Abstract
BackgroundGeneral practice websites are an increasingly important point of interaction, but their readability is largely unexplored. One in four adults struggle with basic literacy, and there is a socioeconomic gradient. Readable content is a prerequisite to promoting health literacy.AimTo assess general practice website readability by analysing text and design factors, and to assess whether practices adapted their website text to the likely literacy levels of their populations.Design and settingWebsites for all general practices across Scotland were analysed from March to December 2019, using a cross-sectional design.MethodText was extracted from five webpages per website and eight text readability factors were measured, including the Flesch Reading Ease and the Flesch-Kincaid Grade Level. The relationship between readability and a practice population’s level of deprivation, measured using the Scottish Index of Multiple Deprivation (SIMD), was assessed. Overall, 10 design factors contributing to readability and accessibility were scored.ResultsIn total, 86.4% (n = 813/941) of Scottish practices had a website; 22.9% (n = 874/3823) of webpages were written at, or below, the government-recommended reading level for online content (9–14 years old), and the content of the remaining websites, 77.1% (n = 2949/3823), was suitable for a higher reading age. Of all webpages, 80.5% (n = 3077/3823) were above the recommended level for easy-to-understand ‘plain English’. There was no statistically significant association between webpage reading age and SIMD. Only 6.7% (n = 51/764) of websites achieved all design and accessibility recommendations.ConclusionChanges to practice websites could improve readability and promote health literacy, but practices will need financial resources and ongoing technical support if this is to be achieved and maintained. Failure to provide readable and accessible websites may widen health inequalities; the topic will become increasingly important as online service use accelerates.
Highlights
Design and setting: All General Practice (GP) websites across Scotland
How this fits in GP’s are encouraged to make more services available online, yet poorly written or produced websites can inadvertently create a barrier to accessing healthcare and widen health inequalities
In the largest study on website readability, all 813 GP websites in Scotland were reviewed and most (77%) were more difficult to read than the government-recommended limits
Summary
General Practice (GP) websites are an increasingly important source of information and provide the first point of interaction between patients and healthcare providers, yet there has been no largescale research that assesses how understandable GP websites are to their practice populations. In Scotland it will soon be a requirement for all practices to make information and services available digitally[2]. This process has been accelerated by the COVID-19 crisis[3, 4]. The basis for GP websites is commonly the practice leaflet, a contractually required document that provides information about the services, opening times, appointments, prescriptions, data protection and staff[2, 5, 6]. General Practice (GP) websites are an increasingly important point of interaction, but their readability is largely unexplored.
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