Improving health literacy and patient-directed knowledge of fecal microbiota transplantation (FMT) through analysis of readability: a cross-sectional infodemiology study

BackgroundThe One Health approach involves collaboration across several sectors, including public health, veterinary and environmental sectors in an integrated manner. These sectors may be disparate and unrelated, however to succeed, all stakeholders need to understand what the other stakeholders are communicating. Likewise, it is important that there is public acceptance and support of One Health approaches, which requires effective communication between professional and institutional organisations and the public. To help aid and facilitate such communication, written materials need to be readable by all stakeholders, in order to communicate effectively. There has been an exponential increase in the publication of papers involving One Health, with <5 per year, in the 2000s, to nearly 500 published in 2023. To date, readability of One Health information has not been scrutinised, nor has it been considered as an integral intervention of One Health policy communication. The aim of this study was therefore to examine readability of public-facing One Health information prepared by 24 global organisations. MethodsReadability was calculated using Readable software, to obtain four readability scores [(ⅰ) Flesch Reading Ease (FRE), (ⅱ) Flesch-Kincaid Grade Level (FKGL), (ⅲ) Gunning Fog Index and (ⅳ) SMOG Index] and two text metrics [words/sentence, syllables/word] for 100 sources of One Health information, from four categories [One Health public information; PubMed abstracts; Science in One Health (SOH) abstracts (articles); SOH abstracts (reviews)]. ResultsReadability of One Health information for the public is poor, not reaching readability reference standards. No information was found that had a readability of less than 9th grade (around 14 years old). Mean values for the FRE and FKGL were (19.4 ± 1.4) (target >60) and (15.6 ± 0.3) (target <8), respectively, with mean words per sentence and syllables per word of 20.5 and 2.0, respectively. Abstracts with “One Health” in the title were more difficult to read than those without “One Health” in the title (FRE: P = 0.0337; FKGL: P = 0.0087). Comparison of FRE and FKGL readability scores for the four categories of One Health information [One Health public information; PubMed abstracts; SOH abstracts (articles); SOH abstracts (reviews)] showed that SOH abstracts from articles were easier to read than those from SOH reviews. No One Health public-facing information from the 100 sources examined met the FKGL target of ≤8. The most easily read One Health information required a Grade Level of 9th grade (14–15 years old), with a mean Grade Level of 15.5 (university/college level). ConclusionConsiderable work is required in making One Health written materials more readable, particularly for children and adolescents (<14 years of age). It is important that any interventions or mitigations taken to support better public understanding of the One Health approach are not ephemeral, but have longer lasting and legacy value. Authors of One Health information should consider using readability calculators when preparing One Health information for their stakeholders, to check the readability of their work, so that the final material is within recommended readability reference parameters, to support the health literacy and stakeholder-directed knowledge of their readers.

Adherence to antifungals is poor in high endemic regions where antifungal resistance is high. Poor readability of prescription/over-the-counter (OTC) antifungals may contribute to poor adherence, due to the patient not fully understanding the purpose, importance, and dosage of their antifungal medicine. As there are no reports on the readability of antifungals, this study examined the readability of patient-facing antifungal information. Antifungals (n=16; five classes [allylamines, azoles, echinocandins, polyenes, and others-flucytosine and griseofulvin]) were selected. Readability of four sources of information, (i) summary of product characteristics, (ii) patient information leaflets (PILs), (iii) OTC patient information, and (iv) patient web-based information, was calculated using Readable software, to obtain readability scores [(i) Flesch Reading Ease [FRE], (ii) Flesch-Kinkaid Grade Level [FKGL], (iii) Gunning Fog Index, and (iv) Simple Measure of Gobbledygook (SMOG) Index) and text metrics [word count, sentence count, words/sentence, and syllables/word]. PILs, web-based resources, and OTC patient information had good readability (FRE mean±sd=52.8±6.7, 58.6±6.9, and 57.3±7.4, respectively), just falling short of the≥ 60 target. For FKGL (target≤8.0), PILs, web-based resources, and OTC patient information also had good readability (mean±sd=8.5±1.0, 7.2±0.86, and 7.8±0.1, respectively). Improved readability scores observed correlate with reduced words, words/sentence and syllables/word. Improving readability may lead to improved patient health literacy. Healthcare professionals, academics, and publishers preparing written materials regarding antifungals for the lay/patient community are encouraged to employ readability calculators to check the readability of their work, so that the final material is within recommended readability reference parameters, to support the health literacy of their patients/readers.

The aim of this research is to evaluate the websites containing "coccydynia, coccyx trauma or fracture" in terms of readability, reliability, accuracy, and quality. Searches for "coccydynia, coccyx trauma, coccyx fracture" were carried out in the 3 most used search engines in the USA: Google, Yahoo, and Bing in February 2022. A total of 141 websites were rated by 2 different neurosurgeons for the "Global Quality Score" and "Alexa Popularity Rank." 97.2% of the sites examined include the definition of the disease, 66% include the importance of the disease, 92.9% include the symptoms of the disease, 88.7% include the treatment of the disease, 78% include the signs of the disease, 77.3% include the mechanism of the disease It has been determined that the websites examined within the scope of the research have high global quality score (GQS) and APR and are enriched with images to a large extent.

A multimetric health literacy analysis of online gender affirmation surgery materials: From facial to genital surgery

Readability, quality, and timeliness of patient online health resources for urticaria

Bullous Pemphigoid: Readability, Quality, and Treatments of Online Health Resources

The American Medical Association (AMA) and National Institutes of Health (NIH) recommend all patient information and consent materials be provided at the fourth- to sixth-grade level. The iMed Consent platform is used nationally by the Veterans Health Administration and private hospitals. We aimed to assess the readability of otolaryngology consents at the West Los Angeles Veterans Affairs (WLA-VA) hospital to determine whether they conform with AMA/NIH guidelines. A readability analysis of 27 otolaryngology iMed consent documents was performed. The main outcome measure was the Flesch-Kincaid Grade Level (FKGL). The setting of the study was an otolaryngology clinic at a major VA hospital. All consents used in the WLA-VA otolaryngology clinic for the month of October 2018 were analyzed using readability metrics. These included the Flesch Reading Ease (FRE) score, the FKGL, the Gunning Fog Index (GFI), Simple Measure of Gobbledygook (SMOG), and Coleman-Liau Index (CLI). The following means of all consents were calculated for each of the readability metrics: FRE 56.3, FKGL 8.3, GFI 14.5, SMOG 11.3, and CLI 11.2. The standardized anesthesia and blood consent were analyzed separately with the following scores: FRE 45.1, FKGL 11.7, GFI 15.5, SMOG 14.6, and CLI 12.6. The average FKGL of the consents was found to be significantly above the sixth-grade level (P: .0013). The average grade level of the otolaryngology iMed consents reviewed was at a reading level above the AMA/NIH recommendations. This objective measure should be taken into consideration when revising the iMed system and in the creation of future standardized consents. Readability analysis does not take into consideration the significant variance that exists as part of the verbal consent process that takes place between patient and provider.

Tuberculosis (TB) continues be the leading cause of death globally due to an infectious agent. There is a paucity of data describing the readability of patient-facing TB information for service users. The aim of this study was to calculate the readability of multiple global TB information sources. Information on tuberculosis (n = 150 sources) included nine categories, Patient-facing information: WHO publications (n = 17), International governments (n = 19), Hospitals (n = 10), Non-government organisations (NGOs)/charities (n = 20), Cochrane Plain Language Summaries (n = 20); LabTestsOnlineUK (n = 4) and Scientific-facing information: Clinical trials (n = 20), Cochrane abstracts (n = 20), Scientific abstracts (n = 20). Readability was calculated using Readable software, defined by (i) Flesch Reading Ease (FRE), (ii) Flesch-Kincaid Grade Level (FKGL), (iii) Gunning Fog Index and (iv) SMOG Index and two text metrics [words/sentence, syllables/word]. Mean readability values for TB information for the FRE and FKGL were 35.6 ± 1.6 (standard error of mean (SEM)) (US Target ≥60; UK Target ≥90) and 12.3 ± 0.3 (US Target ≤8; UK Target ≤6), respectively, with mean words per sentence and syllables per word of 17.2 and 1.8, respectively. Cochrane Plain Language Summaries had similar readability scores to their matching scientific abstract (p = 0.15). LabTestsOnlineUK yielded a mean FRE score of 51.5 ± 1.2, a mean FKGL score of 10.2 ± 0.5 and text metric scores of 16.7 ± 2.3 and 1.6, for words per sentence and syllables per word, respectively. In descending order, TB information from international governments, hospitals and LabTestsOnlineUK were the most readable (FRE = 57.9, 54.1 and 51.5, respectively), whereas scientific abstracts and Cochrane abstracts were the most difficult to read (13.0 and 30.2, respectively). Patient-facing TB information analysed had poor readability. Effective communication of biomedical science concepts and information relating to TB is vital for service users to enhance their health literacy of tuberculosis, thereby promoting better clinical outcomes. Biomedical scientists are important custodians of scientific information for their service user populations, including other healthcare professionals within the TB multidisciplinary (MDT) team and patient service users. When preparing TB information, this should be checked and modified in real time employing readability calculators, to align with health readability targets.

BackgroundIn primary care, low health literacy, particularly reading ability, is associated with worse health outcomes. Most physicians do not receive feedback on the reading levels of written communication that they may provide to patients, including result letters.ObjectiveOur study compares the readability of result letters, written by resident versus attending physicians, to patients with positive or negative screens for reading ability, as determined by the single-item literacy screener (SILS).MethodsResult letters to 50 patients at high risk and 50 patients at low risk of low reading ability were randomly selected starting from January 1st, 2020 at Albany Medical Center. Flesch–Kincaid Grade Level (FKGL), Gunning Fog Index (GFI), Coleman–Liau Index (CLI), Simple Measure of Gobbledygook (SMOG), and Flesch Reading Ease (FRE) were used to compare the readability of resident versus attending result letters.ResultsFor all SILS levels, attending physicians wrote result letters at a lower grade level than resident physicians based on the FKGL, GFI, and SMOG indices. The FKGL, GFI, and SMOG readability scores of result letters written to patients with SILS 3–5 were also lower when written by attending physicians compared to resident physicians.ConclusionsResult letters written by attending physicians may be easier to read than result letters written by resident physicians, especially for patients with low reading ability. Future electronic health record (EHR) software should give physicians and providers feedback on the reading level of their written communication.

ObjectivesReadability of patient-facing information of oral antibiotics detailed in the WHO all oral short (6 months, 9 months) has not been described to date. The aim of this study was therefore to examine (i) how readable patient-facing TB antibiotic information is compared to readability reference standards and (ii) if there are differences in readability between high-incidence countries versus low-incidence countries.MethodsTen antibiotics, including bedaquiline, clofazimine, ethambutol, ethionamide, isoniazid, levofloxacin, linezolid, moxifloxacin, pretomanid, pyrazinamide, were investigated. TB antibiotic information sources were examined, consisting of 85 Patient Information Leaflets (PILs) and 40 antibiotic web resouces. Of these 85 PILs, 72 were taken from the National Medicines Regulator from six countries (3 TB high-incidence [Rwanda, Malaysia, South Africa] + 3 TB low-incidence [UK, Ireland, Malta] countries). Readability data was grouped into three categories, including (i) high TB-incidence countries (n = 33 information sources), (ii) low TB-incidence countries (n = 39 information sources) and (iii) web information (n = 53). Readability was calculated using Readable software, to obtain four readability scores [(i) Flesch Reading Ease (FRE), (ii) Flesch-Kincaid Grade Level (FKGL), (iii) Gunning Fog Index and (iv) SMOG Index], as well as two text metrics [words/sentence, syllables/word].ResultsMean readability scores of patient-facing TB antibiotic information for FRE and FKGL, were 47.4 ± 12.6 (sd) (target ≥ 60) and 9.2 ± 2.0 (target ≤ 8.0), respectively. There was no significant difference in readability between low incidence countries and web resources, but there was significantly poorer readability associated with PILs from high incidence countries versus low incidence countries (FRE; p = 0.0056: FKGL; p = 0.0095).ConclusionsReadability of TB antibiotic PILs is poor. Improving readability of PILs should be an important objective when preparing patient-facing written materials, thereby improving patient health/treatment literacy.

Introduction: Previous studies have shown patient education material (PEM) in ophthalmology has been written at levels exceeding appropriate reading levels. However, information for readability in the field of oculoplastics remains limited. The aim of this study was to evaluate the readability of patient educational brochures from the American Society of Ophthalmic Plastic & Reconstructive Surgery (ASOPRS). Methods: Patient educational brochures from ASOPRS were analyzed for readability. The body of text from all 18 ASOPRS patient brochures was analyzed by ten validated tests for English readability assessment: Flesch Reading Ease Test (FRE), Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG), Coleman-Liau Index (CLI), Gunning Fog Index (GFI), New Dale-Chall Readability (NDC), FORCAST, Fry Graph Readability (FG), Raygor Readability Estimate (RRE), and New Fog Count (NFC). Results: The mean (± SD) readability scores from the 18 ASOPRS patient brochures were 48 (4.3), 11.0 (0.8), 13.0 (0.7), 11.7 (0.8), 13.6 (0.9), 11.3 (0.8), 11.1 (0.5), 12.1 (1.5), 12.2 (1.0), and 10.6 (1.3) for FRE, FKGL, SMOG, CLI, GFI, NDC, FORCAST, FG, RRE, and NFC, respectively. All ten of the mean readability scores were above the recommended reading levels. Conclusions: These findings show that the average patient may have difficulty understanding educational information provided by ASOPRS patient brochures, thereby hindering their ability to make informed decisions on their healthcare. Revision with readability as a primary goal, with input from patients and caregivers, may be necessary to improve health literacy among patients who seek oculoplastic care.

Millions of people surf the Internet every day as a source of health care information looking for materials about symptoms, diagnosis, treatments and their possible adverse effects, or diagnostic procedures. Since its launch in 2001, the free online encyclopedia Wikipedia has become the most popular general reference website, which contains approximately 30 million articles available in up to 287 languages and over 4.6 million English articles. With 18 billion page views and nearly 500 million unique visitors per month, the English version of Wikipedia ranks the fifth place in the list of the most visited websites, thus being very likely a common source of health care information by both patients and caregivers. Worth of note, the first webpage that appears after entering the keyword ‘‘Parkinson’s disease’’ (PD) on Google, the most popular search engine worldwide, is the Wikipedia article on PD (http://en.wikipedia.org/wiki/Par kinson’s_disease) (search conducted on 7 November 2014). Hence, such an article is likely to be the most immediate source of online information on PD for millions of Internet users worldwide. To fully understand the content of health information, people need to have adequate ‘‘health literacy’’ defined as ‘‘a constellation of skills, including the ability to perform basic reading and numerical tasks required to function in the health care environment’’ [1]. Low literacy level may reduce patients’ abilities to understand health information, follow medical instructions, take drugs correctly, and learn about disease prevention [1]. We therefore aimed to evaluate the reading difficulty level of the English Wikipedia article on PD using quantitative readability-assessment scales. On 5 November 2014, the educational material of the Wikipedia article on PD (available at http://en.wikipedia.org/wiki/Parkinson’s_ disease) was downloaded into Microsoft Word and analyzed for its overall level of readability with six different quantitative readability scales, using the online software program ‘‘SMOG Readability Calculator’’ (freely available at http://www.harrymclaughlin.com/SMOG.htm). The readability scales obtained through this software included: the Gunning Fog index, the Coleman Liau index, the Flesch Kincaid Grade Level, the Automated Readability Index, the Simple Measure of Gobbledygook, and the Flesch Reading Ease [2]. The Flesch Reading Ease readability index ranges from 0 to 100, with higher scores indicating more readable text. The other readability indexes correspond instead to the ideal academic grade level (i.e. the number of years of education) that a person would need in order to be able to understand the text easily, on the first reading. Readability calculations are made on the basis of sentence length, number of sentences and the number of syllables or characters per word. Described in general, these calculations penalize polysyllabic words and long, complex sentences. Readility levels of the English Wikipedia article on PD are reported in Table 1. The Flesch Reading Ease yielded F. Brigo Department of Neurology, ‘‘Franz Tappeiner’’ Hospital, Merano, Italy

Results of the First Pilot Randomized Controlled Trial of Fecal Microbiota Transplant In Pediatric Ulcerative Colitis: Lessons, Limitations, and Future Prospects

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

INTRODUCTION: Fecal microbiota transplantation (FMT) is an attractive therapeutic option for patients with inflammatory bowel disease (IBD). While recent studies have shown benefit of FMT in UC, there are no guidelines for the use of FMT in IBD and current regulations limit FMT to treat C difficile infections. Despite these constraints, patients have used FMT for IBD. Our aim is to assess interest and attitudes of patients as well as current clinical practices and attitudes of gastroenterologists as it relates to FMT as therapy for IBD. METHODS: We performed IRB-approved cross-sectional web-based surveys of both patients and providers at a tertiary IBD center from November 2019 to January 2020. All English-speaking patients ≥18 years old with a self-reported diagnosis of IBD were eligible. RESULTS: 100 patients completed the study, 55% female, 56% with Crohn’s, 39% with UC and 5% with IBD-U (Table 1). 40% of patients had heard about FMT as treatment for IBD, though only 12% had discussed it with their GI. No patients had used FMT, but 17% had considered it for their IBD. Most patients (68%) felt more comfortable discussing FMT with their GI after this survey. Patients’ biggest concern of FMT was risk of infection. When told that the FDA recently reported a death related to drug resistant bacteria from FMT, most (53.3%) patients said this changed the way they felt about FMT. 56 providers (GIs) completed the study, 159 were approached: including 19 GI fellows, 22 General GI and 15 IBD specialists with a median of 14 years (range 0-56) in practice. Only 23% of GIs typically ask patients about FMT to treat IBD, though a majority (75%) report that a patient has previously asked them about FMT. A quarter of providers report that their patients have used FMT to treat IBD. Most GIs (84%) have referred a patient for FMT, most commonly for C difficile. The majority of GIs (86%) would consider entering IBD patients into FMT clinical trials. GIs’ biggest concern of FMT was lack of evidence (Figure 2). CONCLUSION: There was a significant minority (17%) of patients that have considered using FMT as a treatment for IBD, but only 23% of providers are asking their patients about FMT. Patients and providers had very different concerns about FMT, with patients concerned about risk of infection and GIs concerned about lack of evidence and efficacy. There is an opportunity to provide resources to providers to help initiate these conversations, and to educate patients on the risks and benefits of FMT for IBD.Table 1.: Characteristics of the Patient Population. Demographics of a patient population for a survey evaluating the patient perceptions and opinions of patients towards fecal microbiota transplantation (FMT) as a treatment for inflammatory bowel disease (IBD) performed at a single tertiary care centerFigure 1.: Patients' Concerns. Graph of patients concerns' about FMT as a treatment for IBD. For those patients with concerns about FMT we asked them to rank their concerns from biggest concern to least concern.Figure 2.: Gastroenterologists' Concerns. Graph of gastroenterologists' concerns regarding FMT as a potential treatment for IBD. We asked them to rank their concerns from most concerning to least concerning.