The readability and suitability of sexual health promotion leaflets

Googling long-acting reversible contraception: A scoping review examining the information available online about intrauterine devices and contraceptive implants

ISSUE ADDRESSED

The internet is an important source of health information, however, the quality of information about long-acting reversible contraception (LARC, including intrauterine devices (IUDs) and contraceptive implants) found online is largely unknown.

METHODS

A scoping review of webpages returned in a Google search was conducted. The first three pages of results were included if they were written in English and contained information about LARC. Results were critically reviewed and assessed using the DISCERN quality of health information tool.

RESULTS

Of 778 results, 306 pages met the eligibility criteria. While most webpages provided key information about LARC, including location in the body, benefits, side effects and risks, the information provided varied considerably. Only half mentioned efficacy and many webpages did not provide information about the cost of insertion and removal, how and where to access the devices or how they work. Despite side effects being mentioned in more than three-quarters of webpages, the depth and specificity of these varied considerably and were often contradictory across different webpages.

CONCLUSIONS

Most webpages provided medically accurate information to consumers; however, many did not include key information such as cost or how they work. Descriptions of side effects varied between webpages, and this may inhibit informed decision-making. SO WHAT?: Most people make decisions about what contraceptive method they might like to use before visiting a health care provider, and most will get this information from the internet. Providing comprehensive, medically accurate and consistent information about both IUDs and contraceptive implants is vital to support informed decision-making.

'You are making it sound like you are talking to a child': exploring community sentiment on developing and disseminating tailored sexual health education resources for migrants

Health communication is a critical component of public health, which includes health education resources. Resource effectiveness is improved where health literacy demands, including the cultural appropriateness of resources, match the intended audience. International guidelines support the tailoring of resources for migrants from culturally and linguistically diverse backgrounds (CaLD). Five focus groups (n = 18) and interviews (n = 9) with people from CaLD migrant backgrounds explored community perspectives on sexual health resources developed by a state department of health, specifically clarity, comprehensiveness, cultural appropriateness and strategies for dissemination. We identified three major thematic areas relating to simplicity, cultural norms and beliefs and dissemination. Participants recommended resource delivery in different formats as part of a broader intervention. Generally, sexual health information was deemed appropriate and easily understood. However, the resources used simplified language that participants reported was vague and inaccurate at times, potentially contributing to misinformation and reinforcing stigma relating both to the status of being a migrant and sexual health. Findings suggest the need for more nuanced health resource development beyond translation and language simplification. Resources developed in different formats, including different health literacy demands, using approaches that engage the target group in design and dissemination and contextualized within a comprehensive health promotion project, are likely to be more effective.

Readability of online monkeypox patient education materials: Improved recognition of health literacy is needed for dissemination of infectious disease information

BACKGROUND

Health literacy is key to navigating the current global epidemic of misinformation and inaccuracy relating to healthcare. The American Medical Association (AMA) suggests health information should be written at the level of American sixth grade. With the monkeypox outbreak being declared a Public Health Emergency of International Concern (PHEIC) in July 2022, we sought to assess the readability of online patient education materials (PEMs) relating to monkeypox to see if they are at the target level of readability.

METHODS

A search was conducted on Google.com using the search term 'Monkeypox'. The top 50 English language webpages with patient education materials (PEMs) relating to monkeypox were compiled and categorised by country of publication and URL domain. Readability was assessed using five readability tools: Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), Gunning Fog Index (GFI), Coleman-Liau Index (CLI), and, Simple Measure of Gobbledygook Index (SMOG). Unpaired t-test for URL domain, and one-way ANOVA for country were performed to determine influence on readability.

RESULTS

Three of the five tools (FRES, GFI, CLI) identified no webpages that met the target readability score. The FKGL and SMOG tools identified one (2%) and two (4%) webpages respectively that met the target level. County and URL domain demonstrated no influence on readability.

CONCLUSION

Online PEMs relating to monkeypox are written above the recommended reading level. Based on the previously established effect of health literacy, this is likely exacerbating health inequalities. This study highlights the need for readability to be considered when publishing online PEMs.

Patient prompts in surgical consultations: A systematic review

BACKGROUND

Quality communication has been found to improve patient outcomes. Despite good communication, information may still be forgotten or misunderstood by patients. A question prompt list is a document to help patients ask questions. Question prompt lists are well perceived by various stakeholders and have been found of benefit to patients. This systematic review evaluated the effectiveness of patient question prompting documents in surgical outpatient consultations.

METHODS

MEDLINE, EMBASE, and PsychINFO were searched on September 13, 2021. Study selection, data extraction, and risk of bias assessment were performed in duplicate. We included English studies that investigated the use of question prompt lists and their influence on patient outcomes. We excluded studies that did not have a comparator group. Because of heterogeneity of outcome measures, meta-analysis was precluded. This study was registered with PROSPERO (identification number: CRD42021279058).

RESULTS

Searches identified 107 suitable studies; however, only 7 studies met eligibility criteria. All included studies were randomized controlled trials, but the designs of studies were heterogenous. Three out of 7 included studies were at a high risk of bias. The included studies investigated different outcomes that could be broadly categorized into 5 themes: consultation characteristics, patient engagement, patient well-being, information exchange, and patient satisfaction. None of the studies looked at patient recall of information. Aside from length of consultation, the overall results for each category were mixed.

CONCLUSION

Current literature has suggested that question prompt lists are a low-risk intervention that could improve patient engagement and patient-doctor communication; however, there is limited evidence at present to conclusively promote their usage in perioperative surgical consultations.

Sexual health communication in COPD: The role, contents and design of patient information leaflets

Understanding need for support and information among people with COPD is important for the delivery of patient-centred care. Especially regarding intimacy matters, many people wish to remain sexually active but may be struggling to find out how, as information and communication regarding sexual health is scarce. This is especially true when it comes to people with chronic obstructive pulmonary disease (COPD). The present review seeks to provide an overview of the role, contents and design of patient information leaflets (PILs) and discuss their application in sexual health communication for COPD. Based on the literature, a number of key points in the design of high-quality PILs are suggested, and important areas for the improvement of patients-clinician communication are highlighted. While PILs is a commonly used format to provide information in healthcare, other formats, e.g. video and podcasts, could be explored. Prioritizing the development of material to support communication in the future is necessary to address the needs of both patients and caregivers and to support clinicians in initiating conversations about sexual health and intimacy matters.

An assessment of the readability of online material related to fluoride

Community water fluoridation has been deemed one of the greatest public health achievements, yet it remains a controversial topic. As those who are concerned about the benefits and safety of community water fluoridation are likely to turn to the Internet to find information, it is important to know the ease with which a person can read popular materials online. The aim of this study was to assess the readability levels of pro- and anti-fluoride articles on the Internet. Using a highly-recommended readability site, the first 100 articles garnered from websites in a Google were analyzed for a multitude of scores on popular readability tests. Of the 100 articles analyzed, 71 were deemed to be pro-fluoride, and 29 were anti-fluoride. Anti-fluoride materials were more readable across all scores when compared to the pro-fluoride materials. It is critical for consumers to be aware of the credibility of the health information they are reading and to be educated on how to determine if a website or source is reliable, especially when information is conflicting. It is also critical that health associations and other websites devoted to public health promotion develop and provide more accessible health information in terms of readability.

Suitability of patient education materials on proton-pump inhibitors deprescribing: a focused review

PURPOSE

Engaging patients in the process of deprescribing is a necessity. Several patient education materials have been developed for this purpose. The aim of this study was to assess the suitability of the existing patient education materials for proton-pump inhibitors deprescribing.

METHODS

We conducted a targeted inventory of the available materials on scientific literature and known repositories. We evaluated their suitability with the Suitability Assessment of Materials (SAM) instrument. Materials were rated independently by two researchers and then discussed until consensus was reached.

RESULTS

Seven patient education materials were identified. Three materials (42.9%) were deemed "superior" and 4 (57.1%) were deemed "adequate". Ratings were generally good in the categories of content, learning stimulation, motivation, typography and layout. The major weaknesses included the use of inappropriate graphics and the too demanding required reading grade level. These may decrease patient attention and comprehension and therefore the effectiveness of education materials.

CONCLUSIONS

Suitability of the patient education materials on proton-pump inhibitors deprescribing is overall satisfactory. Greater attention on readability, graphics and inclusion of summaries will be needed for development of future materials.

‘To be understood as to understand’: A readability analysis of public library acceptable use policies

Acceptable Use Policies (AUPs) are documents stating the limitations users must agree to when first accessing information and communications technologies (ICTs) in organisations, such as employers, educational institutions and public libraries. AUPs lay out the parameters of acceptable use expected of someone accessing the ICT services provided, and should state in clear and understandable terms what behaviours will attract sanctions, both legal and in terms of restricting future access. Utilising a range of standard readability tests used to measure how understandable documents are, the paper investigates how readable the AUPs presented to public library patrons in the UK are in practice. Of the 206 AUPs in use across the local government departments who manage public library services 200 were obtained and subjected to a range of readability testing procedures. Four readability tests were used for analysis: the Flesch Reading Ease, the Coleman-Liau Index, the Gunning Fog Index and the SMOG Grade. Results for all four readability tests administered on all AUPs raise significant questions. For the Flesch Reading Ease score only 5.5% of AUPs scored at the standard readability level or higher (60+), and 8% scored at a very high level of difficulty akin to a piece of scientific writing. Similarly, for SMOG, only 7.5% of the 200 AUPs scored at the recommended level of 10. Likewise, very few AUPs scored at levels recommended for a general audience with either the Gunning Fog Index (11.5%) or the Coleman-Liau Index (2%). With such variability in readability, the fitness for purpose of the average AUP as a contract patrons must agree to can be called into question. This paper presents the first ever analysis of the readability of library AUPs in the literature. Recommendations are made as to how public library services may improve this aspect of practice.

Developing Infographics to Facilitate HIV-Related Patient-Provider Communication in a Limited-Resource Setting

BACKGROUND

Productive patient-provider communication is a recognized component of high-quality health care that leads to better health outcomes. Well-designed infographics can facilitate effective communication, especially when culture, language, or literacy differences are present.

OBJECTIVES

This study aimed to rigorously develop infographics to improve human immunodeficiency virus (HIV)-related patient-provider communication in a limited-resource setting. A secondary purpose was to establish through participant feedback that infographics convey intended meaning in this clinical and cultural context.

METHODS

We adapted a participatory design methodology, developed in a high-resource setting, for use in the Dominican Republic. Initially, content to include was established using a data-triangulation method. Then, infographics were iteratively generated and refined during five phases of design sessions with three stakeholder groups: (1) 25 persons living with HIV, (2) 8 health care providers, and (3) 5 domain experts. Suggestions for improvement were incorporated between design sessions and questions to confirm interpretability of infographics were included at the end of each session.

RESULTS

Each participant group focused on different aspects of infographic designs. Providers drew on past experiences with patients and offered clinically and contextually relevant recommendations of symbols and images to include. Domain experts focused on technical design considerations and interpretations of infographics. While it was difficult for patient participants to provide concrete suggestions, they provided feedback on the meaning of infographics and responded clearly to direct questions regarding possible changes. Fifteen final infographics were developed and all participant groups qualitatively confirmed that they displayed the intended content in a culturally appropriate and clinically meaningful way.

CONCLUSION

Incorporating perspectives from various stakeholders led to the evolution of designs over time and generated design recommendations that will be useful to others creating infographics for use in similar populations. Next steps are to assess the feasibility of using infographics to improve clinical communication and patient outcomes.

Balanced nutrition and hand hygiene for children in South Africa

Globally, ∼5.9 million children under the age of 5 years died in 2015, with the challenges of child mortality and morbidity being common in developing countries. Many of these deaths are preventable and poor nutritional and hygienic practices contribute greatly to these rates. The spread of infectious disease through unhygienic practices, such as inadequate hand hygiene, remains high due to lack of education regarding hygienic infection control practices at home and in the workplace. The aim of this research was to design and implement a participatory health promotion intervention for caregivers at the Rhodes Day Care Centre (RDCC) that highlighted these important public health issues. We conducted a pre-intervention group feedback discussion with caregivers at the RDCC to identify current practices and to establish the current baseline knowledge of the caregivers. Health workshops with caregivers was facilitated by the researcher, and health information leaflets (HILs) were designed for and used during these workshops. Caregivers at RDCC exhibited fair baseline knowledge on the importance of providing nourishing meals to the infants, including the need for exclusive breastfeeding, and the importance of hand hygiene in preventing the spread of disease. This basic knowledge was positively built upon in the two health promotion intervention workshops. This initiative, held at RDCC, was able to catalyse the development of health knowledge that could have a substantial impact on the understanding of health literacy of the caregivers and on the promotion of adequate child health in the community.

Suitability of asthma education materials for school-age children: Implications for health literacy

AIMS AND OBJECTIVES

To investigate the suitability of asthma education materials for school-age children with asthma and elucidate how these children used their health-literacy abilities to identify whether the materials can be accepted, comprehended and applied.

BACKGROUND

Effective asthma self-management education is influenced by the suitability of materials and an individual's health literacy.

DESIGN

A mixed-method research design was developed using quantitative and qualitative surveys.

METHODS

The suitability of the materials was assessed on the basis of the Chinese version of the Suitability Assessment of Materials by five experts. In addition, five school-age children (age: 8-12 years) were recruited and interviewed.

RESULTS

In total, 25 pieces of asthma education material for children were collected. On the basis of their type, the materials were categorised as nine brochures, 11 leaflets and five videos. Of the 25 materials, 17 were rated as superior materials, whereas eight were rated as adequate materials. The suitability scores of the video-based materials were significantly higher than those of the brochures and leaflets (p = .006). One print material was considered to have a reading level suitable for fifth-grade or younger children, whereas the remaining materials were considered suitable for sixth-grade or older children. The following six health-literacy domains were identified: recognising asthma through body knowledge, posing reflective questions, identifying self-care difficulties, receiving adult guidance, learning with enjoyment and addressing learning requirements.

CONCLUSIONS

The video-based materials had integrated content and were appealing to children. Cartoon animations, interactive computer games, and skill demonstrations may enhance learning stimulation and motivation and increase learning effects in children.

RELEVANCE TO CLINICAL PRACTICE

The present results may help healthcare providers to understand children's capacities to manage their disease, effectively address children's requirements and function as a key resource for children to strengthen their literacy in asthma management.

Assessing and Validating an Educational Resource Package for Health Professionals to Improve Smoking Cessation Care in Aboriginal and Torres Strait Islander Pregnant Women

Australian Aboriginal pregnant women have a high smoking prevalence (45%). Health professionals lack adequate educational resources to manage smoking. Resources need to be tailored to ensure saliency, cultural-sensitivity and account for diversity of Indigenous populations. As part of an intervention to improve health professionals' smoking cessation care in Aboriginal pregnant women, a resource package was developed collaboratively with two Aboriginal Medical Services. The purpose of this study was to assess and validate this resource package. A multi-centred community-based participatory 4-step process (with three Aboriginal Medical Services from three Australian states), included: (1) Scientific review by an expert panel (2) 'Suitability of Materials' scoring by two Aboriginal Health Workers (3) Readability scores (4) Focus groups with health professionals. Content was analysed using six pre-determined themes (attraction, comprehension, self-efficacy, graphics and layout, cultural acceptability, and persuasion), with further inductive analysis for emerging themes. Suitability of Material scoring was adequate or superior. Average readability was grade 6.4 for patient resources (range 5.1-7.2), and 9.8 for health provider resources (range 8.5-10.6). Emergent themes included 'Getting the message right'; 'Engaging with family'; 'Needing visual aids'; and 'Requiring practicality under a tight timeframe'. Results were presented back to a Stakeholder and Consumer Aboriginal Advisory Panel and resources were adjusted accordingly. This process ensured materials used for the intervention were culturally responsive, evidence-based and useful. This novel formative evaluation protocol could be adapted for other Indigenous and culturally diverse interventions. The added value of this time-consuming and costly process is yet to be justified in research, and might impact the potential adaption by other projects.

Understanding online health information: Evaluation, tools, and strategies

OBJECTIVE

Considering the status of the Internet as a prominent source of health information, assessing online health material has become a central issue in patient education. We describe the strategies available to evaluate the characteristics of online health information, including readability, emotional content, understandability, usability.

METHODS

Popular tools used in assessment of readability, emotional content and comprehensibility of online health information were reviewed. Tools designed to evaluate both printed and online material were considered.

RESULTS

Readability tools are widely used in online health material evaluation and are highly covariant. Assessment of emotional content of online health-related communications via sentiment analysis tools is becoming more popular. Understandability and usability tools have been developed specifically for health-related material, but each tool has important limitations and has been tested on a limited number of health issues.

CONCLUSION

Despite the availability of numerous assessment tools, their overall reliability differs between readability (high) and understandability (low). Approaches combining multiple assessment tools and involving both quantitative and qualitative observations would optimize assessment strategies.

PRACTICE IMPLICATIONS

Effective assessment of online health information should rely on mixed strategies combining quantitative and qualitative evaluations. Assessment tools should be selected according to their functional properties and compatibility with target material.