Both English and Spanish Anterior Cruciate Ligament Reconstruction Online Patient Education Materials are Written at Higher than Recommended Reading Levels

Abstract

PurposeThe purpose of this study is to examine the overall reading levels of anterior cruciate ligament reconstruction online patient education materials (OPEMs) written in English and Spanish. MethodsInvestigators conducted Google searches for OPEMs utilizing “ACL surgery” and “cirugía LCA” as English and Spanish search terms. Several measures of readability were used to analyze 25 English (Flesch Reading Ease, Flesch Reading Ease Grade Level, Flesch-Kincaid Grade Level, Coleman-Liau Index, Gunning-Fox Index, and the Simple Measure of Gobbledygook) and 25 Spanish (Fernández-Huerta Index, Fernández-Huerta Grade Level, and INFLESZ) OPEMs. English and Spanish OPEMs were compared based on mean overall grade level and number of OPEMs written below a seventh or ninth-grade reading level. ResultsEnglish OPEMs demonstrated a higher mean overall grade level compared to Spanish OPEMs (10.48 ± 1.86 vs 8.64 ± 1.22, p<.001). No significant differences were noted in the number of OPEMs written below a seventh-grade reading level. However, significantly more Spanish OPEMs were written below a ninth-grade reading level, compared to English OPEMs (56% vs 16%, p=.003). ConclusionAlthough Spanish OPEMs were written at a lower reading level, average readability for both English and Spanish OPEMs was significantly higher than the recommended level. Across both languages, only a single English webpage met the AMA-recommended sixth-grade reading level. More Spanish articles were written at or below the average adult reading level in the United States.