1
|
Armache M, Assi S, Wu R, Jain A, Lu J, Gordon L, Jacobs LM, Fundakowski CE, Rising KL, Leader AE, Fakhry C, Mady LJ. Readability of Patient Education Materials in Head and Neck Cancer: A Systematic Review. JAMA Otolaryngol Head Neck Surg 2024:2819695. [PMID: 38900443 DOI: 10.1001/jamaoto.2024.1569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
Importance Patient education materials (PEMs) can promote patient engagement, satisfaction, and treatment adherence. The American Medical Association recommends that PEMs be developed for a sixth-grade or lower reading level. Health literacy (HL) refers to an individual's ability to seek, understand, and use health information to make appropriate decisions regarding their health. Patients with suboptimal HL may not be able to understand or act on health information and are at risk for adverse health outcomes. Objective To assess the readability of PEMs on head and neck cancer (HNC) and to evaluate HL among patients with HNC. Evidence Review A systematic review of the literature was performed by searching Cochrane, PubMed, and Scopus for peer-reviewed studies published from 1995 to 2024 using the keywords head and neck cancer, readability, health literacy, and related synonyms. Full-text studies in English that evaluated readability and/or HL measures were included. Readability assessments included the Flesch-Kincaid Grade Level (FKGL grade, 0-20, with higher grades indicating greater reading difficulty) and Flesch Reading Ease (FRE score, 1-100, with higher scores indicating easier readability), among others. Reviews, conference materials, opinion letters, and guidelines were excluded. Study quality was assessed using the Appraisal Tool for Cross-Sectional Studies. Findings Of the 3235 studies identified, 17 studies assessing the readability of 1124 HNC PEMs produced by professional societies, hospitals, and others were included. The mean FKGL grade ranged from 8.8 to 14.8; none of the studies reported a mean FKGL of grade 6 or lower. Eight studies assessed HL and found inadequate HL prevalence ranging from 11.9% to 47.0%. Conclusions and Relevance These findings indicate that more than one-third of patients with HNC demonstrate inadequate HL, yet none of the PEMs assessed were developed for a sixth grade or lower reading level, as recommended by the American Medical Association. This incongruence highlights the need to address the readability of HNC PEMs to improve patient understanding of the disease and to mitigate potential barriers to shared decision-making for patients with HNC. It is crucial to acknowledge the responsibility of health care professionals to produce and promote more effective PEMs to dismantle the potentially preventable literacy barriers.
Collapse
Affiliation(s)
- Maria Armache
- Department of Otolaryngology-Head & Neck Surgery, The Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Sahar Assi
- Cochlear Center for Hearing and Public Health, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Richard Wu
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
| | - Amiti Jain
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Joseph Lu
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Larissa Gordon
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Lisa M Jacobs
- Mixed Methods Research Lab, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Christopher E Fundakowski
- Department of Otolaryngology-Head and Neck Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Kristin L Rising
- Jefferson Center for Connected Care, Thomas Jefferson University, Philadelphia, Pennsylvania
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Amy E Leader
- Department of Population Health, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
- Department of Medical Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Carole Fakhry
- Department of Otolaryngology-Head & Neck Surgery, The Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Leila J Mady
- Department of Otolaryngology-Head & Neck Surgery, The Johns Hopkins School of Medicine, Baltimore, Maryland
| |
Collapse
|
2
|
Panara K, Grose E, Lee DJ, Safadi J, Douglas JE, Kohanski MA, Palmer JN, Lee JM, Adappa ND, Bosso JV. Readability and quality analysis of patient education materials in aspirin-exacerbated respiratory disease. Int Forum Allergy Rhinol 2023; 13:2259-2261. [PMID: 37365855 DOI: 10.1002/alr.23218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/28/2023] [Accepted: 06/17/2023] [Indexed: 06/28/2023]
Abstract
KEY POINTS Patients are increasingly turning to online education materials to aid with disease management. Patient education materials on aspirin-exacerbated respiratory disease are of poor readability with significant room for improvement.
Collapse
Affiliation(s)
- Kush Panara
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Elysia Grose
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Daniel J Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jenelle Safadi
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jennifer E Douglas
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Michael A Kohanski
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - James N Palmer
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - John M Lee
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Nithin D Adappa
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - John V Bosso
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| |
Collapse
|
3
|
Maisner RS, Keenan E, Mansukhani PA, Berlin R, Weisberger JS, Mulloy CD, Lee ES. A multimetric health literacy analysis of online gender affirmation surgery materials: From facial to genital surgery. J Plast Reconstr Aesthet Surg 2023; 87:449-460. [PMID: 37944456 DOI: 10.1016/j.bjps.2023.10.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 09/20/2023] [Accepted: 10/07/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND The transgender patient population is expanding, and gender affirming surgery (GAS) volume is increasing. Accurate, comprehensive, and easily navigable resources on GAS are lacking. We aim to evaluate the readability of online materials for specific gender affirming surgical procedures to identify mechanisms of improving information access for transgender patients. MATERIALS AND METHODS "Facial feminization", "facial masculinization", "MTF breast augmentation", "FTM chest masculinization", "MTF vaginoplasty", "metoidioplasty", and "FTM phalloplasty" were searched on Google. Per keyword, the first 75 text-containing results were included. Text was analyzed for reading difficulty using the Flesch-Kincaid Reading-Ease (FKRE) test and grade level using the Flesch-Kincaid Grade Level (FKGL) formula, Gunning Fog Index (GFI), Simple Measure of Gobbledygook (SMOG), and Coleman-Liau Index (CLI). Scores were compared using independent t-and ANOVA tests (α = 0.05). RESULTS Mean readability scores (FKRE 37.44) and grade-levels (FKGL 12.87, GFI 15.61, SMOG 11.91, CLI 15.00) correlated with college-level difficulty. Masculinizing surgical materials were more difficult to read than feminizing ones (p ≤ 0.023). Top surgery materials were easier to read than facial and genital surgery materials (p ≤ 0.013). Specifically, chest masculinization resources were more difficult to read than those for breast augmentation (p ≤ 0.006). No differences were found between facial feminization and masculinization surgery resources, nor between resources for different gender affirming genital surgeries. CONCLUSION Online GAS materials are written above the recommended 6th grade reading-level, with resources for transgender men being significantly more challenging to understand. Improving readability of online resources can help overcome barriers to care for the transgender patient population.
Collapse
Affiliation(s)
- Rose S Maisner
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792, USA.
| | - Emily Keenan
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, Newark, NJ 07103, USA
| | - Priya A Mansukhani
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, Newark, NJ 07103, USA
| | - Ryan Berlin
- Department of Surgery, New York-Presbyterian Queens, 56-45 Main Street, Flushing, NY 11355, USA
| | - Joseph S Weisberger
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, Newark, NJ 07103, USA
| | - Clairissa D Mulloy
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, Newark, NJ 07103, USA
| | - Edward S Lee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, Newark, NJ 07103, USA
| |
Collapse
|
4
|
Tan JY, Tan YC, Yap D. Readability and quality of online patient health information on parotidectomy. J Laryngol Otol 2023; 137:1378-1383. [PMID: 37606526 DOI: 10.1017/s0022215123000336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
OBJECTIVE Complications of parotidectomy can have a massive impact on patients' quality of life. This study aimed to evaluate the readability and quality of online health information on parotidectomy. METHOD The search terms 'parotidectomy', 'parotid surgery', 'parotidectomy patient information' and 'parotid surgery patient information' were parsed through three popular search engines. RESULTS The websites were analysed using readability scores of the Flesch Reading Ease test and the Gunning Fog Index. The DISCERN instrument was used to assess quality and reliability. The average Flesch Reading Ease score was 50.2 ± 9.0, indicating that the materials were fairly difficult to read, the Gunning Fog Index score showed that the patient health information was suitable for an individual above 12th grade level, and the DISCERN score indicated that the online patient health information had fair quality. The Kruskal-Wallis test showed a significant difference in Flesch Reading Ease and DISCERN tool scores according to website category (p < 0.05). CONCLUSION Current online patient health information on parotidectomy is too difficult for the public to understand, and it exceeds the reading levels recommended by Health Education England and the American Medical Association.
Collapse
Affiliation(s)
- J Y Tan
- Department of Otolaryngology, Leeds Teaching Hospitals, Leeds, UK
| | - Y C Tan
- Department of Trauma and Orthopaedics, University Hospital Lewisham, London, UK
| | - D Yap
- Department of Otolaryngology, John Radcliffe Hospital, Oxford, UK
| |
Collapse
|
5
|
Ahmadzadeh K, Bahrami M, Zare-Farashbandi F, Adibi P, Boroumand MA, Rahimi A. Patient education information material assessment criteria: A scoping review. Health Info Libr J 2023; 40:3-28. [PMID: 36637218 DOI: 10.1111/hir.12467] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 10/13/2022] [Accepted: 11/03/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Patient education information material (PEIM) is an essential component of patient education programs in increasing patients' ability to cope with their diseases. Therefore, it is essential to consider the criteria that will be used to prepare and evaluate these resources. OBJECTIVE This paper aims to identify these criteria and recognize the tools or methods used to evaluate them. METHODS National and international databases and indexing banks, including PubMed, Scopus, Web of Science, ProQuest, the Cochrane Library, Magiran, SID and ISC, were searched for this review. Original or review articles, theses, short surveys, and conference papers published between January 1990 and June 2022 were included. RESULTS Overall, 4688 documents were retrieved, of which 298 documents met the inclusion criteria. The criteria were grouped into 24 overarching criteria. The most frequently used criteria were readability, quality, suitability, comprehensibility and understandability. CONCLUSION This review has provided empirical evidence to identify criteria, tools, techniques or methods for developing or evaluating a PEIM. The authors suggest that developing a comprehensive tool based on these findings is critical for evaluating the overall efficiency of PEIM using effective criteria.
Collapse
Affiliation(s)
- Khadijeh Ahmadzadeh
- Health Information Technology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Student Research Commitee, Sirjan School of Medical Sciences, Sirjan, Iran
| | - Masoud Bahrami
- Department of Adult Health Nursing, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Firoozeh Zare-Farashbandi
- Health Information Technology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Payman Adibi
- Gastroenterology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Ali Boroumand
- Department of Medical Library and Information Sciences, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Rahimi
- Health Information Technology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
6
|
Online verfügbare Informationen über Parotidektomien sind schwer verständlich. Laryngorhinootologie 2022; 101:632. [PMID: 35915899 DOI: 10.1055/a-1784-9166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
|