The Impact of Medical Terminology on Readability of Patient Education Materials

Readability of Online Patient Education Materials for Congenital Hand Differences

BACKGROUND

The aim of the study is to assess the readability of online patient education materials (PEMs) for congenital hand differences.

METHODS

The top 10 online, English-language PEMs for 10 conditions (polydactyly, syndactyly, trigger finger/thumb, clinodactyly, camptodactyly, symbrachydactyly, thumb hypoplasia, radial dysplasia, reduction defect, and amniotic band syndrome) were compiled and categorized by source and country. Readability was assessed using 5 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). To account for the potential effect of each condition's name in the aforementioned formulas, the analysis was repeated after replacing the name with a monosyllabic word/s.

RESULTS

The mean readability scores of the 100 PEMs were FRES 56.3, where the target was ≥80, FKGL 8.8, GFI 11.5, CLI 10.9, and SMOG 8.6, and the median grade score was 9.8, where the target grade was ≤6.9. Following adjustment, all readability scores improved significantly (P < .001). Postadjustment scores were FRES 63.8, FKGL 7.8, GFI 10.7, CLI 9.1, and SMOG 8.0, and the median grade score was 8.6. Only 1 webpage met the target level using all tools. Two-sample t test for country of publication (the United States and the United Kingdom) demonstrated that PEMs originating from the United Kingdom were easier to read using the preadjustment CLI (P = .009) and median grade metrics (P = .048). A 1-way analysis of variance revealed no influence of condition or source on readability.

CONCLUSION

Most online PEMs for congenital hand differences are written above the recommended reading level of sixth grade, even when adjusted for the effect of the condition's name.

Development and content validity of the caregiver assisted transfer technique instrument

Informal caregivers often provide transfer assistance to individuals with disabilities; however, repeated transfers are associated with a high risk of musculoskeletal pain and injury, and training and education around transfers is minimal. The purpose of this study was to develop and assess the content validity of a new tool, the Caregiver Assisted Transfer Technique Instrument (CATT), which could be used to provide an objective indicator of transfer performance. Item importance, clarity, and appropriateness of responses were rated on a five-point Likert scale by clinicians (n = 15), informal caregivers (n = 10), and individuals with spinal cord injury (n = 5). The content validity index and modified Kappa of each item was calculated. Participants also provided qualitative feedback on item content. In general, items were rated favorably for their importance (4.47 to 5.00), clarity (4.33 to 4.90), and appropriateness of responses (4.38 to 4.90), and most items had excellent content validity (k* ≥ 0.75). Feedback from participants led to the creation of two versions of the CATT: one for manual lifting techniques (CATT-M) and one for transfers performed via lift-based technologies (CATT-L). Future work will focus on establishing the reliability and validity of the CATT as well as developing training and education interventions surrounding assisted transfers.

Assessment of online information on robotic cardiac and thoracic surgery

Online health resources are important for patients seeking perioperative information on robotic cardiac and thoracic surgery. The value of the resources depends on their readability, accuracy, content, quality, and suitability for patient use. We systematically assess current online health information on robotic cardiac and thoracic surgery. Systematic online searches were performed to identify websites discussing robotic cardiac and thoracic surgery. For each website, readability was measured by nine standardized tests, and accuracy and content were assessed by an independent panel of two robotic cardiothoracic surgeons. Quality and suitability of websites were evaluated using the DISCERN and Suitability Assessment of Materials tools, respectively. A total of 220 websites (120 cardiac, and 100 thoracic) were evaluated. Both robotic cardiac and thoracic surgery websites were very difficult to read with mean readability scores of 13.8 and 14.0 (p = 0.97), respectively, requiring at least 13 years of education to be comprehended. Both robotic cardiac and thoracic surgery websites had similar accuracy, amount of content, quality, and suitability (p > 0.05). On multivariable regression, academic websites [Exp (B)], 2.25; 95% confidence interval [CI], 1.60-3.16; P < 0.001), and websites with higher amount of content [Exp (B)],1.73; 95% CI, 1.24-2.41; P < 0.001) were associated with higher accuracy. There was no association between readability of websites and accuracy [Exp (B)], 1.04; 95% CI, 0.90-1.21; P = 0.57). Online information on robotic cardiac and thoracic surgery websites overestimate patients' understanding and require at least 13 years of education to be comprehended. As website accuracy is not associated with ease of reading, the readability of online resources can be improved without compromising accuracy.

Evaluation of quality and readability of internet information on voice disorders

OBJECTIVES

The purpose of this study is to evaluate the readability and quality of Internet information related to vocal health, voice disorders and voice therapy.

STUDY DESIGN

This is a cross-sectional study.

METHODS

Eighty-two websites were included. Websites were then analyzed; their origin (clinic/hospital, non-profit, government), quality (Health On the Net [HON] certification and DISCERN scores) and readability (Ateşman readability formula and Bezirci-Yılmaz new readability formula) were assessed. Statistical analysis was used to examine differences between website origin and quality and readability scores and correlations between readability instruments.

RESULTS

Of the 82 websites, 93% were of private clinic/hospital, 6% were of non-profit organisation and 1% were of government. None of the 82 websites were HON certification, and the mean score of the item determining the general quality measure in DISCERN was 1.83 in a five-point scale. The mean of Ateşman readability formula value was calculated as 50.46 (±8.16). This value is defined as 'moderately hard' according to the readability scale. The average of Bezirci-Yılmaz new readability formula value is 13.85 (±3.48). This value is defined as 13th and 14th grade.

CONCLUSIONS

The quality of Internet-based health information about the voice is generally inadequate, and the sites examined in this study may be limited due to high readability levels. This may be a problem in people with poor literacy skills. For this reason, it is very important for speech and language therapists and other health professionals to evaluate and monitor the quality and readability of Internet-based information.

Predicting Health Material Accessibility: Development of Machine Learning Algorithms

Background

Current health information understandability research uses medical readability formulas to assess the cognitive difficulty of health education resources. This is based on an implicit assumption that medical domain knowledge represented by uncommon words or jargon form the sole barriers to health information access among the public. Our study challenged this by showing that, for readers from non-English speaking backgrounds with higher education attainment, semantic features of English health texts that underpin the knowledge structure of English health texts, rather than medical jargon, can explain the cognitive accessibility of health materials among readers with better understanding of English health terms yet limited exposure to English-based health education environments and traditions.

Objective

Our study explores multidimensional semantic features for developing machine learning algorithms to predict the perceived level of cognitive accessibility of English health materials on health risks and diseases for young adults enrolled in Australian tertiary institutes. We compared algorithms to evaluate the cognitive accessibility of health information for nonnative English speakers with advanced education levels yet limited exposure to English health education environments.

Methods

We used 113 semantic features to measure the content complexity and accessibility of original English resources. Using 1000 English health texts collected from Australian and international health organization websites rated by overseas tertiary students, we compared machine learning (decision tree, support vector machine [SVM], ensemble tree, and logistic regression) after hyperparameter optimization (grid search for the best hyperparameter combination of minimal classification errors). We applied 5-fold cross-validation on the whole data set for the model training and testing, and calculated the area under the operating characteristic curve (AUC), sensitivity, specificity, and accuracy as the measurement of the model performance.

Results

We developed and compared 4 machine learning algorithms using multidimensional semantic features as predictors. The results showed that ensemble classifier (LogitBoost) outperformed in terms of AUC (0.858), sensitivity (0.787), specificity (0.813), and accuracy (0.802). Support vector machine (AUC 0.848, sensitivity 0.783, specificity 0.791, and accuracy 0.786) and decision tree (AUC 0.754, sensitivity 0.7174, specificity 0.7424, and accuracy 0.732) followed. Ensemble classifier (LogitBoost), support vector machine, and decision tree achieved statistically significant improvement over logistic regression in AUC, sensitivity, specificity, and accuracy. Support vector machine reached statistically significant improvement over decision tree in AUC and accuracy. As the best performing algorithm, ensemble classifier (LogitBoost) reached statistically significant improvement over decision tree in AUC, sensitivity, specificity, and accuracy.

Conclusions

Our study shows that cognitive accessibility of English health texts is not limited to word length and sentence length as had been conventionally measured by medical readability formulas. We compared machine learning algorithms based on semantic features to explore the cognitive accessibility of health information for nonnative English speakers. The results showed the new models reached statistically increased AUC, sensitivity, and accuracy to predict health resource accessibility for the target readership. Our study illustrated that semantic features such as cognitive ability–related semantic features, communicative actions and processes, power relationships in health care settings, and lexical familiarity and diversity of health texts are large contributors to the comprehension of health information; for readers such as international students, semantic features of health texts outweigh syntax and domain knowledge.

Written Informed Consent-Translating into Plain Language. A Pilot Study

Background: Informed consent is important in clinical practice, as a person’s written consent is required prior to many medical interventions. Many informed consent forms fail to communicate simply and clearly. The aim of our study was to create an easy-to-understand form. Methods: Our assessment of a Polish-language plastic surgery informed consent form used the Polish-language comprehension analysis program (jasnopis.pl, SWPS University) to assess the readability of texts written for people of various education levels; and this enabled us to modify the form by shortening sentences and simplifying words. The form was re-assessed with the same software and subsequently given to 160 adult volunteers to assess the revised form’s degree of difficulty or readability. Results: The first software analysis found the language was suitable for people with a university degree or higher education, and after revision and re-assessment became suitable for persons with 4–6 years of primary school education and above. Most study participants also assessed the form as completely comprehensible. Conclusions: There are significant benefits possible for patients and practitioners by improving the comprehensibility of written informed consent forms.

ProTGTlsm: Diseño y evaluación de una aplicación para la educación sexual de jóvenes sordos mexicanos

Las personas sordas usuarias de la lengua de señas (LS) conforman una de las poblaciones más vulnerables ante las infecciones de transmisión sexual (ITS) y a tener un embarazo no deseado, debido al limitado acceso a fuentes de información confiables que se ajusten a su lengua. El propósito del estudio fue diseñar y evaluar la usabilidad de una aplicación web como estrategia educativa para promover la salud sexual en jóvenes sordos mexicanos. Un grupo multidisciplinario de seis profesionales y siete miembros de la comunidad sorda participaron en el diseño (centrado en el usuario) y construcción de dicha aplicación, denominada ProTGTlsm. Consta de cinco módulos: ITS, métodos anticonceptivos, uso del preservativo, uso correcto y pasos para su colocación. La usabilidad de la versión final de ProTGTlsm fue evaluada por 13 jóvenes sordos (7 hombres y 6 mujeres, entre 18 y 29 años), bajo los criterios establecidos en la Norma ISO 9241-11. Los resultados sugieren que ProTGTlsm es una herramienta fácil de usar, informativa y del gusto de los participantes, por lo que podría ser utilizada en futuros programas de intervención orientados a esta población.

Readability Assessment of Online Patient Education Materials on Atrial Fibrillation

Health literacy is emerging as an important factor for medical outcomes as more patients turn to the internet for information about their disease. However educational materials on complex conditions such as atrial fibrillation tend to still be esoteric and result in compromised patient autonomy. We add to the current literature by examining the reading level of websites of major healthcare intuitions and general medicine websites. An online Google search using the term "atrial fibrillation" was used to collect patient educational material from the first 20 academic health institutions (AHI) and 20 non-affiliated general medicine websites (GMW). The materials were assessed for readability using nine (9) tests from the analysis software Readability Studio (Oleander Software Solutions Ltd., Maharashtra, India). The patient education materials from the AHI and GMW websites were written at a college freshman reading grade level (13.050 ± 0.845) and high school junior year reading level (11.64 ± 0.789) respectively. The GMW tend to have a wider range of readability levels, and many were scored at the 6th-grade level. In conclusion, the readability levels of patient education materials on atrial fibrillation from both the AHI and GMW are well above the 6th-grade level recommended by the NIH and AMA, posing a risk to the patients' understanding of the materials. The high readability scores found across all websites and the differences between the groups have been attributed to the various goals and target audiences of the material.

The readability of online health resources for phenylketonuria

Phenylketonuria (PKU) is a condition that results in the build-up of phenylalanine in the blood. This can cause severe brain damage and neurological issues if left untreated. Management can be complex and many individuals may turn to the internet to access further information. It is important that resources are understood as misinterpretation could result in harm to health. The aim of this study was to assess the readability of online resources for PKU and to assess their visual appearance using a communication sciences assessment framework. We searched the top five websites through Google using the search term “phenylketonuria/PKU”. We then analysed the text content of the identified websites using five readability formulae to determine the USA and UK reading grade. The median readability level across the five websites was US grade/UK grade 10.6/11.6, with individual grades ranging from 10/11 to 13.3/14.3. We found wide differences in the focus, layout and general appearance of the websites. The readability of resources was much higher than the recommended US 6th grade level. Online resources for PKU need to be simplified to ensure they can be easily understood.

Development and pilot of a decision-aid for patients with bipolar II disorder and their families making decisions about treatment options to prevent relapse

Introduction

Treatment decisions in bipolar II disorder (BPII) are finely-balanced and sensitive to patient preferences. This pilot study evaluated a decision-aid booklet (DA) for patients with BPII (and their family) to obtain evidence on its acceptability, feasibility, safety, and usefulness in potential end-users.

Methods

The DA booklet was developed according to International Patient Decision-Aid Standards. Thirty-one patients diagnosed with BPII and their families (n = 11), who were currently making or had previously made treatment decisions, participated. Participants read the DA and completed validated and purpose-designed questionnaires. A follow-up semi-structured telephone interview elicited more in-depth DA feedback (n = 40).

Results

Patients and family endorsed the DA booklet as: easy-to-use (100% agree), useful in treatment decision-making (100%), presenting balanced (patients = 96.8%, family = 100%), up-to-date (93.5%, 100%) and trustworthy information (93.5%, 100%) that did not provoke anxiety (93.5%, 90.9%). All participants stated that they would recommend the DA to others. Following DA use, all except one participant (97.6%) demonstrated adequate treatment knowledge (> 50% score). Patients reported low decisional conflict (M = 18.90/100) following DA use and felt well-prepared to make treatment decisions (M = 4.28/5). Most patients (90.3%) indicated uptake of treatments consistent with the best available clinical evidence. Additionally, a large proportion of patients made an informed choice about medication (65.5%) with adjunctive psychological treatment (50.0%), based on adequate knowledge and their treatment values. Interview findings further supported the DA’s acceptability among participants.

Discussion

Pilot findings indicate that patients with BPII and their family consider this DA booklet highly acceptable and useful in making evidence-based treatment decisions that align with their treatment preferences.

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

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.

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

Background

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.

Methods

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.

Results

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).

Conclusions

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.

Readability analysis of online resources related to lung cancer

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

Readability Assessment of Patient Information about Lymphedema and Its Treatment

BACKGROUND

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.

METHODS

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.

RESULTS

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).

CONCLUSIONS

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.

Evaluating a handbook for parents of children with food allergy: a randomized clinical trial

BACKGROUND

Educational materials are needed to support parent management of and coping with childhood food allergy.

OBJECTIVES

To evaluate whether a food allergy handbook can improve parental knowledge, confidence, and quality of life associated with the management of food allergy.

METHODS

Participants included 153 parents of children diagnosed as having food allergy within the past 12 months who were recruited from hospital-based allergy clinics and food allergy organizations. Parents were randomly assigned to receive the food allergy handbook either after a baseline survey (handbook group) or at the conclusion of study participation (control group). Outcomes were assessed using online surveys at baseline, 2-week follow-up, and 2-month follow-up.

RESULTS

Compared with parents in the control group, parents in the handbook group had significantly greater improvement in knowledge at the 2-week (mean difference, 2.92; 95% confidence interval [CI], 2.20-3.64; P < .001) and 2-month (mean difference, 2.46; 95% CI, 1.68-3.25; P < .001) follow-ups, significantly greater improvement in confidence at the 2-week (mean difference, 0.24; 95% CI, 0.09-0.39; P = .002) and 2-month (mean difference, 0.47; 95% CI, 0.30-0.63; P < .001) follow-ups, and significantly greater improvement in quality of life at the 2-month follow-up (mean difference, -0.48; 95% CI, -0.79 to -0.16; P = .004). Parents reported satisfaction with the content the handbook, with mean ratings of individual sections ranging from 2.7 to 3.2 on a 0- to 4-point scale and modal ratings of 3 (very useful).

CONCLUSIONS

The food allergy handbook evaluated in this study is an effective parent resource to supplement physician management of food allergy.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT01914978.

Readability of Healthcare Literature for Hepatitis B and C

BACKGROUND

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.

AIM

We explored the readability of online resources concerning hepatitis B and C.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

Posters as assessment strategies: focusing on service users

This article debates whether posters as an assessment strategy in health professionals' education programmes can benefit learners, academics, and service users. Evidence suggests that service-user involvement benefits learning by developing students' communication, partnership and advocacy skills. The authors debate the value of posters as an assessment strategy in postgraduate diploma nursing programmes delivered in an Irish School of Nursing, Midwifery and Health Systems. It is argued that assessment strategies should not only examine programme theory and practice but should also benefit the people that will be using the service. Although the assessment strategy used in these programmes aimed to benefit service users, additional work is required for assessment to be truly inclusive of service users.

Patient education for carpal tunnel syndrome: analysis of readability

BACKGROUND

The National Institutes of Health and American Medical Association recommend a sixth grade reading level for patient-directed content. This study aims to quantitatively evaluate the readability of the most commonly used resources for surgical treatment of carpal tunnel syndrome.

METHODS

A web search for "carpal tunnel surgery" was performed using an Internet search engine, and the 13 most popular sites were identified. Relevant, patient-directed articles immediately accessible from the main site were downloaded and formatted into plain text. A total of 102 articles were assessed for readability using ten established analyses: first overall, then by website for comparison.

RESULTS

Patient information about carpal tunnel surgery had an overall average reading level of 13.1. Secondary analysis by website revealed a range of mean readability from 10.8 (high school sophomore level) to 15.3 (university junior level). All sites exceeded the recommended sixth grade reading level.

CONCLUSIONS

Online patient resources for carpal tunnel surgery uniformly exceed the recommended reading level. These are too difficult to be understood by a large portion of American adults. A better understanding of readability may be useful in tailoring more appropriate resources for average patient literacy.

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

OBJECTIVES/HYPOTHESIS

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.

STUDY DESIGN

Descriptive and correlational design.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

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

OBJECTIVES/HYPOTHESIS

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.

STUDY DESIGN

A descriptive and correlational design was used for this study.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

Readability of hospice materials to prepare families for caregiving at the time of death

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.

Comprehensibility of patient consent forms for radiation therapy of cervical cancer

OBJECTIVE

The construct of Health Literacy (HL) deals with patients' capacity to understand their health-related instructions, consent forms, and other documents. A significant challenge of providing healthcare to patients with low HL is the complex nature of the disease process, and of requisite treatments. In radiation oncology specifically, the delivery of ionizing radiation is difficult enough to describe; describing radiation toxicity in terms of the underlying physics and biology is daunting. A multimodal analysis of a small sample of patient consent forms was undertaken in order to address this issue more closely, and identify the extent to which such literature contributes to the challenges faced by patients with low HL.

METHODS

Members of national cooperative group panels dealing with gynecologic cancer were asked to submit copies of consent forms provided to patients with stage II cervical cancer. Four such forms were submitted and reviewed by a single person with expertise in linguistics using standard tools.

RESULTS

Three of the four consents scored within the lower portion of the "adequate" range. One consent was not suitable. Consent readability ranged from grades 12.18 to 16.13; this means that they required at least a high school education to interpret, and in two cases required post-graduate coursework.

CONCLUSION

There is significant room for improvement in consent form design and structure. When considering cultural and socioeconomic appropriateness of patient consent forms, input of staff with expertise in linguistics should be sought.

Analysis of comprehensibility of patient information regarding complex craniofacial conditions

PURPOSE

Health care consumers are increasingly turning to the Internet for information regarding medical and surgical procedures. When an elective procedure is under consideration, the Internet is often the first resource used by a patient. Caregivers of craniofacial patients are typically overwhelmed during the surgical planning process. A firm understanding of craniofacial condition and the associated procedures is crucial to obtain satisfactory outcomes. Furthermore, health care providers are increasingly referring their patients to on-line sources of patient education material. Currently, the National Institutes of Health suggests the information be at the fourth- to sixth-grade reading level to maximize comprehension. Much of the information available regarding health care targeted at patients is written at a 10th-grade reading level or higher. The purpose of this study was to evaluate readily available on-line patient education information for readability; being aware of this information will aid craniofacial surgeons in appropriately educating their patients.

METHODS

Texts were extracted from commonly used craniofacial educational Web sites regarding reconstructive procedures. Three objective and accepted methods (SMOG, Flesch-Kincaid, and Dale-Chall) were used to assess readability of each condition and its corresponding procedure's text.

RESULTS

The results from all 3 of the methods used were higher than the recommended seventh-grade reading level. The mean reading level for eMedicine was 13.8, 15.2, and 15 for the Flesch-Kincaid, SMOG, and Dale-Chall methods, respectively. Likewise, the mean reading levels for FACES were 7.5, 10.7, and 8.3; and for World Craniofacial Foundation, the levels were 11.9, 13.8, and 13.

CONCLUSIONS

Patient education and understanding is a critical factor in planning for surgery; this is especially true of reconstructive craniofacial procedures. Craniofacial surgery is a diverse field, and its surgeons have correspondingly diverse practices. It is up to each individual surgeon to determine what is appropriate for his or her patients. Our results show that on-line educational material is at a level that is substantially higher than the national reading average. The ultimate impact of this fact will vary from practice to practice, but all surgeons should be aware of the possible conflicts between information distributed and the patient's ability to comprehend that information. This may assist surgeons in preoperative evaluations by discussing conditions with more level appropriate means.

Reading Grade Level of Plan B Instructions and Patient Information Materials on Emergency Contraception

Background:

Plan B recently became a schedule III product in Canada. Patients can now access Plan B without a pharmacist consult and may rely only on the packaging information provided to learn about the medication. It is recommended that health information materials directed at patients be written at or below a grade 8 level. We assessed the reading grade level of the Plan B packaging information and of patient information materials on Plan B and emergency contraception.

Methods:

Plan B packaging information was obtained from the manufacturer, and a convenience sample of 10 patient information materials on Plan B and emergency contraception were collected from pharmacies and clinics in Edmonton, Alberta, and from Canadian websites. The Fry graph and SMOG formula were used to measure readability of the materials.

Results:

The Plan B packaging information had a mean reading grade level of 12.8. The mean reading grade level of patient information materials was 12.9 for print materials and 13.4 for online materials.

Conclusions:

Plan B packaging information and patient information materials relating to Plan B and emergency contraception are written at reading grade levels beyond the recommendations for patient health literature.

Patients and jargon: are we speaking the same language?

STUDY OBJECTIVE

To assess the ability of surgical patients to understand words commonly used during the anesthetic preoperative visit.

DESIGN

Questionnaire study.

SETTING

Preanesthetic holding area of a university hospital.

PATIENTS

96 perioperative ASA physical status I, II, III, and IV outpatients and patients to be admitted.

INTERVENTIONS

Patients were asked to complete a questionnaire that asked each to define 10 terms commonly used during the preoperative interview. Patients also answered three demographic questions as part of the survey.

MEASUREMENTS

Understanding of 10 commonly used terms, first language, age, and highest education level were all recorded.

MAIN RESULTS

Of the 10 terms, 4 had a greater than 80% correct response rate: EKG, i.v., general anesthesia, and local or regional anesthesia, with correct response rates of 92.7%, 91.7%, 81.3%, and 81.3%, respectively. The terms with the poorest understanding were NPO (31.3%), MI (32.3%), and pulse ox (39.6%). The rest of the terms, with their correct response rates, were as follows: GERD (67.7%), hypertension (70.8%), and intubate (60.4%). Whereas higher education was associated with correct answer score, age was not.

CONCLUSIONS

Most patients understand the words EKG and i.v.. Further clarification might be needed when discussing general and regional anesthesia, and other words should be avoided or else explained.