL websites, author information, references, legal disclaimers, and addresses and telephone numbers were excluded.The texts included in the study were assessed using the Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG), and Gunning Frequency of Gobbledygook (FOG) readability formulae. The number of Latin words within the text was determined.Analysis of 300-word sections of the texts revealed that the mean FRES was 47.54 ± 12.54 (quite difficult), mean FKGL and SMOG were 11.92 ± 2.59 and 10.57 ± 1.88 years of education, respectively, and mean Gunning FOG was 14.71 ± 2.76 (very difficult). Within 300-word sections, the mean number of Latin words was identified as 16.56 ± 6.37.In our study, the readability level of Internet-sourced PEM related to "labour analgesia" was identified to be quite high indicating poor readability.

A survey of kidney disease and risk-factor information on the World Wide Web.

PubMed

Calderón, José Luis; Zadshir, Ashraf; Norris, Keith

2004-11-11

Chronic kidney disease (CKD) is epidemic, and informing those at risk is a national health priority. However, the discrepancy between the readability of health information and the literacy skills of those it targets is a recognized barrier to communicating health information that may promote good health outcomes. Because the World Wide Web has become one of the most important sources of health information, we sought to assess the readability of commonly available CKD information. Twelve highly cited English-language, kidney disease Web sites were identified with 4 popular search engines. Each Web site was reviewed for the availability of 6 domains of information germane to CKD and risk-factor information. We estimated readability scores with the Flesch-Kincaid and Flesch Reading Ease Index methods. The deviation of readability scores for CKD information from readability appropriate to average literacy skills and the limited literacy skills of vulnerable populations (low socioeconomic status, health disparities, and elderly) were calculated. Eleven Web sites met the inclusion criteria. Six of 11 sites provided information on all 6 domains of CKD and risk-factor information. Mean readability scores for all 6 domains of CKD information exceeded national average literacy skills and far exceeded the fifth-grade-level readability desired for informing vulnerable populations. Information about CKD and diabetes consistently had higher readability scores. Information on the World Wide Web about CKD and its risk factors may not be readable for comprehension by the general public, especially by underserved minority populations with limited literacy skills. Barriers to health communication may be important contributors to the rising CKD epidemic and disparities in CKD health status experienced by minority populations.

Readability versus Leveling.

ERIC Educational Resources Information Center

Fry, Edward

2002-01-01

Shows some similarities and differences between readability formulas and leveling procedures and reports some current large-scale uses of readability formulas. Presents a dictionary definition of readability and leveling, and a history and background of readability and leveling. Discusses what goes into determining readability and leveling scores.…

[Validation of a questionnaire to assess the quality of health information in Argentinian newspapers].

PubMed

Biondo, Emiliano; Khoury, Marina Claudia

2005-09-01

The daily press is an important source of health information and may influence health care utilization. However, medical reports published in newspapers from developed countries have shown a poor quality. The reliability of the questionnaire Index of Scientific Quality was evaluated by using it to measure the scientific quality of health information published by Argentinian newspapers between 2000 and 2002. It assessed the readability of the texts in grade levels and explored the relationship between quality and other factors. The Spanish adaptation of the instrument consisted in translation, back-traslation and pilot study. The reliability was assessed by applying the instrument to newspaper articles with more than 300 words that discussed therapy, diagnosis, prevention, lifestyle effects, and hazardous exposure. Two physicians independently graded 129 articles. Inter-observer and intra-observer concordance was quantified for each item with the intra-class correlation coefficient (CI95%). To measure scientific quality, a randomized sample of 210 articles was assessed. Each received a mark that ranged from 0 to 100. Readability was determined by the FRY graph method. The relationship between quality and other variables was explored with multiple linear regression analysis. The inter-rater concordance varied between 0.48 (0.34-0.61) and 0.67 (0.56-0.75). Intra-rater concordance varied from 0.51 (0.37-0.63) to 0.95 (0.93-0.96). The internal consistency (Cronbach's alpha) was 0.88. The quality-of-health-information was rated at 25 points (16.7, 33.3) [median (intercuartil range)]. The reading level was assessed to be at the 10.4 grade (10.2-10.6) [mean (CI 95%)]. Quality of the health information was greatly deficient; however, no specific factors were related with quality. Readability was probably a key barrier for access to the health information.

Accuracy and readability of cardiovascular entries on Wikipedia: are they reliable learning resources for medical students?

PubMed

Azer, Samy A; AlSwaidan, Nourah M; Alshwairikh, Lama A; AlShammari, Jumana M

2015-10-06

To evaluate accuracy of content and readability level of English Wikipedia articles on cardiovascular diseases, using quality and readability tools. Wikipedia was searched on the 6 October 2013 for articles on cardiovascular diseases. Using a modified DISCERN (DISCERN is an instrument widely used in assessing online resources), articles were independently scored by three assessors. The readability was calculated using Flesch-Kincaid Grade Level. The inter-rater agreement between evaluators was calculated using the Fleiss κ scale. This study was based on 47 English Wikipedia entries on cardiovascular diseases. The DISCERN scores had a median=33 (IQR=6). Four articles (8.5%) were of good quality (DISCERN score 40-50), 39 (83%) moderate (DISCERN 30-39) and 4 (8.5%) were poor (DISCERN 10-29). Although the entries covered the aetiology and the clinical picture, there were deficiencies in the pathophysiology of diseases, signs and symptoms, diagnostic approaches and treatment. The number of references varied from 1 to 127 references; 25.9±29.4 (mean±SD). Several problems were identified in the list of references and citations made in the articles. The readability of articles was 14.3±1.7 (mean±SD); consistent with the readability level for college students. In comparison, Harrison's Principles of Internal Medicine 18th edition had more tables, less references and no significant difference in number of graphs, images, illustrations or readability level. The overall agreement between the evaluators was good (Fleiss κ 0.718 (95% CI 0.57 to 0.83). The Wikipedia entries are not aimed at a medical audience and should not be used as a substitute to recommended medical resources. Course designers and students should be aware that Wikipedia entries on cardiovascular diseases lack accuracy, predominantly due to errors of omission. Further improvement of the Wikipedia content of cardiovascular entries would be needed before they could be considered a supplementary resource. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Survey of quality, readability, and social reach of websites on osteosarcoma in adolescents.

PubMed

Lam, Catherine G; Roter, Debra L; Cohen, Kenneth J

2013-01-01

Little is known about Internet resources for adolescent patients. This study assessed the quality, readability, and social reach of websites on an illustrative adolescent cancer diagnosis, osteosarcoma. The top 50 results from four queries in two search engines were screened. Quality and readability were determined using standard DISCERN tool, Flesch Reading Ease and Flesch-Kinkaid Grade. Social reach was gauged by social networking links, global website traffic, and a pilot adolescent-specificity measure. Of 400 websites assessed, 56 (14%) met inclusion criteria. Websites' mean quality was fair (49.8 on 75-point scale; range 31.0-66.0, poor to excellent); 86% failed readability standards (Grade>8); 75% offered at least one social networking link; and 34% offered site-specific social media. More than 60% received over 50,000 visits in the past month. Only 12.5% included adolescent-specific content. Of the 10 websites ranked highest for quality, only one achieved both readability targets and adolescent-specific content. Although some patient-oriented websites on osteosarcoma are of acceptable quality, most failed readability targets, and few appeared to address adolescents. Better awareness of Internet health resources and social media for adolescents with cancer is needed to address gaps, promote health literacy and facilitate patient-provider communication. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Evaluation of websites that contain information relating to malaria in pregnancy.

PubMed

Hamwela, V; Ahmed, W; Bath, P A

2018-04-01

The study identified available websites on malaria in pregnancy on the World Wide Web and sought to evaluate their readability and information quality. A purposeful sample of websites were selected which provided information on Malaria in pregnancy. A total of 31 websites were identified from searches using Google, Yahoo and Bing search engines. Two generic tools (Discern and HON), one specific tool designed to assess information quality of malaria in pregnancy and readability tests (Flesch Reading Ease and Flesh-Kincaid Grade level) were used to evaluate the websites. Most of the websites scored below 50% with the HON Code tool, with most lacking information on the symptoms. One website scored over 70 with the reading ease with two (2) achieving a score of 7 for the reading level test. The readability of the websites was too advanced for an ordinary consumer. The results of this study indicated that the information quality of malaria in pregnancy websites varied from fair to medium. It was also found that the readability of the websites was too advanced for an ordinary consumer. These findings suggest that most websites are not comprehensive in addressing all the relevant aspects of malaria in pregnancy. Copyright © 2018 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Prostate Cancer Information Available in Health-Care Provider Offices: An Analysis of Content, Readability, and Cultural Sensitivity.

PubMed

Choi, Seul Ki; Seel, Jessica S; Yelton, Brooks; Steck, Susan E; McCormick, Douglas P; Payne, Johnny; Minter, Anthony; Deutchki, Elizabeth K; Hébert, James R; Friedman, Daniela B

2018-07-01

Prostate cancer (PrCA) is the most common cancer affecting men in the United States, and African American men have the highest incidence among men in the United States. Little is known about the PrCA-related educational materials being provided to patients in health-care settings. Content, readability, and cultural sensitivity of materials available in providers' practices in South Carolina were examined. A total of 44 educational materials about PrCA and associated sexual dysfunction was collected from 16 general and specialty practices. The content of the materials was coded, and cultural sensitivity was assessed using the Cultural Sensitivity Assessment Tool. Flesch Reading Ease, Flesch-Kincaid Grade Level, and the Simple Measure of Gobbledygook were used to assess readability. Communication with health-care providers (52.3%), side effects of PrCA treatment (40.9%), sexual dysfunction and its treatment (38.6%), and treatment options (34.1%) were frequently presented. All materials had acceptable cultural sensitivity scores; however, 2.3% and 15.9% of materials demonstrated unacceptable cultural sensitivity regarding format and visual messages, respectively. Readability of the materials varied. More than half of the materials were written above a high-school reading level. PrCA-related materials available in health-care practices may not meet patients' needs regarding content, cultural sensitivity, and readability. A wide range of educational materials that address various aspects of PrCA, including treatment options and side effects, should be presented in plain language and be culturally sensitive.

Evaluating Text Complexity and Flesch-Kincaid Grade Level

ERIC Educational Resources Information Center

Solnyshkina, Marina I.; Zamaletdinov, Radif R.; Gorodetskaya, Ludmila A.; Gabitov, Azat I.

2017-01-01

The article presents the results of an exploratory study of the use of T.E.R.A., an automated tool measuring text complexity and readability based on the assessment of five text complexity parameters: narrativity, syntactic simplicity, word concreteness, referential cohesion and deep cohesion. Aimed at finding ways to utilize T.E.R.A. for…

The Reading Process--The Relationship Between Word Recognition and Comprehension.

ERIC Educational Resources Information Center

Hays, Warren S.

The purpose of this study was to determine the relationship between word recognition and comprehension achieved by second and fifth grade students when reading material at various levels of readability. A random sample of twenty-five second and twenty-five fifth graders, taken from three middle class schools, was administered a…

Systematic Assessment Reveals Lack of Understandability for Prostate Biopsy Online Patient Education Materials.

PubMed

Maciolek, Kimberly A; Jarrard, David F; Abel, E Jason; Best, Sara L

2017-11-01

To evaluate the accuracy, readability, understandability, and actionability of Internet patient education materials (PEM) about transrectal ultrasound-guided prostate biopsy. A comprehensive Internet search was performed to find PEM with pre- or postbiopsy instructions. PEM that were duplicates, government affiliated, international, or video based were excluded. Biopsy instructions were evaluated for accuracy and presence of essential topics. Readability was assessed via word count and Flesch-Kincaid Grade Level. Understandability and actionability were measured using the Patient Education Materials Assessment Tool (PEMAT). Effects of authorship and geographical variation were determined using Fischer exact and Kruskal-Wallis tests. We identified 148 unique PEM. Only 31 (21%) sites adhered to the recommended <8th grade reading level. Most PEM did not contain recommended graphics (14%), checklists (2%), or summaries (6%). The PEMAT understandability score for academic PEM was higher than private (P = .02) and unaffiliated PEM (P = .01). No websites had inaccurate content. Only 2 PEM sites (1%) included all essential content (stop anticoagulants, antibiotics, need for urinalysis, biopsy pain, when to resume activity, and bleeding complications). Few significant differences based on geographic region were observed for word count, readability, PEMAT scores, or content. Transrectal ultrasound-guided prostate biopsy PEM adhere poorly to guidelines for easy-to-understand materials. Most PEM lack vital information and are written at a reading level that is too complex for patient comprehension. The urology community can construct better websites by consulting PEM advisory materials and providing nontechnical language, figures, and specific instructions. Published by Elsevier Inc.

Readability of internet-sourced patient education material related to “labour analgesia”

PubMed Central

Boztas, Nilay; Omur, Dilek; Ozbılgın, Sule; Altuntas, Gözde; Piskin, Ersan; Ozkardesler, Sevda; Hanci, Volkan

2017-01-01

Abstract We evaluated the readability of Internet-sourced patient education materials (PEMs) related to “labour analgesia.” In addition to assessing the readability of websites, we aimed to compare commercial, personal, and academic websites. We used the most popular search engine (http://www.google.com) in our study. The first 100 websites in English that resulted from a search for the key words “labour analgesia” were scanned. Websites that were not in English, graphs, pictures, videos, tables, figures and list formats in the text, all punctuation, the number of words in the text is less than 100 words, feedback forms not related to education, (Uniform Resource Locator) URL websites, author information, references, legal disclaimers, and addresses and telephone numbers were excluded. The texts included in the study were assessed using the Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG), and Gunning Frequency of Gobbledygook (FOG) readability formulae. The number of Latin words within the text was determined. Analysis of 300-word sections of the texts revealed that the mean FRES was 47.54 ± 12.54 (quite difficult), mean FKGL and SMOG were 11.92 ± 2.59 and 10.57 ± 1.88 years of education, respectively, and mean Gunning FOG was 14.71 ± 2.76 (very difficult). Within 300-word sections, the mean number of Latin words was identified as 16.56 ± 6.37. In our study, the readability level of Internet-sourced PEM related to “labour analgesia” was identified to be quite high indicating poor readability. PMID:29137057

The Assessment of Quality, Accuracy, and Readability of Online Educational Resources for Platelet-Rich Plasma.

PubMed

Ghodasra, Jason H; Wang, Dean; Jayakar, Rohit G; Jensen, Andrew R; Yamaguchi, Kent T; Hegde, Vishal V; Jones, Kristofer J

2018-01-01

To critically evaluate the quality, accuracy, and readability of readily available Internet patient resources for platelet-rich plasma (PRP) as a treatment modality for musculoskeletal injuries. Using the 3 most commonly used Internet search engines (Google, Bing, Yahoo), the search term "platelet rich plasma" was entered, and the first 50 websites from each search were reviewed. The website's affiliation was identified. Quality was evaluated using 25-point criteria based on guidelines published by the American Academy of Orthopaedic Surgeons, and accuracy was assessed with a previously described 12-point grading system by 3 reviewers independently. Readability was evaluated using the Flesch-Kincaid (FK) grade score. A total of 46 unique websites were identified and evaluated. The average quality and accuracy was 9.4 ± 3.4 (maximum 25) and 7.9 ± 2.3 (maximum 12), respectively. The average FK grade level was 12.6 ± 2.4, which is several grades higher than the recommended eighth-grade level for patient education material. Ninety-one percent (42/46) of websites were authored by physicians, and 9% (4/46) contained commercial bias. Mean quality was significantly greater in websites authored by health care providers (9.8 ± 3.1 vs 5.9 ± 4.7, P = .029) and in websites without commercial bias (9.9 ± 3.1 vs 4.5 ± 3.2, P = .002). Mean accuracy was significantly lower in websites authored by health care providers (7.6 ± 2.2 vs 11.0 ± 1.2, P = .004). Only 24% (11/46) reported that PRP remains an investigational treatment. The accuracy and quality of online patient resources for PRP are poor, and the information overestimates the reading ability of the general population. Websites authored by health care providers had higher quality but lower accuracy. Additionally, the majority of websites do not identify PRP as an experimental treatment, which may fail to provide appropriate patient understanding and expectations. Physicians should educate patients that many online patient resources have poor quality and accuracy and can be difficult to read. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Readability of patient information pamphlets in urogynecology.

PubMed

Reagan, Krista M L; O'Sullivan, David M; Harvey, David P; Lasala, Christine A

2015-01-01

The purpose of this study was to determine the reading level of frequently used patient information pamphlets and documents in the field of urogynecology. Urogynecology pamphlets were identified from a variety of sources. Readability was determined using 4 different accepted formulas: the Flesch-Kincaid Grade Level, the simple measure of gobbledygook Index, the Coleman-Liau Index, and the Gunning Fog index. The scores were calculated using an online calculator (http://www.readability-score.com). Descriptive statistics were used for analysis. The average of the 4 scores was calculated for each pamphlet. Subsequently, Z-scores were used to standardize the averages between the reading scales. Of the 40 documents reviewed, only a single pamphlet met the National Institutes of Health-recommended reading level. This document was developed by the American Urological Association and was specifically designated as a "Low-Literacy Brochure." The remainder of the patient education pamphlets, from both industry-sponsored and academic-sponsored sources, consistently rated above the recommended reading level for maximum comprehension. The majority of patient education pamphlets, from both industry-sponsored and academic-sponsored sources, are above the reading level recommended by the National Institutes of Health for maximum patient comprehension. Future work should be done to improve the educational resources available to patients by simplifying the verbiage in these documents.

The quality of mental health information commonly searched for on the Internet.

PubMed

Grohol, John M; Slimowicz, Joseph; Granda, Rebecca

2014-04-01

Previous research has reviewed the quality of online information related to specific mental disorders. Yet, no comprehensive study has been conducted on the overall quality of mental health information searched for online. This study examined the first 20 search results of two popular search engines-Google and Bing-for 11 common mental health terms. They were analyzed using the DISCERN instrument, an adaptation of the Depression Website Content Checklist (ADWCC), Flesch Reading Ease and Flesch-Kincaid Grade Level readability measures, HONCode badge display, and commercial status, resulting in an analysis of 440 web pages. Quality of Web site results varied based on type of disorder examined, with higher quality Web sites found for schizophrenia, bipolar disorder, and dysthymia, and lower quality ratings for phobia, anxiety, and panic disorder Web sites. Of the total Web sites analyzed, 67.5% had good or better quality content. Nearly one-third of the search results produced Web sites from three entities: WebMD, Wikipedia, and the Mayo Clinic. The mean Flesch Reading Ease score was 41.21, and the mean Flesch-Kincaid Grade Level score was 11.68. The presence of the HONCode badge and noncommercial status was found to have a small correlation with Web site quality, and Web sites displaying the HONCode badge and commercial sites had lower readability scores. Popular search engines appear to offer generally reliable results pointing to mostly good or better quality mental health Web sites. However, additional work is needed to make these sites more readable.

Analysis of the accuracy and readability of herbal supplement information on Wikipedia.

PubMed

Phillips, Jennifer; Lam, Connie; Palmisano, Lisa

2014-01-01

To determine the completeness and readability of information found in Wikipedia for leading dietary supplements and assess the accuracy of this information with regard to safety (including use during pregnancy/lactation), contraindications, drug interactions, therapeutic uses, and dosing. Cross-sectional analysis of Wikipedia articles. The contents of Wikipedia articles for the 19 top-selling herbal supplements were retrieved on July 24, 2012, and evaluated for organization, content, accuracy (as compared with information in two leading dietary supplement references) and readability. Accuracy of Wikipedia articles. No consistency was noted in how much information was included in each Wikipedia article, how the information was organized, what major categories were used, and where safety and therapeutic information was located in the article. All articles in Wikipedia contained information on therapeutic uses and adverse effects but several lacked information on drug interactions, pregnancy, and contraindications. Wikipedia articles had 26%-75% of therapeutic uses and 76%-100% of adverse effects listed in the Natural Medicines Comprehensive Database and/or Natural Standard. Overall, articles were written at a 13.5-grade level, and all were at a ninth-grade level or above. Articles in Wikipedia in mid-2012 for the 19 top-selling herbal supplements were frequently incomplete, of variable quality, and sometimes inconsistent with reputable sources of information on these products. Safety information was particularly inconsistent among the articles. Patients and health professionals should not rely solely on Wikipedia for information on these herbal supplements when treatment decisions are being made.

A systematic evaluation of websites offering information on chronic kidney disease.

PubMed

Lutz, Erin R; Costello, Kaitlin L; Jo, Minjeong; Gilet, Constance A; Hawley, Jennifer M; Bridgman, Jessica C; Song, Mi-Kyung

2014-01-01

In this study, we described the content and characteristics of 40 non-proprietary websites offering information about chronic kidney disease (CKD) and evaluated their information quality using the DISCERN scale and readability using Flesch Reading Ease and Flesch-Kincaid grade level. The areas in which the websites scored the lowest on the DISCERN scale were whether the website discussed knowledge gaps, presented balanced information, and was clear about the information source. Websites that rated higher quality on the DISCERN scale were more difficult to read. The quality and readability of many websites about CKD to be used as meaningful educational resources for patients who desire to learn more about CKD and treatment options remain inadequate.

The Reading Grade Level of Common Measures in Child and Adolescent Clinical Psychology

ERIC Educational Resources Information Center

Jensen, Scott A.; Fabiano, Gregory A.; Lopez-Williams, Andy; Chacko, Anil

2006-01-01

The purpose of this article is to provide easily accessible readability information for 49 parent- and 35 child- and adolescent-report measures commonly used by clinicians and researchers. There is a great deal of variability in reading ability required across measures. The majority of parent-report measures (65%) required reading ability above…

Making Health Information Clear and Readable for the Masses

ERIC Educational Resources Information Center

Staggers, Sydney M.; Brann, Maria

2011-01-01

Many federal agencies rely on print materials to convey important information to the public, and many of the materials are written at a 10th-grade reading level or above, further limiting those individuals with low literacy. As such, the Department of Health and Human Services (DHHS) recommends the application of existing best practices for…

Structure and content of chronic kidney disease information on the World Wide Web: barriers to public understanding of a pandemic.

PubMed

Calderón, José Luis; Zadshir, Ashraf; Norris, Keith

2004-10-01

Chronic kidney disease (CKD) is a pandemic and the need to inform those at risk has never been more important. The World Wide Web (WWW) is no w considered a key source of health information, but the quality and utility of this information has been challenged. In this article, we assess structural, content, and linguistic barriers to accessed CKD information and discuss the implications of limited Internet access to communicating health. Technical (number of hyperlinks), content (number of six core CKD and risk factor information domains included), and linguistic (readability and variation in readability) barriers were assessed for websites offered by 12 kidney disease associations. The Flesch Reading Ease Index method was used to estimate readability scores, and variation in the readability of information was assessed. Eleven websites met inclusion criteria. Six of 11 websites provided information in all 6 domains of CKD information. A mean of 4 hyperlinks (range 3-5) was clicked before CKD information was available and a mean of 6 hyperlinks (range 4-12) was clicked to access all available CKD information. Mean readability scores for all six domains of CKD information exceeded national average literacy skills and far exceeded the 5th grade level readability desired for informing vulnerable populations. Information about CKD and diabetes consistently had higher readability scores. The WWW currently has little utility for informing populations at greatest risk for CKD. Barriers to accessing CKD information on the WWW are socioeconomic, technical, and linguistic. Having lower socioeconomic status, less access to computers and the WWW, multiple website hyperlinks, incomplete information, difficult readability, and significant variation in readability of CKD information on the WWW are social, structural, and content barriers to communicating CKD information. This may contribute to the growing epidemics of diminished public understanding about CKD, and disparities in CKD health status experienced by racial/ethnic minority populations globally.

An evaluation of Wikipedia as a resource for patient education in nephrology.

PubMed

Thomas, Garry R; Eng, Lawson; de Wolff, Jacob F; Grover, Samir C

2013-01-01

Wikipedia, a multilingual online encyclopedia, is a common starting point for patient medical searches. As its articles can be authored and edited by anyone worldwide, the credibility of the medical content of Wikipedia has been openly questioned. Wikipedia medical articles have also been criticized as too advanced for the general public. This study assesses the comprehensiveness, reliability, and readability of nephrology articles on Wikipedia. The International Statistical Classification of Diseases and Related problems, 10th Edition (ICD-10) diagnostic codes for nephrology (N00-N29.8) were used as a topic list to investigate the English Wikipedia database. Comprehensiveness was assessed by the proportion of ICD-10 codes that had corresponding articles. Reliability was measured by both the number of references per article and proportion of references from substantiated sources. Finally, readability was assessed using three validated indices (Flesch-Kincaid grade level, Automated readability index, and Flesch reading ease). Nephrology articles on Wikipedia were relatively comprehensive, with 70.5% of ICD-10 codes being represented. The articles were fairly reliable, with 7.1 ± 9.8 (mean ± SD) references per article, of which 59.7 ± 35.0% were substantiated references. Finally, all three readability indices determined that nephrology articles are written at a college level. Wikipedia is a comprehensive and fairly reliable medical resource for nephrology patients that is written at a college reading level. Accessibility of this information for the general public may be improved by hosting it at alternative Wikipedias targeted at a lower reading level, such as the Simple English Wikipedia. © 2013 Wiley Periodicals, Inc.

Internet search term affects the quality and accuracy of online information about developmental hip dysplasia.

PubMed

Fabricant, Peter D; Dy, Christopher J; Patel, Ronak M; Blanco, John S; Doyle, Shevaun M

2013-06-01

The recent emphasis on shared decision-making has increased the role of the Internet as a readily accessible medical reference source for patients and families. However, the lack of professional review creates concern over the quality, accuracy, and readability of medical information available to patients on the Internet. Three Internet search engines (Google, Yahoo, and Bing) were evaluated prospectively using 3 difference search terms of varying sophistication ("congenital hip dislocation," "developmental dysplasia of the hip," and "hip dysplasia in children"). Sixty-three unique Web sites were evaluated by each of 3 surgeons (2 fellowship-trained pediatric orthopaedic attendings and 1 orthopaedic chief resident) for quality and accuracy using a set of scoring criteria based on the AAOS/POSNA patient education Web site. The readability (literacy grade level) of each Web site was assessed using the Fleisch-Kincaid score. There were significant differences noted in quality, accuracy, and readability of information depending on the search term used. The search term "developmental dysplasia of the hip" provided higher quality and accuracy compared with the search term "congenital hip dislocation." Of the 63 total Web sites, 1 (1.6%) was below the sixth grade reading level recommended by the NIH for health education materials and 8 (12.7%) Web sites were below the average American reading level (eighth grade). The quality and accuracy of information available on the Internet regarding developmental hip dysplasia significantly varied with the search term used. Patients seeking information about DDH on the Internet may not understand the materials found because nearly all of the Web sites are written at a level above that recommended for publically distributed health information. Physicians should advise their patients to search for information using the term "developmental dysplasia of the hip" or, better yet, should refer patients to Web sites that they have personally reviewed for content and clarity. Orthopaedic surgeons, professional societies, and search engines should undertake efforts to ensure that patients have access to information about DDH that is both accurate and easily understandable.

A North American perspective of content and quality of websites in the English language on childhood-onset lupus erythematosus.

PubMed

Cutler, C; Peng, T; Stinson, J; Tucker, L; Boneparth, A; Klein Gitelman, M; Moorthy, L Nandini

2018-04-01

Objective The objective of this article is to examine the quality, content, and readability of information and resources in the English language and accessible on the internet by pediatric patients with systemic lupus erythematosus (SLE) and their families in North America. Methods Keywords relevant to SLE were generated by an undergraduate student, a first-year medical student, and a third-year pediatric resident, and a search was conducted across five commonly used search engines. Quality of information found was evaluated independently by an undergraduate student, a graduate student, a first-year medical student, and a third-year pediatric resident using the DISCERN tool. Two pediatric rheumatologists assessed website accuracy and completeness. Readability of websites was determined using the Flesch-Kincaid grade level and Reading Ease score. Results Out of 2000 websites generated in the search, only 34 unique websites met inclusion criteria. Only 16 of these websites had DISCERN scores above 50% (fair quality). Overall quality of website information was fair with mean ±standard deviation (SD) DISCERN quality score of 44 ± 7 (range: 30-56). Only nine websites of 34 had DISCERN scores above 50 (>66%, indicating greater quality) and were further assessed for completeness. Flesch-Kincaid grade level was 11 ± 1 (mean±SD) and reading ease score was 39 ± 10 (mean±SD, range of 11-61). Conclusion Our study highlights the need for more complete, readable information regarding the unique needs of pediatric patients with childhood-onset SLE and their families.

Malaria rapid diagnostic kits: quality of packaging, design and labelling of boxes and components and readability and accuracy of information inserts.

PubMed

Gillet, Philippe; Maltha, Jessica; Hermans, Veerle; Ravinetto, Raffaella; Bruggeman, Cathrien; Jacobs, Jan

2011-02-13

The present study assessed malaria RDT kits for adequate and correct packaging, design and labelling of boxes and components. Information inserts were studied for readability and accuracy of information. Criteria for packaging, design, labelling and information were compiled from Directive 98/79 of the European Community (EC), relevant World Health Organization (WHO) documents and studies on end-users' performance of RDTs. Typography and readability level (Flesch-Kincaid grade level) were assessed. Forty-two RDT kits from 22 manufacturers were assessed, 35 of which had evidence of good manufacturing practice according to available information (i.e. CE-label affixed or inclusion in the WHO list of ISO13485:2003 certified manufacturers). Shortcomings in devices were (i) insufficient place for writing sample identification (n=40) and (ii) ambiguous labelling of the reading window (n=6). Buffer vial labels were lacking essential information (n=24) or were of poor quality (n=16). Information inserts had elevated readability levels (median Flesch Kincaid grade 8.9, range 7.1-12.9) and user-unfriendly typography (median font size 8, range 5-10). Inadequacies included (i) no referral to biosafety (n=18), (ii) critical differences between depicted and real devices (n=8), (iii) figures with unrealistic colours (n=4), (iv) incomplete information about RDT line interpretations (n=31) and no data on test characteristics (n=8). Other problems included (i) kit names that referred to Plasmodium vivax although targeting a pan-species Plasmodium antigen (n=4), (ii) not stating the identity of the pan-species antigen (n=2) and (iii) slight but numerous differences in names displayed on boxes, device packages and information inserts. Three CE labelled RDT kits produced outside the EC had no authorized representative affixed and the shape and relative dimensions of the CE symbol affixed did not comply with the Directive 98/79/EC. Overall, RDTs with evidence of GMP scored better compared to those without but inadequacies were observed in both groups. Overall, malaria RDTs showed shortcomings in quality of construction, design and labelling of boxes, device packages, devices and buffers. Information inserts were difficult to read and lacked relevant information.

A Systematic Evaluation of Websites Offering Information on Chronic Kidney Disease

PubMed Central

Lutz, Erin R.; Costello, Kaitlin L.; Jo, Minjeong; Gilet, Constance A.; Hawley, Jennifer M.; Bridgman, Jessica C.; Song, Mi-Kyung

2014-01-01

In this study, we described the content and characteristics of 40 non-proprietary websites offering information about chronic kidney disease (CKD) and evaluated their information quality using the DISCERN scale and readability using Flesch Reading Ease and Flesch-Kincaid grade level. The areas in which the websites scored the lowest on the DISCERN scale were whether the website discussed knowledge gaps, presented balanced information, and was clear about the information source. Websites that rated higher quality on the DISCERN scale were more difficult to read. The quality and readability of many websites about CKD to be used as meaningful educational resources for patients who desire to learn more about CKD and treatment options remain inadequate. PMID:25244890

Online nutrition information for pregnant women: a content analysis.

PubMed

Storr, Tayla; Maher, Judith; Swanepoel, Elizabeth

2017-04-01

Pregnant women actively seek health information online, including nutrition and food-related topics. However, the accuracy and readability of this information have not been evaluated. The aim of this study was to describe and evaluate pregnancy-related food and nutrition information available online. Four search engines were used to search for pregnancy-related nutrition web pages. Content analysis of web pages was performed. Web pages were assessed against the 2013 Australian Dietary Guidelines to assess accuracy. Flesch-Kincaid (F-K), Simple Measure of Gobbledygook (SMOG), Gunning Fog Index (FOG) and Flesch reading ease (FRE) formulas were used to assess readability. Data was analysed descriptively. Spearman's correlation was used to assess the relationship between web page characteristics. Kruskal-Wallis test was used to check for differences among readability and other web page characteristics. A total of 693 web pages were included. Web page types included commercial (n = 340), not-for-profit (n = 113), blogs (n = 112), government (n = 89), personal (n = 36) and educational (n = 3). The accuracy of online nutrition information varied with 39.7% of web pages containing accurate information, 22.8% containing mixed information and 37.5% containing inaccurate information. The average reading grade of all pages analysed measured by F-K, SMOG and FOG was 11.8. The mean FRE was 51.6, a 'fairly difficult to read' score. Only 0.5% of web pages were written at or below grade 6 according to F-K, SMOG and FOG. The findings suggest that accuracy of pregnancy-related nutrition information is a problem on the internet. Web page readability is generally difficult and means that the information may not be accessible to those who cannot read at a sophisticated level. © 2016 John Wiley & Sons Ltd. © 2016 John Wiley & Sons Ltd.

The quality of websites addressing fibromyalgia: an assessment of quality and readability using standardised tools

PubMed Central

MacDermid, Joy C; Wilkins, Seanne; Gibson, Jane; Shaw, Lynn

2011-01-01

Background Patients living with fibromyalgia strongly prefer to access health information on the web. However, the majority of subjects in previous studies strongly expressed their concerns about the quality of online information resources. Objectives The purpose of this study was to evaluate existing online fibromyalgia information resources for content, quality and readability by using standardised quality and readability tools. Methods The first 25 websites were identified using Google and the search keyword ‘fibromyalgia’. Pairs of raters independently evaluated website quality using two structured tools (DISCERN and a quality checklist). Readability was assessed using the Flesch Reading Ease score maps. Results Ranking of the websites' quality varied by the tool used, although there was general agreement about the top three websites (Fibromyalgia Information, Fibromyalgia Information Foundation and National Institute of Arthritis and Musculoskeletal and Skin Diseases). Content analysis indicated that 72% of websites provided information on treatment options, 68% on symptoms, 60% on diagnosis and 40% on coping and resources. DISCERN ratings classified 32% websites as ‘very good’, 32% as ‘good and 36% as ‘marginal’. The mean overall DISCERN score was 36.88 (good). Only 16% of websites met the recommended literacy level grade of 6–8 (range 7–15). Conclusion Higher quality websites tended to be less readable. Online fibromyalgia information resources do not provide comprehensive information about fibromyalgia, and have low quality and poor readability. While information is very important for those living with fibromyalgia, current resources are unlikely to provide necessary or accurate information, and may not be usable for most people. PMID:22021777

The quality of websites addressing fibromyalgia: an assessment of quality and readability using standardised tools.

PubMed

Daraz, Lubna; Macdermid, Joy C; Wilkins, Seanne; Gibson, Jane; Shaw, Lynn

2011-07-31

Background Patients living with fibromyalgia strongly prefer to access health information on the web. However, the majority of subjects in previous studies strongly expressed their concerns about the quality of online information resources. Objectives The purpose of this study was to evaluate existing online fibromyalgia information resources for content, quality and readability by using standardised quality and readability tools. Methods The first 25 websites were identified using Google and the search keyword 'fibromyalgia'. Pairs of raters independently evaluated website quality using two structured tools (DISCERN and a quality checklist). Readability was assessed using the Flesch Reading Ease score maps. Results Ranking of the websites' quality varied by the tool used, although there was general agreement about the top three websites (Fibromyalgia Information, Fibromyalgia Information Foundation and National Institute of Arthritis and Musculoskeletal and Skin Diseases). Content analysis indicated that 72% of websites provided information on treatment options, 68% on symptoms, 60% on diagnosis and 40% on coping and resources. DISCERN ratings classified 32% websites as 'very good', 32% as 'good and 36% as 'marginal'. The mean overall DISCERN score was 36.88 (good). Only 16% of websites met the recommended literacy level grade of 6-8 (range 7-15). Conclusion Higher quality websites tended to be less readable. Online fibromyalgia information resources do not provide comprehensive information about fibromyalgia, and have low quality and poor readability. While information is very important for those living with fibromyalgia, current resources are unlikely to provide necessary or accurate information, and may not be usable for most people.

Quality of medication information available on retail pharmacy Web sites.

PubMed

Ghoshal, Malini; Walji, Muhammad F

2006-12-01

The Internet is becoming an important source for medication information. Although the quality of consumer medication information (CMI) in brick and mortar pharmacies has been reported to be suboptimal, little is known about the quality of CMI offered by pharmacy Web sites. To evaluate the quality, readability, and provision of Web functionality of 4 popular medications (atenolol, nitroglycerin, atorvastatin, and glyburide) available on the websites of 3 of the largest retail pharmacies: Walgreens, CVS Pharmacy, and Rite Aid. The quality of online medication information was evaluated by 2 reviewers using a preexisting evaluation instrument created by a national panel of experts. Readability level was assessed using the Gunning Fog Test. We also assessed the presence of 4 Web-specific functional criteria: (1) capability for font enlargement, (2) availability of a glossary of terms, (3) presence of an "Ask a pharmacist" feature, and (4) access to detailed medication information or full prescribing information. Overall, medication information was 77% adherent to the criteria evaluated. When broken down by drug, CMI was most adherent for atorvastatin (83%), followed by glyburide (77%), atenolol (76%), and nitroglycerin (75%). The average readability level was found to be 10th grade. No pharmacy Web site provided the ability for font enlargement, a glossary of terms, or access to detailed medication information; however, all pharmacy Web sites provided an "Ask a pharmacist" service. Although pharmacy Web sites were found to have an overall good content quality, the high readability level of text, areas of incomplete information, and limited use of desirable Web functionality suggest room for improvement.

Migrant Student Record Transfer System (MSRTS) [machine-readable data file].

ERIC Educational Resources Information Center

Arkansas State Dept. of Education, Little Rock. General Education Div.

The Migrant Student Record Transfer System (MSRTS) machine-readable data file (MRDF) is a collection of education and health data on more than 750,000 migrant children in grades K-12 in the United States (except Hawaii), the District of Columbia, and the outlying territories of Puerto Rico and the Mariana and Marshall Islands. The active file…

Assessment of readability, quality and popularity of online information on ureteral stents.

PubMed

Mozafarpour, Sarah; Norris, Briony; Borin, James; Eisner, Brian H

2018-02-12

To evaluate the quality and readability of online information on ureteral stents. Google.com was queried using the search terms "ureteric stent", "ureteral stent", "double J stent" and, "Kidney stent" derived from Google AdWords. Website popularity was determined using Google Rank and the Alexa tool. Website quality assessment was performed using the following criteria: Journal of the American Medical Association (JAMA) benchmarks, Health on the Net (HON) criteria, and a customized DISCERN questionnaire. The customized DISCERN questionnaire was developed by combining the short validated DISCERN questionnaire with additional stent-specific items including definition, placement, complications, limitations, removal and "when to seek help". Scores related to stent items were considered as the "stent score" (SS). Readability was evaluated using five readability tests. Thirty-two websites were included. The mean customized DISCERN score and "stent score" were 27.1 ± 7.1 (maximum possible score = 59) and 14.6 ± 3.8 (maximum possible score = 24), respectively. A minority of websites adequately addressed "stent removal" and "when to seek medical attention". Only two websites (6.3%) had HON certification (drugs.com, radiologyinfo.org) and only one website (3.3%) met all JAMA criteria (bradyurology.blogspot.com). Readability level was higher than the American Medical Association recommendation of sixth-grade level for more than 75% of the websites. There was no correlation between Google rank, Alexa rank, and the quality scores (P > 0.05). Among the 32 most popular websites on the topic of ureteral stents, online information was highly variable. The readability of many of the websites was far higher than standard recommendations and the online information was questionable in many cases. These findings suggest a need for improved online resources in order to better educate patients about ureteral stents and also should inform physicians that popular websites may have incomplete information.

Health literacy and ophthalmic patient education

PubMed Central

Muir, Kelly W.; Lee, Paul P.

2010-01-01

In 1997, Ebrahimzadeh, Davalos and Lee wrote in this journal that only 32% of the ophthalmic patient educational materials reviewed were written at or below the recommended eighth grade reading level. Since that time, the National Assessment of Adult Literacy found that more than one third of adult Americans possess only basic or below basic health literacy skills, defined as the ability to understand written information in a healthcare setting. Subsequently, investigators have shown that poor health literacy skills are associated with poor prescription medication adherence, increased hospital admissions and increased mortality. We review the readability of currently available ophthalmic educational materials, with particular attention to the health literacy status of the patient population for which the materials are intended. Examples of prose at various readability levels are provided. Optimizing patient education and improving clinical outcomes requires understanding the attributes that the patient brings to the patient–physician relationship, including health literacy. PMID:20650503

Quality and Health Literacy Demand of Online Heart Failure Information.

PubMed

Cajita, Maan Isabella; Rodney, Tamar; Xu, Jingzhi; Hladek, Melissa; Han, Hae-Ra

The ubiquity of the Internet is changing the way people obtain their health information. Although there is an abundance of heart failure information online, the quality and health literacy demand of these information are still unknown. The purpose of this study is to evaluate the quality and health literacy demand (readability, understandability, and actionability) of the heart failure information found online. Google, Yahoo, Bing, Ask.com, and DuckDuckGo were searched for relevant heart failure Web sites. Two independent raters then assessed the quality and health literacy demand of the included Web sites. The quality of the heart failure information was assessed using the DISCERN instrument. Readability was assessed using 7 established readability tests. Finally, understandability and actionability were assessed using the Patient Education Materials Assessment Tool for Print Materials. A total of 46 Web sites were included in this analysis. The overall mean quality rating was 46.0 ± 8.9 and the mean readability score was 12.6 grade reading level. The overall mean understandability score was 56.3% ± 16.2%. Finally, the overall mean actionability score was 34.7% ± 28.7%. The heart failure information found online was of fair quality but required a relatively high health literacy level. Web content authors need to consider not just the quality but also the health literacy demand of the information found in their Web sites. This is especially important considering that low health literacy is likely prevalent among the usual audience.

My Website Reads at an Eighth Grade Level: Why Plain Language Benefits Your Users (and You)

ERIC Educational Resources Information Center

Skaggs, Danielle

2017-01-01

Writing in plain language aims to help users find what they need and ensures that the information is both useful and understandable. This is key for distance students whose primary library interaction may be with the library Website. A mix of user research and readability scores can be used to measure whether content is findable, useful, and…

Textual Demands of Passages in Three English/Language Arts Common Core Assessments and One Core Literacy Program for Intermediate Elementary Grades

ERIC Educational Resources Information Center

Morrison, Timothy G.; Wilcox, Brad; Murdoch, Erica; Bird, Lauren

2018-01-01

The Common Core has emphasized reading for comprehension, including making inferences. However, little is known about the textual demands found within assessment and instructional passages that are promoted as being in line with Common Core expectations. The purpose of this content analysis was to identify the readability levels, passage length,…

Short forms of the Social Interaction Anxiety Scale and the Social Phobia Scale.

PubMed

Fergus, Thomas A; Valentiner, David P; McGrath, Patrick B; Gier-Lonsway, Stephanie L; Kim, Hyun-Soo

2012-01-01

Mattick and Clarke's (1998) Social Interaction Anxiety Scale (SIAS) and Social Phobia Scale (SPS) are commonly used self-report measures that assess 2 dimensions of social anxiety. Given the need for short, readable measures, this research proposes short forms of both scales. Item-level analyses of readability characteristics of the SIAS and SPS items led to the selection of 6 items from each scale for use in the short forms. The SIAS and SPS short forms had reading levels at approximately the 6th and 5th grade level, respectively. Results using nonclinical (Study 1: N = 469) and clinical (Study 2: N = 145) samples identified these short forms as being factorially sound, possessing adequate internal consistency, and having strong convergence with their full-length counterparts. Moreover, these short forms showed convergence with other measures of social anxiety, showed divergence from measures assessing related constructs, and predicted concurrent interpersonal functioning. Recommendations for the use of these short forms are discussed.

A content analysis of Internet resources about the risks of seafood consumption.

PubMed

Henderson, Heather C; Hong, Jie; Friedman, Daniela B; Porter, Dwayne E; Halfacre, Angela C; Scott, Geoffrey I; Lead, Jamie R

2016-08-01

Seafood consumption is a main source of human exposure to certain environmental contaminants. Therefore, it is valuable to assess the online health risk messages focused on this topic, as people in the US are increasingly accessing the Internet for health-related information. Previous research indicates that online health information tends to be written at a reading level that is more advanced than ability of the general population. The purpose of this research was to examine the content and readability of Internet resources targeted toward consumers in the US regarding the health risks from consumption of contaminated seafood. Sources for analysis were gathered through a targeted search of state and national government websites, as well as through a Google search. The overall mean readability level was Grade 9.21, which is slightly above the average reading level of US adults. Future research should evaluate the accuracy of the health risk messages, as well as consumer perceptions of risk.

A descriptive study of the readability of patient information leaflets designed by nurses.

PubMed

Mumford, M E

1997-11-01

Written patient information materials can be valuable communication tools for teaching and reinforcing the verbal message, especially in the present climate of today's health service where patients are in hospital for such short times. They are only useful if the patient is able to read and understand them, otherwise they become an expensive waste of resources. Various studies have shown that many healthcare information leaflets are written at university or postgraduate level and would cause problems with understanding for many people reading them. This study set out to examine the readability of nurse-designed written information leaflets using the Flesch Reading Ease score and the FOG and SMOG readability formulae. This descriptive study used a sample of 24 leaflets designed by trained nurses in a large teaching hospital. The results produced a mean grade of 11.3 with a range of 8.9 to 14.8. This was similar to the results of other studies and meant that patients may have difficulty comprehending the information. It would appear that little progress has been made in 40 years in this area and potential reasons are discussed. Advantages and disadvantages of readability formulae and other guidelines available for developing information leaflets are explored. Recommendations for further research are made.

Reassessing the Accuracy and Use of Readability Formulae

ERIC Educational Resources Information Center

Janan, Dahlia; Wray, David

2014-01-01

Purpose: The purpose of the study is to review readability formulae and offer a critique, based on a comparison of the grading of a variety of texts given by six well-known formulae. Methodology: A total of 64 texts in English were selected either by or for native English speaking children aged between six and 11 years. Each text was assessed…

Prostate Cancer on the Web-Expedient Tool for Patients' Decision-Making?

PubMed

Borgmann, Hendrik; Wölm, Jan-Henning; Vallo, Stefan; Mager, Rene; Huber, Johannes; Breyer, Johannes; Salem, Johannes; Loeb, Stacy; Haferkamp, Axel; Tsaur, Igor

2017-03-01

Many patients diagnosed with cancer search for health information on the Web. We aimed to assess the quality and reliability of online health information on prostate cancer. Google, Yahoo, and Bing were searched for the term "prostate cancer." After selecting the most frequented websites, quality was measured by DISCERN score, JAMA benchmark criteria, and presence of HONcode certification. Popularity was assessed by Alexa tool, while accessibility, usability, and reliability were investigated by LIDA tool. Readability was analyzed by Flesch-Kincaid Reading Grade Level and Automated Readability Index. All 13 selected websites were rated as being of high quality according to the DISCERN instrument (76.5 ± 2.6 out of 80 points). JAMA benchmark criteria were fulfilled by 87 % of websites, whereas only 37 % were certified by the HONcode. Median Alexa Traffic Rank was 2718 ranging from 7 to 679,038. Websites received 2.3 ± 0.5 daily pageviews per visitor and users spent an average of 2 min 58 s ± 39 sec on the website. Accessibility (92 ± 5 %) and usability (92 ± 3 %) scores were high and reliability (88 ± 8 %) moderate according to the LIDA tool. Flesch-Kincaid Grade Level was 7.9 ± 2.2, and Automated Readability Index was 7.5 ± 2.4, rating the websites as fairly difficult to read. In conclusion, quality, accessibility, and usability of websites on prostate cancer provided a high rating in the current analysis. These findings are encouraging in view of the growing frequency of patients' access of health information online.

Variable Quality and Readability of Patient-oriented Websites on Colorectal Cancer Screening.

PubMed

Schreuders, Eline H; Grobbee, Esmée J; Kuipers, Ernst J; Spaander, Manon C W; Veldhuyzen van Zanten, Sander J O

2017-01-01

The efficacy of colorectal cancer (CRC) screening is dependent on participation and subsequent adherence to surveillance. The internet increasingly is used for health information and is important to support decision making. We evaluated the accuracy, quality, and readability of online information on CRC screening and surveillance. A Website Accuracy Score and Polyp Score were developed, which awarded points for various aspects of CRC screening and surveillance. Websites also were evaluated using validated internet quality instruments (Global Quality Score, LIDA, and DISCERN), and reading scores. Two raters independently assessed the top 30 websites appearing on Google.com. Portals, duplicates, and news articles were excluded. Twenty websites were included. The mean website accuracy score was 26 of 44 (range, 9-41). Websites with the highest scores were www.cancer.org, www.bowelcanceraustralia.org, and www.uptodate.com. The median polyp score was 3 of 10. The median global quality score was 3 of 5 (range, 2-5). The median overall LIDA score was 74% and the median DISCERN score was 45, both indicating moderate quality. The mean Flesch-Kincaid grade level was 11th grade, rating the websites as difficult to read, 30% had a reading level acceptable for the general public (Flesch Reading Ease > 60). There was no correlation between the Google rank and the website accuracy score (r s  = -0.31; P = .18). There is marked variation in quality and readability of websites on CRC screening. Most websites do not address polyp surveillance. The poor correlation between quality and Google ranking suggests that screenees will miss out on high-quality websites using standard search strategies. Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.

Third Molars on the Internet: A Guide for Assessing Information Quality and Readability.

PubMed

Hanna, Kamal; Brennan, David; Sambrook, Paul; Armfield, Jason

2015-10-06

Directing patients suffering from third molars (TMs) problems to high-quality online information is not only medically important, but also could enable better engagement in shared decision making. This study aimed to develop a scale that measures the scientific information quality (SIQ) for online information concerning wisdom tooth problems and to conduct a quality evaluation for online TMs resources. In addition, the study evaluated whether a specific piece of readability software (Readability Studio Professional 2012) might be reliable in measuring information comprehension, and explored predictors for the SIQ Scale. A cross-sectional sample of websites was retrieved using certain keywords and phrases such as "impacted wisdom tooth problems" using 3 popular search engines. The retrieved websites (n=150) were filtered. The retained 50 websites were evaluated to assess their characteristics, usability, accessibility, trust, readability, SIQ, and their credibility using DISCERN and Health on the Net Code (HoNCode). Websites' mean scale scores varied significantly across website affiliation groups such as governmental, commercial, and treatment provider bodies. The SIQ Scale had a good internal consistency (alpha=.85) and was significantly correlated with DISCERN (r=.82, P<.01) and HoNCode (r=.38, P<.01). Less than 25% of websites had SIQ scores above 75%. The mean readability grade (10.3, SD 1.9) was above the recommended level, and was significantly correlated with the Scientific Information Comprehension Scale (r=.45. P<.01), which provides evidence for convergent validity. Website affiliation and DISCERN were significantly associated with SIQ (P<.01) and explained 76% of the SIQ variance. The developed SIQ Scale was found to demonstrate reliability and initial validity. Website affiliation, DISCERN, and HoNCode were significant predictors for the quality of scientific information. The Readability Studio software estimates were associated with scientific information comprehensiveness measures.

Metal-on-Metal Total Hip Arthroplasty: Quality of Online Patient Information.

PubMed

Crozier-Shaw, Geoff; Queally, Joseph M; Quinlan, John F

2017-03-01

Metal-on-metal total hip arthroplasty (THA) has generated much attention in the media because of early failure of certain implant systems. This study assessed the quality, accuracy, and readability of online information on metal-on-metal THA. The search terms "metal-on-metal hip replacement" and "metal hip replacement" were entered into the 3 most popular search engines. Information quality was assessed with the DISCERN score and a specific metal-on-metal THA content score. Accuracy of information was assessed with a customized score. Readability of the websites was assessed with the Flesch-Kincaid grade level score. A total of 61 unique websites were assessed. For 56% of websites, the target audience was patients. Media or medicolegal sources accounted for 44% of websites. As assessed by DISCERN (range, 16-80) and metal-on-metal THA (range, 0-25) scores, quality of the websites was moderate at best (47.1 and 9.6, respectively). Accuracy (range, 0-8) of the information presented also was moderate, with a mean score of 6.6. Media and medicolegal websites had the lowest scores for both quality and accuracy, despite making up the greatest proportion of sites assessed. Only 1 website (2%) had a Flesch-Kincaid grade level at or less than the recommended level of 8th grade. This study found that online information on metal-on-metal THA was of poor quality, often was inaccurate, and was presented at an inappropriately high reading level, particularly for media and medicolegal websites. Health care providers should counsel patients on the quality of information available and recommend appropriate online resources. [Orthopedics. 2017; 40(2):e262-e268.]. Copyright 2016, SLACK Incorporated.

Workbook for Naval Science 3: An Illustrated Workbook for the NJROTC Student. Focus on the Trained Person. Technical Report 124.

ERIC Educational Resources Information Center

Omans, S. E.; And Others

This workbook (first in a series of three) supplements the textbook of the third year Naval Junior Reserve Officers Training Corps (NJROTC) program and is designed for NJROTC students who do not have the reading skills necessary to fully benefit from the regular curriculum materials. The workbook is written at the eighth-grade readability level as…

Smart Language: Readers, Readability, and the Grading of Text

ERIC Educational Resources Information Center

DuBay, William H.

2007-01-01

The purpose of this book is to introduce the research on readability, defined here as reading ease. The first part of the book covers how people read. A series of national literacy surveys show that the average person in the U.S. and most other countries are adults of limited reading skills. For example, the average adult in the U.S. reads at the…

Readability assessment of concussion and traumatic brain injury publications by Centers for Disease Control and Prevention

PubMed Central

Gill, Preetinder S; Gill, Tejkaran S; Kamath, Ashwini; Whisnant, Billy

2012-01-01

Health literacy is associated with a person’s capacity to find, access, contextualize, and understand information needed for health care-related decisions. The level of health literacy thus has an influence on an individual’s health status. It can be argued that low health literacy is associated with poor health status. Health care literature (eg, pamphlets, brochures, postcards, posters, forms) are published by public and private organizations worldwide to provide information to the general public. The ability to read, use, and understand is critical to the successful application of knowledge disseminated by this literature. This study assessed the readability, suitability, and usability of health care literature associated with concussion and traumatic brain injury published by the United States Centers for Disease Control and Prevention. The Flesch–Kincaid Grade Level, Flesch Reading Ease, Gunning Fog, Simple Measure of Gobbledygook, and Suitability Assessment of Materials indices were used to assess 40 documents obtained from the Centers for Disease Control and Prevention website. The documents analyzed were targeted towards the general public. It was found that in order to be read properly, on average, these documents needed more than an eleventh grade/high school level education. This was consistent with the findings of other similar studies. However, the qualitative Suitability Assessment of Materials index showed that, on average, usability and suitability of these documents was superior. Hence, it was concluded that formatting, illustrations, layout, and graphics play a pivotal role in improving health care-related literature and, in turn, promoting health literacy. Based on the comprehensive literature review and assessment of the 40 documents associated with concussion and traumatic brain injury, recommendations have been made for improving the readability, suitability, and usability of health care-related documents. The recommendations are presented in the form of an incremental improvement process cycle and a list of dos and don’ts. PMID:23204856

Malaria rapid diagnostic kits: quality of packaging, design and labelling of boxes and components and readability and accuracy of information inserts

PubMed Central

2011-01-01

Background The present study assessed malaria RDT kits for adequate and correct packaging, design and labelling of boxes and components. Information inserts were studied for readability and accuracy of information. Methods Criteria for packaging, design, labelling and information were compiled from Directive 98/79 of the European Community (EC), relevant World Health Organization (WHO) documents and studies on end-users' performance of RDTs. Typography and readability level (Flesch-Kincaid grade level) were assessed. Results Forty-two RDT kits from 22 manufacturers were assessed, 35 of which had evidence of good manufacturing practice according to available information (i.e. CE-label affixed or inclusion in the WHO list of ISO13485:2003 certified manufacturers). Shortcomings in devices were (i) insufficient place for writing sample identification (n = 40) and (ii) ambiguous labelling of the reading window (n = 6). Buffer vial labels were lacking essential information (n = 24) or were of poor quality (n = 16). Information inserts had elevated readability levels (median Flesch Kincaid grade 8.9, range 7.1 - 12.9) and user-unfriendly typography (median font size 8, range 5 - 10). Inadequacies included (i) no referral to biosafety (n = 18), (ii) critical differences between depicted and real devices (n = 8), (iii) figures with unrealistic colours (n = 4), (iv) incomplete information about RDT line interpretations (n = 31) and no data on test characteristics (n = 8). Other problems included (i) kit names that referred to Plasmodium vivax although targeting a pan-species Plasmodium antigen (n = 4), (ii) not stating the identity of the pan-species antigen (n = 2) and (iii) slight but numerous differences in names displayed on boxes, device packages and information inserts. Three CE labelled RDT kits produced outside the EC had no authorized representative affixed and the shape and relative dimensions of the CE symbol affixed did not comply with the Directive 98/79/EC. Overall, RDTs with evidence of GMP scored better compared to those without but inadequacies were observed in both groups. Conclusion Overall, malaria RDTs showed shortcomings in quality of construction, design and labelling of boxes, device packages, devices and buffers. Information inserts were difficult to read and lacked relevant information. PMID:21314992

Evaluation of breastfeeding Web sites for patient education.

PubMed

Dornan, Barbara A; Oermann, Marilyn H

2006-01-01

To evaluate the quality of Web sites on breastfeeding for patient education. Descriptive study of 30 Web sites on breastfeeding for patient education, evaluated based on the Health Information Technology Institute (HITI) criteria, readability, and eight content criteria from the American Academy of Pediatrics (AAP) policy statement on breastfeeding. The mean Flesch-Kincaid Grade Level for readability of the 30 sites was 9.2. Seven of the sites included all eight of the content criteria from the AAP, and three sites did not include any of the information recommended by the AAP content criteria. Nurses should be able to recommend best patient education materials for their patients. The five best Web sites for breastfeeding education are identified for patient teaching, and the HITI criteria are explained for nurses to learn how to evaluate Web sites for themselves and their patients.

Patient information materials in general practices and promotion of health literacy: an observational study of their effectiveness.

PubMed

Protheroe, Joanne; Estacio, Emee Vida; Saidy-Khan, Sirandou

2015-03-01

Government policy in the UK emphasises providing patients with good health information to encourage participation in their health care. Patient information leaflets (PILs) form part of this policy and have been shown to affect patient health outcomes; however, many are poorly written. To describe the PILs in general practice surgeries in Stoke-on-Trent in terms of readability and variety of content. An observational study of randomly selected GP practices (n = 17) across Stoke-on-Trent. PILs were assessed for readability (Flesch Reading Ease and Flesch-Kincaid Grade Level) and compared with national skills level data and with the recommended level for medical information. The PILs were also categorised for content using the Rudd (2007) health material classification framework. A total of 345 PILs were collected and assessed. Only 24.3% meet recommended reading-level criteria. Compared with national skills levels, over 75% of the PILs collected were too complex for at least 15% of the English population. Of the PILs, 47.8% were classified as 'systems navigation' (information regarding services); 22.9% were disease prevention (screening and immunisations); 14.2% personal and public safety; and less than 10% were for managing illness or health promotion. Current PILs in general practices do not all promote health literacy. Information only accessible to a proportion of higher skilled patients may increase inequalities in health. Less than 10% of PILs promote managing illness or healthy lifestyles. Processes must be put in place to improve the readability and variety of content of PILs in GP practices. © British Journal of General Practice 2015.

Informed consent and the readability of the written consent form.

PubMed

Sivanadarajah, N; El-Daly, I; Mamarelis, G; Sohail, M Z; Bates, P

2017-11-01

Introduction The aim of this study was to objectively ascertain the level of readability of standardised consent forms for orthopaedic procedures. Methods Standardised consent forms (both in summary and detailed formats) endorsed by the British Orthopaedic Association (BOA) were retrieved from orthoconsent.com and assessed for readability. This involved using an online tool to calculate the validated Flesch reading ease score (FRES). This was compared with the FRES for the National Health Service (NHS) Consent Form 1. Data were analysed and interpreted according to the FRES grading table. Results The FRES for Consent Form 1 was 55.6, relating to the literacy expected of an A level student. The mean FRES for the BOA summary consent forms (n=27) was 63.6 (95% confidence interval [CI]: 61.2-66.0) while for the detailed consent forms (n=32), it was 68.9 (95% CI: 67.7-70.0). All BOA detailed forms scored >60, correlating to the literacy expected of a 13-15-year-old. The detailed forms had a higher FRES than the summary forms (p<0.001). Conclusions This study demonstrates that the BOA endorsed standardised consent forms are much easier to read and understand than the NHS Consent Form 1, with the detailed BOA forms being the easiest to read. Despite this, owing to varying literacy levels, a significant proportion of patients may struggle to give informed consent based on the written information provided to them.

Examining the online approaches used by hospitals in Sydney, Australia to inform patients about healthcare associated infections and infection prevention strategies.

PubMed

Park, J; Seale, H

2017-12-21

Provision of information plays a critical role in supporting patients to be engaged or empowered to be involved with infection prevention measures in hospitals. This explorative study evaluated the suitability, readability and accessibility of information on healthcare associated infections (HCAIs) and infection prevention strategies targeted at patients from the websites of 19 acute care public hospitals in Sydney, Australia. We included hospitals with greater than 200 beds in the sample. We examined online information targeted at patients on HCAIs and infection prevention and compared it using the Suitability Assessment of Material (SAM) and Simple Measure of Gobbledygook (SMOG) readability formulas for suitability, readability and accessibility. Thirty-six webpages were identified as being relevant and containing information about HCAIs or infection prevention. Based on the SAM/SMOG scores, only three webpages were found to be 'superior'. Many of the webpages scored poorly in content, literacy, graphics, learning stimulation and cultural appropriateness. In comparison, most of the webpages scored well in the layout and typography. The majority (97%) of the materials were written at a level higher than the recommended reading grade level. Lastly, the websites scored poorly on the ability to locate the information easily, as messages about HCAIs/infection prevention were usually embedded into other topics. While providing information online is only one approach to delivering messages about infection prevention, it is becoming increasingly important in today's technology society. Hospitals are neglecting to use best practices when designing their online resources and current websites are difficult to navigate. The findings point to the need to review patient information on HCAIs regarding suitability, readability and accessibility.

Robotic Prostatectomy on the Web: A Cross-Sectional Qualitative Assessment.

PubMed

Borgmann, Hendrik; Mager, René; Salem, Johannes; Bründl, Johannes; Kunath, Frank; Thomas, Christian; Haferkamp, Axel; Tsaur, Igor

2016-08-01

Many patients diagnosed with prostate cancer search for information on robotic prostatectomy (RobP) on the Web. We aimed to evaluate the qualitative characteristics of the mostly frequented Web sites on RobP with a particular emphasis on provider-dependent issues. Google was searched for the term "robotic prostatectomy" in Europe and North America. The mostly frequented Web sites were selected and classified as physician-provided and publically-provided. Quality was measured using Journal of the American Medical Association (JAMA) benchmark criteria, DISCERN score, and addressing of Trifecta surgical outcomes. Popularity was analyzed using Google PageRank and Alexa tool. Accessibility, usability, and reliability were investigated using the LIDA tool and readability was assessed using readability indices. Twenty-eight Web sites were physician-provided and 15 publically-provided. For all Web sites, 88% of JAMA benchmark criteria were fulfilled, DISCERN quality score was high, and 81% of Trifecta outcome measurements were addressed. Popularity was average according to Google PageRank (mean 2.9 ± 1.5) and Alexa Traffic Rank (median, 49,109; minimum, 7; maximum, 8,582,295). Accessibility (85 ± 7%), usability (92 ± 3%), and reliability scores (88 ± 8%) were moderate to high. Automated Readability Index was 7.2 ± 2.1 and Flesch-Kincaid Grade Level was 9 ± 2, rating the Web sites as difficult to read. Physician-provided Web sites had higher quality scores and lower readability compared with publically-provided Web sites. Websites providing information on RobP obtained medium to high ratings in all domains of quality in the current assessment. In contrast, readability needs to be significantly improved so that this content can become available for the populace. Copyright © 2015 Elsevier Inc. All rights reserved.

Third Molars on the Internet: A Guide for Assessing Information Quality and Readability

PubMed Central

Brennan, David; Sambrook, Paul; Armfield, Jason

2015-01-01

Background Directing patients suffering from third molars (TMs) problems to high-quality online information is not only medically important, but also could enable better engagement in shared decision making. Objectives This study aimed to develop a scale that measures the scientific information quality (SIQ) for online information concerning wisdom tooth problems and to conduct a quality evaluation for online TMs resources. In addition, the study evaluated whether a specific piece of readability software (Readability Studio Professional 2012) might be reliable in measuring information comprehension, and explored predictors for the SIQ Scale. Methods A cross-sectional sample of websites was retrieved using certain keywords and phrases such as “impacted wisdom tooth problems” using 3 popular search engines. The retrieved websites (n=150) were filtered. The retained 50 websites were evaluated to assess their characteristics, usability, accessibility, trust, readability, SIQ, and their credibility using DISCERN and Health on the Net Code (HoNCode). Results Websites’ mean scale scores varied significantly across website affiliation groups such as governmental, commercial, and treatment provider bodies. The SIQ Scale had a good internal consistency (alpha=.85) and was significantly correlated with DISCERN (r=.82, P<.01) and HoNCode (r=.38, P<.01). Less than 25% of websites had SIQ scores above 75%. The mean readability grade (10.3, SD 1.9) was above the recommended level, and was significantly correlated with the Scientific Information Comprehension Scale (r=.45. P<.01), which provides evidence for convergent validity. Website affiliation and DISCERN were significantly associated with SIQ (P<.01) and explained 76% of the SIQ variance. Conclusion The developed SIQ Scale was found to demonstrate reliability and initial validity. Website affiliation, DISCERN, and HoNCode were significant predictors for the quality of scientific information. The Readability Studio software estimates were associated with scientific information comprehensiveness measures. PMID:26443470

Quality and readability of English-language internet information for aphasia.

PubMed

Azios, Jamie H; Bellon-Harn, Monica; Dockens, Ashley L; Manchaiah, Vinaya

2017-08-14

Little is known about the quality and readability of treatment information in specific neurogenic disorders, such as aphasia. The purpose of this study was to assess quality and readability of English-language Internet information available for aphasia treatment. Forty-three aphasia treatment websites were aggregated using five different country-specific search engines. Websites were then analysed using quality and readability assessments. Statistical calculations were employed to examine website ratings, differences between website origin and quality and readability scores, and correlations between readability instruments. Websites exhibited low quality with few websites obtaining Health On the Net (HON) certification or clear, thorough information as measured by the DISCERN. Regardless of website origin, readability scores were also poor. Approximate educational levels required to comprehend information on aphasia treatment websites ranged from 13 to 16 years of education. Significant differences were found between website origin and readability measures with higher levels of education required to understand information on websites of non-profit organisations. Current aphasia treatment websites were found to exhibit low levels of quality and readability, creating potential accessibility problems for people with aphasia and significant others. Websites including treatment information for aphasia must be improved in order to increase greater information accessibility.

The Effect of Technology-Based Altered Readability Levels on Struggling Readers' Science Comprehension

ERIC Educational Resources Information Center

Marino, Matthew T.; Coyne, Michael; Dunn, Michael

2010-01-01

This article reports findings from a study examining how altered readability levels affected struggling readers' (N = 288) comprehension of scientific concepts and vocabulary. Specifically, the researchers were interested in learning what effect altered readability levels have when low ability readers participate in a technology-based science…

Managing cognitive difficulties after traumatic brain injury: a review of online resources for families.

PubMed

Poulin, Valérie; Dawson, Deirdre R; Bottari, Carolina; Verreault, Cynthia; Turcotte, Samantha; Jean, Alexandra

2018-03-22

To identify and critically appraise the content, readability, reliability and usability of websites providing information for managing cognitive difficulties in everyday life for the families of adults with moderate to severe traumatic brain injury. Systematic searches on the Internet for relevant websites were conducted using five search engines, and through consultation of the lists of resources published on websites of traumatic brain injury organizations. Two team members assessed eligibility of the websites. To be included, they had to provide information related to management of cognitive difficulties following moderate to severe traumatic brain injury, to be in English or French and available free of charge. Two reviewers evaluated each website according to: (1) its readability using Flesch-Kincaid Grade Level; (2) the quality of its content using a checklist of eight recommendations for managing memory, attention and executive function problems; (3) its usability (e.g., clear design) and reliability (e.g., currency of information) using the Minervation Validation Instrument for Health Care Web Sites. Of the 38 websites included, 10 provide specific tips for families that cover several domains of cognitive function, including memory, attention and executive function. The most frequent recommendations focused on the use of environmental supports for memory problems (n = 33 websites). The readability of information is below the recommended grade 7 for only nine of the websites. All sites show acceptable usability, but their quality is variable in terms of reliability of the information. This review provides useful information for selecting online resources to educate families about the management of cognitive difficulties following moderate to severe traumatic brain injury, as a complement to information and training provided by the rehabilitation team. Implications for rehabilitation This review describes standardized criteria for the evaluation of the content, readability, reliability and usability of websites for family education post-TBI. Given the variability in the content, the readability and the reliability of websites providing information for families about the management of cognitive difficulties post-TBI, careful attention to the selection of appropriate resources is required. Findings from this review may facilitate clinicians' identification of relevant websites to educate families about the management of cognitive difficulties post-TBI, as a complement to other information and training from the rehabilitation team.

Readability and Comprehension of the Geriatric Depression Scale and PROMIS® Physical Function Items in Older African Americans and Latinos

PubMed Central

Paz, Sylvia H.; Jones, Loretta; Calderón, José L.; Hays, Ron D.

2016-01-01

Background Depression and physical function are especially important health domains for the elderly. The Geriatric Depression Scale (GDS) and the Patient-Reported Outcomes Measurement Information System (PROMIS®) Physical Function Item Bank are two surveys commonly used to measure these domains. It is unclear if these two instruments adequately measure these aspects of health in minority elderly. Objective To estimate the readability of the GDS and PROMIS® Physical Function items and to assess their comprehensibility by a sample of African American and Latino elderly. Methods Readability was estimated using the Flesch-Kincaid (F-K) and Flesch-Reading-Ease (FRE) formulae for English versions, and a Spanish adaptation of the FRE formula for the Spanish versions. Comprehension of the GDS and PROMIS items by minority elderly was evaluated with 30 cognitive interviews. Results Readability estimates of a number of items in English and Spanish of the GDS and PROMIS physical functioning items exceed the recommended 5th grade level, or were rated as fairly difficult, difficult, or very difficult to read. Cognitive interviews revealed that many participants felt that more than the two (yes/no) GDS response options were needed to answer the questions. Wording of several PROMIS items was considered confusing and responses potentially uninterpretable because they were based on physical aids. Conclusions Problems with item wording and response options of the GDS and PROMIS Physical Function items may negatively affect reliability and validity of measurement when used with minority elderly. PMID:27599978

Assessing the Accuracy and Readability of Online Health Information for Patients With Pancreatic Cancer.

PubMed

Storino, Alessandra; Castillo-Angeles, Manuel; Watkins, Ammara A; Vargas, Christina; Mancias, Joseph D; Bullock, Andrea; Demirjian, Aram; Moser, A James; Kent, Tara S

2016-09-01

The degree to which patients are empowered by written educational materials depends on the text's readability level and the accuracy of the information provided. The association of a website's affiliation or focus on treatment modality with its readability and accuracy has yet to be thoroughly elucidated. To compare the readability and accuracy of patient-oriented online resources for pancreatic cancer by treatment modality and website affiliation. An online search of 50 websites discussing 5 pancreatic cancer treatment modalities (alternative therapy, chemotherapy, clinical trials, radiation therapy, and surgery) was conducted. The website's affiliation was identified. Readability was measured by 9 standardized tests, and accuracy was assessed by an expert panel. Nine standardized tests were used to compute the median readability level of each website. The median readability scores were compared among treatment modality and affiliation categories. Accuracy was determined by an expert panel consisting of 2 medical specialists and 2 surgical specialists. The 4 raters independently evaluated all websites belonging to the 5 treatment modalities (a score of 1 indicates that <25% of the information is accurate, a score of 2 indicates that 26%-50% of the information is accurate, a score of 3 indicates that 51%-75% of the information is accurate, a score of 4 indicates that 76%-99% of the information is accurate, and a score of 5 indicates that 100% of the information is accurate). The 50 evaluated websites differed in readability and accuracy based on the focus of the treatment modality and the website's affiliation. Websites discussing surgery (with a median readability level of 13.7 and an interquartile range [IQR] of 11.9-15.6) were easier to read than those discussing radiotherapy (median readability level, 15.2 [IQR, 13.0-17.0]) (P = .003) and clinical trials (median readability level, 15.2 [IQR, 12.8-17.0]) (P = .002). Websites of nonprofit organizations (median readability level, 12.9 [IQR, 11.2-15.0]) were easier to read than media (median readability level, 16.0 [IQR, 13.4-17.0]) (P < .001) and academic (median readability level, 14.8 [IQR, 12.9-17.0]) (P < .001) websites. Privately owned websites (median readability level, 14.0 [IQR, 12.1-16.1]) were easier to read than media websites (P = .001). Among treatment modalities, alternative therapy websites exhibited the lowest accuracy scores (median accuracy score, 2 [IQR, 1-4]) (P < .001). Nonprofit (median accuracy score, 4 [IQR, 4-5]), government (median accuracy score, 5 [IQR, 4-5]), and academic (median accuracy score, 4 [IQR, 3.5-5]) websites were more accurate than privately owned (median accuracy score, 3.5 [IQR, 1.5-4]) and media (median accuracy score, 4 [IQR, 2-4]) websites (P < .004). Websites with higher accuracy were more difficult to read than websites with lower accuracy. Online information on pancreatic cancer overestimates the reading ability of the overall population and lacks accurate information about alternative therapy. In the absence of quality control on the Internet, physicians should provide guidance to patients in the selection of online resources with readable and accurate information.

Evaluation of printed health education materials for use by low-education families.

PubMed

Ryan, Lesa; Logsdon, M Cynthia; McGill, Sarah; Stikes, Reetta; Senior, Barbara; Helinger, Bridget; Small, Beth; Davis, Deborah Winders

2014-07-01

Millions of adults lack adequate reading skills and many written patient education materials do not reflect national guidelines for readability and suitability of materials, resulting in barriers to patients being partners in their own health care. The purpose of this study was to evaluate commonly used printed health materials for readability and suitability for patients with limited general or health literacy skills, while providing easy recommendations to health care providers for how to improve the materials. Materials (N = 97) from three clinical areas that represented excellence in nursing care in our organization (stroke, cancer, and maternal-child) were reviewed for a composite reading grade level and a Suitability Assessment of Materials (SAM) score. Twenty-eight percent of the materials were at a 9th grade or higher reading level, and only 23% were 5th grade or below. The SAM ratings for not suitable, adequate, and superior were 11%, 58%, and 31%, respectively. Few materials were superior on both scales. The SAM scale was easy to use and required little training of reviewers to achieve interrater reliability. Improving outcomes and reducing health disparities are increasingly important, and patients must be partners in their care for this to occur. One step to increasing patient understanding of written instructions is improving the quality of the materials in the instruction for all patients and their families, especially those with limited literacy skills. Using materials that are written in a manner that facilitates the uptake and use of patient education content has great potential to improve the ability of patients and families to be partners in care and to improve outcomes, especially for those patients and families with limited general literacy or health literacy skills. © 2014 Sigma Theta Tau International.

Health literacy demands of written health information materials: an assessment of cervical cancer prevention materials.

PubMed

Helitzer, Deborah; Hollis, Christine; Cotner, Jane; Oestreicher, Nancy

2009-01-01

Health literacy requires reading and writing skills as well as knowledge of health topics and health systems. Materials written at high reading levels with ambiguous, technical, or dense text, often place great comprehension demands on consumers with lower literacy skills. This study developed and used an instrument to analyze cervical cancer prevention materials for readability, comprehensibility, suitability, and message design. The Suitability Assessment of Materials (SAM) was amended for ease of use, inclusivity, and objectivity with the encouragement of the original developers. Other novel contributions were specifically related to "comprehensibility" (CAM). The resulting SAM + CAM was used to score 69 materials for content, literacy demand, numeric literacy, graphics, layout/typography, and learning stimulation variables. Expert reviewers provided content validation. Inter-rater reliability was "substantial" (kappa = .77). The mean reading level of materials was 11th grade. Most materials (68%) scored as "adequate" for comprehensibility, suitability, and message design; health education brochures scored better than other materials. Only one-fifth were ranked "superior" for ease of use and comprehensibility. Most written materials have a readability level that is too high and require improvement in ease of use and comprehensibility for the majority of readers.

The accessibility, readability, and quality of online resources for gender affirming surgery.

PubMed

Vargas, Christina R; Ricci, Joseph A; Lee, Michelle; Tobias, Adam M; Medalie, Daniel A; Lee, Bernard T

2017-09-01

The transgender population is disproportionally affected by health disparities related to access to care. In many communities, transgender specialists are geographically distant and locally available medical professionals may be unfamiliar with unique needs of transgender patients. As a result, use of Internet resources for information about gender affirming surgery is particularly important. This study simulates a patient search for online educational material about gender affirming surgery and evaluates the accessibility, readability, and quality of the information. An Internet search for the term "transgender surgery" was performed, and the first 10 relevant hits were identified. Readability was assessed using 10 established tests: Coleman-Liau, Flesch-Kincaid, FORCAST, Fry, Gunning Fog, New Dale-Chall, New Fog Count, Raygor Estimate, Simple Measure of Gobbledygook, and Flesch Reading Ease. Quality was assessed using Journal of the American Medical Association criteria and the DISCERN instrument. Review of 69 results was required to identify 10 sites with relevant patient information. There were 97 articles collected; overall mean reading level was 14.7. Individual Web site reading levels ranged from 12.0 to 17.5. All articles and Web sites exceeded the recommended sixth grade level. Quality ranged from 0 to 4 (Journal of the American Medical Association) and 35 to 79 (DISCERN) across Web sites. Web sites with relevant patient information about gender affirming surgery were difficult to identify from search results. The content of these sites universally exceeded the recommended reading level. A wide range of Web site quality was noted, and this may further complicate successful navigation. Barriers in access to appropriately written patient information on the Internet may contribute to disparities in referral, involvement, satisfaction, and outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

A Software Application for Assessing Readability in the Japanese EFL Context

ERIC Educational Resources Information Center

Ozasa, Toshiaki; Weir, George R. S.; Fukui, Masayasu

2010-01-01

We have been engaged in developing a readability index and its application software attuned for Japanese EFL learners. The index program, Ozasa-Fukui Year Level Program, Ver. 1.0, was used in developing the readability metric Ozasa-Fukui Year Level Index but tended to assume a high level of computer knowledge in its users. As a result, the…

Universally Designed Text on the Web: Towards Readability Criteria Based on Anti-Patterns.

PubMed

Eika, Evelyn

2016-01-01

The readability of web texts affects accessibility. The Web Content Accessibility guidelines (WCAG) state that the recommended reading level should match that of someone who has completed basic schooling. However, WCAG does not give advice on what constitutes an appropriate reading level. Web authors need tools to help composing WCAG compliant texts, and specific criteria are needed. Classic readability metrics are generally based on lengths of words and sentences and have been criticized for being over-simplistic. Automatic measures and classifications of texts' reading levels employing more advanced constructs remain an unresolved problem. If such measures were feasible, what should these be? This work examines three language constructs not captured by current readability indices but believed to significantly affect actual readability, namely, relative clauses, garden path sentences, and left-branching structures. The goal is to see whether quantifications of these stylistic features reflect readability and how they correspond to common readability measures. Manual assessments of a set of authentic web texts for such uses were conducted. The results reveal that texts related to narratives such as children's stories, which are given the highest readability value, do not contain these constructs. The structures in question occur more frequently in expository texts that aim at educating or disseminating information such as strategy and journal articles. The results suggest that language anti-patterns hold potential for establishing a set of deeper readability criteria.

The Massachusetts BMI letter: A qualitative study of responses from parents of obese children

PubMed Central

Moyer, Lindsay J.; Carbone, Elena T.; Anliker, Jean A.; Goff, Sarah L.

2015-01-01

Objectives Massachusetts (MA) public schools conduct mandated body-mass index (BMI) screening and until recently, communicated results in a letter to parents/caregivers, to encourage primary care visits and provide aggregate data to the state Department of Public Health. This study assessed the letter's readability and qualitatively explored parents’ responses to it. Methods Readability of the BMI letter was calculated. Audio-taped 1-h focus groups were conducted with parents/caregivers of 8- to 14-year-old obese (≥95th BMI-for-age percentile) children. A semistructured interview guide was used to elicit responses. Qualitative content analysis was conducted on transcripts to identify emergent themes. Results Readability analysis showed higher grade levels than recommended. Eight focus groups consisting of two to six parents each were conducted (n = 29); 83% were female, mean age 41 ± 9 years, and 65% self-identified as Hispanic/Latino. Key themes identified included usefulness of the BMI letter, concerns about utility of BMI for screening, concerns about impacting self-esteem, and failure to understand the letter. Conclusions The MA BMI letter may not have been achieving its desired goal with some parents. Practice implications: Emergent themes from this study could be used to test effectiveness of similar BMI letters nationwide and develop strategies to improve communication to parents. PMID:24290240

Quality and readability of internet-based information on halitosis.

PubMed

Jo, Jung Hwan; Kim, Eui Joo; Kim, Ji Rak; Kim, Moon Jong; Chung, Jin Woo; Park, Ji Woon

2018-03-01

To evaluate quality and readability of Internet-based information on halitosis. An Internet search through 3 engines (Google, Yahoo, and Bing) was done with the terms ("bad breath," "halitosis," "oral malodor," "foul breath," "mouth malodor," "breath malodor," "fetor ex ore," "fetor oris," "ozostomia," and "stomatodysodia"). The first 50 websites from each engine resulting from each search term were screened. Included websites were evaluated using Health on the Net (HON) criteria, Journal of American Medical Association (JAMA) benchmarks, DISCERN, Ensuring Quality Information for Patients (EQIP), Flesch Reading Ease (FRE) score, and Flesch-Kincaid Grade level. A total of 101 websites were included. HON, DISCERN, EQIP, and FRE score were 42.9%, 37.6%, 37.4%, and 51.9% of the maximum score, respectively. Fewer than 50% of sites displayed attribution, disclosure, and currency according to JAMA benchmarks. HON score, DISCERN score, and EQIP score had significant correlation with each other and were significantly higher in sites displaying the HON seal. The current quality and readability of informative websites on halitosis are generally low and poorly organized. Clinicians should be able to assess the Internet-based information on halitosis, as well as give accurate advice and guide patients concerning this issue. Copyright © 2017 Elsevier Inc. All rights reserved.

National Aspects of Creating and Using MARC/RECON Records.

ERIC Educational Resources Information Center

Rather, John C., Ed.; Avram, Henriette D., Ed.

The Retrospective Conversion (RECON) Working Task Force investigated the problems of converting retrospective catalog records to machine readable form. The major conclusions and recommendations of the Task Force cover five areas: the level of machine-readable records, conversion of other machine-readable data bases, a machine-readable National…

Assessment of printed patient-educational materials for chronic kidney disease

PubMed Central

Tuot, Delphine S; Davis, Elizabeth; Velasquez, Alexandra; Banerjee, Tanushree; Powe, Neil R

2013-01-01

Background Awareness of chronic kidney disease (CKD) is suboptimal among patients with CKD, perhaps due to poor readability of patient education materials (PEMs). We reviewed the suitability and readability of common PEMs that focused on 5 content areas: basics of CKD, risk factors for CKD development, risk factors for CKD progression, complications of CKD and self-management strategies to improve kidney health. Methods Three reviewers (nephrologist, primary care physician, patient) used the Suitability Assessment of Materials to rate PEMs on message content/stimulation of learning, typography, visuals and layout and determined literacy level. Mean ratings were calculated for each PEM by content area and overall (Superior=70–100; Adequate=40–69; Inadequate=<40). Linear regression was used to determine the impact of literacy level on mean rating. Results We reviewed 69 PEMs from 19 organizations, divided into 113 content area sections. Most (79%) PEM sections were “Adequate” (mean rating, 58.3%). Inclusion of patient-centered content and opportunities for patient interaction were associated with “Superior” ratings. Mean ratings (SD) were similar across content areas: basics of CKD, 58.9% [9.1]; risk factors for CKD development, 57.0% [12.3]; risk factors for CKD progression, 58.5% [12.0]; CKD complications, 62.3% [15.7] and self-management strategies, 62.2% [12.3]. ≤ 6th grade literacy level (vs >6th grade) was associated with an 11.7 point higher mean rating. Conclusion Most PEMs for kidney disease were adequate. Outstanding PEMs shared characteristics of patient centeredness, a low literacy level, and patient interaction. Providers should be aware of strengths and limitations of PEMs when educating their patients about CKD. PMID:23970127

Assessment of printed patient-educational materials for chronic kidney disease.

PubMed

Tuot, Delphine S; Davis, Elizabeth; Velasquez, Alexandra; Banerjee, Tanushree; Powe, Neil R

2013-01-01

Awareness of chronic kidney disease (CKD) is suboptimal among patients with CKD, perhaps due to poor readability of patient education materials (PEMs). We reviewed the suitability and readability of common PEMs that focused on 5 content areas: basics of CKD, risk factors for CKD development, risk factors for CKD progression, complications of CKD and self-management strategies to improve kidney health. Three reviewers (nephrologist, primary care physician, patient) used the Suitability Assessment of Materials to rate PEMs on message content/stimulation of learning, typography, visuals and layout and determined literacy level. Mean ratings were calculated for each PEM by content area and overall (superior = 70-100; adequate = 40-69; inadequate = <40). Linear regression was used to determine the impact of literacy level on mean rating. We reviewed 69 PEMs from 19 organizations, divided into 113 content area sections. Most (79%) PEM sections were 'adequate' (mean rating, 58.3%). Inclusion of patient-centered content and opportunities for patient interaction were associated with 'superior' ratings. Mean ratings (SD) were similar across content areas: basics of CKD, 58.9% (9.1); risk factors for CKD development, 57.0% (12.3); risk factors for CKD progression, 58.5% (12.0); CKD complications, 62.3% (15.7), and self-management strategies, 62.2% (12.3). ≤6th grade literacy level (vs. >6th grade) was associated with an 11.7 point higher mean rating. Most PEMs for kidney disease were adequate. Outstanding PEMs shared characteristics of patient centeredness, a low literacy level, and patient interaction. Providers should be aware of strengths and limitations of PEMs when educating their patients about CKD. Copyright © 2013 S. Karger AG, Basel.

Evaluating the Quality and Readability of Internet Information on Meningiomas.

PubMed

Saeed, Fozia; Anderson, Ian

2017-01-01

The Internet is a highly powerful resource for patients and provides an extensive amount of information on medical conditions. It is therefore important that the information accessible is accurate, up to date, and at an appropriate comprehensive level for the general public. This article aims to evaluate the quality of patient information on meningiomas. The term meningioma was searched using the following search engines: Google, Bing, Yahoo, Ask, and AOL. The top 100 meningioma Web sites were analyzed for readability using the Flesch Reading Ease score and the Flesch-Kincaid grade level. The quality of each Web page was assessed with the DISCERN instrument and the Centers for Disease Control and Prevention (CDC) Clear Communication Index (CCI). The quality of information on the Internet on meningiomas is highly variable. The overall mean Flesch Reading Ease score was 43.1 (standard deviation = 13.3) and the mean Flesch-Kincaid grade of all the Web sites was 11.2 (standard deviation = 2.3). This finding suggests that the information is on average difficult to read. Only one Web site was at the recommended seventh-grade level and the remainder were above this grade. Only one third of the Web pages had Health On the Net Code of Conduct or The Information Standard certification and were found to be significantly of higher quality: DISCERN (P = 0.022) and CDC CCI (P = 0.027). More than 50% of the Web sites had significantly poor or average DISCERN scores and only 2 Web sites fulfilled the CDC CCI criteria. It is recommended that clinicians personally research material for their patients to be able to guide them to reliable and accurate Web sites. It is also encouraged to become Health On the Net Code of Conduct/The Information Standard certified because this may indicate information of high quality. In addition, it is also recommended that authors of existing information assess the quality of their online health information against the CDC CCI criteria. Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

Readability Levels of the Reading Passages in the ITED: Final Report. Iowa Testing Programs Research Report. Number 6.

ERIC Educational Resources Information Center

Forsyth, Robert

The readability level of passages from three subtests of the Iowa Tests of Educational Development (ITED), Forms X-6 and Y-6, were compared with the readability level of passages selected from the Des Moines Resister, Reader's Digest, Time, Newsweek, Saturday Review, and 18 high school textbooks from the fields of social studies, science, and…

Analysis of Readability and Interest of Marketing Education Textbooks: Implications for Special Needs Learners.

ERIC Educational Resources Information Center

Jones, Karen H.; And Others

1993-01-01

The readability, reading ease, interest level, and writing style of 20 current textbooks in secondary marketing education were evaluated. Readability formulas consistently identified lower reading levels for special needs education, human interest scores were not very reliable information sources, and writing style was also a weak variable. (JOW)

A Comparison of Two Methods of Assessing Textbook Readability of Selected College Level Electronics Textbooks.

ERIC Educational Resources Information Center

Froelich, Donald Max

Fifty-eight students enrolled in basic electronics courses from three state colleges in Missouri, were involved in comparing the cloze readability technique with the Flesch Reading Ease Formula to ascertain the effectiveness of each in assessing the readability of selected college level electronics textbooks. Pearson product-moment correlations…

Readability and Content Assessment of Informed Consent Forms for Medical Procedures in Croatia

PubMed Central

Vučemilo, Luka; Borovečki, Ana

2015-01-01

Background High quality of informed consent form is essential for adequate information transfer between physicians and patients. Current status of medical procedure consent forms in clinical practice in Croatia specifically in terms of the readability and the content is unknown. The aim of this study was to assess the readability and the content of informed consent forms for diagnostic and therapeutic procedures used with patients in Croatia. Methods 52 informed consent forms from six Croatian hospitals on the secondary and tertiary health-care level were tested for reading difficulty using Simple Measure of Gobbledygook (SMOG) formula adjusted for Croatian language and for qualitative analysis of the content. Results The averaged SMOG grade of analyzed informed consent forms was 13.25 (SD 1.59, range 10–19). Content analysis revealed that informed consent forms included description of risks in 96% of the cases, benefits in 81%, description of procedures in 78%, alternatives in 52%, risks and benefits of alternatives in 17% and risks and benefits of not receiving treatment or undergoing procedures in 13%. Conclusions Readability of evaluated informed consent forms is not appropriate for the general population in Croatia. The content of the forms failed to include in high proportion of the cases description of alternatives, risks and benefits of alternatives, as well as risks and benefits of not receiving treatments or undergoing procedures. Data obtained from this research could help in development and improvement of informed consent forms in Croatia especially now when Croatian hospitals are undergoing the process of accreditation. PMID:26376183

Patient-oriented cancer information on the internet: a comparison of wikipedia and a professionally maintained database.

PubMed

Rajagopalan, Malolan S; Khanna, Vineet K; Leiter, Yaacov; Stott, Meghan; Showalter, Timothy N; Dicker, Adam P; Lawrence, Yaacov R

2011-09-01

A wiki is a collaborative Web site, such as Wikipedia, that can be freely edited. Because of a wiki's lack of formal editorial control, we hypothesized that the content would be less complete and accurate than that of a professional peer-reviewed Web site. In this study, the coverage, accuracy, and readability of cancer information on Wikipedia were compared with those of the patient-orientated National Cancer Institute's Physician Data Query (PDQ) comprehensive cancer database. For each of 10 cancer types, medically trained personnel scored PDQ and Wikipedia articles for accuracy and presentation of controversies by using an appraisal form. Reliability was assessed by using interobserver variability and test-retest reproducibility. Readability was calculated from word and sentence length. Evaluators were able to rapidly assess articles (18 minutes/article), with a test-retest reliability of 0.71 and interobserver variability of 0.53. For both Web sites, inaccuracies were rare, less than 2% of information examined. PDQ was significantly more readable than Wikipedia: Flesch-Kincaid grade level 9.6 versus 14.1. There was no difference in depth of coverage between PDQ and Wikipedia (29.9, 34.2, respectively; maximum possible score 72). Controversial aspects of cancer care were relatively poorly discussed in both resources (2.9 and 6.1 for PDQ and Wikipedia, respectively, NS; maximum possible score 18). A planned subanalysis comparing common and uncommon cancers demonstrated no difference. Although the wiki resource had similar accuracy and depth as the professionally edited database, it was significantly less readable. Further research is required to assess how this influences patients' understanding and retention.

Emotioncy: A Potential Measure of Readability

ERIC Educational Resources Information Center

Pishghadamn, Reza; Abbasnejad, Hannaheh

2016-01-01

Given the deficiencies of readability formulae as reliable tools for measuring text readability in educational settings, this study aims to offer a new measure to improve the current methods of testing the readability levels of texts through the incorporation of the newly-developed concept of emotioncy. To this end, a group of 221 students were…

Using Readability Tests to Improve the Accuracy of Evaluation Documents Intended for Low-Literate Participants

ERIC Educational Resources Information Center

Kouame, Julien B.

2010-01-01

Background: Readability tests are indicators that measure how easy a document can be read and understood. Simple, but very often ignored, readability statistics cannot only provide information about the level of difficulty of the readability of particular documents but also can increase an evaluator's credibility. Purpose: The purpose of this…

Can Consumers Trust Web-Based Information About Celiac Disease? Accuracy, Comprehensiveness, Transparency, and Readability of Information on the Internet

PubMed Central

McNally, Shawna L; Donohue, Michael C; Newton, Kimberly P; Ogletree, Sandra P; Conner, Kristen K; Ingegneri, Sarah E

2012-01-01

Background Celiac disease is an autoimmune disease that affects approximately 1% of the US population. Disease is characterized by damage to the small intestinal lining and malabsorption of nutrients. Celiac disease is activated in genetically susceptible individuals by dietary exposure to gluten in wheat and gluten-like proteins in rye and barley. Symptoms are diverse and include gastrointestinal and extraintestinal manifestations. Treatment requires strict adherence to a gluten-free diet. The Internet is a major source of health information about celiac disease. Nonetheless, information about celiac disease that is available on various websites often is questioned by patients and other health care professionals regarding its reliability and content. Objectives To determine the accuracy, comprehensiveness, transparency, and readability of information on 100 of the most widely accessed websites that provide information on celiac disease. Methods Using the search term celiac disease, we analyzed 100 of the top English-language websites published by academic, commercial, nonprofit, and other professional (nonacademic) sources for accuracy, comprehensiveness, transparency, and reading grade level. Each site was assessed independently by 3 reviewers. Website accuracy and comprehensiveness were probed independently using a set of objective core information about celiac disease. We used 19 general criteria to assess website transparency. Website readability was determined by the Flesch-Kincaid reading grade level. Results for each parameter were analyzed independently. In addition, we weighted and combined parameters to generate an overall score, termed website quality. Results We included 98 websites in the final analysis. Of these, 47 (48%) provided specific information about celiac disease that was less than 95% accurate (ie, the predetermined cut-off considered a minimum acceptable level of accuracy). Independent of whether the information posted was accurate, 51 of 98 (52%) websites contained less than 50% of the core celiac disease information that was considered important for inclusion on websites that provide general information about celiac disease. Academic websites were significantly less transparent (P = .005) than commercial websites in attributing authorship, timeliness of information, sources of information, and other important disclosures. The type of website publisher did not predict website accuracy, comprehensiveness, or overall website quality. Only 4 of 98 (4%) websites achieved an overall quality score of 80 or above, which a priori was set as the minimum score for a website to be judged trustworthy and reliable. Conclusions The information on many websites addressing celiac disease was not sufficiently accurate, comprehensive, and transparent, or presented at an appropriate reading grade level, to be considered sufficiently trustworthy and reliable for patients, health care providers, celiac disease support groups, and the general public. This has the potential to adversely affect decision making about important aspects of celiac disease, including its appropriate and proper diagnosis, treatment, and management. PMID:23611901

Can consumers trust web-based information about celiac disease? Accuracy, comprehensiveness, transparency, and readability of information on the internet.

PubMed

McNally, Shawna L; Donohue, Michael C; Newton, Kimberly P; Ogletree, Sandra P; Conner, Kristen K; Ingegneri, Sarah E; Kagnoff, Martin F

2012-04-04

Celiac disease is an autoimmune disease that affects approximately 1% of the US population. Disease is characterized by damage to the small intestinal lining and malabsorption of nutrients. Celiac disease is activated in genetically susceptible individuals by dietary exposure to gluten in wheat and gluten-like proteins in rye and barley. Symptoms are diverse and include gastrointestinal and extraintestinal manifestations. Treatment requires strict adherence to a gluten-free diet. The Internet is a major source of health information about celiac disease. Nonetheless, information about celiac disease that is available on various websites often is questioned by patients and other health care professionals regarding its reliability and content. To determine the accuracy, comprehensiveness, transparency, and readability of information on 100 of the most widely accessed websites that provide information on celiac disease. Using the search term celiac disease, we analyzed 100 of the top English-language websites published by academic, commercial, nonprofit, and other professional (nonacademic) sources for accuracy, comprehensiveness, transparency, and reading grade level. Each site was assessed independently by 3 reviewers. Website accuracy and comprehensiveness were probed independently using a set of objective core information about celiac disease. We used 19 general criteria to assess website transparency. Website readability was determined by the Flesch-Kincaid reading grade level. Results for each parameter were analyzed independently. In addition, we weighted and combined parameters to generate an overall score, termed website quality. We included 98 websites in the final analysis. Of these, 47 (48%) provided specific information about celiac disease that was less than 95% accurate (ie, the predetermined cut-off considered a minimum acceptable level of accuracy). Independent of whether the information posted was accurate, 51 of 98 (52%) websites contained less than 50% of the core celiac disease information that was considered important for inclusion on websites that provide general information about celiac disease. Academic websites were significantly less transparent (P = .005) than commercial websites in attributing authorship, timeliness of information, sources of information, and other important disclosures. The type of website publisher did not predict website accuracy, comprehensiveness, or overall website quality. Only 4 of 98 (4%) websites achieved an overall quality score of 80 or above, which a priori was set as the minimum score for a website to be judged trustworthy and reliable. The information on many websites addressing celiac disease was not sufficiently accurate, comprehensive, and transparent, or presented at an appropriate reading grade level, to be considered sufficiently trustworthy and reliable for patients, health care providers, celiac disease support groups, and the general public. This has the potential to adversely affect decision making about important aspects of celiac disease, including its appropriate and proper diagnosis, treatment, and management.

Content and quality of websites supporting self-management of chronic breathlessness in advanced illness: a systematic review

PubMed Central

Luckett, Tim; Disler, Rebecca; Hosie, Annmarie; Johnson, Miriam; Davidson, Patricia; Currow, David; Sumah, Anthony; Phillips, Jane

2016-01-01

Chronic breathlessness is a common, burdensome and distressing symptom in many advanced chronic illnesses. Self-management strategies are essential to optimise treatment, daily functioning and emotional coping. People with chronic illness commonly search the internet for advice on self-management. A review was undertaken in June 2015 to describe the content and quality of online advice on breathlessness self-management, to highlight under-served areas and to identify any unsafe content. Google was searched from Sydney, Australia, using the five most common search terms for breathlessness identified by Google Trends. We also hand-searched the websites of national associations. Websites were included if they were freely available in English and provided practical advice on self-management. Website quality was assessed using the American Medical Association Benchmarks. Readability was assessed using the Flesch–Kincaid grades, with grade 8 considered the maximum acceptable for enabling access. Ninety-one web pages from 44 websites met the inclusion criteria, including 14 national association websites not returned by Google searches. Most websites were generated in the USA (n=28, 64%) and focused on breathing techniques (n=38, 86%) and chronic obstructive pulmonary disease (n=27, 61%). No websites were found to offer unsafe advice. Adherence to quality benchmarks ranged from 9% for disclosure to 77% for currency. Fifteen (54%) of 28 written websites required grade ⩾9 reading level. Future development should focus on advice and tools to support goal setting, problem solving and monitoring of breathlessness. National associations are encouraged to improve website visibility and comply with standards for quality and readability. PMID:27225898

The validation of science virtual test to assess 7th grade students’ critical thinking on matter and heat topic (SVT-MH)

NASA Astrophysics Data System (ADS)

Sya’bandari, Y.; Firman, H.; Rusyati, L.

2018-05-01

The method used in this research was descriptive research for profiling the validation of SVT-MH to measure students’ critical thinking on matter and heat topic in junior high school. The subject is junior high school students of 7th grade (13 years old) while science teacher and expert as the validators. The instruments that used as a tool to obtain the data are rubric expert judgment (content, media, education) and rubric of readability test. There are four steps to validate SVT-MH in 7th grade Junior High School. These steps are analysis of core competence and basic competence based on Curriculum 2013, expert judgment (content, media, education), readability test and trial test (limited and larger trial test). The instrument validation resulted 30 items that represent 8 elements and 21 sub-elements to measure students’ critical thinking based on Inch in matter and heat topic. The alpha Cronbach (α) is 0.642 which means that the instrument is sufficient to measure students’ critical thinking matter and heat topic.

Privacy Policies for Apps Targeted Toward Youth: Descriptive Analysis of Readability

PubMed Central

Das, Gitanjali; Cheung, Cynthia; Nebeker, Camille; Bietz, Matthew

2018-01-01

Background Due to the growing availability of consumer information, the protection of personal data is of increasing concern. Objective We assessed readability metrics of privacy policies for apps that are either available to or targeted toward youth to inform strategies to educate and protect youth from unintentional sharing of personal data. Methods We reviewed the 1200 highest ranked apps from the Apple and Google Play Stores and systematically selected apps geared toward youth. After applying exclusion criteria, 99 highly ranked apps geared toward minors remained, 64 of which had a privacy policy. We obtained and analyzed these privacy policies using reading grade level (RGL) as a metric. Policies were further compared as a function of app category (free vs paid; entertainment vs social networking vs utility). Results Analysis of privacy policies for these 64 apps revealed an average RGL of 12.78, which is well above the average reading level (8.0) of adults in the United States. There was also a small but statistically significant difference in word count as a function of app category (entertainment: 2546 words, social networking: 3493 words, and utility: 1038 words; P=.02). Conclusions Although users must agree to privacy policies to access digital tools and products, readability analyses suggest that these agreements are not comprehensible to most adults, let alone youth. We propose that stakeholders, including pediatricians and other health care professionals, play a role in educating youth and their guardians about the use of Web-based services and potential privacy risks, including the unintentional sharing of personal data. PMID:29301737

Spanish translation and cross-language validation of a sleep habits questionnaire for use in clinical and research settings.

PubMed

Baldwin, Carol M; Choi, Myunghan; McClain, Darya Bonds; Celaya, Alma; Quan, Stuart F

2012-04-15

To translate, back-translate and cross-language validate (English/Spanish) the Sleep Heart Health Study Sleep Habits Questionnaire for use with Spanish-speakers in clinical and research settings. Following rigorous translation and back-translation, this cross-sectional cross-language validation study recruited bilingual participants from academic, clinic, and community-based settings (N = 50; 52% women; mean age 38.8 ± 12 years; 90% of Mexican heritage). Participants completed English and Spanish versions of the Sleep Habits Questionnaire, the Epworth Sleepiness Scale, and the Acculturation Rating Scale for Mexican Americans II one week apart in randomized order. Psychometric properties were assessed, including internal consistency, convergent validity, scale equivalence, language version intercorrelations, and exploratory factor analysis using PASW (Version18) software. Grade level readability of the sleep measure was evaluated. All sleep categories (duration, snoring, apnea, insomnia symptoms, other sleep symptoms, sleep disruptors, restless legs syndrome) showed Cronbach α, Spearman-Brown coefficients and intercorrelations ≥ 0.700, suggesting robust internal consistency, correlation, and agreement between language versions. The Epworth correlated significantly with snoring, apnea, sleep symptoms, restless legs, and sleep disruptors) on both versions, supporting convergent validity. Items loaded on 4 factors accounted for 68% and 67% of the variance on the English and Spanish versions, respectively. The Spanish-language Sleep Habits Questionnaire demonstrates conceptual and content equivalency. It has appropriate measurement properties and should be useful for assessing sleep health in community-based clinics and intervention studies among Spanish-speaking Mexican Americans. Both language versions showed readability at the fifth grade level. Further testing is needed with larger samples.

Patient-Oriented Cancer Information on the Internet: A Comparison of Wikipedia and a Professionally Maintained Database

PubMed Central

Rajagopalan, Malolan S.; Khanna, Vineet K.; Leiter, Yaacov; Stott, Meghan; Showalter, Timothy N.; Dicker, Adam P.; Lawrence, Yaacov R.

2011-01-01

Purpose: A wiki is a collaborative Web site, such as Wikipedia, that can be freely edited. Because of a wiki's lack of formal editorial control, we hypothesized that the content would be less complete and accurate than that of a professional peer-reviewed Web site. In this study, the coverage, accuracy, and readability of cancer information on Wikipedia were compared with those of the patient-orientated National Cancer Institute's Physician Data Query (PDQ) comprehensive cancer database. Methods: For each of 10 cancer types, medically trained personnel scored PDQ and Wikipedia articles for accuracy and presentation of controversies by using an appraisal form. Reliability was assessed by using interobserver variability and test-retest reproducibility. Readability was calculated from word and sentence length. Results: Evaluators were able to rapidly assess articles (18 minutes/article), with a test-retest reliability of 0.71 and interobserver variability of 0.53. For both Web sites, inaccuracies were rare, less than 2% of information examined. PDQ was significantly more readable than Wikipedia: Flesch-Kincaid grade level 9.6 versus 14.1. There was no difference in depth of coverage between PDQ and Wikipedia (29.9, 34.2, respectively; maximum possible score 72). Controversial aspects of cancer care were relatively poorly discussed in both resources (2.9 and 6.1 for PDQ and Wikipedia, respectively, NS; maximum possible score 18). A planned subanalysis comparing common and uncommon cancers demonstrated no difference. Conclusion: Although the wiki resource had similar accuracy and depth as the professionally edited database, it was significantly less readable. Further research is required to assess how this influences patients' understanding and retention. PMID:22211130

Is Wikipedia a reliable learning resource for medical students? Evaluating respiratory topics.

PubMed

Azer, Samy A

2015-03-01

The aim of the present study was to critically evaluate the accuracy and readability of English Wikipedia articles on the respiratory system and its disorders and whether they can be a suitable resource for medical students. On April 27, 2014, English Wikipedia was searched for articles on respiratory topics. Using a modified DISCERN instrument, articles were independently scored by three assessors. The scoring targeted content accuracy, frequency of updating, and quality of references. The readability of articles was measured using two other instruments. The mean DISCERN score for the 40 articles identified was 26.4±6.3. Most articles covered causes, signs and symptoms, prevention, and treatment. However, several knowledge deficiencies in the pathogenesis of diseases, investigations needed, and treatment were observed. The total number of references for the 40 articles was 1,654, and the references varied from 0 to 168 references, but several problems were identified in the list of references and citations made. The readability of articles was in the range of 9.4±1.8 to 22.6±10.7 using the Flesch-Kincaid Grade Level instrument and 10.0±2.6 to 19.6±8.3 using the Readability Coleman-Liau index. A strong correlation was found between the two instruments (r2=0.744, P<0.001). The agreement between the assessors had mean κ scores in the range of 0.712-0.857. In conclusion, despite the effort placed in creating Wikipedia respiratory articles by anonymous volunteers (wikipedians), most articles had knowledge deficiencies, were not accurate, and were not suitable for medical students as learning resources. Copyright © 2015 The American Physiological Society.

Quality and Readability of English-Language Internet Information for Voice Disorders.

PubMed

Dueppen, Abigail J; Bellon-Harn, Monica L; Radhakrishnan, Nandhakumar; Manchaiah, Vinaya

2017-12-15

The purpose of this study is to evaluate the readability and quality of English-language Internet information related to vocal hygiene, vocal health, and prevention of voice disorders. This study extends recent work because it evaluates readability, content quality, and website origin across broader search criteria than previous studies evaluating online voice material. Eighty-five websites were aggregated using five different country-specific search engines. Websites were then analyzed using quality and readability assessments. The entire web page was evaluated; however, no information or links beyond the first page was reviewed. Statistical calculations were employed to examine website ratings, differences between website origin and quality and readability scores, and correlations between readability instruments. Websites exhibited acceptable quality as measured by the DISCERN. However, only one website obtained the Health On the Net certification. Significant differences in quality were found among website origin, with government websites receiving higher quality ratings. Approximate educational levels required to comprehend information on the websites ranged from 8 to 9 years of education. Significant differences were found between website origin and readability measures with higher levels of education required to understand information on websites of nonprofit organizations. Current vocal hygiene, vocal health, and prevention of voice disorders websites were found to exhibit acceptable levels of quality and readability. However, highly rated Internet information related to voice care should be made more accessible to voice clients through Health On the Net certification. Published by Elsevier Inc.

Evaluating the Readibility of Informed Consent Forms Available Before Anaesthesia: A Comparative Study

PubMed Central

Boztaş, Nilay; Özbilgin, Şule; Öçmen, Elvan; Altuntaş, Gözde; Özkardeşler, Sevda; Hancı, Volkan; Günerli, Ali

2014-01-01

Objective Informed consent forms that are used prior to administering anaesthesia inform patients before any proposed surgical procedure or treatment. They should provide patients with sufficient information about the operation and treatment. Readibility refers to whether it is easy or hard for a reader to read and understand an available text, and this is evaluated via various formulas. The aim of this study was to evaluate the readability of different informed consent forms commonly used in the anaesthesiology departments of different hospitals in our country using different readability formulas. Methods After obtaining ethics committee approval, the readability of different consent forms used in the anaesthesiology departments of university hospitals (n=15), Ministry of Health (MOH) education and research hospitals (n=15), and public hospitals (n=15) was analysed. Each consent form was displayed electronically in “Microsoft Word” and the number of words contained was counted automatically. The first 100 words on the first page of the forms were evaluated using the Gunning Fog, Flesch-Kincaid and Ateşman readability formulations. The rate of medical terms detected within these 100 words was determined as a percentage (%). Results Different consent forms obtained from 45 anaesthesia departments were assessed using various readability formulas. According to the Gunning Fog index, the readability of the consent forms obtained from MOH education and research and public hospitals was relatively low. The Flesch-Kincaid index measured very low levels of readability in all institutions. The Ateşman index displayed very low readability levels for the consent forms used in university hospitals, and low levels in other institutions. Conclusion We conclude that the readability of the anaesthesia informed consent forms is low. The level of education in our country should be considered in the preparation of anaesthesia consent forms. We believe that physicians should pay more attention to this medical and legal issue. PMID:27366408

Evaluation of online disaster and emergency preparedness resources.

PubMed

Friedman, Daniela B; Tanwar, Manju; Richter, Jane V E

2008-01-01

Increasingly, individuals are relying on the Internet as a major source of health information. When faced with sudden or pending disasters, people resort to the Internet in search of clear, current, and accurate instructions on how to prepare for and respond to such emergencies. Research about online health resources ascertained that information was written at the secondary education and college levels and extremely difficult for individuals with limited literacy to comprehend. This content analysis is the first to assess the reading difficulty level and format suitability of a large number of disaster and emergency preparedness Web pages intended for the general public. The aims of this study were to: (1) assess the readability and suitability of disaster and emergency preparedness information on the Web; and (2) determine whether the reading difficulty level and suitability of online resources differ by the type of disaster or emergency and/or Website domain. Fifty Websites containing information on disaster and/or emergency preparedness were retrieved using the Google search engine. Readability testing was conducted on the first Web page, suggested by Google, addressing preparedness for the general public. The reading level was assessed using Flesch-Kincaid (F-K) and Flesch Reading Ease (FRE) measures. The Suitability Assessment of Materials (SAM) instrument was used to evaluate additional factors such as graphics, layout, and cultural appropriateness. The mean F-K readability score of the 50 Websites was Grade 10.74 (95% CI = 9.93, 11.55). The mean FRE score was 45.74 (95% CI = 41.38, 50.10), a score considered "difficult."A Web page with content about both risk and preparedness supplies was the most difficult to read according to F-K (Grade level = 12.1). Web pages with general disaster and emergency information and preparedness supplies were considered most difficult according to the FRE (38.58, 95% CI = 30.09, 47.08). The average SAM score was 48% or 0.48 (95% CI = 0.45, 0.51), implying below average suitability of these Websites. Websites on pandemics and bioterrorism were the most difficult to read (F-K: p = 0.012; FRE: p = 0.014) and least suitable (SAM: p = 0.035) compared with other disasters and emergencies. The results suggest the need for readily accessible preparedness resources on the Web that are easy-to-read and visually appropriate. Interdisciplinary collaborations between public health educators, risk communication specialists, and Web page creators and writers are recommended to ensure the development and dissemination of disaster and emergency resources that consider literacy abilities of the general public.

Textbooks in Management, Marketing and Finance: An Analysis of Readability.

ERIC Educational Resources Information Center

Gallagher, Daniel J.; Thompson, G. Rodney

1982-01-01

Examines the readability of texts in basic junior level college courses in the fields of management, marketing, and finance. The readability model is described, along with its application and results. Specific texts and how they fared are listed in accompanying tables. (CT)

Glue ear: how good is the information on the World Wide Web?

PubMed

Ritchie, L; Tornari, C; Patel, P M; Lakhani, R

2016-02-01

This paper objectively evaluates current information available to the general public related to glue ear on the World Wide Web. The term 'glue ear' was typed into the 3 most frequently used internet search engines - Google, Bing and Yahoo - and the first 20 links were analysed. The first 400 words of each page were used to calculate the Flesch-Kincaid readability score. Each website was subsequently graded using the Discern instrument, which gauges quality and content of literature. The websites Webmd.boots.com, Bupa.co.uk and Patient.co.uk received the highest overall scores. These reflected top scores in either readability or Discern instrument assessment, but not both. Readability and Discern scores increased with the presence of a marketing or advertising incentive. The Patient.co.uk website had the highest Discern score and third highest readability score. There is huge variation in the quality of information available to patients on the internet. Some websites may be accessible to a wide range of reading ages but have poor quality content, and vice versa. Clinicians should be aware of indicators of quality, and use validated instruments to assess and recommend literature.

Participatory Design of Mass Health Communication in Three Languages for Seniors and People With Disabilities on Medicaid

PubMed Central

Rothschild, Beccah; Graham, Carrie; Ivey, Susan L.; Konishi, Susana

2009-01-01

Objectives. We used participatory design methods to develop and test guidebooks about health care choices intended for 600 000 English-, Spanish-, and Chinese-speaking seniors and people with disabilities receiving Medicaid in California. Methods. Design and testing processes were conducted with consumers and professionals; they included 24 advisory group interviews, 36 usability tests, 18 focus groups (105 participants), 51 key informant interviews, guidebook readability and suitability testing, linguistic adaptation, and iterative revisions of 4 prototypes. Results. Participatory design processes identified preferences of intended audiences for guidebook content, linguistic adaptation, and format; guidebook readability was scored at the sixth- to eighth-grade level and suitability at 95%. These findings informed the design of a separate efficacy study that showed high guidebook usage and satisfaction, and better gains in knowledge, confidence, and intended behaviors among intervention participants than among control participants. Conclusions. Participatory design can be used effectively in mass communication to inform vulnerable audiences of health care choices. The techniques described can be adapted for a broad range of health communication interventions. PMID:19833990

Participatory design of mass health communication in three languages for seniors and people with disabilities on Medicaid.

PubMed

Neuhauser, Linda; Rothschild, Beccah; Graham, Carrie; Ivey, Susan L; Konishi, Susana

2009-12-01

We used participatory design methods to develop and test guidebooks about health care choices intended for 600 000 English-, Spanish-, and Chinese-speaking seniors and people with disabilities receiving Medicaid in California. Design and testing processes were conducted with consumers and professionals; they included 24 advisory group interviews, 36 usability tests, 18 focus groups (105 participants), 51 key informant interviews, guidebook readability and suitability testing, linguistic adaptation, and iterative revisions of 4 prototypes. Participatory design processes identified preferences of intended audiences for guidebook content, linguistic adaptation, and format; guidebook readability was scored at the sixth- to eighth-grade level and suitability at 95%. These findings informed the design of a separate efficacy study that showed high guidebook usage and satisfaction, and better gains in knowledge, confidence, and intended behaviors among intervention participants than among control participants. Participatory design can be used effectively in mass communication to inform vulnerable audiences of health care choices. The techniques described can be adapted for a broad range of health communication interventions.

Privacy Policies for Apps Targeted Toward Youth: Descriptive Analysis of Readability.

PubMed

Das, Gitanjali; Cheung, Cynthia; Nebeker, Camille; Bietz, Matthew; Bloss, Cinnamon

2018-01-04

Due to the growing availability of consumer information, the protection of personal data is of increasing concern. We assessed readability metrics of privacy policies for apps that are either available to or targeted toward youth to inform strategies to educate and protect youth from unintentional sharing of personal data. We reviewed the 1200 highest ranked apps from the Apple and Google Play Stores and systematically selected apps geared toward youth. After applying exclusion criteria, 99 highly ranked apps geared toward minors remained, 64 of which had a privacy policy. We obtained and analyzed these privacy policies using reading grade level (RGL) as a metric. Policies were further compared as a function of app category (free vs paid; entertainment vs social networking vs utility). Analysis of privacy policies for these 64 apps revealed an average RGL of 12.78, which is well above the average reading level (8.0) of adults in the United States. There was also a small but statistically significant difference in word count as a function of app category (entertainment: 2546 words, social networking: 3493 words, and utility: 1038 words; P=.02). Although users must agree to privacy policies to access digital tools and products, readability analyses suggest that these agreements are not comprehensible to most adults, let alone youth. We propose that stakeholders, including pediatricians and other health care professionals, play a role in educating youth and their guardians about the use of Web-based services and potential privacy risks, including the unintentional sharing of personal data. ©Gitanjali Das, Cynthia Cheung, Camille Nebeker, Matthew Bietz, Cinnamon Bloss. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 04.01.2018.

Mindfulness-Based Symptom and Stress Management Apps for Adults With Chronic Lung Disease: Systematic Search in App Stores

PubMed Central

2018-01-01

Background Up to 70% of lung cancer survivors are affected by chronic obstructive pulmonary disease (COPD), a common, debilitating, comorbid disease. Lung cancer and COPD are both characterized by symptoms such as breathlessness, fatigue, and psychological distress. These distressing chronic symptoms are exacerbated by stress and detract from an individual’s quality of life. Objective The aim of this study was to identify and evaluate evidence-based, commercially available apps for promoting mindfulness-based strategies among adults with a COPD or lung cancer history (ie, chronic lung disease). Methods For this review, an interdisciplinary research team used 19 keyword combinations in the search engines of Google and iOS app stores in May 2017. Evaluations were conducted on the apps’ (1) content, (2) usability heuristics, (3) grade-level readability, and (4) cultural sensitivity. Results The search resulted in 768 apps (508 in iOS and 260 in Google stores). A total of 9 apps met the inclusion criteria and received further evaluation. Only 1 app had below an eighth-grade reading level; the ninth one did not have enough text to calculate a readability score. None of the 9 apps met the cultural sensitivity evaluation criteria. Conclusions This systematic review identified critical design flaws that may affect the ease of using the apps in this study. Few mobile apps promote mindfulness-based strategies among adults with chronic lung disease (ie, COPD or lung cancer or both), but those that exist, overall, do not meet the latest scientific evidence. Recommendations include more stringent regulation of health-related apps, use of evidence-based frameworks and participatory design processes, following evidence-based usability practices, use of culturally sensitive language and images, and ensuring that content is written in plain language. PMID:29764800

How evidence-based is the information on the internet about nausea and vomiting of pregnancy?

PubMed

Sacks, Samantha; Abenhaim, Haim A

2013-08-01

The Internet has become an important source of information about pregnancy and about health related concerns in general. This study assessed the quality of information available on the Internet for the common problem of nausea and vomiting of pregnancy (NVP). We used three search terms, "nausea and vomiting in pregnancy," "morning sickness," and "hyperemesis gravidarum," to identify the most popular sites as rated by Google. With modifications of previously described tools, the quality of the websites was rated in three categories: accountability using the Silberg criteria, presentation using a modified Abbott's score, and readability using the Flesch-Kincaid grade level score. Subsequently the information on the websites was compared with the SOGC guideline on management of NVP. We identified 24 unique websites as most popular. The overall scores for accountability indicated poor quality, with only 25% of the websites meeting the required criteria and less than one half of the sites indicating authorship and credentials. Esthetic appeal criteria were met in over 75% of the websites. The readability score of the websites was significantly above the score recommended for the general population, with an average Flesch-Kincaid Grade level score of 10.7 (max = 12). Eighty-seven percent of the websites contained accurate, evidence-based recommendations according to the information provided in the SOGC clinical practice guideline on management of NVP. Overall, the majority of information available online is accurate; however, the web pages demonstrated poor accountability and targeted an audience with a higher reading ability than the general population. Consideration of these findings would help create easy to navigate, credible web pages containing information to help women make informed decisions during pregnancy.

The Content and Quality of Health Information on the Internet for Patients and Families on Adult Kidney Cancer.

PubMed

Alsaiari, Ahmed; Joury, Abdulaziz; Aljuaid, Mossab; Wazzan, Mohammed; Pines, Jesse M

2017-12-01

The Internet is one of the major sources for health information for patients and their families, particularly when patients face serious life-threatening conditions such as kidney cancer in adults. In this study, we evaluate the content and quality of health information on adult kidney cancer using several validated instruments. We accessed the three most popular search engines (Google, Yahoo, Bing), using two terms: "kidney cancer" and "renal cell carcinoma," and reviewed the top 30 hits. After exclusion of duplicated websites, websites targeting health care professionals, and unrelated websites, 35 websites were included. Content was assessed using a 22-item checklist adapted from the American Cancer Society. We assessed website quality using the DISCERN questionnaire, HONcode and JAMA benchmark criteria, readability using three readability scores, and ALEXA for global traffic ranking systems. The average website had 16 of 22 content items while 6 websites fulfilled all 22 items. Among all websites, the average DISCERN quality score was 42 out of 80, 15 (42.8 %) of websites had HONcode certification, and only 3 (8.5 %) fulfilled all JAMA benchmark criteria. The average website readability was at the ninth grade reading level. The content and quality of health-related information on the Internet for adult kidney cancer are variable in comprehensiveness and quality. Many websites are difficult to read without a high school education. A standardized approach to presenting cancer information on the Internet for patients and families may be warranted.

Using a home blood pressure monitor: do accompanying instructional materials meet low literacy guidelines?

PubMed

Wallace, Lorraine S; Keenum, Amy J

2008-08-01

To evaluate the readability and related features of English language Quick Reference Guides (QRGs) and User Manuals (UMs) accompanying home blood pressure monitors (HBPMs). We evaluated QRGs and UMs for 22 HBPMs [arm (n=12); wrist (n=10)]. Using established criteria, we evaluated reading grade level, language availability, dimensions, text point size, use of illustrations, layout/formatting characteristics, and emphasis of key points of English-language patient instructions accompanying HBPMs. Readability was calculated using McLaughlin's Simplified Measure of Gobbledygoop. Items from the Suitability of Materials Assessment and User-Friendliness Tool were used to assess various layout features. Simplified Measure of Gobbledygoop scores of both QRGs (mean+/-SD=9.1+/-0.8) and UMs (9.3+/-0.8) ranged from 8th to 10th grade. QRGs and UMs presented steps in chronological order, used active voice throughout, avoided use of specialty fonts, focused on need to know, and used realistic illustrations. Seven sets of instructions included all seven key points related to proper HPBM use, whereas three sets of instructions included less than or equal to three key points (mean=4.8+/-1.9). Although most QRGs and UMs met at least some recommended low-literacy formatting guidelines, all instructional materials should be developed and tested to meet the needs of the patient population at large. Key points related to proper HBPM use should not only be included within these instructions, but highlighted to emphasize their importance.

Lead poison prevention: a comparative review of brochures.

PubMed

Endres, Jeannette; Montgomery, Joe; Welch, Patricia

2002-01-01

Although eliminating lead from the environment is the most effective way to prevent lead poisoning, outreach and education also must be addressed. This study reports a consensus summary of lead-poisoning prevention topics and reading levels derived from state brochures. This information may be useful in the evaluation and design of future lead prevention brochures. A point system was used to assess the readability and topic content of 20 brochures from 11 states. Only half of the brochures were written at the targeted grade level. Frequently covered topics were wash hands and face, provide foods that contain good sources of key nutrients, and use damp cleaning methods when dusting and mopping. The findings about topics and reading levels can be used throughout the development of lead-hazard prevention brochures.

Matching Readers to Instructional Materials: The Use of Classic Readability Measures for Students with Language Learning Disabilities and Dyslexia.

ERIC Educational Resources Information Center

Kotula, Andrea Winokur

2003-01-01

The matching of students with language learning disabilities and dyslexia to appropriate reading materials is discussed, and formal and informal methods are presented for determining reading levels for accuracy, fluency, and comprehension instruction and practice. The Spache Readability Formula, the New Dale-Challe Readability Formula, and…

A comparative analysis of online education resources for patients undergoing endoscopic transsphenoidal surgery.

PubMed

Fahey, Natalie; Patel, Vimal; Rosseau, Gail

2014-12-01

Endoscopic transsphenoidal surgery has become the most commonly performed surgical procedure for pituitary tumor removal. As such, there are many patient-oriented educational materials on the technique available online for members of the public who desire to learn more about the surgery. It has been recommended that educational resources be written to the national average reading level, which in the United States is between sixth and seventh grade. This study assesses the reading level of the educational materials currently available online for endoscopic transsphenoidal surgery and determines whether these resources are written at a suitable comprehension level for most readers. Sixteen patient educational resources describing endoscopic transsphenoidal surgery were identified online and assessed using 4 standard readability assessments. Patient educational resources written for endoscopic transsphenoidal surgery are written far above the recommended reading level of sixth grade. The online educational resources written for patients about endoscopic transsphenoidal surgery are above the recommended reading level for patient education materials. Further revisions to simplify these resources on endoscopic transsphenoidal surgery are needed to ensure that most patients can comprehend this important material and make informed decisions about their health care. Copyright © 2014. Published by Elsevier Inc.

Readability Levels of Health-Based Websites: From Content to Comprehension

ERIC Educational Resources Information Center

Schutten, Mary; McFarland, Allison

2009-01-01

Three of the national health education standards include decision-making, accessing information and analyzing influences. WebQuests are a popular inquiry-oriented method used by secondary teachers to help students achieve these content standards. While WebQuests support higher level thinking skills, the readability level of the information on the…

Initial Readability Assessment of Clinical Trial Eligibility Criteria

PubMed Central

Kang, Tian; Elhadad, Noémie; Weng, Chunhua

2015-01-01

Various search engines are available to clinical trial seekers. However, it remains unknown how comprehensible clinical trial eligibility criteria used for recruitment are to a lay audience. This study initially investigated this problem. Readability of eligibility criteria was assessed according to (i) shallow and lexical characteristics through the use of an established, generic readability metric; (ii) syntactic characteristics through natural language processing techniques; and (iii) health terminological characteristics through an automated comparison to technical and lay health texts. We further stratified clinical trials according to various study characteristics (e.g., source country or study type) to understand potential factors influencing readability. Mainly caused by frequent use of technical jargons, a college reading level was found to be necessary to understand eligibility criteria text, a level much higher than the average literacy level of the general American population. The use of technical jargons should be minimized to simplify eligibility criteria text. PMID:26958204

[Global analysis of the readability of the informed consent forms used in public hospitals of Spain].

PubMed

Mariscal-Crespo, M I; Coronado-Vázquez, M V; Ramirez-Durán, M V

To analyse the readability of informed consent forms (ICF) used in Public Hospitals throughout Spain, with the aim of checking their function of providing comprehensive information to people who are making any health decision no matter where they are in Spain. A descriptive study was performed on a total of 11,339 ICF received from all over Spanish territory, of which 1617 ICF were collected from 4 web pages of Health Portal and the rest (9722) were received through email and/or telephone contact from March 2012 to February 2013. The readability level was studied using the Inflesz tool. A total of 372 ICF were selected and analysed using simple random sampling. The Inflesz scale and the Flesch-Szigriszt index were used to analyse the readability. The readability results showed that 62.4% of the ICF were rated as a "little difficult", the 23.4% as "normal", and the 13.4% were rated as "very difficult". The highest readability means using the Flesch index were scored in Andalusia with a mean of 56.99 (95% CI; 55.42-58.57) and Valencia with a mean of 51.93 (95% CI; 48.4-55.52). The lowest readability means were in Galicia with a mean of 40.77 (95% CI; 9.83-71.71) and Melilla, mean=41.82 (95% CI; 35.5-48.14). The readability level of Spanish informed consent forms must be improved because their scores using readability tools could not be classified in normal scales. Furthermore, there was very wide variability among Spanish ICF, which showed a lack of equity in information access among Spanish citizens. Copyright © 2017 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

A systematic review of readability and comprehension instruments used for print and web-based cancer information.

PubMed

Friedman, Daniela B; Hoffman-Goetz, Laurie

2006-06-01

Adequate functional literacy skills positively influence individuals' ability to take control of their health. Print and Web-based cancer information is often written at difficult reading levels. This systematic review evaluates readability instruments (FRE, F-K, Fog, SMOG, Fry) used to assess print and Web-based cancer information and word recognition and comprehension tests (Cloze, REALM, TOFHLA, WRAT) that measure people's health literacy. Articles on readability and comprehension instruments explicitly used for cancer information were assembled by searching MEDLINE and Psyc INFO from 1993 to 2003. In all, 23 studies were included; 16 on readability, 6 on comprehension, and 1 on readability and comprehension. Of the readability investigations, 14 focused on print materials, and 2 assessed Internet information. Comprehension and word recognition measures were not applied to Web-based information. None of the formulas were designed to determine the effects of visuals or design factors that could influence readability and comprehension of cancer education information.

An analysis of cluster headache information provided on internet websites.

PubMed

Peterlin, B Lee; Gambini-Suarez, Eduardo; Lidicker, Jeffrey; Levin, Morris

2008-03-01

To evaluate the quality of websites providing cluster headache information for patients and healthcare providers. The Internet has become an increasingly important source of healthcare information. However, limited data exist regarding the quality of websites providing headache information. This was a cross-sectional study conducted in February 2007. Websites providing cluster headache information were determined on the search engine MetaCrawler and classified as either patient oriented or healthcare provider oriented. The overall quality of each site was evaluated using a score system. Readability was evaluated using the Flesch-Kincaid Grade Level Readability Score (FKRS). Website quality was analyzed based on ownership, purpose, authorship, author qualifications, attribution, interactivity, and currency. The technical quality of the cluster headache information was analyzed based on content specific to cluster headache. The final ranking, based on the sum of the ranks of all 3 categories, was determined and then contrasted between the patient-oriented and healthcare professional-oriented websites using 2-sample t-tests. Of the first 40 websites found on MetaCrawler, 72.5% were advertisements, unrelated to headache, or repeated websites. Although the standard US writing averages are at a seventh to eighth grade level, the mean FKRS of all sites was at a 12th grade level of difficulty, with no significant difference between the patient-oriented or healthcare provider-oriented websites (P = .54). Of a total possible 14 points, the overall mean quality component score was 9.9 for all sites; and of a total possible 23 points, the overall mean technical component score was 13.9. There was no significant difference for either the quality or technical component scores between patient-oriented or healthcare provider-oriented websites (P = .45 and P = .80, respectively). There are numerous cluster headache websites that can be found on the Internet. The quality of most of the websites dedicated to cluster headache is mediocre, and although there are some excellent cluster headache websites, these sites may be challenging for many users to locate. There was no significant difference in the overall quality of websites oriented for patients or healthcare providers providing cluster headache information evaluated in this study. In addition, websites providing high-quality cluster headache information are written at an educational level too high for a significant portion of the general population to fully utilize. Physicians should strongly consider providing lists of quality websites on cluster headache for their patients.

Assessing the Readability of College Textbooks in Public Speaking: Attending to Entry Level Instruction

ERIC Educational Resources Information Center

Schneider, David E.

2011-01-01

More research is needed that examines textbooks intended for the entry level college classroom. This study offers valuable information to academics that adopt a public speaking textbook for instruction as well as objective feedback to the collective authors. Readability levels of 22 nationally published textbooks, based on McGlaughlin's (1969)…

Subject matter expert and public evaluations of a veterinary toxicology course brochure-writing assignment.

PubMed

Dorman, David C; Alpi, Kristine M; Chappell, Kimberly H

2013-01-01

Veterinary schools are increasingly developing students' communication skills, with an emphasis placed on practice conveying medical and scientific knowledge to different audiences. We describe how patient-centered written communication has been integrated into the training of veterinary students using toxicology-related preventive materials. Third-year veterinary students were given an assignment to prepare a client-focused brochure related to veterinary toxicology. Since 2010, 148 students have completed this assignment, with an average score of 93.4%. Use of a grading rubric was instituted in 2011 and resulted in a more rigorous assessment of the brochures by the course instructors. In this study, we evaluated a sample (n=6) selected from 10 brochures volunteered for further public and expert assessment. Each brochure was measured for readability and assessed with a rubric for perceived usefulness and acceptability by 12 veterinary toxicologists and 10 or 11 adult members of the public attending a college of veterinary medicine open house. Veterinary toxicologist review anticipated that the brochures would be useful for most clients, and the public reviewers confirmed this assessment. Evaluation of the brochures using set marking criteria and readability indexes showed that students had successfully targeted the chosen audiences. Feedback showed that the general public rated the sample brochures highly in terms of quality, usefulness, and interest. Completion of this study has resulted in revision of the grading rubric, an increased use of brochure examples, and additional instruction in readability assessment and brochure development, thereby improving the assignment as a learning exercise.

Quality of Web-based Information for the 10 Most Common Fractures.

PubMed

Memon, Muzammil; Ginsberg, Lydia; Simunovic, Nicole; Ristevski, Bill; Bhandari, Mohit; Kleinlugtenbelt, Ydo Vincent

2016-06-17

In today's technologically advanced world, 75% of patients have used Google to search for health information. As a result, health care professionals fear that patients may be misinformed. Currently, there is a paucity of data on the quality and readability of Web-based health information on fractures. In this study, we assessed the quality and readability of Web-based health information related to the 10 most common fractures. Using the Google search engine, we assessed websites from the first results page for the 10 most common fractures using lay search terms. Website quality was measured using the DISCERN instrument, which scores websites as very poor (15-22.5), poor (22.5-37.5), fair (37.5-52.5), good (52.5-67.5), or excellent (67.5-75). The presence of Health on the Net code (HONcode) certification was assessed for all websites. Website readability was measured using the Flesch Reading Ease Score (0-100), where 60-69 is ideal for the general public, and the Flesch-Kincaid Grade Level (FKGL; -3.4 to ∞), where the mean FKGL of the US adult population is 8. Overall, website quality was "fair" for all fractures, with a mean (standard deviation) DISCERN score of 50.3 (5.8). The DISCERN score correlated positively with a higher website position on the search results page (r(2)=0.1, P=.002) and with HONcode certification (P=.007). The mean (standard deviation) Flesch Reading Ease Score and FKGL for all fractures were 62.2 (9.1) and 6.7 (1.6), respectively. The quality of Web-based health information on fracture care is fair, and its readability is appropriate for the general public. To obtain higher quality information, patients should select HONcode-certified websites. Furthermore, patients should select websites that are positioned higher on the results page because the Google ranking algorithms appear to rank the websites by quality.

Quality of Web-based Information for the 10 Most Common Fractures

PubMed Central

Ginsberg, Lydia; Simunovic, Nicole; Ristevski, Bill; Bhandari, Mohit; Kleinlugtenbelt, Ydo Vincent

2016-01-01

Background In today's technologically advanced world, 75% of patients have used Google to search for health information. As a result, health care professionals fear that patients may be misinformed. Currently, there is a paucity of data on the quality and readability of Web-based health information on fractures. Objectives In this study, we assessed the quality and readability of Web-based health information related to the 10 most common fractures. Methods Using the Google search engine, we assessed websites from the first results page for the 10 most common fractures using lay search terms. Website quality was measured using the DISCERN instrument, which scores websites as very poor (15-22.5), poor (22.5-37.5), fair (37.5-52.5), good (52.5-67.5), or excellent (67.5-75). The presence of Health on the Net code (HONcode) certification was assessed for all websites. Website readability was measured using the Flesch Reading Ease Score (0-100), where 60-69 is ideal for the general public, and the Flesch-Kincaid Grade Level (FKGL; −3.4 to ∞), where the mean FKGL of the US adult population is 8. Results Overall, website quality was “fair” for all fractures, with a mean (standard deviation) DISCERN score of 50.3 (5.8). The DISCERN score correlated positively with a higher website position on the search results page (r2=0.1, P=.002) and with HONcode certification (P=.007). The mean (standard deviation) Flesch Reading Ease Score and FKGL for all fractures were 62.2 (9.1) and 6.7 (1.6), respectively. Conclusion The quality of Web-based health information on fracture care is fair, and its readability is appropriate for the general public. To obtain higher quality information, patients should select HONcode-certified websites. Furthermore, patients should select websites that are positioned higher on the results page because the Google ranking algorithms appear to rank the websites by quality. PMID:27317159

Readability and writing style analysis of selected allied health professional journals.

PubMed

Hedl, J J; Glazer-Waldman, H R; Parker, H J; Hopkins, K M

1991-01-01

Using US Department of Defense text sampling procedures, nine allied health journals were analyzed for readability and selected writing style indices via Right Writer, a commercial software program. Two indices of readability were computed for each journal as were several indices of writing style. The computed readability ranged from 13.0 to 15.4, depending upon the journal in question. Two journals showed the highest levels of readability (15.4) compared to the other seven journals. The writing style analyses indicated generally normal ranges for the descriptive and jargon indices, but seven journals showed below recommended strength indices. Sentence structure analyses indicated a need to reduce sentence structure complexity. Implications for journal editors and authors are discussed.

Elements of a next generation time-series ASCII data file format for Earth Sciences

NASA Astrophysics Data System (ADS)

Webster, C. J.

2015-12-01

Data in ASCII comma separated value (CSV) format are recognized as the most simple, straightforward and readable type of data present in the geosciences. Many scientific workflows developed over the years rely on data using this simple format. However, there is a need for a lightweight ASCII header format standard that is easy to create and easy to work with. Current OGC grade XML standards are complex and difficult to implement for researchers with few resources. Ideally, such a format should provide the data in CSV for easy consumption by generic applications such as spreadsheets. The format should use an existing time standard. The header should be easily human readable as well as machine parsable. The metadata format should be extendable to allow vocabularies to be adopted as they are created by external standards bodies. The creation of such a format will increase the productivity of software engineers and scientists because fewer translators and checkers would be required. Data in ASCII comma separated value (CSV) format are recognized as the most simple, straightforward and readable type of data present in the geosciences. Many scientific workflows developed over the years rely on data using this simple format. However, there is a need for a lightweight ASCII header format standard that is easy to create and easy to work with. Current OGC grade XML standards are complex and difficult to implement for researchers with few resources. Ideally, such a format would provide the data in CSV for easy consumption by generic applications such as spreadsheets. The format would use existing time standard. The header would be easily human readable as well as machine parsable. The metadata format would be extendable to allow vocabularies to be adopted as they are created by external standards bodies. The creation of such a format would increase the productivity of software engineers and scientists because fewer translators would be required.

Websites on Bladder Cancer: an Appropriate Source of Patient Information?

PubMed

Salem, Johannes; Paffenholz, Pia; Bolenz, Christian; von Brandenstein, Melanie; Cebulla, Angelika; Haferkamp, Axel; Kuru, Timur; Lee, Cheryl T; Pfister, David; Tsaur, Igor; Borgmann, Hendrik; Heidenreich, Axel

2018-01-08

A growing number of patients search for health information online. An early investigation of websites about bladder cancer (BCa) revealed mostly incomplete and particularly inaccurate information. We analyzed the quality, readability, and popularity of the most frequented websites on BCa. An Internet search on www.google.com was performed for the term "bladder cancer." After selecting the most frequented websites for patient information, HONcode quality certification, Alexa popularity rank, and readability scores (according to US grade levels) were investigated. A 36-point checklist was used to assess the content according to the EAU guidelines on BCa, which was categorized into seven topics. The popularity of the 49 websites analyzed was average, with a median Alexa popularity rank of 41,698 (interquartile range [IQR] 7-4,671,246). The readability was rated difficult with 11 years of school education needed to understand the information. Thirteen (27%) websites were HONcode certified. Out of 343 topics (seven EAU guideline topics each on 49 websites), 79% were mentioned on the websites. Of these, 10% contained incorrect information, mostly outdated or biased, and 34% contained incomplete information. Publically provided websites mentioned more topics per website (median [IQR] 7 [5.5-7] vs. 5.5 [3.3-7]; p = 0.022) and showed less incorrect information (median [IQR] 0 [0-1] vs. 1 [0-1]; p = 0.039) than physician-provided websites. Our study revealed mostly correct but partially incomplete information on BCa websites for patients. Physicians and public organizations should strive to keep their website information up-to-date and unbiased to optimize patients' health literacy.

The quality and readability of colorectal cancer information on the internet.

PubMed

Grewal, P; Alagaratnam, S

2013-01-01

Patients can rapidly access the internet and more young people are using their mobile to access health-related information. The aim of this study is to assess the readability and quality of colorectal disease websites for colorectal cancer. We searched the Google, Yahoo and Bing for colorectal cancer. Readability was assessed using Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade (FKG) and Gunning Fog Index (GFI). The LIDA tool and DISCERN instrument were used to measure the design and content of health information on the Internet. A sub-group analysis was performed on websites certified by HONcode and Information Standard against non-certified websites. The mean FRES were 56.3, mean FKG of 6.9, mean GFI of 9.5, equivalent to TIME magazine. The mean LIDA Tool overall score was 85.6% and mean DISCERN instrument was 52.2 (95% CI 45-59.4). This study shows that colorectal cancer websites were readable but potentially unreliable. Government certified sites were superior to non-certified sites. Improvements are required to provide patients with reliable information to make informed decisions on medical treatments. We propose that national cancer services develop reliable and easily readable information regarding the diagnosis and investigation of colorectal cancer. The site should provide adequate information regarding the treatment options and importantly how each treatment option would affect the patient's quality of life. Clinicians can then provide these websites to the patients before and after their consultations to allow the patient to be fully informed. Copyright © 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

Self-presentation on the Web: agencies serving abused and assaulted women.

PubMed

Sorenson, Susan B; Shi, Rui; Zhang, Jingwen; Xue, Jia

2014-04-01

We examined the content and usability of the Web sites of agencies serving women victims of violence. We entered the names of a systematic 10% sample of 3774 agencies listed in 2 national directories into a search engine. We took (in April 2012) and analyzed screenshots of the 261 resulting home pages and the readability of 193 home and first-level pages. Victims (94%) and donors (68%) were the primary intended audiences. About one half used social media and one third provided cues to action. Almost all (96.4%) of the Web pages were rated "fairly difficult" to "very confusing" to read, and 81.4% required more than a ninth-grade education to understand. The service and marketing functions were met fairly well by the agency home pages, but usability (particularly readability and offer of a mobile version) and efforts to increase user safety could be improved. Internet technologies are an essential platform for public health. They are particularly useful for reaching people with stigmatized health conditions because of the anonymity allowed. The one third of agencies that lack a Web site will not reach the substantial portion of the population that uses the Internet to find health information and other resources.

Readability: Theory and Practice.

ERIC Educational Resources Information Center

Wells, Barron; Spinks, Nelda

1991-01-01

Investigates readability levels of correspondence sent out by Gulf Coast area business offices. Finds that a large majority of the correspondence sent out from the offices under study is written at too high a reading level. Finds also that the greatest problem lies in syllable intensity--the use of "big" words where everyday words would have…

Magnet Trade Books: Attracting and Repelling Concepts

ERIC Educational Resources Information Center

Barrow, Lloyd H.; Robinson, Richard D.

2007-01-01

A series of magnet trade books were analyzed against a validated list of magnet concepts (Barrow, 1990a) and their Flesch (1974) Readability was determined. These trade books were used to supplement a second grade unit on magnetism locally constructed from AIM's "Mostly Magnets" (1991). All trade books accurately described how like and unlike…

Teaching for Real Learning: Classroom Applications, Grades 4-12

ERIC Educational Resources Information Center

Devlin-Scherer, Roberta

2005-01-01

Here is a roadmap to success affecting the growth and achievement of all students. This book integrates research about teaching and learning using a variety of sources, both popular and academic, to create a readable text. The author offers: (1) A description of current practices in schools that successfully promote positive relationships; (2)…

[Systematic analysis of the readability of patient information on the websites of clinics for plastic surgery].

PubMed

Esfahani, B Janghorban; Faron, A; Roth, K S; Schaller, H-E; Medved, F; Lüers, J-C

2014-12-01

The Internet is becoming increasing-ly important as a source of information for patients in medical issues. However, many patients have problems to adequately understand texts, especially with medical content. A basic requirement to understand a written text is the read-ability of a text. The aim of the present study was to examine texts on the websites of German -plastic-surgical hospitals with patient information regarding their readability. In this study, the read-ability of texts of 27 major departments of plastic and Hand surgery in Germany was systematically analysed using 5 recognised readability indices. First, texts were searched based on 20 representative key words and themes. Thereafter, texts were assigned to one of 3 major themes in order to enable statistical analysis. In addition to the 5 readability indices, further objective text parameters were also recorded. Overall, 288 texts were found for analyzation. Most articles were found on the topic of "handsurgery" (n=124), less were found for "facial plastic surgery" (n=80) and "flaps, breast and reconstructive surgery" (n=84). Consistently, all readability indices showed a poor readability for the vast majority of analysed texts with the text appearing readable only for readers with a higher educational level. No significant differences in readability were found between the 3 major themes. Especially in the communication of medical information, it is important to consider the knowledge and education of the addressee. The texts studied consistently showed a readability that is understandable only for academics. Thus, a large part of the intended target group is probably not reached. In order to adequately deliver online information material, a revision of the analysed internet texts appears to be recommendable. © Georg Thieme Verlag KG Stuttgart · New York.

Assessing Text Readability Using Cognitively Based Indices

ERIC Educational Resources Information Center

Crossley, Scott A.; Greenfield, Jerry; McNamara, Danielle S.

2008-01-01

Many programs designed to compute the readability of texts are narrowly based on surface-level linguistic features and take too little account of the processes which a reader brings to the text. This study is an exploratory examination of the use of Coh-Metrix, a computational tool that measures cohesion and text difficulty at various levels of…

Consumer health information for pet owners

PubMed Central

Murphy, Sarah Anne

2006-01-01

Objective: The author studied health information available for veterinary consumers both in print and online. Methods: WorldCat was searched using a list of fifty-three Library of Congress subject headings relevant to veterinary consumer health to identify print resources for review. Identified items were then collected and assessed for authority, comprehensiveness of coverage, validity, and other criteria outlined by Rees. An in-depth assessment of the information available for feline lower urinary tract disease (FLUTD) and canine congestive heart failure (CHF) was then conducted to examine the availability and quality of information available for specific diseases and disorders. A reading grade level was assigned for each passage using the Flesch-Kincaid formula in the Readability Statistics feature in Microsoft Word. Results/Discussion: A total of 187 books and 7 Websites were identified and evaluated. More than half of the passages relating to FLUTD and CHF were written above an 11th-grade reading level. A limited quantity of quality, in-depth resources that address specific diseases and disorders and are written at an appropriate reading level for consumers is available. Conclusion: The library's role is to facilitate access to the limited number of quality consumer health resources that are available to veterinary consumers. PMID:16636707

Readability Formulas as Applied to College Economics Textbooks.

ERIC Educational Resources Information Center

McConnell, Campbell R.

1982-01-01

Determines from empirical information on the application of four readability formulas to a group of widely used college economics textbooks that there is no consistency in the absolute reading levels or the rank orderings of these books. (AEA)

Evaluating the quality and readability of thyroplasty information on the Internet.

PubMed

Ting, Kimberly; Hu, Amanda

2014-05-01

To assess the quality and readability of thyroplasty information available on the Internet. Cross-sectional study. We conducted a Google search for "thyroplasty treatment" and analyzed the first 50 Web sites using the DISCERN instrument, the Flesch Reading Ease Score (FRES), and the Flesch-Kincaid Grade Level (FKGL) score. DISCERN is a 16-item validated questionnaire used to assess the quality of written health information for patients. FRES and FKGL are commonly used instruments to assess readability of written information. We also further analyzed major versus minor and patient-targeted versus professional Web sites. Overall DISCERN score was 2.20 ± 0.60. Overall FRES score was 29.68 ± 16.64. Overall FKGL score was 13.07 ± 3.95. We found significant differences between patient-targeted and professional Web sites on FRES (43.80 ± 2.78 and 18.58 ± 9.04, respectively) and FKGL (11.46 ± 3.36 and 14.33 ± 4.30, respectively) (P < 0.00 and P = 0.01, respectively). We also found significant differences between major and minor Web sites on DISCERN (2.35 ± 2.35 and 1.95 ± 0.61, respectively), FRES (24.75 ± 14.61 and 37.71 ± 16.97, respectively), and FKGL (14.19 ± 3.68 and 11.24 ± 3.77, respectively) (P = 0.03, 0.01, and 0.01, respectively). Thyroplasty information available online is of suboptimal quality and written at a level too difficult for the average American adult to read comfortably. Major Web sites have higher quality information but are more difficult to read. Professional Web sites are also more difficult to read than patient-targeted Web sites. Copyright © 2014 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Analysis of readability and quality of web pages addressing both common and uncommon topics in pediatric surgery.

PubMed

Adorisio, Ottavio; Silveri, Massimiliano; Rivosecchi, Massimo; Tozzi, Alberto Eugenio; Scottoni, Federico; Buonuomo, Paola Sabrina

2012-06-01

The quality medical information on Internet is highly variable. The aim of this study is to determine if Web pages addressing four common pediatric surgical topics (CT) and four uncommon pediatric surgical topics (UT) differ significantly in terms of quality and/or characteristics. We performed an Internet search regarding four CT, addressing more frequent clinical conditions with an incidence≤1:1.500 children (inguinal hernia, varicocele, umbilical hernia, and phimosis) and four UT addressing less frequent clinical conditions with an incidence≥1:1.500 children (anorectal malformation, intestinal atresia, gastroschisis, and omphalocele), using a popular search engine (Google). We evaluated readability with the Flesch reading ease (FRE) and the Flesch-Kincaid grade (FKG) and quality of content using the site checker of the HON Code of Conduct (HON code) for each website. In this study, 30/40 websites addressing CT versus 33/50 addressing UT responded to our criteria. No differences statistically significant in advertisements between the two groups were found (15 vs. 16%) (p>0.05). No differences were found in terms of time from last update, owner/author type, financial disclosure, accreditation, or advertising. CT had higher quality level according to the HON code (6.54±1.38 vs. 5.05±1.82) (p<0.05). Mean FRE was 47.38±14.27 versus 46.24±14.56, respectively, for CT and UT (p>0.05). The mean FKG was 8.1±1.9 for CT versus 8±1.9 for UT (p>0.05). Websites devoted to pediatric surgical topics have higher readability and quality information for disease diagnosis and natural history. Otherwise, the quality of pediatric surgical information on the Internet is high for CT and UT. A high reading level is required to use these resources. Copyright © 2012 by Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Comparison of neurological healthcare oriented educational resources for patients on the internet.

PubMed

Punia, Vineet; Dagar, Anjali; Agarwal, Nitin; He, Wenzhuan; Hillen, Machteld

2014-12-01

The internet has become a major contributor to health literacy promotion. The average American reads at 7th-8th grade level and it is recommended to write patient education materials at or below 6th grade reading level. We tried to assess the level of literacy required to read and understand online patient education materials (OPEM) for neurological diseases from various internet resources. We then compared those to an assumed reference OPEM source, namely the patient education brochures from the American Academy of Neurology (AAN), the world's largest professional association of neurologists. Disease specific patient education brochures were downloaded from the AAN website. OPEM for these diseases were also accessed from other common online sources determined using a predefined criterion. All OPEM were converted to Microsoft Word (Microsoft Corp., Redmond, WA, USA) and their reading level was analyzed using Readability Studio Professional Edition version 2012.1 (Oleander Software, Vandalia, OH, USA). Descriptive analysis and analysis of variance were used to compare reading levels of OPEM from different resources. Medline Plus, Mayo clinic and Wikipedia qualified for OPEM analysis. All OPEM from these resources, including the AAN, were written above the recommended 6th grade reading level. They were also found to be "fairly difficult", "difficult" or "confusing" on the Flesch Reading Ease scale. AAN OPEM on average needed lower reading level, with Wikipedia OPEM being significantly (p<0.01) more difficult to read compared to the other three resources. OPEM on neurological diseases are being written at a level of reading complexity higher than the average American and the recommended reading levels. This may be undermining the utility of these resources. Copyright © 2014 Elsevier Ltd. All rights reserved.

Mindfulness-Based Symptom and Stress Management Apps for Adults With Chronic Lung Disease: Systematic Search in App Stores.

PubMed

Owens, Otis L; Beer, Jenay M; Reyes, Ligia I; Gallerani, David G; Myhren-Bennett, Amanda R; McDonnell, Karen K

2018-05-15

Up to 70% of lung cancer survivors are affected by chronic obstructive pulmonary disease (COPD), a common, debilitating, comorbid disease. Lung cancer and COPD are both characterized by symptoms such as breathlessness, fatigue, and psychological distress. These distressing chronic symptoms are exacerbated by stress and detract from an individual's quality of life. The aim of this study was to identify and evaluate evidence-based, commercially available apps for promoting mindfulness-based strategies among adults with a COPD or lung cancer history (ie, chronic lung disease). For this review, an interdisciplinary research team used 19 keyword combinations in the search engines of Google and iOS app stores in May 2017. Evaluations were conducted on the apps' (1) content, (2) usability heuristics, (3) grade-level readability, and (4) cultural sensitivity. The search resulted in 768 apps (508 in iOS and 260 in Google stores). A total of 9 apps met the inclusion criteria and received further evaluation. Only 1 app had below an eighth-grade reading level; the ninth one did not have enough text to calculate a readability score. None of the 9 apps met the cultural sensitivity evaluation criteria. This systematic review identified critical design flaws that may affect the ease of using the apps in this study. Few mobile apps promote mindfulness-based strategies among adults with chronic lung disease (ie, COPD or lung cancer or both), but those that exist, overall, do not meet the latest scientific evidence. Recommendations include more stringent regulation of health-related apps, use of evidence-based frameworks and participatory design processes, following evidence-based usability practices, use of culturally sensitive language and images, and ensuring that content is written in plain language. ©Otis L Owens, Jenay M Beer, Ligia I Reyes, David G Gallerani, Amanda R Myhren-Bennett, Karen K McDonnell. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 15.05.2018.

Spanish Translation and Cross-Language Validation of a Sleep Habits Questionnaire for Use in Clinical and Research Settings

PubMed Central

Baldwin, Carol M.; Choi, Myunghan; McClain, Darya Bonds; Celaya, Alma; Quan, Stuart F.

2012-01-01

Study Objectives: To translate, back-translate and cross-language validate (English/Spanish) the Sleep Heart Health Study Sleep Habits Questionnaire for use with Spanish-speakers in clinical and research settings. Methods: Following rigorous translation and back-translation, this cross-sectional cross-language validation study recruited bilingual participants from academic, clinic, and community-based settings (N = 50; 52% women; mean age 38.8 ± 12 years; 90% of Mexican heritage). Participants completed English and Spanish versions of the Sleep Habits Questionnaire, the Epworth Sleepiness Scale, and the Acculturation Rating Scale for Mexican Americans II one week apart in randomized order. Psychometric properties were assessed, including internal consistency, convergent validity, scale equivalence, language version intercorrelations, and exploratory factor analysis using PASW (Version18) software. Grade level readability of the sleep measure was evaluated. Results: All sleep categories (duration, snoring, apnea, insomnia symptoms, other sleep symptoms, sleep disruptors, restless legs syndrome) showed Cronbach α, Spearman-Brown coefficients and intercorrelations ≥ 0.700, suggesting robust internal consistency, correlation, and agreement between language versions. The Epworth correlated significantly with snoring, apnea, sleep symptoms, restless legs, and sleep disruptors) on both versions, supporting convergent validity. Items loaded on 4 factors accounted for 68% and 67% of the variance on the English and Spanish versions, respectively. Conclusions: The Spanish-language Sleep Habits Questionnaire demonstrates conceptual and content equivalency. It has appropriate measurement properties and should be useful for assessing sleep health in community-based clinics and intervention studies among Spanish-speaking Mexican Americans. Both language versions showed readability at the fifth grade level. Further testing is needed with larger samples. Citation: Baldwin CM; Choi M; McClain DB; Celaya A; Quan SF. Spanish translation and cross-language validation of a Sleep Habits Questionnaire for use in clinical and research settings. J Clin Sleep Med 2012;8(2):137-146. PMID:22505858

Evaluation of Pediatric Human Papillomavirus Vaccination Provider Counseling Written Materials: A Health Literacy Perspective.

PubMed

Chhabra, Rosy; Chisolm, Deena J; Bayldon, Barbara; Quadri, Maheen; Sharif, Iman; Velazquez, Jessica J; Encalada, Karen; Rivera, Angelic; Harris, Millie; Levites-Agababa, Elana; Yin, H Shonna

2018-03-01

Despite recommendations supporting human papillomavirus (HPV) vaccination, pediatric vaccination rates remain suboptimal in the United States; lack of tools to support provider counseling is one barrier. We sought to evaluate HPV-related counseling materials for readability, suitability, and content, and assess parent perceptions of materials, using a health literacy perspective. A systematic search was conducted for written materials developed for HPV vaccination counseling by examining state Department of Health Web sites and associated links to local and national organizations. Materials were assessed for the following: 1) readability (Flesch Reading Ease, Flesch-Kincaid, Gunning Fog, Simple Measure of Gobbledygook, Fry), 2) suitability (understandability and actionability) (Suitability Assessment of Materials; Patient Education Materials Assessment Tool for Printable Materials), and 3) coverage of 8 key content areas (recommended by Centers for Disease Control and Prevention). Semistructured interviews were conducted with English-speaking parents or caregivers of children 9 to 17 years of age from 3 pediatric clinics (New York, Ohio, Illinois) serving predominantly low-income families to assess perceptions and usefulness of 4 handouts selected for review. Thirty-eight documents were assessed. Mean ± standard deviation (SD) reading grade level was 9.4 ± 2; 10.5% (n = 4) had a reading level of 6th grade or below; 68.4% (n = 26) were considered not suitable. Mean understandability was 41.7% and mean actionability was 20.7%. Only 5.3% (n = 2) addressed all 8 content areas mean ± SD (number of areas = 6.7 ± 1.2). Brochure comprehensiveness and inclusion of a personal story were cited as factors that would be helpful in influencing parents to vaccinate against HPV. Few written materials for HPV vaccination counseling were optimal from a health literacy best practices perspective. Content comprehensiveness was important for informed decision making. Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

A method for the design and development of medical or health care information websites to optimize search engine results page rankings on Google.

PubMed

Dunne, Suzanne; Cummins, Niamh Maria; Hannigan, Ailish; Shannon, Bill; Dunne, Colum; Cullen, Walter

2013-08-27

The Internet is a widely used source of information for patients searching for medical/health care information. While many studies have assessed existing medical/health care information on the Internet, relatively few have examined methods for design and delivery of such websites, particularly those aimed at the general public. This study describes a method of evaluating material for new medical/health care websites, or for assessing those already in existence, which is correlated with higher rankings on Google's Search Engine Results Pages (SERPs). A website quality assessment (WQA) tool was developed using criteria related to the quality of the information to be contained in the website in addition to an assessment of the readability of the text. This was retrospectively applied to assess existing websites that provide information about generic medicines. The reproducibility of the WQA tool and its predictive validity were assessed in this study. The WQA tool demonstrated very high reproducibility (intraclass correlation coefficient=0.95) between 2 independent users. A moderate to strong correlation was found between WQA scores and rankings on Google SERPs. Analogous correlations were seen between rankings and readability of websites as determined by Flesch Reading Ease and Flesch-Kincaid Grade Level scores. The use of the WQA tool developed in this study is recommended as part of the design phase of a medical or health care information provision website, along with assessment of readability of the material to be used. This may ensure that the website performs better on Google searches. The tool can also be used retrospectively to make improvements to existing websites, thus, potentially enabling better Google search result positions without incurring the costs associated with Search Engine Optimization (SEO) professionals or paid promotion.

Readability and Content Assessment of Informed Consent Forms for Phase II-IV Clinical Trials in China

PubMed Central

Wen, Gaiyan; Liu, Xinchun; Huang, Lihua; Shu, Jingxian; Xu, Nana; Chen, Ruifang; Huang, Zhijun; Yang, Guoping; Wang, Xiaomin; Xiang, Yuxia; Lu, Yao; Yuan, Hong

2016-01-01

Purpose To explore the readability and content integrity of informed consent forms (ICFs) used in China and to compare the quality of Chinese local ICFs with that of international ICFs. Methods The length, readability and content of 155 consent documents from phase II-IV drug clinical trials from the Third Xiangya Hospital Ethics Committee from November 2009 to January 2015 were evaluated. Reading difficulty was tested using a readability formula adapted for the Chinese language. An ICF checklist containing 27 required elements was successfully constructed to evaluate content integrity. The description of alternatives to participation was assessed. The quality of ICFs from different sponsorships were also compared. Results Among the 155 evaluable trials, the ICFs had a median length of 5286 words, corresponding to 7 pages. The median readability score was 4.31 (4.02–4.41), with 63.9% at the 2nd level and 36.1% at the 3rd level. Five of the 27 elements were frequently neglected. The average score for the description of alternatives to participation was 1.06, and 27.7% of the ICFs did not mention any alternatives. Compared with Chinese local ICFs, international ICFs were longer, more readable and contained more of the required elements (P < 0.05). Conclusion The ICFs used in China were difficult to read for most participants. These forms had poor description of alternatives to participation, and failed to provide a high degree of information disclosure, including an explanation of informed consent, follow-up processing of the data/sample, inclusion/exclusion criteria, double blinding, and unpredictable risks. International ICFs had better readability and content integrity than Chinese local ICFs. More efforts should thus be made to improve the quality of consent documents in China. PMID:27701471

Readability and Content Assessment of Informed Consent Forms for Phase II-IV Clinical Trials in China.

PubMed

Wen, Gaiyan; Liu, Xinchun; Huang, Lihua; Shu, Jingxian; Xu, Nana; Chen, Ruifang; Huang, Zhijun; Yang, Guoping; Wang, Xiaomin; Xiang, Yuxia; Lu, Yao; Yuan, Hong

2016-01-01

To explore the readability and content integrity of informed consent forms (ICFs) used in China and to compare the quality of Chinese local ICFs with that of international ICFs. The length, readability and content of 155 consent documents from phase II-IV drug clinical trials from the Third Xiangya Hospital Ethics Committee from November 2009 to January 2015 were evaluated. Reading difficulty was tested using a readability formula adapted for the Chinese language. An ICF checklist containing 27 required elements was successfully constructed to evaluate content integrity. The description of alternatives to participation was assessed. The quality of ICFs from different sponsorships were also compared. Among the 155 evaluable trials, the ICFs had a median length of 5286 words, corresponding to 7 pages. The median readability score was 4.31 (4.02-4.41), with 63.9% at the 2nd level and 36.1% at the 3rd level. Five of the 27 elements were frequently neglected. The average score for the description of alternatives to participation was 1.06, and 27.7% of the ICFs did not mention any alternatives. Compared with Chinese local ICFs, international ICFs were longer, more readable and contained more of the required elements (P < 0.05). The ICFs used in China were difficult to read for most participants. These forms had poor description of alternatives to participation, and failed to provide a high degree of information disclosure, including an explanation of informed consent, follow-up processing of the data/sample, inclusion/exclusion criteria, double blinding, and unpredictable risks. International ICFs had better readability and content integrity than Chinese local ICFs. More efforts should thus be made to improve the quality of consent documents in China.

A readability analysis of elementary-level science textbooks

NASA Astrophysics Data System (ADS)

Trainer, Robyn

Given both the unprecedented attention to the importance of providing children with the best possible science textbooks and the overwhelming evidence that students in the United States are severely lacking the most basic science knowledge, the decline in the number of students pursuing science degrees is alarming. In spite of all the efforts being made, a disparity still exists between (1) the wealth of science information available, (2) the apparent ease of access to scientific information, and (3) the lack of scientific academic progress being made in classrooms across the United States. A literature review was conducted which included the areas of textbook analysis and textbook readability levels, the fields of textbook analysis and readability, and findings from recently published books about textbook readability. The majority of the literature reflected an urgent need for science textbooks to be revised. Based on the information gathered during the literature review, the study examined the readability levels of elementary level science textbooks that were published by six textbook publishers. Results from the study revealed that when used properly, readability formulas provide an objective look at textbooks. After applying these formulas to the selected elementary level science textbooks, it became clear that very few changes were implemented between the most recent previous editions and the current editions. The textbooks remain too difficult for the students using them. The findings from this study will help science textbook publishers and textbook writers see that some changes need to be made in the way their textbooks are written. In order to maintain a competitive edge in the global marketplace, more students need to pursue science. In order for more students to do that, they need to pursue science degrees, but in order for them to pursue science degrees, they need to have a certain degree of confidence and level of interest in the subject matter. For that to happen, science textbooks need to be more inviting, more user-friendly, and more interesting to the readers. This study concludes with recommendations for further research.

Sunlight-readable display technology: a dual-use case study

NASA Astrophysics Data System (ADS)

Blanchard, Randall D.

1996-05-01

This paper describes our vision of sunlight readable color display requirements, an alternate technology that offers a high level of performance, and how we implemented it for the military avionics display market. This knowledge base and product development experience was then applied with a comparable level of performance to commercial applications. The successful dual use of this technology for these two diverse markets is presented. Details of the technical commonality and a comparison of the design and performance differences are presented. A basis for specifying the required level of performance for a sunlight readable full color display is discussed. With the objective of providing a high level of image brightness and high ambient light rejection, a display architecture using collimated light is used. The resulting designs of two military cockpit display products, with contrast ratios above 20:1 in sunlight are shown. The performance of a commercial display providing several thousand foot- Lamberts of image brightness is presented.

Evaluating the Linguistic Appropriateness and Cultural Sensitivity of a Self-Report System for Spanish-Speaking Patients with Cancer

PubMed Central

Gonzalez, Laura; Negrón, Rosalyn; Berry, Donna L.

2014-01-01

Spanish speakers in the United States encounter numerous communication barriers during cancer treatment. Communication-focused interventions may help Spanish speakers communicate better with healthcare providers and manage symptoms and quality of life issues (SQOL). For this study, we developed a Spanish version of the electronic self-report assessment for cancer (ESRA-C), a web-based program that helps people with cancer report, track, and manage cancer-related SQOL. Four methods were used to evaluate the Spanish version. Focus groups and cognitive interviews were conducted with 51 Spanish-speaking individuals to elicit feedback. Readability was assessed using the Fry readability formula. The cultural sensitivity assessment tool was applied by three bilingual, bicultural reviewers. Revisions were made to personalize the introduction using a patient story and photos and to simplify language. Focus group participants endorsed changes to the program in a second round of focus groups. Cultural sensitivity of the program was scored unacceptable (x¯=3.0) for audiovisual material and acceptable (x¯=3.0) for written material. Fry reading levels ranged from 4th to 10th grade. Findings from this study provide several next steps to refine ESRA-C for Spanish speakers with cancer. PMID:25045535

Self-Presentation on the Web: Agencies Serving Abused and Assaulted Women

PubMed Central

Shi, Rui; Zhang, Jingwen; Xue, Jia

2014-01-01

Objectives. We examined the content and usability of the Web sites of agencies serving women victims of violence. Methods. We entered the names of a systematic 10% sample of 3774 agencies listed in 2 national directories into a search engine. We took (in April 2012) and analyzed screenshots of the 261 resulting home pages and the readability of 193 home and first-level pages. Results. Victims (94%) and donors (68%) were the primary intended audiences. About one half used social media and one third provided cues to action. Almost all (96.4%) of the Web pages were rated “fairly difficult” to “very confusing” to read, and 81.4% required more than a ninth-grade education to understand. Conclusions. The service and marketing functions were met fairly well by the agency home pages, but usability (particularly readability and offer of a mobile version) and efforts to increase user safety could be improved. Internet technologies are an essential platform for public health. They are particularly useful for reaching people with stigmatized health conditions because of the anonymity allowed. The one third of agencies that lack a Web site will not reach the substantial portion of the population that uses the Internet to find health information and other resources. PMID:24524489

The association of patients' oral health literacy and dental school communication tools: a pilot study.

PubMed

Tam, Amy; Yue, Olivia; Atchison, Kathryn A; Richards, Jessica K; Holtzman, Jennifer S

2015-05-01

The aim of this pilot study was to assess adult patients' ability to read and understand two communication tools at the University of California, Los Angeles, School of Dentistry: the dental school clinic website and a patient education brochure pertaining to sedation in children that was written by dental school personnel. A convenience sample of 100 adults seeking treatment at the school's general dental clinic during 2012-13 completed a health literacy screening instrument. They were then asked to read clinic educational and informational materials and complete a survey. Analyses were conducted to determine the association between the subjects' oral health literacy and sociodemographics and their ability to locate and interpret information in written oral health information materials. SMOG and Flesch-Kincade formulas were used to assess the readability level of the electronic and written communication tools. The results demonstrated an association between these adults' oral health literacy and their dental knowledge and ability to navigate health information website resources and understand health education materials. Health literacy was not associated with age or gender, but was associated with education and race/ethnicity. The SMOG Readability Index determined that the website and the sedation form were written at a ninth grade reading level. These results suggest that dental schools and other health care organizations should incorporate a health-literate approach for their digital and written materials to enhance patients' ability to navigate and understand health information, regardless of their health literacy.

What's New in Children's Literature for the Children of Louisiana? A Selected Annotated Bibliography with Readability Levels (Selected) and Associated Louisiana Content Standards

ERIC Educational Resources Information Center

Webre, Elizabeth C.

2011-01-01

An annotated list of children's books published within the last 15 years and related to Louisiana culture, environment, and economics are linked to the Louisiana Content Standards. Readability levels of selected books are included, providing guidance as to whether a book is appropriate for independent student use. The thirty-three books listed are…

The Varied Uses of Readability Measurement.

ERIC Educational Resources Information Center

Fry, Edward

Readability formulas have varied uses. In education they are used to match children's reading ability to the difficulty level of material, select stories and books for classroom use and for individual students' particular needs, select textbooks and other reading materials, aid educational research, and check reading materials of newly literate…

An Analysis of the Readability of Financial Accounting Textbooks.

ERIC Educational Resources Information Center

Smith, Gerald; And Others

1981-01-01

The Flesch formula was used to calculate the readability of 15 financial accounting textbooks. The 15 textbooks represented introductory, intermediate, and advanced levels and also were classified by five different publishers. Two-way analysis of variance and Tukey's post hoc analysis revealed some significant differences. (Author/CT)

A Readability Analysis of Selected Introductory Economics.

ERIC Educational Resources Information Center

Gallagher, Daniel J.; Thompson, G. Rodney

1981-01-01

To aid secondary school and college level economics teachers as they select textbooks for introductory economics courses, this article recounts how teachers can use the Flesch Reading Ease Test to measure readability. Data are presented on application of the Flesch Reading Ease Test to 15 introductory economics textbooks. (Author/DB)

Readability of alphanumeric characters having various contrast levels as a function of age and illumination mode.

DOT National Transportation Integrated Search

1977-07-01

Readability data of alphanumeric characters that vary in figure-to- ground contrast ratio were obtained from 36 subjects; 12 subjects were placed in each of three age groups (20-25 yr, 40-45 yr, and 60-65 yr). Minimum illuminance required to identify...

Readability of Internet Information on Hearing: Systematic Literature Review.

PubMed

Laplante-Lévesque, Ariane; Thorén, Elisabet Sundewall

2015-09-01

This systematic literature review asks the following question: “ What is the readability of Internet information on hearing that people with hearing impairment and their significant others can access in the context of their hearing care?” Searches were completed in three databases: CINAHL, PubMed, and Scopus. Seventy-eight records were identified and systematically screened for eligibility: 8 records were included that contained data on the readability of Internet information on hearing that people with hear ing impairment and their significant others can access in the context of their hearing care. Records reported mean readability levels from 9 to over 14. In other words, people with hearing impairment and their significant others need 9 to 14 years of education to read and understand Internet information on hearing that they access in the context of their hearing care. The poor readability of Internet information on hearing has been well documented; it is time to focus on valid and sustainable initiatives that address this problem.

A Mismatch Between Patient Education Materials About Sickle Cell Disease and the Literacy Level of Their Intended Audience.

PubMed

McClure, Elizabeth; Ng, Jared; Vitzthum, Kelly; Rudd, Rima

2016-05-12

Despite the first goal of the 2010 National Action Plan to Improve Health Literacy, the literacy demands of much health information exceeds the reading skills of most US adults. The objective of this study was to assess the health literacy level of publicly available patient education materials for people with sickle cell disease (SCD). We used 5 validated tools to evaluate 9 print and 4 online patient education materials: the simple measure of gobbledygook (SMOG) to assess reading grade level, the Peter Mosenthal and Irwin Kirsch readability formula (PMOSE/IKIRSCH) to assess structure and density, the Patient Education Materials Assessment Tool (PEMAT) to assess actionability (how well readers will know what to do after reading the material) and understandability, the Centers for Disease Control and Prevention's (CDC's) Clear Communication Index (Index) to obtain a comprehensive literacy demand score, and the Printed Cancer Education Materials for African Americans Cultural Sensitivity Assessment Tool. Materials' scores reflected high reading levels ranging from 8th grade to 12th grade, appropriate (low) structural demand, and low actionability relative to understandability. CDC suggests that an appropriate Index score should fall in or above the 90th percentile. The scores yielded by materials evaluated in this assessment ranged from the 44th to the 76th percentiles. Eight of the 13 materials scored within the acceptable range for cultural sensitivity. Reading levels of available patient education materials exceed the documented average literacy level of the US adult population. Health literacy demands should be a key consideration in the revision and development of patient education materials for people with SCD.

Report on Phase I (Interest, Comprehension, & Readability) Prepublication Learner Verification of "Reading Basics Plus," Harper & Row, Publishers, Inc.

ERIC Educational Resources Information Center

Ball, Edward H.

"Reading Basics Plus" consists of an integrated set of texts, workbooks, duplicating masters, word cards, charts, and teacher's guidebooks. By a process of small group trials, students' and teachers' reactions to the proposed content of the "Reading Basics Plus" program for grades four, five, and six were obtained in order to provide editors and…

Spanish Readability Formulas for Elementary-Level Texts: A Validation Study.

ERIC Educational Resources Information Center

Parker, Richard I.; Hasbrouck, Jan E.; Weaver, Laurie

2001-01-01

Uses two formulas developed for Spanish language text to analyze 9 stories that were read by 36 Spanish-speaking second graders with limited English proficiency. Finds that the Spanish readability formulas only weakly predicted student performance, indicating the need to pursue broader, qualitative indices of difficulty for Spanish text. (SG)

Predicting the Readability of FORTRAN Programs.

ERIC Educational Resources Information Center

Domangue, J. C.; Karbowski, S. A.

This paper reports the results of two studies of the readability of FORTRAN programs, i.e., the ease with which a programmer can read and analyze programs already written, particularly in the processes of maintenance and debugging. In the first study, low-level characteristics of 202 FORTRAN programs stored on the general-use UNIX systems at Bell…

Readability of consumer health information on the internet: a comparison of U.S. government-funded and commercially funded websites.

PubMed

Risoldi Cochrane, Zara; Gregory, Philip; Wilson, Amy

2012-01-01

The Internet has become an extremely prevalent means of communicating health information to consumers. Guidelines for selecting reliable health information websites give preference to U.S. government sites over commercially funded sites. However, these websites are not useful to consumers unless they are able to read and understand them. The authors' objective was to compare the readability of Internet health information intended for consumers found on U.S. government-funded websites versus that found on commercially funded websites. Consumer health websites were identified through a systematic Internet search. Webpages for 10 common health topics were extracted from each website. Readability of webpages was determined by 3 validated measures: Flesch Reading Ease, Flesch-Kincaid Reading Level, and SMOG Formula. Mean readability of government-funded and commercially funded websites was compared using the Mann-Whitney U test. Commercially funded websites were significantly more difficult to read as measured by Flesch Reading Ease (49.7 vs. 55.6 for government-funded sites, p = .002) and Flesch-Kincaid Reading Level (10.1 vs. 9.3, p = .012). There was no significant difference according to SMOG Formula (12.8 vs. 13.2, p = .150). The overall readability of Internet health information intended for consumers was poor. Efforts should be made to ensure that health information communicated via the Internet is easy for consumers to read and understand.

[Systematic Readability Analysis of Medical Texts on Websites of German University Clinics for General and Abdominal Surgery].

PubMed

Esfahani, B Janghorban; Faron, A; Roth, K S; Grimminger, P P; Luers, J C

2016-12-01

Background: Besides the function as one of the main contact points, websites of hospitals serve as medical information portals. As medical information texts should be understood by any patients independent of the literacy skills and educational level, online texts should have an appropriate structure to ease understandability. Materials and Methods: Patient information texts on websites of clinics for general surgery at German university hospitals (n = 36) were systematically analysed. For 9 different surgical topics representative medical information texts were extracted from each website. Using common readability tools and 5 different readability indices the texts were analysed concerning their readability and structure. The analysis was furthermore stratified in relation to geographical regions in Germany. Results: For the definite analysis the texts of 196 internet websites could be used. On average the texts consisted of 25 sentences and 368 words. The reading analysis tools congruously showed that all texts showed a rather low readability demanding a high literacy level from the readers. Conclusion: Patient information texts on German university hospital websites are difficult to understand for most patients. To fulfill the ambition of informing the general population in an adequate way about medical issues, a revision of most medical texts on websites of German surgical hospitals is recommended. Georg Thieme Verlag KG Stuttgart · New York.

Readability and Comprehension of the Geriatric Depression Scale and PROMIS® Physical Function Items in Older African Americans and Latinos.

PubMed

Paz, Sylvia H; Jones, Loretta; Calderón, José L; Hays, Ron D

2017-02-01

Depression and physical function are particularly important health domains for the elderly. The Geriatric Depression Scale (GDS) and the Patient-Reported Outcomes Measurement Information System (PROMIS ® ) physical function item bank are two surveys commonly used to measure these domains. It is unclear if these two instruments adequately measure these aspects of health in minority elderly. The aim of this study was to estimate the readability of the GDS and PROMIS ® physical function items and to assess their comprehensibility using a sample of African American and Latino elderly. Readability was estimated using the Flesch-Kincaid and Flesch Reading Ease (FRE) formulae for English versions, and a Spanish adaptation of the FRE formula for the Spanish versions. Comprehension of the GDS and PROMIS ® items by minority elderly was evaluated with 30 cognitive interviews. Readability estimates of a number of items in English and Spanish of the GDS and PROMIS ® physical functioning items exceed the U.S. recommended 5th-grade threshold for vulnerable populations, or were rated as 'fairly difficult', 'difficult', or 'very difficult' to read. Cognitive interviews revealed that many participants felt that more than the two (yes/no) GDS response options were needed to answer the questions. Wording of several PROMIS ® items was considered confusing, and interpreting responses was problematic because they were based on using physical aids. Problems with item wording and response options of the GDS and PROMIS ® physical function items may reduce reliability and validity of measurement when used with minority elderly.

The development of an integrated assessment instrument for measuring analytical thinking and science process skills

NASA Astrophysics Data System (ADS)

Irwanto, Rohaeti, Eli; LFX, Endang Widjajanti; Suyanta

2017-05-01

This research aims to develop instrument and determine the characteristics of an integrated assessment instrument. This research uses 4-D model, which includes define, design, develop, and disseminate. The primary product is validated by expert judgment, tested it's readability by students, and assessed it's feasibility by chemistry teachers. This research involved 246 students of grade XI of four senior high schools in Yogyakarta, Indonesia. Data collection techniques include interview, questionnaire, and test. Data collection instruments include interview guideline, item validation sheet, users' response questionnaire, instrument readability questionnaire, and essay test. The results show that the integrated assessment instrument has Aiken validity value of 0.95. Item reliability was 0.99 and person reliability was 0.69. Teachers' response to the integrated assessment instrument is very good. Therefore, the integrated assessment instrument is feasible to be applied to measure the students' analytical thinking and science process skills.

A content analysis of the consumer-facing online information about My Health Record: Implications for increasing knowledge and awareness to facilitate uptake and use.

PubMed

Walsh, Louisa; Hill, Sophie; Allan, Meredith; Balandin, Susan; Georgiou, Andrew; Higgins, Isabel; Kraal, Ben; McCarthy, Shaun; Hemsley, Bronwyn

2017-01-01

Low health literacy, low levels of positive belief and privacy and security concerns have been identified as a significant barrier to personal electronic health record uptake and use. An important tool for overcoming these barriers is the consumer-facing information which accompanies the system. My Health Record (MyHR) is the Australian national e-health record system, for which a large suite of online resources exists to facilitate consumer registration and use. This study uses a number of different measures of health resource quality to assess the MyHR online consumer-facing information and identify any gaps or areas for improvement. To analyse the quality and content of the online consumer-facing resources which support the uptake and use of MyHR. Australian information resources aimed at healthcare consumers about the MyHR were included in this study. A comprehensive search using Internet search engines was conducted to locate all online consumer-facing resources about MyHR from both government and non-government sources. Readability (measured by Flesch-Kincaid grade level), year of publication/review, publishing organisation type, presentation style, linked websites, target audience, and themes were identified as important measures of health information quality, and these were recorded and reported on for each resource. Eighty resources met the inclusion criteria. The mean Flesch-Kincaid grade level was 11.8. Most resources were created by Australian government sources ( n = 55), and the most common target audience was the general public ( n = 65). Registration ( n = 51), privacy/security ( n = 49), and benefits of use ( n = 46) were the most common resource themes. The authors identified a number of gaps and areas for improvement in the provision of consumer-facing information about MyHR. Readability is too high for the general Australian population, and there are few translated resources, which means that the information provided does not cater to people with low literacy levels, communication disability, and/or difficulties in understanding written English. The target audiences for resources do not reflect priority groups that were identified during the MyHR development processes. There are also gaps in information provision about how consumers can use MyHR as a tool to meaningfully engage with health professionals and services to support their own person-centred care.

Internet resources for Tommy John injuries: what are patients reading?

PubMed

Johnson, Christine C; Garcia, Grant H; Liu, Joseph N; Stepan, Jeffrey G; Patel, Ronak M; Dines, Joshua S

2016-12-01

The quality of medical information on the Internet has come under scrutiny. This study investigates the quality, accuracy, and readability of online information regarding ulnar collateral ligament (UCL) injuries. Three search terms ("elbow ulnar collateral ligament injury," "tommy john injury," and "pitcher's elbow") were entered into 3 Internet search engines. Three independent reviewers evaluated the content and accuracy of the information with a set of predetermined scoring criteria. Website quality was further assessed by the Journal of the American Medical Association benchmark criteria and Health on the Net Foundation certification. Website readability was ascertained with the Flesch-Kincaid score. We evaluated 113 unique websites. The average quality for all websites was 8.88 ± 6.8 (maximum, 32 points). Website quality and accuracy were lower with use of the search term "pitcher's elbow" as compared with "elbow ulnar collateral ligament injury" or "tommy john injury" (P ≤ .001). Sites certified by the Health on the Net Foundation had higher quality scores than non-certified sites (P = .034). The mean reading grade level was 10.7. Reading level was significantly correlated with website accuracy and quality (P ≤ .001) and physician authorship (P = .012). Forty-three websites (38.1%) described surgical reconstruction; of these, 16 (37.2%) mentioned improved pitching performance postoperatively. Online information on UCL injuries is often inaccurate and written at an inappropriate reading level. Information quality depends on the search term used, website authorship, and commercial bias. Clinicians must be aware of factors influencing website quality in order to direct patients to appropriate resources. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Measuring the Readability of Training Materials by the PLATO IV Computer-Based Instructional System,

DTIC Science & Technology

1974-09-15

Technical Information Center ATTN: DTIC-DDAB P83-0290 Cameron Sta BG 5 Alexandria VA 22314 1. I regret that it took so long to respond to your request...8217- ConeokeO -; ’ the~r grade .,evec tl"-a wr, er3 5:~ng -not e *QLrisse. TV- -are :~n. - ~-t-r ecked bv~ nine educatiorwtrainine 5ptCiaiist- using Vi

Machine-Readable Data Files in the Social Sciences: An Anthropologist and a Librarian Look at the Issues.

ERIC Educational Resources Information Center

Bernard, H. Russell; Jones, Ray

1984-01-01

Focuses on problems in making machine-readable data files (MRDFs) accessible and in using them: quality of data in MRDFs themselves (social scientists' concern) and accessibility--availability of bibliographic control, quality of documentation, level of user skills (librarians' concern). Skills needed by social scientists and librarians are…

Further Issues in Determining the Readability of Self-Report Items: Comment on McHugh and Behar (2009)

ERIC Educational Resources Information Center

Schinka, John A.

2012-01-01

Objective: Issues regarding the readability of self-report assessment instruments, methods for establishing the reading ability level of respondents, and guidelines for development of scales designed for marginal readers have been inconsistently addressed in the literature. A recent study by McHugh and Behar (2009) provided new findings relevant…

Readability of medicinal package leaflets: a systematic review

PubMed Central

Pires, Carla; Vigário, Marina; Cavaco, Afonso

2015-01-01

OBJECTIVE To review studies on the readability of package leaflets of medicinal products for human use. METHODS We conducted a systematic literature review between 2008 and 2013 using the keywords “Readability and Package Leaflet” and “Readability and Package Insert” in the academic search engine Biblioteca do Conhecimento Online, comprising different bibliographic resources/databases. The preferred reporting items for systematic reviews and meta-analyses criteria were applied to prepare the draft of the report. Quantitative and qualitative original studies were included. Opinion or review studies not written in English, Portuguese, Italian, French, or Spanish were excluded. RESULTS We identified 202 studies, of which 180 were excluded and 22 were enrolled [two enrolling healthcare professionals, 10 enrolling other type of participants (including patients), three focused on adverse reactions, and 7 descriptive studies]. The package leaflets presented various readability problems, such as complex and difficult to understand texts, small font size, or few illustrations. The main methods to assess the readability of the package leaflet were usability tests or legibility formulae. Limitations with these methods included reduced number of participants; lack of readability formulas specifically validated for specific languages (e.g., Portuguese); and absence of an assessment on patients literacy, health knowledge, cognitive skills, levels of satisfaction, and opinions. CONCLUSIONS Overall, the package leaflets presented various readability problems. In this review, some methodological limitations were identified, including the participation of a limited number of patients and healthcare professionals, the absence of prior assessments of participant literacy, humor or sense of satisfaction, or the predominance of studies not based on role-plays about the use of medicines. These limitations should be avoided in future studies and be considered when interpreting the results. PMID:25741660

Readability of medicinal package leaflets: a systematic review.

PubMed

Pires, Carla; Vigário, Marina; Cavaco, Afonso

2015-01-01

OBJECTIVE To review studies on the readability of package leaflets of medicinal products for human use. METHODS We conducted a systematic literature review between 2008 and 2013 using the keywords "Readability and Package Leaflet" and "Readability and Package Insert" in the academic search engine Biblioteca do Conhecimento Online, comprising different bibliographic resources/databases. The preferred reporting items for systematic reviews and meta-analyses criteria were applied to prepare the draft of the report. Quantitative and qualitative original studies were included. Opinion or review studies not written in English, Portuguese, Italian, French, or Spanish were excluded. RESULTS We identified 202 studies, of which 180 were excluded and 22 were enrolled [two enrolling healthcare professionals, 10 enrolling other type of participants (including patients), three focused on adverse reactions, and 7 descriptive studies]. The package leaflets presented various readability problems, such as complex and difficult to understand texts, small font size, or few illustrations. The main methods to assess the readability of the package leaflet were usability tests or legibility formulae. Limitations with these methods included reduced number of participants; lack of readability formulas specifically validated for specific languages (e.g., Portuguese); and absence of an assessment on patients literacy, health knowledge, cognitive skills, levels of satisfaction, and opinions. CONCLUSIONS Overall, the package leaflets presented various readability problems. In this review, some methodological limitations were identified, including the participation of a limited number of patients and healthcare professionals, the absence of prior assessments of participant literacy, humor or sense of satisfaction, or the predominance of studies not based on role-plays about the use of medicines. These limitations should be avoided in future studies and be considered when interpreting the results.

A survey of Canadian websites providing information about female urinary incontinence.

PubMed

Farrell, Karen D; Robinson, Lynne M; Baydock, Sandra A; Farrell, Scott A; Irving, Linda E; O'Connell, Colleen M

2006-08-01

Urinary incontinence (UI) is a prevalent health issue that has significant detrimental effects on quality of life. The Internet offers a unique vehicle for incontinent women to access information that could facilitate conservative self-help therapy. An evaluation of Canadian websites offering female UI information was conducted to determine their quality and readability. We evaluated websites using published general quality criteria for health sites and a quality assessment tool compiled by the authors for specific UI information derived from published, peer-reviewed clinical practice guidelines. Three health care professionals reviewed sites for quality, Canadian content, and interactivity. The readability of health information was also evaluated. Fifty-six Canadian sites (18 professional, 22 organizational, 16 commercial) were evaluated. Significant agreement was found among the raters' evaluations on all measures. For all sites, the mean scores were general quality, 9/14; specific UI quality, 30/122; reading ease, 37/100; grade level, 10.9. The median score for Canadian content was high, but for interactivity it was low. The only significant difference between site types was for general quality (F [2,165]=3.38, P=0.036). Post hoc Tukey's tests showed a significant difference between organizational and commercial sites, with organizational sites having higher general quality. Canadian websites providing female UI information have moderately high general quality, low specific UI information quality, minimal interactivity, and more than minimal Canadian content. The reading level of most sites is too high for average consumers. A webliography of the best sites has been developed to guide patients.

Improving Web Searches: Case Study of Quit-Smoking Web Sites for Teenagers

PubMed Central

Skinner, Harvey

2003-01-01

Background The Web has become an important and influential source of health information. With the vast number of Web sites on the Internet, users often resort to popular search sites when searching for information. However, little is known about the characteristics of Web sites returned by simple Web searches for information about smoking cessation for teenagers. Objective To determine the characteristics of Web sites retrieved by search engines about smoking cessation for teenagers and how information quality correlates with the search ranking. Methods The top 30 sites returned by 4 popular search sites in response to the search terms "teen quit smoking" were examined. The information relevance and quality characteristics of these sites were evaluated by 2 raters. Objective site characteristics were obtained using a page-analysis Web site. Results Only 14 of the 30 Web sites are of direct relevance to smoking cessation for teenagers. The readability of about two-thirds of the 14 sites is below an eighth-grade school level and they ranked significantly higher (Kendall rank correlation, tau = -0.39, P= .05) in search-site results than sites with readability above or equal to that grade level. Sites that ranked higher were significantly associated with the presence of e-mail address for contact (tau = -0.46, P= .01), annotated hyperlinks to external sites (tau = -0.39, P= .04), and the presence of meta description tag (tau = -0.48, P= .002). The median link density (number of external sites that have a link to that site) of the Web pages was 6 and the maximum was 735. A higher link density was significantly associated with a higher rank (tau = -0.58, P= .02). Conclusions Using simple search terms on popular search sites to look for information on smoking cessation for teenagers resulted in less than half of the sites being of direct relevance. To improve search efficiency, users could supplement results obtained from simple Web searches with human-maintained Web directories and learn to refine their searches with more advanced search syntax. PMID:14713656

Web-based information on the treatment of oral leukoplakia - quality and readability.

PubMed

Wiriyakijja, Paswach; Fedele, Stefano; Porter, Stephen; Ni Riordain, Richeal

2016-09-01

To categorise the content and assess the quality and readability of the online information regarding the treatment for oral leukoplakia. An online search using the term 'leukoplakia treatment' was carried out on 8th June 2015 using the Google search engine. The content, quality and readability of the first 100 sites were explored. The quality of the web information was assessed using the following tools, the DISCERN instrument and the Journal of the American Medical Association (JAMA) benchmarks for website analysis and the HON seal. Readability was assessed via the Flesch Reading Ease Score. The search strategy generated 357 000 sites on the Google search engine. Due to duplicate links, non-operating links and irrelevant links, a total of 47 of the first 100 websites were included in this study. The mean overall rating achieved by included websites using the DISCERN instrument was 2.3. With regard to the JAMA benchmarks, the vast majority of examined websites (95.7%) completely fulfilled the disclosure benchmark and less than 50% of included websites met the three remaining criteria. A mean total readability score of 47.5 was recorded with almost 90% of websites having a readability level ranging from fairly difficult to very difficult. Based on this study, the online health information regarding oral leukoplakia has challenging readability with content of questionable accuracy. As patients often search for health information online, it would be prudent for clinicians to highlight the caution with which online information should be interpreted. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

A Method for the Design and Development of Medical or Health Care Information Websites to Optimize Search Engine Results Page Rankings on Google

PubMed Central

Cummins, Niamh Maria; Hannigan, Ailish; Shannon, Bill; Dunne, Colum; Cullen, Walter

2013-01-01

Background The Internet is a widely used source of information for patients searching for medical/health care information. While many studies have assessed existing medical/health care information on the Internet, relatively few have examined methods for design and delivery of such websites, particularly those aimed at the general public. Objective This study describes a method of evaluating material for new medical/health care websites, or for assessing those already in existence, which is correlated with higher rankings on Google's Search Engine Results Pages (SERPs). Methods A website quality assessment (WQA) tool was developed using criteria related to the quality of the information to be contained in the website in addition to an assessment of the readability of the text. This was retrospectively applied to assess existing websites that provide information about generic medicines. The reproducibility of the WQA tool and its predictive validity were assessed in this study. Results The WQA tool demonstrated very high reproducibility (intraclass correlation coefficient=0.95) between 2 independent users. A moderate to strong correlation was found between WQA scores and rankings on Google SERPs. Analogous correlations were seen between rankings and readability of websites as determined by Flesch Reading Ease and Flesch-Kincaid Grade Level scores. Conclusions The use of the WQA tool developed in this study is recommended as part of the design phase of a medical or health care information provision website, along with assessment of readability of the material to be used. This may ensure that the website performs better on Google searches. The tool can also be used retrospectively to make improvements to existing websites, thus, potentially enabling better Google search result positions without incurring the costs associated with Search Engine Optimization (SEO) professionals or paid promotion. PMID:23981848

Discriminability measures for predicting readability of text on textured backgrounds

NASA Technical Reports Server (NTRS)

Scharff, L. F.; Hill, A. L.; Ahumada, A. J. Jr; Watson, A. B. (Principal Investigator)

2000-01-01

Several discriminability measures were examined for their ability to predict reading search times for three levels of text contrast and a range of backgrounds (plain, a periodic texture, and four spatial-frequency-filtered textures created from the periodic texture). Search times indicate that these background variations only affect readability when the text contrast is low, and that spatial frequency content of the background affects readability. These results were not well predicted by the single variables of text contrast (Spearman rank correlation = -0.64) and background RMS contrast (0.08), but a global masking index and a spatial-frequency-selective masking index led to better predictions (-0.84 and -0.81, respectively). c2000 Optical Society of America.

The Readability of Electronic Cigarette Health Information and Advice: A Quantitative Analysis of Web-Based Information.

PubMed

Park, Albert; Zhu, Shu-Hong; Conway, Mike

2017-01-06

The popularity and use of electronic cigarettes (e-cigarettes) has increased across all demographic groups in recent years. However, little is currently known about the readability of health information and advice aimed at the general public regarding the use of e-cigarettes. The objective of our study was to examine the readability of publicly available health information as well as advice on e-cigarettes. We compared information and advice available from US government agencies, nongovernment organizations, English speaking government agencies outside the United States, and for-profit entities. A systematic search for health information and advice on e-cigarettes was conducted using search engines. We manually verified search results and converted to plain text for analysis. We then assessed readability of the collected documents using 4 readability metrics followed by pairwise comparisons of groups with adjustment for multiple comparisons. A total of 54 documents were collected for this study. All 4 readability metrics indicate that all information and advice on e-cigarette use is written at a level higher than that recommended for the general public by National Institutes of Health (NIH) communication guidelines. However, health information and advice written by for-profit entities, many of which were promoting e-cigarettes, were significantly easier to read. A substantial proportion of potential and current e-cigarette users are likely to have difficulty in fully comprehending Web-based health information regarding e-cigarettes, potentially hindering effective health-seeking behaviors. To comply with NIH communication guidelines, government entities and nongovernment organizations would benefit from improving the readability of e-cigarettes information and advice. ©Albert Park, Shu-Hong Zhu, Mike Conway. Originally published in JMIR Public Health and Surveillance (http://publichealth.jmir.org), 06.01.2017.

Assessment of the quality and content of website health information about herbal remedies for menopausal symptoms.

PubMed

Sowter, Julie; Astin, Felicity; Dye, Louise; Marshall, Paul; Knapp, Peter

2016-06-01

To assess the quality, readability and coverage of website information about herbal remedies for menopausal symptoms. A purposive sample of commercial and non-commercial websites was assessed for quality (DISCERN), readability (SMOG) and information coverage. Non-parametric and parametric tests were used to explain the variability of these factors across types of websites and to assess associations between website quality and information coverage. 39 sites were assessed. Median quality and information coverage scores were 44/80 and 11/30 respectively. The median readability score was 18.7, similar to UK broadsheets. Commercial websites scored significantly lower on quality (p=0.014), but there were no statistical differences for information coverage or readability. There was a significant positive correlation between information quality and coverage scores irrespective of website provider (r=0.69, p<0.001, n=39). Overall website quality and information coverage are poor and the required reading level high. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Toward Ensuring Health Equity: Readability and Cultural Equivalence of OMERACT Patient-reported Outcome Measures.

PubMed

Petkovic, Jennifer; Epstein, Jonathan; Buchbinder, Rachelle; Welch, Vivian; Rader, Tamara; Lyddiatt, Anne; Clerehan, Rosemary; Christensen, Robin; Boonen, Annelies; Goel, Niti; Maxwell, Lara J; Toupin-April, Karine; De Wit, Maarten; Barton, Jennifer; Flurey, Caroline; Jull, Janet; Barnabe, Cheryl; Sreih, Antoine G; Campbell, Willemina; Pohl, Christoph; Duruöz, Mehmet Tuncay; Singh, Jasvinder A; Tugwell, Peter S; Guillemin, Francis

2015-12-01

The goal of the Outcome Measures in Rheumatology (OMERACT) 12 (2014) equity working group was to determine whether and how comprehensibility of patient-reported outcome measures (PROM) should be assessed, to ensure suitability for people with low literacy and differing cultures. The English, Dutch, French, and Turkish Health Assessment Questionnaires and English and French Osteoarthritis Knee and Hip Quality of Life questionnaires were evaluated by applying 3 readability formulas: Flesch Reading Ease, Flesch-Kincaid grade level, and Simple Measure of Gobbledygook; and a new tool, the Evaluative Linguistic Framework for Questionnaires, developed to assess text quality of questionnaires. We also considered a study assessing cross-cultural adaptation with/without back-translation and/or expert committee. The results of this preconference work were presented to the equity working group participants to gain their perspectives on the importance of comprehensibility and cross-cultural adaptation for PROM. Thirty-one OMERACT delegates attended the equity session. Twenty-six participants agreed that PROM should be assessed for comprehensibility and for use of suitable methods (4 abstained, 1 no). Twenty-two participants agreed that cultural equivalency of PROM should be assessed and suitable methods used (7 abstained, 2 no). Special interest group participants identified challenges with cross-cultural adaptation including resources required, and suggested patient involvement for improving translation and adaptation. Future work will include consensus exercises on what methods are required to ensure PROM are appropriate for people with low literacy and different cultures.

Toward Ensuring Health Equity: Readability and Cultural Equivalence of OMERACT Patient-reported Outcome Measures

PubMed Central

Petkovic, Jennifer; Epstein, Jonathan; Buchbinder, Rachelle; Welch, Vivian; Rader, Tamara; Lyddiatt, Anne; Clerehan, Rosemary; Christensen, Robin; Boonen, Annelies; Goel, Niti; Maxwell, Lara J.; Toupin-April, Karine; De Wit, Maarten; Barton, Jennifer; Flurey, Caroline; Jull, Janet; Barnabe, Cheryl; Sreih, Antoine G.; Campbell, Willemina; Pohl, Christoph; Duruöz, Mehmet Tuncay; Singh, Jasvinder A.; Tugwell, Peter S.; Guillemin, Francis

2016-01-01

Objective The goal of the Outcome Measures in Rheumatology (OMERACT) 12 (2014) equity working group was to determine whether and how comprehensibility of patient-reported outcome measures (PROM) should be assessed, to ensure suitability for people with low literacy and differing cultures. Methods The English, Dutch, French, and Turkish Health Assessment Questionnaires and English and French Osteoarthritis Knee and Hip Quality of Life questionnaires were evaluated by applying 3 readability formulas: Flesch Reading Ease, Flesch-Kincaid grade level, and Simple Measure of Gobbledygook; and a new tool, the Evaluative Linguistic Framework for Questionnaires, developed to assess text quality of questionnaires. We also considered a study assessing cross-cultural adaptation with/without back-translation and/or expert committee. The results of this preconference work were presented to the equity working group participants to gain their perspectives on the importance of comprehensibility and cross-cultural adaptation for PROM. Results Thirty-one OMERACT delegates attended the equity session. Twenty-six participants agreed that PROM should be assessed for comprehensibility and for use of suitable methods (4 abstained, 1 no). Twenty-two participants agreed that cultural equivalency of PROM should be assessed and suitable methods used (7 abstained, 2 no). Special interest group participants identified challenges with cross-cultural adaptation including resources required, and suggested patient involvement for improving translation and adaptation. Conclusion Future work will include consensus exercises on what methods are required to ensure PROM are appropriate for people with low literacy and different cultures. PMID:26077410

Developing low-literacy health education materials for women.

PubMed

Wilson, Lindsey D

2011-01-01

Research has consistently shown that people absorb information significantly better when written information is provided in conjunction with verbal explanations. Despite this, studies also show that many written health education materials do not have readability levels that are appropriate for women who have low literacy skills. This article summarizes the process and essential considerations, such as content of the material, readability, layout, design, culture, language, and medium of delivery in the development of low-literacy health education materials.

Reading level of privacy policies on Internet health Web sites.

PubMed

Graber, Mark A; D'Alessandro, Donna M; Johnson-West, Jill

2002-07-01

Most individuals would like to maintain the privacy of their medical information on the World Wide Web (WWW). In response, commercial interests and other sites post privacy policies that are designed to inform users of how their information will be used. However, it is not known if these statements are comprehensible to most WWW users. The purpose of this study was to determine the reading level of privacy statements on Internet health Web sites and to determine whether these statements can inform users of their rights. This was a descriptive study. Eighty Internet health sites were examined and the readability of their privacy policies was determined. The selected sample included the top 25 Internet health sites as well as other sites that a user might encounter while researching a common problem such as high blood pressure. Sixty percent of the sites were commercial (.com), 17.5% were organizations (.org), 8.8% were from the United Kingdom (.uk), 3.8% were United States governmental (.gov), and 2.5% were educational (.edu). The readability level of the privacy policies was calculated using the Flesch, the Fry, and the SMOG readability levels. Of the 80 Internet health Web sites studied, 30% (including 23% of the commercial Web sites) had no privacy policy posted. The average readability level of the remaining sites required 2 years of college level education to comprehend, and no Web site had a privacy policy that was comprehensible by most English-speaking individuals in the United States. The privacy policies of health Web sites are not easily understood by most individuals in the United States and do not serve to inform users of their rights. Possible remedies include rewriting policies to make them comprehensible and protecting online health information by using legal statutes or standardized insignias indicating compliance with a set of privacy standards (eg, "Health on the Net" [HON] http://www.hon.ch).

Quality and readability of online information resources on insomnia.

PubMed

Ma, Yan; Yang, Albert C; Duan, Ying; Dong, Ming; Yeung, Albert S

2017-09-01

The internet is a major source for health information. An increasing number of people, including patients with insomnia, search for remedies online; however, little is known about the quality of such information. This study aimed to evaluate the quality and readability of insomnia-related online information. Google was used as the search engine, and the top websites on insomnia that met the inclusion criteria were evaluated for quality and readability. The analyzed websites belonged to nonprofit, commercial, or academic organizations and institutions such as hospitals and universities. Insomnia-related websites typically included definitions (85%), causes and risk factors (100%), symptoms (95%), and treatment options (90%). Cognitive behavioral therapy for insomnia (CBT-I) was the most commonly recommended approach for insomnia treatment, and sleep drugs are frequently mentioned. The overall quality of the websites on insomnia is moderate, but all the content exceeded the recommended reading ease levels. Concerns that must be addressed to increase the quality and trustworthiness of online health information include sharing metadata, such as authorship, time of creation and last update, and conflicts of interest; providing evidence for reliability; and increasing the readability for a layman audience.

A Manual for Readable Writing.

ERIC Educational Resources Information Center

Klare, George R.

One of the ways to handle the increasing demands on readers' skills is to make writing more readable. The problem has two different aspects: predicting how readable writing will be to a reader, and producing writing that is readable to that reader. Prediction is relatively simple, and can be done statistically with readability formulas. Production…

Surfing for juvenile idiopathic arthritis: perspectives on quality and content of information on the Internet.

PubMed

Stinson, Jennifer N; Tucker, Lori; Huber, Adam; Harris, Heather; Lin, Carmen; Cohen, Lindsay; Gill, Navreet; Lukas-Bretzler, Jacqueline; Proulx, Laurie; Prowten, David

2009-08-01

To determine the quality and content of English language Internet information about juvenile idiopathic arthritis (JIA) from the perspectives of consumers and healthcare professionals. Key words relevant to JIA were searched across 10 search engines. Quality of information was appraised independently by 2 health professionals, 1 young adult with JIA, and a parent using the DISCERN tool. Concordance of the website content (i.e., accuracy and completeness) with available evidence about the management of JIA was determined. Readability was determined using Flesch-Kincaid grade level and Reading Ease Score. Out of the 3000 Web pages accessed, only 58 unique sites met the inclusion criteria. Of these sites only 16 had DISCERN scores above 50% (indicating fair quality). These sites were then rated by consumers. Most sites targeted parents and none were specifically developed for youth with JIA. The overall quality of website information was fair, with a mean DISCERN quality rating score of 48.92 out of 75 (+/- 6.56, range 34.0-59.5). Overall completeness of sites was 9.07 out of 16 (+/- 2.28, range 5.25-13.25) and accuracy was 3.09 out of 4 (+/- 0.86, range 2-4), indicating a moderate level of accuracy. Average Flesch-Kincaid grade level and Reading Ease Score were 11.48 (+/- 0.74, range 10.1-12.0) and 36.36 (+/- 10.86, range 6.30-48.1), respectively, indicating that the material was difficult to read. Our study highlights the paucity of high quality Internet health information at an appropriate reading level for youth with JIA and their parents.

Online Health Information Regarding Male Infertility: An Evaluation of Readability, Suitability, and Quality.

PubMed

Robins, Stephanie; Barr, Helena J; Idelson, Rachel; Lambert, Sylvie; Zelkowitz, Phyllis

2016-10-21

Many men lack knowledge about male infertility, and this may have consequences for their reproductive and general health. Men may prefer to seek health information online, but these sources of information vary in quality. The objective of this study is to determine if online sources of information regarding male infertility are readable, suitable, and of appropriate quality for Internet users in the general population. This study used a cross-sectional design to evaluate online sources resulting from search engine queries. The following categories of websites were considered: (1) Canadian fertility clinics, (2) North American organizations related to fertility, and (3) the first 20 results of Google searches using the terms "male infertility" and "male fertility preservation" set to the search locations worldwide, English Canada, and French Canada. Websites that met inclusion criteria (N=85) were assessed using readability indices, the Suitability Assessment of Materials (SAM), and the DISCERN tool. The associations between website affiliation (government, university/medical, non-profit organization, commercial/corporate, private practice) and Google placement to readability, suitability, and quality were also examined. None of the sampled websites met recommended levels of readability. Across all websites, the mean SAM score for suitability was 45.37% (SD 11.21), or "adequate", while the DISCERN mean score for quality was 43.19 (SD 10.46) or "fair". Websites that placed higher in Google obtained a higher overall score for quality with an r (58) value of -.328 and a P value of .012, but this position was not related to readability or suitability. In addition, 20% of fertility clinic websites did not include fertility information for men. There is a lack of high quality online sources of information on male fertility. Many websites target their information to women, or fail to meet established readability criteria for the general population. Since men may prefer to seek health information online, it is important that health care professionals develop high quality sources of information on male fertility for the general population.

Development of SMOG-Cro readability formula for healthcare communication and patient education.

PubMed

Brangan, Sanja

2015-03-01

Effective communication shows a positive impact on patient satisfaction, compliance and medical outcomes, at the same time reducing the healthcare costs. Written information for patients needs to correspond to health literacy levels of the intended audiences. Readability formulas correlate well with the reading and comprehension tests but are considered an easier and quicker method to estimate a text difficulty. SMOG readability formula designed for English language needs to be modified if used for texts in other languages. The aim of this study was to develop a readability formula based on SMOG, that could be used to estimate text difficulty of written materials for patients in Croatian language. Contras- tive analysis of English and Croatian language covering a corpus of almost 100,000 running words showed clear linguis- tic differences in the number of polysyllabic words. The new formula, named SMOG-Cro, is presented as an equation: SMOG-Cro = 2 + √4+ syllables, with the score showing the number of years of education a person needs to be able to understand a piece of writing. The presented methodology could help in the development of readability formulas for other languages. We hope the results of this study are soon put into practice for more effective healthcare communication and patient education, and for development of a health literacy assessment tool in Croatian language.

A Machine Learning Approach to Measurement of Text Readability for EFL Learners Using Various Linguistic Features

ERIC Educational Resources Information Center

Kotani, Katsunori; Yoshimi, Takehiko; Isahara, Hitoshi

2011-01-01

The present paper introduces and evaluates a readability measurement method designed for learners of EFL (English as a foreign language). The proposed readability measurement method (a regression model) estimates the text readability based on linguistic features, such as lexical, syntactic and discourse features. Text readability refers to the…

Dr Google: The readability and accuracy of patient education websites for Graves' disease treatment.

PubMed

Purdy, Amanda C; Idriss, Almoatazbellah; Ahern, Susan; Lin, Elizabeth; Elfenbein, Dawn M

2017-11-01

National guidelines emphasize the importance of incorporating patient preferences into the recommendations for the treatment of Graves' disease. Many patients use the Internet to obtain health information, and search results can affect their treatment decisions. This study compares the readability and accuracy of patient-oriented online resources for the treatment of Graves' disease by website affiliation and treatment modality. A systematic Internet search was used to identify the top websites discussing the treatment of Graves' disease. Readability was measured using 5 standardized tests. Accuracy was assessed by a blinded, expert panel, which scored the accuracy of sites on a scale of 1 to 5. Mean readability and accuracy scores were compared among website affiliations and treatment modalities. We identified 13 unique websites, including 2 academic, 2 government, 5 nonprofit, and 4 private sites. There was a difference in both readability (mean 13.2, range 9.1-15.7, P = .003) and accuracy (mean 4.04, range 2.75-4.50, P = .019) based on website affiliation. Government sites (mean readability 11.1) were easier to read than academic (14.3, P < .01), nonprofit (13.9, P < .01), and private sites (13.5, P < .05). Academic sites (mean accuracy 4.50) were more accurate than private sites (3.56, P < .05). Online patient resources for the treatment of Graves' disease are written at an inappropriately high reading level. Academic sites contain both the most accurate and the most difficult to read information. Private sites represented the majority of our top results but contained the least accurate information. Copyright © 2017 Elsevier Inc. All rights reserved.

Evaluation of English Websites on Dental Caries by Using Consumer Evaluation Tools.

PubMed

Blizniuk, Anastasiya; Furukawa, Sayaka; Ueno, Masayuki; Kawaguchi, Yoko

2016-01-01

To evaluate the quality of patient-oriented online information about dental caries using existing consumer evaluation tools and to judge the efficacy of these tools in quality assessment. The websites for the evaluation were pooled by using two general search engines (Google and Yahoo!). The search terms were: 'dental caries', 'tooth decay' and 'tooth cavity'. Three assessment tools (LIDA, DISCERN and FRES) were used to evaluate the quality of the information in the areas of accessibility, usability, reliability and readability. In total, 77 websites were analysed. The median scores of LIDA accessibility and usability were 45.0 and 8.0, respectively, which corresponded to a medium level of quality. The median reliability scores for LIDA (12.0) and DISCERN (20.0) both corresponded to low level of quality. The readability was high with the median FRES score 59.7. The websites on caries had good accessibility, usability and readability, while reliability of the information was poor. The LIDA instrument was found to be more convenient than DISCERN and can be recommended to lay people for quick quality assessment.

Determining Readability: How to Select and Apply Easy-to-Use Readability Formulas to Assess the Difficulty of Adult Literacy Materials

ERIC Educational Resources Information Center

Burke, Victoria; Greenberg, Daphne

2010-01-01

There are many readability tools that instructors can use to help adult learners select reading materials. We describe and compare different types of readability tools: formulas calculated by hand, tools found on the Web, tools embedded in a word processing program, and readability tools found in a commercial software program. Practitioners do not…

Assessing Face Validity of a Food Behavior Checklist for Limited-resource Filipinos

PubMed Central

Buchthal, Opal Vanessa; Tauyan, Socorro

2015-01-01

Abstract Diet-related chronic health conditions are prevalent in the Filipino American community; however, there is a lack of rigorously validated nutrition education evaluation tools in Tagalog for use in this population. This study aimed to develop and evaluate the face validity of a Tagalog-language food behavior checklist (FBC). A multi-step method was used, involving translation of questionnaire text from English to Tagalog by a team of professionals, creation of accompanying color photographs, cognitive testing with the target population, final review by the team of professionals, and assessment of readability. Subjects for cognitive testing were men (n=6) and women (n=14) 18 years or older in Hawai‘i who received or were eligible to receive Supplemental Nutrition Assistance Program (SNAP) benefits, self-identified as Filipino, and preferred Tagalog rather than English. Participants were recruited from churches, the Filipino Center, and other community sites. Cognitive interviews revealed several issues with text and photographs, such as preferences for specific terms, and images that did not adequately illustrate the text. Image changes were made to reflect items most commonly consumed. The team of professionals agreed with participant suggestions. Assessment of readability revealed a reading level appropriate for a low-literacy population of grade 5.9. The multi-step process, which allowed members of the target audience to reveal the appropriateness of the questionnaire, yielded a Tagalog-language FBC found to have adequate face validity. After further evaluation of validity and reliability, this tool may be used to evaluate behavior change resulting from the United States Department of Agriculture's (USDA) nutrition education programs. PMID:26535163

A Qualitative and Quantitative Comparative Analysis of Commercial and Independent Online Information for Hip Surgery: A Bias in Online Information Targeting Patients?

PubMed

Kelly, Martin J; Feeley, Iain H; O'Byrne, John M

2016-10-01

Direct to consumer (DTC) advertising, targeting the public over the physician, is an increasingly pervasive presence in medical clinics. It is trending toward a format of online interaction rather than that of traditional print and television advertising. We analyze patient-focused Web pages from the top 5 companies supplying prostheses for total hip arthroplasties, comparing them to the top 10 independent medical websites. Quantitative comparison is performed using the Journal of American Medical Association benchmark and DISCERN criteria, and for comparative readability, we use the Flesch-Kincaid grade level, the Flesch reading ease, and the Gunning fog index. Content is analyzed for information on type of surgery and surgical approach. There is a statistically significant difference between the independent and DTC websites in both the mean DISCERN score (independent 74.6, standard deviation [SD] = 4.77; DTC 32.2, SD = 10.28; P = .0022) and the mean Journal of American Medical Association score (Independent 3.45, SD = 0.49; DTC 1.9, SD = 0.74; P = .004). The difference between the readability scores is not statistically significantly. The commercial content is found to be heavily biased in favor of the direct anterior approach and minimally invasive surgical techniques. We demonstrate that the quality of information on commercial websites is inferior to that of the independent sites. The advocacy of surgical approaches by industry to the patient group is a concern. This study underlines the importance of future regulation of commercial patient education Web pages. Copyright © 2016 Elsevier Inc. All rights reserved.

Informing the Uninformed: Optimizing the Consent Message Using a Fractional Factorial Design

PubMed Central

Tait, Alan R.; Voepel-Lewis, Terri; Nair, Vijayan N.; Narisetty, Naveen N.; Fagerlin, Angela

2013-01-01

Objective Research information should be presented in a manner that promotes understanding. However, many parents and research subjects have difficulty understanding and making informed decisions. This study was designed to examine the effect of different communication strategies on parental understanding of research information. Participants 640 parents of children scheduled for elective surgery Design Observational study using a fractional factorial design Setting Large tertiary care children's hospital Interventions Parents were randomized to receive information about a hypothetical pain trial presented in one of 16 consent documents containing different combinations of 5 selected communication strategies (i.e., length, readability, processability [formatting], graphical display, and supplemental verbal disclosure). Main outcome measures Parents were interviewed to determine their understanding of the study elements (e.g., protocol, alternatives etc.) and their gist (main point) and verbatim (actual) understanding of the risks and benefits. Results Main effects for understanding were found for processability, readability, message length, use of graphics, and verbal discussion. Consent documents with high processability, 8th grade reading level, and graphics resulted in significantly greater gist and verbatim understanding compared with forms without these attributes (mean difference, 95% CI = 0.57, 0.26–0.88, correct responses out of 7 and 0.54, 0.20–0.88 correct responses out of 4 for gist and verbatim, respectively). Conclusions Results identified several communication strategy combinations that improved parents' understanding of research information. Adoption of these active strategies by investigators, clinicians, IRBs, and study sponsors represents a simple, practical, and inexpensive means to optimize the consent message and enhance parental, participant, and patient understanding. PMID:23700028

A critical appraisal of vertebral fracture assessment in paediatrics.

PubMed

Kyriakou, Andreas; Shepherd, Sheila; Mason, Avril; Faisal Ahmed, S

2015-12-01

There is a need to improve our understanding of the clinical utility of vertebral fracture assessment (VFA) in paediatrics and this requires a thorough evaluation of its readability, reproducibility, and accuracy for identifying VF. VFA was performed independently by two observers, in 165 children and adolescents with a median age of 13.4 years (range, 3.6, 18). In 20 of these subjects, VFA was compared to lateral vertebral morphometry assessment on lateral spine X-ray (LVM). 1528 (84%) of the vertebrae were adequately visualised by both observers for VFA. Interobserver agreement in vertebral readability was 94% (kappa, 0.73 [95% CI, 0.68, 0.73]). 93% of the non-readable vertebrae were located between T6 and T9. Interobserver agreement per-vertebra for the presence of VF was 99% (kappa, 0.85 [95% CI, 0.79, 0.91]). Interobserver agreement per-subject was 91% (kappa, 0.78 [95% CI, 0.66, 0.87]). Per-vertebra agreement between LVM and VFA was 95% (kappa 0.79 [95% CI, 0.62, 0.92]) and per-subject agreement was 95% (kappa, 0.88 [95% CI, 0.58, 1.0]). Accepting LVM as the gold standard, VFA had a positive predictive value (PPV) of 90% and a negative predictive value (NPV) of 95% in per-vertebra analysis and a PPV of 100% and NPV of 93% in per-subject analysis. VFA reaches an excellent level of agreement between observers and a high level of accuracy in identifying VF in a paediatric population. The readability of vertebrae at the mid thoracic region is suboptimal and interpretation at this level should be exercised with caution. Copyright © 2015 Elsevier Inc. All rights reserved.

Readability of the Written Study Information in Pediatric Research in France

PubMed Central

Ménoni, Véronique; Lucas, Noël; Leforestier, Jean-François; Doz, François; Chatellier, Gilles; Jacqz-Aigain, Evelyne; Giraud, Carole; Tréluyer, Jean-Marc; Chappuy, Hélène

2011-01-01

Background The aim was to evaluate the readability of research information leaflets (RIL) for minors asked to participate in biomedical research studies and to assess the factors influencing this readability. Methods and Findings All the pediatric protocols from three French pediatric clinical research units were included (N = 104). Three criteria were used to evaluate readability: length of the text, Flesch's readability score and presence of illustrations. We compared the readability of RIL to texts specifically written for children (school textbooks, school exams or extracts from literary works). We assessed the effect of protocol characteristics on readability. The RIL had a median length of 608 words [350 words, 25th percentile; 1005 words, 75th percentile], corresponding to two pages. The readability of the RIL, with a median Flesch score of 40 [30; 47], was much poorer than that of pediatric reference texts, with a Flesch score of 67 [60; 73]. A small proportion of RIL (13/91; 14%) were illustrated. The RIL were longer (p<0.001), more readable (p<0.001) and more likely to be illustrated (p<0.009) for industrial than for institutional sponsors. Conclusion Researchers should routinely compute the reading ease of study information sheets and make greater efforts to improve the readability of written documents for potential participants. PMID:21494689

Accessibility of online self-management support websites for people with osteoarthritis: A text content analysis.

PubMed

Chapman, Lara; Brooks, Charlotte; Lawson, Jem; Russell, Cynthia; Adams, Jo

2017-01-01

Objectives This study assessed accessibility of online self-management support webpages for people with osteoarthritis by considering readability of text and inclusion of images and videos. Methods Eight key search terms developed and agreed with patient and public involvement representatives were entered into the Google search engine. Webpages from the first page of Google search results were identified. Readability of webpage text was assessed using two standardised readability indexes, and the number of images and videos included on each webpage was recorded. Results Forty-nine webpages met the inclusion criteria and were assessed. Only five of the webpages met the recommended reading level for health education literature. Almost half (44.9%) of webpages did not include any informative images to support written information. A minority of the webpages (6.12%) included relevant videos. Discussion Information provided on health webpages aiming to support patients to self-manage osteoarthritis may not be read, understood or used effectively by many people accessing it. Recommendations include using accessible language in health information, supplementing written information with visual resources and reviewing content and readability in collaboration with patient and public involvement representatives.

Neural Networks for Readability Analysis.

ERIC Educational Resources Information Center

McEneaney, John E.

This paper describes and reports on the performance of six related artificial neural networks that have been developed for the purpose of readability analysis. Two networks employ counts of linguistic variables that simulate a traditional regression-based approach to readability. The remaining networks determine readability from "visual…

Sexuality Education Websites for Adolescents: A Framework-Based Content Analysis.

PubMed

Marques, Sara S; Lin, Jessica S; Starling, M Summer; Daquiz, Aubrey G; Goldfarb, Eva S; Garcia, Kimberly C R; Constantine, Norman A

2015-01-01

The web has unique potential for adolescents seeking comprehensive sexual health information. As such, it is important to understand the nature, scope, and readability of the content and messaging provided by sexuality educational websites. We conducted a content analysis of 14 sexuality education websites for adolescents, based on the 7 essential components (sexual and reproductive health and HIV, relationships, sexual rights and sexual citizenship, pleasure, violence, diversity, and gender) of the International Planned Parenthood Framework for Comprehensive Sexuality Education. A majority of content across all sites focused on sexual and reproductive health and HIV, particularly pregnancy and STI prevention, and other information about STIs and HIV. No other topic comprised more than 10% of content coverage across a majority of sites. The authors found little discussion of gender issues, sexual rights, sexual diversity, or sexual violence. Most sites provided brief references to sexual pleasure, generally moderated with cautionary words. Language used implied a heterosexual female audience. Reading levels for most sites were above the 9th-grade level, with several at the college level. These findings have implications for enhancing online sexuality education and broadening the coverage of essential topics.

Promoting improved family caregiver health literacy: evaluation of caregiver communication resources.

PubMed

Wittenberg, Elaine; Goldsmith, Joy; Ferrell, Betty; Ragan, Sandra L

2017-07-01

Family caregivers of cancer patients have a vital role in facilitating and sharing information about cancer, revealing a need to develop caregiver health literacy skills to support caregiver communication. The goal of this study was to investigate caregiver print materials and develop and assess a new caregiver communication resource titled A Communication Guide for Caregivers TM . Using a model of six domains of caregiver health literacy skills, print cancer education materials were collected and evaluated for caregiver communication support. A new caregiver communication resource was also developed and assessed by caregivers and healthcare providers. Caregivers reviewed content and assessed utility, relatability, and reading quality. Healthcare providers also assessed whether the material would be understandable and usable for cancer caregivers. Only three of the 28 print materials evaluated were written at the recommended sixth grade reading level and only five addressed all six caregiver health literacy skills. Readability scores for A Communication Guide for Caregivers TM were at the sixth grade level, and caregivers reported its contents were relatable, useful, and easy to read. Healthcare providers also rated the material as easy for patient/family members of diverse backgrounds and varying levels of literacy to understand and use. Existing print-based caregiver education materials do not address caregivers' health literacy skill needs and are aimed at a highly literate caregiving population. A Communication Guide for Caregivers TM meets health literacy standards and family caregiver and provider communication needs. The findings are relevant for healthcare professionals who provide cancer education. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Assessing the Readability of Materials for Elementary ESL Pupils.

ERIC Educational Resources Information Center

Baldauf, Richard B., Jr.; Propst, Ivan K., Jr.

This paper assesses the effectiveness of readability indices, standard cloze procedure, and the matching cloze procedure as determinants of the readability of supplementary English materials for elementary ESL students in a Pacific Island context. A review of readability indices and the standard cloze procedure indicated that neither procedure is…

The Readability of Principles of Macroeconomics Textbooks

ERIC Educational Resources Information Center

Tinkler, Sarah; Woods, James

2013-01-01

The authors evaluated principles of macroeconomics textbooks for readability using Coh-Metrix, a computational linguistics tool. Additionally, they conducted an experiment on Amazon's Mechanical Turk Web site in which participants ranked the readability of text samples. There was a wide range of scores on readability indexes both among…

Online Health Information Regarding Male Infertility: An Evaluation of Readability, Suitability, and Quality

PubMed Central

Robins, Stephanie; Barr, Helena J; Idelson, Rachel; Lambert, Sylvie

2016-01-01

Background Many men lack knowledge about male infertility, and this may have consequences for their reproductive and general health. Men may prefer to seek health information online, but these sources of information vary in quality. Objective The objective of this study is to determine if online sources of information regarding male infertility are readable, suitable, and of appropriate quality for Internet users in the general population. Methods This study used a cross-sectional design to evaluate online sources resulting from search engine queries. The following categories of websites were considered: (1) Canadian fertility clinics, (2) North American organizations related to fertility, and (3) the first 20 results of Google searches using the terms “male infertility” and “male fertility preservation” set to the search locations worldwide, English Canada, and French Canada. Websites that met inclusion criteria (N=85) were assessed using readability indices, the Suitability Assessment of Materials (SAM), and the DISCERN tool. The associations between website affiliation (government, university/medical, non-profit organization, commercial/corporate, private practice) and Google placement to readability, suitability, and quality were also examined. Results None of the sampled websites met recommended levels of readability. Across all websites, the mean SAM score for suitability was 45.37% (SD 11.21), or “adequate”, while the DISCERN mean score for quality was 43.19 (SD 10.46) or “fair”. Websites that placed higher in Google obtained a higher overall score for quality with an r (58) value of -.328 and a P value of .012, but this position was not related to readability or suitability. In addition, 20% of fertility clinic websites did not include fertility information for men. Conclusions There is a lack of high quality online sources of information on male fertility. Many websites target their information to women, or fail to meet established readability criteria for the general population. Since men may prefer to seek health information online, it is important that health care professionals develop high quality sources of information on male fertility for the general population. PMID:27769954

A COMPARISON OF PATIENT AND HEALTHCARE PROFESSIONAL VIEWS WHEN ASSESSING QUALITY OF INFORMATION ON PITUITARY ADENOMA AVAILABLE ON THE INTERNET.

PubMed

Druce, Irena; Williams, Chantal; Baggoo, Carolyn; Keely, Erin; Malcolm, Janine

2017-10-01

Patients are increasingly turning to the internet to seek reliable sources of health information and desire guidance in assessing the quality of information as healthcare becomes progressively more complex. Pituitary adenomas are a rare, diverse group of tumors associated with increased mortality and morbidity whose management requires a multidisciplinary approach. As such, patients with this disorder are often searching for additional sources of healthcare information. We undertook a study to assess the quality of information available on the internet for patients with pituitary adenoma. After exclusion, 42 websites were identified based on a search engine query with various search terms. Each website was assessed in triplicate: once by a health professional, once by a simulated patient, and once by a patient who had a pituitary adenoma and underwent medical and surgical treatment. The assessment tools included a content-specific questionnaire, the DISCERN tool, and the Ensuring Quality Information for Patients tool. The readability of the information was assessed with the Flesch-Kincaid grade level. We found that the overall quality of information on pituitary adenoma on the internet was variable and written at a high grade level. Correlation between the different assessors was poor, indicating that there may be differences in how healthcare professionals and patients view healthcare information. Our findings highlight the importance of assessment of the health information by groups of the intended user to ensure the needs of that population are met. Abbreviation: EQIP = Ensuring Quality Information for Patients.

The Principles of Readability

ERIC Educational Resources Information Center

DuBay, William H.

2004-01-01

The principles of readability are in every style manual. Readability formulas are in every writing aid. What is missing is the research and theory on which they stand. This short review of readability research spans 100 years. The first part covers the history of adult literacy studies in the U.S., establishing the stratified nature of the adult…

Quality of consumer-targeted internet guidance on home firearm and ammunition storage.

PubMed

Freundlich, Katherine L; Skoczylas, Maria Shakour; Schmidt, John P; Keshavarzi, Nahid R; Mohr, Bethany Anne

2016-10-01

Four storage practices protect against unintentional and/or self-inflicted firearm injury among children and adolescents: keeping guns locked (1) and unloaded (2) and keeping ammunition locked up (3) and in a separate location from the guns (4). Our aim was to mimic common Google search strategies on firearm/ammunition storage and assess whether the resulting web pages provided recommendations consistent with those supported by the literature. We identified 87 web pages by Google search of the 10 most commonly used search terms in the USA related to firearm/ammunition storage. Two non-blinded independent reviewers analysed web page technical quality according to a 17-item checklist derived from previous studies. A single reviewer analysed readability by US grade level assigned by Flesch-Kincaid Grade Level Index. Two separate, blinded, independent reviewers analysed deidentified web page content for accuracy and completeness describing the four accepted storage practices. Reviewers resolved disagreements by consensus. The web pages described, on average, less than one of four accepted storage practices (mean 0.2 (95% CL 0.1 to 0.4)). Only two web pages (2%) identified all four practices. Two web pages (2%) made assertions inconsistent with recommendations; both implied that loaded firearms could be stored safely. Flesch-Kincaid Grade Level Index averaged 8.0 (95% CL 7.3 to 8.7). The average technical quality score was 7.1 (95% CL 6.8 to 7.4) out of an available score of 17. There was a high degree of agreement between reviewers regarding completeness (weighted κ 0.78 (95% CL 0.61 to 0.97)). The internet currently provides incomplete information about safe firearm storage. Understanding existing deficiencies may inform future strategies for improvement. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Consenting of the vulnerable: the informed consent procedure in advanced cancer patients in Mexico.

PubMed

Verástegui, Emma L

2006-12-13

A topic of great concern in bioethics is the medical research conducted in poor countries sponsored by wealthy nations. Western drug companies increasingly view Latin America as a proper place for clinical research trials. The region combines a large population, modern medical facilities, and low per capita incomes. Participants from developing countries may have little or non alternative means of treatment other than that offered through clinical trials. Therefore, the provision of a valid informed consent is important. To gain insight about some aspects of the informed consent procedure in a major cancer centre in Mexico, we conducted a three-step evaluation process: 1) a ten point multiple choice survey questionnaires, was used to explore some aspects of the patients' experiences during the informed consent process, 2) researchers' knowledge about specific aspects of the informed consent was evaluated in this study using survey questionnaires; and 3) the comprehensibility, readability and number of pages of the consent forms were analysed. The socioeconomic and educational level of the patients, were also considered. Results were reported using a numerical scale. Thirty five patients, 20 doctors, and 10 individuals working at the hospital agreed to participate in the study. Eighty three percent of the patients in the study were classified as living in poverty; education level was poor or non existent, and 31% of the patients were illiterate. The consent forms were difficult to understand according to 49% of the patients, most doctors agreed that the forms were not comprehensible to the patients. The average length of the IC documents analysed was 14 pages, and the readability average score was equivalent to 8th grade. The results presented in this work describe some relevant characteristics of the population seen at public health care institutions in Mexico. Poverty, limited or no education, and the complexity of the information provided to the patients may question the validity of the informed consent procedure in this group of patients.

Consenting of the vulnerable: the informed consent procedure in advanced cancer patients in Mexico

PubMed Central

Verástegui, Emma L

2006-01-01

Background A topic of great concern in bioethics is the medical research conducted in poor countries sponsored by wealthy nations. Western drug companies increasingly view Latin America as a proper place for clinical research trials. The region combines a large population, modern medical facilities, and low per capita incomes. Participants from developing countries may have little or non alternative means of treatment other than that offered through clinical trials. Therefore, the provision of a valid informed consent is important. Methods To gain insight about some aspects of the informed consent procedure in a major cancer centre in Mexico, we conducted a three-step evaluation process: 1) a ten point multiple choice survey questionnaires, was used to explore some aspects of the patients' experiences during the informed consent process, 2) researchers' knowledge about specific aspects of the informed consent was evaluated in this study using survey questionnaires; and 3) the comprehensibility, readability and number of pages of the consent forms were analysed. The socioeconomic and educational level of the patients, were also considered. Results were reported using a numerical scale. Results Thirty five patients, 20 doctors, and 10 individuals working at the hospital agreed to participate in the study. Eighty three percent of the patients in the study were classified as living in poverty; education level was poor or non existent, and 31% of the patients were illiterate. The consent forms were difficult to understand according to 49% of the patients, most doctors agreed that the forms were not comprehensible to the patients. The average length of the IC documents analysed was 14 pages, and the readability average score was equivalent to 8TH Grade. Conclusion The results presented in this work describe some relevant characteristics of the population seen at public health care institutions in Mexico. Poverty, limited or no education, and the complexity of the information provided to the patients may question the validity of the informed consent procedure in this group of patients. PMID:17166274

Lost in Translation: The Unintended Consequences of Advance Directive Law on Clinical Care

PubMed Central

Castillo, Lesley S.; Williams, Brie A.; Hooper, Sarah M.; Sabatino, Charles P.; Weithorn, Lois A.; Sudore, Rebecca L.

2011-01-01

Background Advance directive law may compromise the clinical effectiveness of advance directives. Purpose To identify unintended legal consequences of advance directive law that may prevent patients from communicating end-of-life preferences. Data Sources Advance directive legal statutes for all 50 U.S. states and the District of Columbia and English-language searches of LexisNexis, Westlaw, and MEDLINE from 1966 to August 2010. Study Selection Two independent reviewers selected 51 advance directive statutes and 20 articles. Three independent legal reviewers selected 105 legal proceedings. Data Extraction Two reviewers independently assessed data sources and used critical content analysis to determine legal barriers to the clinical effectiveness of advance directives. Disagreements were resolved by consensus. Data Synthesis Legal and content-related barriers included poor readability (that is, laws in all states were written above a 12th-grade reading level), health care agent or surrogate restrictions (for example, 40 states did not include same-sex or domestic partners as default surrogates), and execution requirements needed to make forms legally valid (for example, 35 states did not allow oral advance directives, and 48 states required witness signatures, a notary public, or both). Vulnerable populations most likely to be affected by these barriers included patients with limited literacy, limited English proficiency, or both who cannot read or execute advance directives; same-sex or domestic partners who may be without legally valid and trusted surrogates; and unbefriended, institutionalized, or homeless patients who may be without witnesses and suitable surrogates. Limitation Only appellate-level legal cases were available, which may have excluded relevant cases. Conclusion Unintended negative consequences of advance directive legal restrictions may prevent all patients, and particularly vulnerable patients, from making and communicating their end-of-life wishes and having them honored. These restrictions have rendered advance directives less clinically useful. Recommendations include improving readability, allowing oral advance directives, and eliminating witness or notary requirements. Primary Funding Source U.S. Department of Veterans Affairs and the Pfizer Foundation. PMID:21242368

37 CFR 1.825 - Amendments to or replacement of sequence listing and computer readable copy thereof.

Code of Federal Regulations, 2014 CFR

2014-07-01

... of sequence listing and computer readable copy thereof. 1.825 Section 1.825 Patents, Trademarks, and... Amino Acid Sequences § 1.825 Amendments to or replacement of sequence listing and computer readable copy... copy of the computer readable form (§ 1.821(e)) including all previously submitted data with the...

37 CFR 1.825 - Amendments to or replacement of sequence listing and computer readable copy thereof.

Code of Federal Regulations, 2013 CFR

2013-07-01

... of sequence listing and computer readable copy thereof. 1.825 Section 1.825 Patents, Trademarks, and... Amino Acid Sequences § 1.825 Amendments to or replacement of sequence listing and computer readable copy... copy of the computer readable form (§ 1.821(e)) including all previously submitted data with the...

37 CFR 1.825 - Amendments to or replacement of sequence listing and computer readable copy thereof.

Code of Federal Regulations, 2012 CFR

2012-07-01

... of sequence listing and computer readable copy thereof. 1.825 Section 1.825 Patents, Trademarks, and... Amino Acid Sequences § 1.825 Amendments to or replacement of sequence listing and computer readable copy... copy of the computer readable form (§ 1.821(e)) including all previously submitted data with the...

A Study of Readability of Texts in Bangla through Machine Learning Approaches

ERIC Educational Resources Information Center

Sinha, Manjira; Basu, Anupam

2016-01-01

In this work, we have investigated text readability in Bangla language. Text readability is an indicator of the suitability of a given document with respect to a target reader group. Therefore, text readability has huge impact on educational content preparation. The advances in the field of natural language processing have enabled the automatic…

37 CFR 1.825 - Amendments to or replacement of sequence listing and computer readable copy thereof.

Code of Federal Regulations, 2010 CFR

2010-07-01

... of sequence listing and computer readable copy thereof. 1.825 Section 1.825 Patents, Trademarks, and... Amino Acid Sequences § 1.825 Amendments to or replacement of sequence listing and computer readable copy... copy of the computer readable form (§ 1.821(e)) including all previously submitted data with the...

37 CFR 1.825 - Amendments to or replacement of sequence listing and computer readable copy thereof.

Code of Federal Regulations, 2011 CFR

2011-07-01

... of sequence listing and computer readable copy thereof. 1.825 Section 1.825 Patents, Trademarks, and... Amino Acid Sequences § 1.825 Amendments to or replacement of sequence listing and computer readable copy... copy of the computer readable form (§ 1.821(e)) including all previously submitted data with the...

Suitability of prostate cancer education materials: applying a standardized assessment tool to currently available materials.

PubMed

Weintraub, Debra; Maliski, Sally L; Fink, Arlene; Choe, Sarah; Litwin, Mark S

2004-11-01

Written educational materials serve as important teaching instruments for prostate cancer patients and their families. However, they must be understandable for their intended audiences. We examined prostate cancer brochures and pamphlets using the Suitability Assessment of Materials (SAM) instrument for the materials' overall suitability, readability, and cultural appropriateness. These factors are crucial to ensure that patients are able to understand and relate to the information. Our evaluation of 29 materials demonstrated that the majority, 22 (75.8%), scored "adequate" for their overall suitability. However, 26 materials (90%) scored "not suitable" for their reading grade level, while 55% of the materials could not be rated on cultural appropriateness because of lack of cues about the intended audience. Also, many of the materials scored poorly on content, graphics, self-efficacy, and learning motivation and stimulation. Most of the materials did well with typography and layout. Overall, the findings point to the need to carefully assess written materials used for multicultural audiences with low reading ability.

[Systematic analysis of the readability of patient information on websites of German nonuniversity ENT hospitals].

PubMed

Meyer, M F; Bacher, R; Roth, K S; Beutner, D; Luers, J C

2014-03-01

Besides their function as one of the main contact points, websites of hospitals serve as medical information portals. All patients should be able to understand medical information texts; regardless of their literacy skills and educational level. Online texts should thus have an appropriate structure to ease their comprehension. Patient information texts on every German nonuniversity ENT hospital website (n = 125) were systematically analysed. For ten different ENT topics a representative medical information text was extracted from each website. Using objective text parameters and five established readability indices, the texts were analysed in terms of their readability and structure. Furthermore, we stratified the analysis in relation to the hospital organisation system and geographical region in Germany. Texts from 142 internet sites could be used for the definite analysis. On average, texts consisted of 15 sentences and 237 words. Readability indices congruously showed that the analysed texts could generally only be understood by a well-educated or even academic reader. The majority of patient information texts on German hospital websites are difficult to understand for most patients. In order to fulfil their goal of adequately informing the general population about disease, therapeutic options and the particular focal points of the clinic, a revision of most medical texts on the websites of German ENT hospitals is recommended.

Determining the Best Science Blogger: Teachers or Scientists?

NASA Astrophysics Data System (ADS)

Timm, K.; Lower, T. A.; Sparrow, E. B.; Niles, B. A.

2011-12-01

The International Polar Year (2007-2008) was an international scientific campaign to study and raise awareness of the Earth's polar regions. Several scientists and educators that visited the polar regions during this time used a blog to share their day-to-day and scientific research activities with school children and the general public. Due to advances in technology, scientists and others were able to post their daily stories and photos online to share the science and their adventures from sometimes very remote locations in the polar regions. Not having large budgets for outreach, blogs are a commonly used outreach tool because they can be free or relatively inexpensive to set up and maintain. However, in order for this approach to be successful, the readability and words used must be accessible to the target audience. This study uses the Flesch Reading Ease Analysis and Quantitative Phenomenology to compare blogs from three groups of people, including teachers, scientists, and scientists who had received special blog and multimedia training. Quantitative Phenomenology provides a quantitative means to analyze large quantities of written text and determine relative word frequencies by comparing word counts from a selected body of text with that of the American National Corpus. This method was used to determine the amount of scientific jargon used in the blogs of each group, because cognitively, approaching jargon when reading is like approaching a complex word with several syllables. Despite training, both groups of scientists wrote on average at an eighth to ninth grade reading level and used more scientific jargon in their blogs. Teachers who wrote from the field wrote on average at a seventh grade level, and while they used some scientific jargon they spent more time talking about life in the field than scientists. As funding agencies continue to require and encourage outreach activities by scientists, such as blogs, it is important that proper training and tools are in place so that activities are accessible to the target audiences and match their cognitive abilities. While the seventh to ninth grade reading level is probably fairly accessible for many adults, the grade level is probably too high for most elementary and early middle school students and much higher than popular literature. Science blogs have the potential to contribute greatly to scientific literacy, but only if the public and students are able to read and understand what they are reading with ease.

[Readability of surgical informed consent in Spain].

PubMed

San Norberto, Enrique María; Gómez-Alonso, Daniel; Trigueros, José M; Quiroga, Jorge; Gualis, Javier; Vaquero, Carlos

2014-03-01

To assess the readability of informed consent documents (IC) of the different national surgical societies. During January 2012 we collected 504 IC protocols of different specialties. To calculate readability parameters the following criteria were assessed: number of words, syllables and phrases, syllables/word and word/phrase averages, Word correlation index, Flesch-Szigriszt index, Huerta Fernández index, Inflesz scale degree and the Gunning-Fog index. The mean Flesch-Szigriszt index was 50.65 ± 6,72, so readability is considered normal. There are significant differences between specialties such as Urology (43.00 ± 4.17) and Angiology and Vascular Surgery (63.00 ± 3.26, P<.001). No IC would be appropriate for adult readability according to the Fernández-Huerta index (total mean 55.77 ± 6.57); the IC of Angiology and Vascular Surgery were the closest ones (67.85 ± 3.20). Considering the Inflesz scale degree (total mean of 2.84 ± 3,23), IC can be described as «somewhat difficult». There are significant differences between the IC of Angiology and Vascular Surgery (3.23 ± 0.47) that could be qualified as normal, or Cardiovascular Surgery (2.79 ± 0.43) as «nearly normal readability»; and others such as Urology (1, 70 ± 0.46, P<.001) and Thoracic Surgery (1.90 ± 0.30, P<.001), with a readability between «very» and «somewhat» difficult. The Gunning-Fog indexes are far from the readability for a general audience (total mean of 26.29 ± 10,89). IC developed by scientific societies of different surgical specialties do not have an adequate readability for patients. We recommend the use of readability indexes during the writing of these consent forms. Copyright © 2012 AEC. Published by Elsevier Espana. All rights reserved.

Reply to "Further issues in determining the readability of self-report items: comment on McHugh and Behar (2009)".

PubMed

McHugh, R Kathryn; Behar, Evelyn

2012-12-01

In his commentary on our previously published article "Readability of Self-Report Measures of Depression and Anxiety," J. Schinka (2012) argued for the importance of considering readability of patient materials and highlighted limitations of existing methodologies for this assessment. Schinka's commentary articulately described the weaknesses of readability assessment and emphasized the importance of the development of improved strategies for assessing readability to maximize the validity of self-report measures in applied settings. In our reply, we support and extend Schinka's argument, highlighting the importance of consideration of the range of factors (e.g., use of reverse-scored items) that may increase respondent difficulty with comprehension. Consideration of the readability of self-report symptom measures is critical to the validity of these measures in both clinical practice and research settings.

Physics Matters, 1st Edition, with Student Access Card eGrade Plus 1 Term Set

NASA Astrophysics Data System (ADS)

Trefil, James

2004-04-01

Written by authors who have vast experience in communicating science to general audiences, Physics Matters conveys the principles of physics in a manner that is understandable to non-majors. In a prose style that is clear, engaging, and contemporary, it pays particular attention to the relevance of physics in comprehending our modern technological society and the issues created by those technologies. It offers a broad, relatively non-mathematical, and highly readable survey of all the standard topics in physics. Before you buy, make sure you are getting the best value and all the learning tools you'll need to succeed in your course. If your professor requires eGrade Plus, you can purchase it now at no additional cost! With this special eGrade Plus package you get the new text--no highlighting, no missing pages, no food stains--an activity book with class activities, self study and homework assignments, as well as a registration code to eGrade Plus, a suite of effective learning tools to help you get a better grade. eGrade Plus gives you: A complete online version of the textbook Video experiments Student web projects Self assessment tests Homework questions with links to the relevant section of the online book eGrade Plus is a powerful online tool that provides students with an integrated suite of teaching and learning resources and an online version of the text in one easy-to-use website.

Assessment of Readability and Learning of Easy-to-Read Educational Health Materials Designed and Written with the Help of Citizens by Means of Two Non-Alternative Methods

ERIC Educational Resources Information Center

Daghio, M. Monica; Fattori, Giuseppe; Ciardullo, Anna V.

2006-01-01

Objectives: We compared two non-alternative methods to assess the readability and learning of easy-to-read educational health materials co-written by physicians, educators and citizens. Methods: Data from seven easy-to-read materials were analyzed. Readability formulae, and ad hoc data on readability and learning were also computed. Results: The…

The PRIDE (Partnership to Improve Diabetes Education) Toolkit: Development and Evaluation of Novel Literacy and Culturally Sensitive Diabetes Education Materials.

PubMed

Wolff, Kathleen; Chambers, Laura; Bumol, Stefan; White, Richard O; Gregory, Becky Pratt; Davis, Dianne; Rothman, Russell L

2016-02-01

Patients with low literacy, low numeracy, and/or linguistic needs can experience challenges understanding diabetes information and applying concepts to their self-management. The authors designed a toolkit of education materials that are sensitive to patients' literacy and numeracy levels, language preferences, and cultural norms and that encourage shared goal setting to improve diabetes self-management and health outcomes. The Partnership to Improve Diabetes Education (PRIDE) toolkit was developed to facilitate diabetes self-management education and support. The PRIDE toolkit includes a comprehensive set of 30 interactive education modules in English and Spanish to support diabetes self-management activities. The toolkit builds upon the authors' previously validated Diabetes Literacy and Numeracy Education Toolkit (DLNET) by adding a focus on shared goal setting, addressing the needs of Spanish-speaking patients, and including a broader range of diabetes management topics. Each PRIDE module was evaluated using the Suitability Assessment of Materials (SAM) instrument to determine the material's cultural appropriateness and its sensitivity to the needs of patients with low literacy and low numeracy. Reading grade level was also assessed using the Automated Readability Index (ARI), Coleman-Liau, Flesch-Kincaid, Fry, and SMOG formulas. The average reading grade level of the materials was 5.3 (SD 1.0), with a mean SAM of 91.2 (SD 5.4). All of the 30 modules received a "superior" score (SAM >70%) when evaluated by 2 independent raters. The PRIDE toolkit modules can be used by all members of a multidisciplinary team to assist patients with low literacy and low numeracy in managing their diabetes. © 2015 The Author(s).

Readability, Reading Ability, and Readership.

ERIC Educational Resources Information Center

Kern, Richard P.; And Others

This paper presents data describing large differences between the reading difficulty levels of printed materials used in certain military occupational specialties (MOSs) and the relatively lower reading ability levels of men assigned to these MOSs. Initial data explore the relationship between reading ability and utilization of printed materials…

A rapid review of treatment literacy materials for tuberculosis patients.

PubMed

Brumwell, A; Noyes, E; Kulkarni, S; Lin, V; Becerra, M C; Yuen, C M

2018-03-01

To assess available treatment literacy materials for patients undergoing treatment for tuberculosis (TB). We conducted a rapid review by searching the US Centers for Disease Control's Find TB Resources website and the websites of health departments and TB-focused organizations. We included English-language documents intended to educate TB patients about anti-tuberculosis treatment. We evaluated the format, readability, and content of documents, and audience. We defined 12 essential content elements based on those previously identified as facilitating human immunodeficiency virus treatment literacy. Of the 205 documents obtained, 45 were included in our review. The median reading grade level was 7 (IQR 5-8). The median number of essential content elements present was 6 (IQR 4-8), with the most comprehensive document containing 11 of the 12 elements. Only two documents were written for children with TB or their care givers, and two for patients with drug-resistant TB. Many documents contained paternalistic and non-patient-centered language. We found few examples of comprehensive, patient-centered documents. Work is needed to achieve consensus as to the essential elements of TB treatment literacy and to create additional materials for children, patients with drug-resistant TB, and those with lower literacy levels.

Toolsets for Airborne Data (TAD): Improving Machine Readability for ICARTT Data Files

NASA Astrophysics Data System (ADS)

Northup, E. A.; Early, A. B.; Beach, A. L., III; Kusterer, J.; Quam, B.; Wang, D.; Chen, G.

2015-12-01

NASA has conducted airborne tropospheric chemistry studies for about three decades. These field campaigns have generated a great wealth of observations, including a wide range of the trace gases and aerosol properties. The ASDC Toolsets for Airborne Data (TAD) is designed to meet the user community needs for manipulating aircraft data for scientific research on climate change and air quality relevant issues. TAD makes use of aircraft data stored in the International Consortium for Atmospheric Research on Transport and Transformation (ICARTT) file format. ICARTT has been the NASA standard since 2010, and is widely used by NOAA, NSF, and international partners (DLR, FAAM). Its level of acceptance is due in part to it being generally self-describing for researchers, i.e., it provides necessary data descriptions for proper research use. Despite this, there are a number of issues with the current ICARTT format, especially concerning the machine readability. In order to overcome these issues, the TAD team has developed an "idealized" file format. This format is ASCII and is sufficiently machine readable to sustain the TAD system, however, it is not fully compatible with the current ICARTT format. The process of mapping ICARTT metadata to the idealized format, the format specifics, and the actual conversion process will be discussed. The goal of this presentation is to demonstrate an example of how to improve the machine readability of ASCII data format protocols.

What Are Your Patients Reading Online About Soft-tissue Fillers? An Analysis of Internet Information

PubMed Central

Al Youha, Sarah A.; Bull, Courtney E.; Butler, Michael B.; Williams, Jason G.

2016-01-01

Background: Soft-tissue fillers are increasingly being used for noninvasive facial rejuvenation. They generally offer minimal downtime and reliable results. However, significant complications are reported and patients need to be aware of these as part of informed consent. The Internet serves as a vital resource to inform patients of the risks and benefits of this procedure. Methods: Three independent reviewers performed a structured analysis of 65 Websites providing information on soft-tissue fillers. Validated instruments were used to analyze each site across multiple domains, including readability, accessibility, reliability, usability, quality, and accuracy. Associations between the endpoints and Website characteristics were assessed using linear regression and proportional odds modeling. Results: The majority of Websites were physician private practice sites (36.9%) and authored by board-certified plastic surgeons or dermatologists (35.4%) or nonphysicians (27.7%). Sites had a mean Flesch-Kincaid grade level of 11.9 ± 2.6, which is well above the recommended average of 6 to 7 grade level. Physician private practice sites had the lowest scores across all domains with a notable lack of information on complications. Conversely, Websites of professional societies focused in plastic surgery and dermatology, as well as academic centers scored highest overall. Conclusions: As the use of soft-tissue fillers is rising, patients should be guided toward appropriate sources of information such as Websites sponsored by professional societies. Medical professionals should be aware that patients may be accessing poor information online and strive to improve the overall quality of information available on soft-tissue fillers. PMID:27536503

Machine-readable files developed for the High Plains Regional Aquifer-System analysis in parts of Colorado, Kansas, Nebraska, New Mexico, Oklahoma, South Dakota, Texas, and Wyoming

USGS Publications Warehouse

Ferrigno, C.F.

1986-01-01

Machine-readable files were developed for the High Plains Regional Aquifer-System Analysis project are stored on two magnetic tapes available from the U.S. Geological Survey. The first tape contains computer programs that were used to prepare, store, retrieve, organize, and preserve the areal interpretive data collected by the project staff. The second tape contains 134 data files that can be divided into five general classes: (1) Aquifer geometry data, (2) aquifer and water characteristics , (3) water levels, (4) climatological data, and (5) land use and water use data. (Author 's abstract)

Document fraud deterrent strategies: four case studies

NASA Astrophysics Data System (ADS)

Mercer, John W.

1998-04-01

This paper discusses the approaches taken to deter fraud committed against four documents: the machine-readable passport; the machine-readable visa; the Consular Report of Birth Abroad; and the Border Crossing Card. General approaches are discussed first, with an emphasis on the reasons for the document, the conditions of its use and the information systems required for it to function. A cost model of counterfeit deterrence is introduced. Specific approaches to each of the four documents are then discussed, in light of the issuance circumstances and criteria, the intent of the issuing authority, the applicable international standards and the level of protection and fraud resistance appropriate for the document.

Textbook Reading Levels

ERIC Educational Resources Information Center

Hopkins, Charles R.; Kim, Paul Y.

1974-01-01

Since the reading abilities of general business students vary from one individual to the next, the author's report on the readability of three general business textbooks to guide business teachers in their selection of textbooks. (AG)

Selected Reading Materials for Learning Disabled Adolescents.

ERIC Educational Resources Information Center

Graham, Steve

1983-01-01

To identify reading materials suitable for learning disabled adolescents, teachers should determine areas of student interest, predict the student's reading level, and determine the material's readablity. Then the match between the student and material should be evaluated in terms of reading level, interest, word recognition, and comprehension.…

Readability Approaches: Implications for Turkey

ERIC Educational Resources Information Center

Ulusoy, Mustafa

2006-01-01

Finding the right fit between students' reading ability and textbooks is very important for comprehension. Readability studies aim to analyse texts to find the right fit between students and texts. In this literature review, readability studies are classified under quantitative, qualitative and combined quantitative-qualitative readability…

Readability in 1968.

ERIC Educational Resources Information Center

Bormuth, John R., Ed.

This bulletin presents four papers on how to control, manipulate, and predict the readability of printed materials. The first paper describes trends in readability brought about by research tools developed by psychologists and linguists. The second paper explores the effects of word frequency in printed materials on comprehension and concludes…

Readability and Recall of Short Prose Passages: A Theoretical Analysis.

ERIC Educational Resources Information Center

Miller, James R.; Kintsch, Walter

1980-01-01

To support the view of readability as an interaction between a text and the reader's prose-processing capabilities, this article applies an extended and formalized version of the Kintch and van Dijk prose-processing model to 20 texts of varying readability. (Author/GSK)

We the People: Elementary Pre-Service Teachers and Constitutional Readability

ERIC Educational Resources Information Center

Meier, Lori T.; Keith, Karin J.; Dwyer, Edward J.

2014-01-01

In light of increasing mandates to incorporate close reading of primary source historical documents at the elementary level, this study explored the reading difficulty level of the US Constitution with preservice elementary teachers using a traditional cloze assessment procedure. While best practice pedagogy of social studies has long included…

Readability as a Factor in Magazine Ad Copy Recall.

ERIC Educational Resources Information Center

Wesson, David A.

1989-01-01

Examines the relationship between advertising copy readability and advertising effectiveness. Finds that recall is improved when the copy style is either fairly easy or fairly hard to read. Suggests the value of considering copy readability as a potential contributor, though a minor one, to the success of magazine advertising. (RS)

Measuring the Readability of Elementary Algebra Using the Cloze Technique.

ERIC Educational Resources Information Center

Kulm, Gerald

The relationship to readability of ten variables characterizing structural properties of mathematical prose was investigated in elementary algebra textbooks. Readability was measured by algebra student's responses to two forms of cloze tests. Linear and currilinear correlations were calculated between each structural variable and the cloze test.…

Xeml Lab: a tool that supports the design of experiments at a graphical interface and generates computer-readable metadata files, which capture information about genotypes, growth conditions, environmental perturbations and sampling strategy.

PubMed

Hannemann, Jan; Poorter, Hendrik; Usadel, Björn; Bläsing, Oliver E; Finck, Alex; Tardieu, Francois; Atkin, Owen K; Pons, Thijs; Stitt, Mark; Gibon, Yves

2009-09-01

Data mining depends on the ability to access machine-readable metadata that describe genotypes, environmental conditions, and sampling times and strategy. This article presents Xeml Lab. The Xeml Interactive Designer provides an interactive graphical interface at which complex experiments can be designed, and concomitantly generates machine-readable metadata files. It uses a new eXtensible Mark-up Language (XML)-derived dialect termed XEML. Xeml Lab includes a new ontology for environmental conditions, called Xeml Environment Ontology. However, to provide versatility, it is designed to be generic and also accepts other commonly used ontology formats, including OBO and OWL. A review summarizing important environmental conditions that need to be controlled, monitored and captured as metadata is posted in a Wiki (http://www.codeplex.com/XeO) to promote community discussion. The usefulness of Xeml Lab is illustrated by two meta-analyses of a large set of experiments that were performed with Arabidopsis thaliana during 5 years. The first reveals sources of noise that affect measurements of metabolite levels and enzyme activities. The second shows that Arabidopsis maintains remarkably stable levels of sugars and amino acids across a wide range of photoperiod treatments, and that adjustment of starch turnover and the leaf protein content contribute to this metabolic homeostasis.

Survey of Commercially Available Computer-Readable Bibliographic Data Bases.

ERIC Educational Resources Information Center

Schneider, John H., Ed.; And Others

This document contains the results of a survey of 94 U. S. organizations, and 36 organizations in other countries that were thought to prepare machine-readable data bases. Of those surveyed, 55 organizations (40 in U. S., 15 in other countries) provided completed camera-ready forms describing 81 commercially available, machine-readable data bases…

Readability and Its Effects on Reading Rate, Subjective Judgments of Comprehensibility and Comprehension.

ERIC Educational Resources Information Center

Coke, Esther U.

Prose passages read aloud or silently were rated for pronounceability and comprehensibility. The relationships of text-derived readability indices to reading rate, comprehensibility ratings and comprehension test scores were explored. Reading rate in syllables per minute was unrelated to readability. The high correlation between rate in words per…

77 FR 7 - Revisions to Labeling Requirements for Blood and Blood Components, Including Source Plasma

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-03

... requirements will facilitate the use of a labeling system using machine-readable information that would be... components. Furthermore, we proposed the use of a labeling system using machine-readable information that...; Facilitates the use of a labeling system using machine- readable information that would be acceptable as a...

How Readability and Topic Incidence Relate to Performance on Mathematics Story Problems in Computer-Based Curricula

ERIC Educational Resources Information Center

Walkington, Candace; Clinton, Virginia; Ritter, Steven N.; Nathan, Mitchell J.

2015-01-01

Solving mathematics story problems requires text comprehension skills. However, previous studies have found few connections between traditional measures of text readability and performance on story problems. We hypothesized that recently developed measures of readability and topic incidence measured by text-mining tools may illuminate associations…

Computational Text Analysis: A More Comprehensive Approach to Determine Readability of Reading Materials

ERIC Educational Resources Information Center

Aziz, Anealka; Fook, Chan Yuen; Alsree, Zubaida

2010-01-01

Reading materials are considered having high readability if readers are interested to read the materials, understand the content of the materials and able to read the materials fluently. In contrast, reading materials with low readability discourage readers from reading the materials, create difficulties for readers to understand the content of…

6 CFR 37.19 - Machine readable technology on the driver's license or identification card.

Code of Federal Regulations, 2011 CFR

2011-01-01

..., States must use the ISO/IEC 15438:2006(E) Information Technology—Automatic identification and data... 6 Domestic Security 1 2011-01-01 2011-01-01 false Machine readable technology on the driver's..., Verification, and Card Issuance Requirements § 37.19 Machine readable technology on the driver's license or...

6 CFR 37.19 - Machine readable technology on the driver's license or identification card.

Code of Federal Regulations, 2010 CFR

2010-01-01

..., States must use the ISO/IEC 15438:2006(E) Information Technology—Automatic identification and data... 6 Domestic Security 1 2010-01-01 2010-01-01 false Machine readable technology on the driver's..., Verification, and Card Issuance Requirements § 37.19 Machine readable technology on the driver's license or...

Text Readability and Intuitive Simplification: A Comparison of Readability Formulas

ERIC Educational Resources Information Center

Crossley, Scott A.; Allen, David B.; McNamara, Danielle S.

2011-01-01

Texts are routinely simplified for language learners with authors relying on a variety of approaches and materials to assist them in making the texts more comprehensible. Readability measures are one such tool that authors can use when evaluating text comprehensibility. This study compares the Coh-Metrix Second Language (L2) Reading Index, a…