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

Assessing parental comprehension of online resources on childhood pain

We aimed to examine the patient education materials (PEMs) on the internet about "Child Pain" in terms of readability, reliability, quality and content. For our observational study, a search was made on February 28, 2024, using the keywords "Child Pain," "Pediatric Pain," and "Children Pain" in the Google search engine. The readability of PEMs was assessed using computer-based readability formulas (Flesch Reading Ease Score [FRES], Flesch-Kincaid Grade Level [FKGL], Automated readability index (ARI), Gunning Fog [GFOG], Coleman-Liau score [CL], Linsear Write [LW], Simple Measure of Gobbledygook [SMOG]). The reliability and quality of websites were determined using the Journal of American Medical Association (JAMA) score, Global Quality Score (GQS), and DISCERN score. 96 PEM websites included in our study. We determined that the FRES was 64 (32-84), the FKGL was 8.24 (4.01-15.19), ARI was 8.95 (4.67-17.38), GFOG was 11 (7.1-19.2), CL was 10.1 (6.95-15.64), LW was 8.08 (3.94-19.0) and SMOG was 8.1 (4.98-13.93). The scores of readability formulas showed that, the readability level of PEMs was statistically higher than sixth-grade level with all formulas (P = .011 for FRES, P < .001 for GFOG, P < .001 for ARI, P < .001 for FKGL, P < .001 for CL and P < .001 for SMOG), except LW formula (P = .112). The websites had moderate-to-low reliability and quality. Health-related websites had the highest quality with JAMA score. We found a weak negative correlation between Blexb score and JAMA score (P = .013). Compared to the sixth-grade level recommended by the American Medical Association and the National Institutes of Health, the readability grade level of child pain-related internet-based PEMs is quite high. On the other hand, the reliability and quality of PEMs were determined as moderate-to-low. The low readability and quality of PEMs could cause an anxious parent and unnecessary hospital admissions. PEMs on issues threatening public health should be prepared with attention to the recommendations on readability.

Readability of online patient education materials for shoulder instability surgery in English and Spanish

BACKGROUND

Online patient education materials (OPEMs) exist to inform patient medical decisions, yet the average adult in the United States reads at an eighth-grade level and 50% of Medicaid patients read at or below a fifth-grade level. To appropriately meet US health literacy needs, the American Medical Association and National Institutes of Health recommend that patient education materials not exceed a sixth-grade level. The purpose of this study was to assess and compare the readability of English and Spanish online patient education materials pertaining to shoulder instability surgery.

METHODS

Google searches of the terms "shoulder instability surgery" and "cirugía de inestabilidad de hombro'' were conducted to include 25 eligible online patient education materials OPEMs per language. English OPEM readability was calculated using Flesch-Kincaid Grade Level, Flesch Reading Ease, Flesch Reading Ease Grade Level, Gunning-Fog Index, Coleman-Liau Index, and Simple Measure of Gobbledygook. Spanish OPEM readability was assessed using Fernandez-Huerta Index (FHI) (the Spanish equivalent of Flesch Reading Ease), FHI Grade Level, Gutiérrez de Polini's Fórmula de comprensibilidad, and INFLESZ.

RESULTS

Readability index analysis revealed that the mean Flesch Reading Ease of English online patient education materials was significantly lower than the mean FHI of Spanish online patient education materials. English materials were also found to be written at a significantly higher grade level than Spanish materials.

CONCLUSIONS

Shoulder instability surgery online patient education materials in both English and Spanish are written at higher reading levels than recommended by the American Medical Association and National Institutes of Health, though Spanish online patient education materials were more readable on average.

Assessing the Utility of ChatGPT in Simplifying Text Complexity of Patient Educational Materials

INTRODUCTION

AI chatbots are being increasingly used in healthcare settings. There is growing interest in using AI to assist in patient education. Currently, extensive healthcare information is found online but is often too complex to understand. Our objective is to determine if physicians can recommend the free version of ChatGPT version 3.5 (OpenAI, San Francisco, CA, USA) for patients to simplify text from the American Academy of Ophthalmology (AAO) in English and Spanish. This version of ChatGPT was assessed in this study due to its increased accessibility across various patient populations.

METHODS

Fifteen articles were chosen from AAO in both languages and simplified with ChatGPT 10 times each. The readability of original and simplified articles was assessed with the Flesch Reading Ease and Gunning Fog Index for English and Fernández Huerta, Gutiérrez, Szigriszt-Pazo, INFLESZ, and Legibilidad-µ for Spanish. Grade levels to assess readability were calculated with Flesch Kincaid Grade Level and Crawford Nivel-de-Grado. Mean, standard deviation, and two-tailed t-tests were performed to assess differences before and after simplification.

RESULTS

Average grade levels before and after simplification were as follows: English 8.43±1.17 to 8.9±2.1 (p=0.41) and Spanish 5.3±0.34 to 4.1±1.1 (p=0.0001). Spanish articles were significantly simplified per Legibilidad-µ (p=0.003). No significant difference was noted for other scales.

CONCLUSIONS

The readability of AAO articles in English worsened without significance but significantly improved in Spanish. This may result from simpler syllable structures and a lesser overall vocabulary in Spanish. With increased testing, physicians can recommend ChatGPT for Spanish-speaking patients to improve health literacy.

Assessment of the Readability of the Online Patient Education Materials of Intensive and Critical Care Societies

OBJECTIVES

This study aimed to evaluate the readability of patient education materials (PEMs) on websites of intensive and critical care societies.

DATA SOURCES

Websites of intensive and critical care societies, which are members of The World Federation of Intensive and Critical Care and The European Society of Intensive Care Medicine.

SETTING

Cross-sectional observational, internet-based, website, PEMs, readability study.

STUDY SELECTION

The readability of the PEMs available on societies' sites was evaluated.

DATA EXTRACTION

The readability formulas used were the Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG), and Gunning Fog (GFOG).

DATA SYNTHESIS

One hundred twenty-seven PEM from 11 different societies were included in our study. In the readability analysis of PEM, the FRES was 58.10 (48.85-63.77) (difficult), the mean FKGL and SMOG were 10.19 (8.93-11.72) and 11.10 (10.11-11.87) years, respectively, and the mean GFOG score was 12.73 (11.37-14.15) (very difficult). All readability formula results were significantly higher than the recommended sixth-grade level ( p < 0.001). All PEMs were above the sixth-grade level when the societies were evaluated individually according to all readability results ( p < 0.05).

CONCLUSIONS

Compared with the sixth-grade level recommended by the American Medical Association and the National Institutes of Health, the readability of PEMs in intensive and critical care societies is relatively high. PEMs in intensive and critical care societies should be prepared with attention to recommendations on readability.

Assessing the readability and quality of online information on benign paroxysmal positional vertigo

INTRODUCTION

Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vertigo. It can have a significant impact on quality of life, with individuals often seeking information online for reassurance and education. The aim of this study is to assess the readability and quality of online information on BPPV.

METHODS

The terms 'benign paroxysmal positional vertigo' and 'BPPV' were entered into Google. The first 50 websites generated for each search term were screened. Readability was assessed using the Flesch-Kincaid Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG) Index and Gunning Fog Index (GFOG). Quality was assessed using the DISCERN instrument. Spearman's correlation between quality and readability was calculated.

RESULTS

A total of 39 websites met the inclusion criteria. The mean and 95% confidence intervals for the FRES, FKGL, SMOG, GFOG and DISCERN scores were 50.2 (46.1-54.3), 10.6 (9.87-11.4), 10.1 (9.5-10.7), 13.6 (12.7-14.4) and 36.7 (34.6-38.7), respectively. Weak correlation was noted between DISCERN and FRES (rs = -0.23, p = 0.17).

CONCLUSION

Online information on BPPV is generally of poor quality and low readability. It is essential that healthcare professionals inform their patients of this limitation and advocate for improved online patient education resources that are both high quality and easy to comprehend.

Readability of American Society of Metabolic Surgery's Patient Information Publications

INTRODUCTION

Appropriate education and information are the keystones of patient autonomy. Surgical societies support this goal through online informational publications. Despite these recommendations, many of these sources do not provide the appropriate level of reading for the average patient. Multiple national organizations, including the AMA and NIH, have recommended that such materials be written at or below a 6th-grade level. We therefore aimed to evaluate the readability of patient information publications provided by the American Society of Metabolic and Bariatric Surgery (ASMBS).

METHODS

Patient information publications were collected from the ASMBS webpage (https://asmbs.org/patients) and evaluated for readability. Microsoft Office was utilized to calculate Flesch Reading Ease (FRE) and Flesch-Kincaid Grade Level (FKGL) scores. Flesch Reading Ease (FRE) is a 0-100 score, with higher scores equating to easier reading (≥80 = 6th-grade reading level). Flesch-Kincaid Grade Level (FKGL) rates text on a US grade school level. Qualitative and univariate analyses were performed.

RESULTS

Eleven patient information publications were evaluated. None of the publications achieved an FRE score of 80 or an FKGL of a 6th-grade reading level. The average FRE score was 35.8 (range 14.9-53.6). The average FKGL score was 13.1 (range 10.1-17.5). The publication with the highest FRE and lowest FKGL (best readability) was that for benefits of weight loss. The brochure with the lowest FRE and highest FKGL (worst readability) was that for Medical Tourism.

CONCLUSIONS

Although the ASMBS patient information publications are a trusted source of patient literature, none of the 11 publications met the recommended criteria for patient readability. Further refinement of these will be needed to provide the appropriate reading level for the average patient.

How readable and quality are online patient education materials about Helicobacter pylori?: Assessment of the readability, quality and reliability

This study aimed to examine the readability, reliability, quality, and content of patient education materials (PEM) on the Internet about "Helicobacter pylori (H pylori)." A search was conducted on March 14, 2023, using the keyword "H pylori" in the Google search engine. The readability of PEMs was assessed using the Flesch reading ease score, FKGL, simple measure of gobbledygook, and gunning fog readability formulas. The reliability and quality of the websites were determined using the Journal of American Medical Association score, health on the net foundation code of conduct, global quality score, and DISCERN score. A total of 93 patient education websites were included in the study. In the readability analysis of PEMs, we determined that the Flesch reading ease score was 49,73 (47,46-52,00) (difficult), the mean Flesch-Kincaid grade level and simple measure of gobbledygook were 9,69 (9,26-10,12) and 9,28 (8,96-9,61) years, respectively, and the mean gunning fog score was 12,47 (12,03-12,91) (very difficult). Most of the evaluated patient educational materials were commercial websites (n = 50, 53.8%). It was found that 16.1% of the websites were of high quality according to global quality score, 30.1% were HON code certified, and 23.7% of the websites were highly reliable according to Journal of American Medical Association scores. There was no statistically significant difference between website typologies and readability (P > .05). However, there was a statistically significant difference between website typologies and quality and reliability scores (P < .005). Compared to the sixth grade level recommended by the American Medical Association and National Institutes of Health, the readability of H pylori-related internet-based PEMs is quite high. On the other hand, the reliability and quality of the PEMs were determined as moderate to poor. PEMs for issues threatening public health should be prepared with attention to recommendations on readability.

Evaluating the readability, quality and reliability of online patient education materials on transcutaneuous electrical nerve stimulation (TENS)

Increasing digitization also raises concerns regarding the reliability and comprehensibility of online health information. In this study, we aimed to examine the readability, reliability, and quality of internet-based patient education materials on "transcutaneous electrical nerve stimulation." On September 15, 2022, we used Google search engine to search the keyword "Transcutaneous Electrical Nerve Stimulation" and obtained information from 200 websites. The readability of the websites was evaluated using the Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level, Simple Measure of Gobbledygook, and Gunning Fog. The Journal of American Medical Association score and Health on the Net Foundation code of conduct were used to determine the reliability of the websites, whereas the DISCERN score and Global Quality Score were used to evaluate the quality of the websites. In the readability analysis of 102 websites that met the inclusion criteria of this study, we found that the Flesch Reading Ease Score was 47.91 ± 13.79 (difficult), average Flesch-Kincaid Grade Level and Simple Measure of Gobbledygook were 11.20 ± 2.85 and 10.53 ± 2.11 years, respectively, and average Gunning Fog score was 14.04 ± 2.74 (very difficult). Commercial websites constituted the highest proportion of websites (n = 36, 35.5%). Overall, 16.7% of the websites were found to be of high quality according to the Global Quality Score, 16 (15.7%) websites had Health on the Net Foundation code of conduct certification, and 8.8% of the websites were found to be highly reliable according to the Journal of American Medical Association scores. There was a statistically significant difference between website typologies and quality and reliability scores (P < .001). Compared with the sixth-grade level recommended by the American Medical Association and the National Institute of Health, the readability of transcutaneous electrical nerve stimulation-related internet-based patient education materials was considerably high, but they showed low reliability and moderate-to-poor quality. Thus, the quality, reliability, and readability of websites developed by health professionals play a major role in conveying accurate and easily understandable information.

Viral Disease Goes Viral: Characterizing How Cancer Patients Use Internet Resources for COVID-19 Information

This study aims to evaluate the usage of Internet resources for COVID-19 information among cancer patients. Specifically, to understand where patients are seeking information, what topics are most frequently searched, and how physicians and web developers can improve clinical conversations and digital resources, respectively, to support cancer patients' needs. From May to June 2021, cancer patients who were attending follow-up at a tertiary cancer center completed a survey consisting of 28 closed and open-ended questions. Quantitative results were evaluated using descriptive statistics and qualitative responses were evaluated using a grounded-theory approach. Fifty-seven surveys were distributed, and fifty-two surveys were received (91% response rate). The majority of respondents (96%) were Internet users. Seventy percent used the Internet as a source of information about COVID-19 and cancer personally, with another 15% reporting that friends and family accessed online information on their behalf. The vast majority used Google as their choice of search engine, with COVID-19 rates and vaccine information being the most frequently searched topics. Three quarters (74%) considered Internet information easy to understand, and 90% stated that the Internet increased their understanding of COVID-19 and cancer. Only 15% of patients had been recommended online resource(s) by a physician, yet 100% of those patients found the physician-recommended sites useful. Most cancer patients use the Internet to search for COVID-19 information. Healthcare professionals (HCPs) should help guide patients towards credible online sources and address knowledge gaps to improve physician-patient communication and support educational needs.

Assessing the quality and readability of online content on shock wave therapy for erectile dysfunction

Patients are becoming increasingly reliant on online platforms for obtaining health information. Previous research has shown that the quality of information available on the internet regarding novel medical therapies is generally poor and frequently misleading. Shock wave therapy represents a novel restorative therapy for erectile dysfunction (ED) that has recently gained attention. We hypothesised that online sources regarding shock wave therapy for ED would be fraught with misleading claims and unreliable health information. Our objective was to evaluate the quality and readability of online medical information on shock wave therapy as a treatment for ED. Websites were generated using a Google search of 'shock wave therapy for erectile dysfunction' with location filters disabled. Readability was analysed using the Readable software (Readable.com, Horsham, United Kingdom). Quality was assessed independently by three reviewers using the DISCERN tool. Articles were subdivided into those from private clinic websites and those from universities or news media websites. Statistical analysis was conducted using the Student's t test. Nine articles that resulted from the Google search had mean readability scores as follows: Flesch-Kincaid grade level (10.8), Gunning-Fog Index (13.67), Coleman-Liau Index (12.74), Simple Measure of Gobbledygook (SMOG) Index (13.33), FORCAST Grade Level (11.33), and Automated Readability Index (11.08). The mean Flesch Reading Ease score was 46.4. The articles had a mean DISCERN score of 3.1, suggesting 'moderate quality' content. Articles from universities (n = 2) or news sources (n = 3) had significantly higher DISCERN scores than articles from private medical practices (n = 4). There was no difference in readability scores between the groups. Articles from private clinics are just as readable as those from universities or news media, but they are significantly more biased and misleading. The current online material relating to shock wave therapy for ED may not adequately inform patients in their medical decisions making, thereby necessitating closer collaboration between the sources disseminating information and urologists.

Evaluating the readability, quality and reliability of online information on Behçet’s disease

There are concerns over the reliability and comprehensibility of health-related information on the internet. The goal of our research was to analyze the readability, reliability, and quality of information obtained from websites associated with Behçet’s disease (BD). On September 20, 2021, the term BD was used to perform a search on Google, and 100 eligible websites were identified. The Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), and Gunning Fog (GFOG) were used to evaluate the readability of the website. The JAMA score was used to assess the websites’ reliability, the DISCERN score and the Health on the Net Foundation code of conduct (HONcode) were used to assess quality, and Alexa was used to analyze their popularity. Sections of the text were evaluated, and the results revealed that the mean FRES was 35.49±14.42 (difficult) and the mean GFOG was 14.93±3.13 years (very difficult). According to the JAMA scores, 36% of the websites had a high reliability rating and 20% adhered to the HONcode. The readability was found to significantly differ from the reliability of the websites (p<0.05). Moreover, websites with scientific content were found to have higher readability and reliability (p<0.05). The readability of BD-related information on the Internet was found to be considerably higher than that recommended by the National Health Institute’s Grade 6, with moderate reliability and good quality. We believe that online information should have some level of readability and must have reliable content that is appropriate to educate the public, particularly for websites that provide with patient education material.

Evaluating breast cancer websites targeting Arabic speakers: empirical investigation of popularity, availability, accessibility, readability, and quality

Background

Nowadays, patients have access to all types of health information on the internet, influencing their decision-making process. The Middle East and North Africa (MENA) region consists of 22 countries with an estimated population of around 600 million. Breast cancer is the highest diagnosed cancer in this region. Websites are commonly the go-to cancer information sources. A large population of the MENA region is only fluent in the Arabic language, thus access to Arabic websites is in more demand. However, little is known about breast cancer websites that cater to an Arabic-speaking audience. This study aims at evaluating Arabic breast cancer websites and offering recommendations to improve engagement and access to health information.

Methods

This study employed a cross-sectional analysis approach. Google trends was used to reveal the top searched topics across the MENA region, which in turn were used as search terms to identify the websites. To be included, a website had to be active, available in Arabic, and contain breast cancer information. The evaluation was based on a combination of automated and expert-based evaluation methods through five dimensions: Availability, Accessibility, Readability, Quality, and Popularity.

Results

Overall most of the websites performed poorly in the five dimensions and require careful reassessment concerning design, content, and readability levels; Only one website performed well in all dimensions, except for readability. Generally, the readability scores indicated that the websites were above the recommended level of reading. None of the websites passed the automated accessibility tests. The expert evaluation using the “Health on the Net” checklist showed good results for most websites.

Conclusions

Breast cancer rates are rising in the MENA region, therefore having comprehensive, accurate, trustworthy, and easy-to-understand health information in their native language is a must. The results from this study show a need for improving the accessibility to breast cancer information websites available to Arabic speakers. The search was limited to three search engines yielding 10 websites and only one tool was used per dimension. Future work is needed to overcome these limitations. Collaboration between multiple stakeholders is necessary to develop websites that contain easy-to-read and understand high-quality information.

Understanding Information Needs and Barriers to Accessing Health Information Across All Stages of Pregnancy: Systematic Review

BACKGROUND

Understanding consumers' health information needs across all stages of the pregnancy trajectory is crucial to the development of mechanisms that allow them to retrieve high-quality, customized, and layperson-friendly health information.

OBJECTIVE

The objective of this study was to identify research gaps in pregnancy-related consumer information needs and available information from different sources.

METHODS

We conducted a systematic review of CINAHL, Cochrane, PubMed, and Web of Science for relevant articles that were published from 2009 to 2019. The quality of the included articles was assessed using the Critical Appraisal Skills Program. A descriptive data analysis was performed on these articles. Based on the review result, we developed the Pregnancy Information Needs Ontology (PINO) and made it publicly available in GitHub and BioPortal.

RESULTS

A total of 33 articles from 9 countries met the inclusion criteria for this review, of which the majority were published no earlier than 2016. Most studies were either descriptive (9/33, 27%), interviews (7/33, 21%), or surveys/questionnaires (7/33, 21%); 20 articles mentioned consumers' pregnancy-related information needs. Half (9/18, 50%) of the human-subject studies were conducted in the United States. More than a third (13/33, 39%) of all studies focused on during-pregnancy stage; only one study (1/33, 3%) was about all stages of pregnancy. The most frequent consumer information needs were related to labor delivery (9/20, 45%), medication in pregnancy (6/20, 30%), newborn care (5/20, 25%), and lab tests (6/20, 30%). The most frequently available source of information was the internet (15/24, 63%). PINO consists of 267 classes, 555 axioms, and 271 subclass relationships.

CONCLUSIONS

Only a few articles assessed the barriers to access to pregnancy-related information and the quality of each source of information; further work is needed. Future work is also needed to address the gaps between the information needed and the information available.

An Evaluation of the Comprehensibility Levels of Ophthalmology Surgical Consent Forms

Background/Aim

This study aimed to evaluate the comprehensibility of the consent forms used for interventional procedures in the ophthalmology clinic of a university hospital and to determine which texts could be read according to patient age and education level.

Materials and methods

Forty separate consent forms used as the standard for various interventional procedures in the ophthalmology department of a university hospital were evaluated. The comprehensibility formulas used were developed for the Turkish language by Ateşman and Bezirci-Yilmaz.

Results

As a result of the evaluation of the consent forms in this study, a mean of 55.6±5.73 points was obtained according to the Ateşman comprehensibility index, and this value was found to correspond to being understood by eleventh and twelfth-grade school students. According to the Bezirci-Yilmaz comprehensibility index, the mean points of the consent forms were 10.05±2, which corresponded to a level that could be understood by 10th and 11th-grade students.

Conclusion

The comprehensibility level of the consent forms given to patients was found to be low in this study, which was similar to the findings of previous studies in the literature. When preparing informed consent forms, the education level of the country must be taken into consideration.

Assessing the Readability of Online Patient Education Resources Related to Gynecomastia

BACKGROUND

The Internet has a plethora of online patient education resources for many symptoms and diseases. National medical governing bodies recommend that patient education materials are written at or below the eighth-grade level, and the literature suggests that health literacy has been linked to increased adherence to treatment regimens and improved outcomes. The primary aim of the study is to assess the readability of online patient materials relating to gynecomastia and ascertain the availability of patient materials in non-English languages.

METHODS

The readability of patient education materials relating to gynecomastia for academic-based websites and nonacademic websites was assessed using the Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (FKGL), and Simple Measure of Gobbledygook (SMOG). The prevalence of non-English patient education materials was assessed for both academic-based and nonacademic websites.

RESULTS

Fifty-eight documents were collected across academic websites. Overall median values were 10.7 for the FKGL, 47.0 for the FRE, and 11.4 for the SMOG. For the 10 nonacademic institutions, the overall median values were 10.6 for the FKGL, 45.2 for the FRE, and 10.8 for the SMOG. No appreciable differences were observed for readability when stratified by region or source. The prevalence of non-English patient materials was 19.1% across institutions. None of the noninstitutional materials had information in non-English languages.

CONCLUSIONS

The readability of patient education materials related to gynecomastia is at higher levels than recommended by national organizations. There are limited non-English patient education materials. Future efforts should focus on improving the readability and accessibility of patient materials.

Readability, understandability, and quality of retinopathy of prematurity information on the web

BACKGROUND

The purpose of this study is to assess the readability, understandability, and quality of information on retinopathy of prematurity presented at websites frequently visited by parents.

METHODS

A total of 220 websites were assessed, which were recruited by searching for "retinopathy of prematurity" at the Google search engine. The readability of each web page was assessed by Flesch Reading Ease Score, Gobbledygook's Gunning Frequency, Flesch Kincaid Grade Level, Coleman Liau score, The Simple Measure of Gobbledygook, Fry Graph Readability Formula, and Automated readability score. The understandability of the web pages included in the study was measured by using the Patient Education Materials Assessment Tool. Quality was evaluated using Health in Net code and JAMA. The ALEXA traffic tool was used to reference the domains' popularity and visibility.

RESULTS

Sixty-four websites were included to the study. The average Flesch Reading Ease Score was 50.1 ± 11.4, Gunning Frequency of Gobbledygook level was 13.4 ± 2.5, The Flesch-Kincaid Grade level was 10.7 ± 2.2, Coleman Liau level was 10.8 ± 1.7, Simple Measure of Gobbledygook level was 10.0 ± 1.9, and Fry Graph Readability Formula 11.9 ± 2.7, Automated readability score 10.4 ± 2.5. The average understandability score for all website-based patient education materials was 76.9 ± 15.2. Total JAMA Benchmark score is 2.27 ± 1.14 (range from 1 to 4). The quality of information at most websites were determined by our chosen assessments to not to be good.

CONCLUSION

Websites addressed to parents for retinopathy of prematurity had found to have high understandability. It was concluded based on this study that readability and quality of presented written materials at online sources need to be improved.

Web-Based Health Information Following the Renewal of the Cervical Screening Program in Australia: Evaluation of Readability, Understandability, and Credibility

BACKGROUND

Three main changes were implemented in the Australian National Cervical Screening Program (NCSP) in December 2017: an increase in the recommended age to start screening, extended screening intervals, and change from the Papanicolaou (Pap) test to primary human papillomavirus screening (cervical screening test). The internet is a readily accessible source of information to explain the reasons for these changes to the public. It is important that web-based health information about changes to national screening programs is accessible and understandable for the general population.

OBJECTIVE

This study aimed to evaluate Australian web-based resources that provide information about the changes to the cervical screening program.

METHODS

The term cervical screening was searched in 3 search engines. The first 10 relevant results across the first 3 pages of each search engine were selected. Overall, 2 authors independently evaluated each website for readability (Flesch Reading Ease [FRE], Flesch-Kincaid Grade Level, and Simple Measure of Gobbledygook [SMOG] index), quality of information (Patient Education Materials Assessment Tool [PEMAT] for printable materials), credibility (Journal of the American Medical Association [JAMA] benchmark criteria and presence of Health on the Net Foundation code of conduct [HONcode] certification), website design, and usability with 5 simulation questions to assess the relevance of information. A descriptive analysis was conducted for the readability measures, PEMAT, and the JAMA benchmark criteria.

RESULTS

Of the 49 websites identified in the search, 15 were eligible for inclusion. The consumer-focused websites were classed as fairly difficult to read (mean FRE score 51.8, SD 13.3). The highest FRE score (easiest to read) was 70.4 (Cancer Council Australia Cervical Screening Consumer Site), and the lowest FRE score (most difficult to read) was 33.0 (NCSP Clinical Guidelines). A total of 9 consumer-focused websites and 4 health care provider-focused websites met the recommended threshold (sixth to eighth grade; SMOG index) for readability. The mean PEMAT understandability scores were 87.7% (SD 6.0%) for consumer-focused websites and 64.9% (SD 13.8%) for health care provider-focused websites. The mean actionability scores were 58.1% (SD 19.1%) for consumer-focused websites and 36.7% (SD 11.0%) for health care provider-focused websites. Moreover, 9 consumer-focused and 3 health care provider-focused websites scored above 70% for understandability, and 2 consumer-focused websites had an actionability score above 70%. A total of 3 websites met all 4 of the JAMA benchmark criteria, and 2 websites displayed the HONcode.

CONCLUSIONS

It is important for women to have access to information that is at an appropriate reading level to better understand the implications of the changes to the cervical screening program. These findings can help health care providers direct their patients toward websites that provide information on cervical screening that is written at accessible reading levels and has high understandability.

[Readability of Information Material in Obstetrics]

Up-to-date health care implies users' autonomous decision-making on diagnostic and therapeutic measures (informed consent). Patients depend on comprehensible information material to be able to understand an intervention and its consequences. Informed consent sheets on cesarean section, other obstetrical measures, and anesthesia methods were assessed for readability using tools including the G-SMOG, Flesch Index, Amstad Formula, and LIX. In addition, comparative material on the same topics, e. g., from the Internet, was assessed. The assessment tools developed for the German language proved to be useful for readability screening. Most texts were found to be difficult or very difficult to read. Especially the included informed consent sheets were assessed as clearly above the recommended readability level. Efforts need to be made to prepare readable and comprehensible information material, e. g., by using the "Hamburg Model of Comprehensibility."