Average Readability Score Research Articles

Quality and Readability of Online Information on Percutaneous Needle Electrolysis

Objective PNE (Percutaneous needle electrolysis) is a relatively new and effective method used to treat musculoskeletal injuries. The aim of this study was to evaluate PNE-related websites in terms of information quality, readability and content. In addition, this study aimed to identify typologies of websites that provide highly reliable information about PNE. Methods On April 7, 2024, the term “percutaneous needle electrolysis” was searched on the Google search engine. The categories, quality, content, readability, The Journal of American Medical Association (JAMA) score were used for quality assessment, and the Flesch–Kincaid grade (FKG) and the Simple Measure of Gobbledygook (SMOG) were used for readability assessment. Results Of the 153 websites, 107 had high-quality content. The quality of professional websites and scientific publishing sites appeared to be high. There was no significant difference in quality between the initial 10 websites and the remaining websites (p = .317). The average readability scores of the websites were not at the recommended level. Conclusion Most PNE-related websites are of high quality, but do not meet the recommended readability levels. It is important to review existing online content on PNE and create new high quality content that meets the readability recommendations.

Comparing the Accuracy of Two Generated Large Language Models in Identifying Health-Related Rumors or Misconceptions and the Applicability in Health Science Popularization: Proof-of-Concept Study.

Health-related rumors and misconceptions are spreading at an alarming rate, fueled by the rapid development of the internet and the exponential growth of social media platforms. This phenomenon has become a pressing global concern, as the dissemination of false information can have severe consequences, including widespread panic, social instability, and even public health crises. The aim of the study is to compare the accuracy of rumor identification and the effectiveness of health science popularization between 2 generated large language models in Chinese (GPT-4 by OpenAI and Enhanced Representation through Knowledge Integration Bot [ERNIE Bot] 4.0 by Baidu). In total, 20 health rumors and misconceptions, along with 10 health truths, were randomly inputted into GPT-4 and ERNIE Bot 4.0. We prompted them to determine whether the statements were rumors or misconceptions and provide explanations for their judgment. Further, we asked them to generate a health science popularization essay. We evaluated the outcomes in terms of accuracy, effectiveness, readability, and applicability. Accuracy was assessed by the rate of correctly identifying health-related rumors, misconceptions, and truths. Effectiveness was determined by the accuracy of the generated explanation, which was assessed collaboratively by 2 research team members with a PhD in nursing. Readability was calculated by the readability formula of Chinese health education materials. Applicability was evaluated by the Chinese Suitability Assessment of Materials. GPT-4 and ERNIE Bot 4.0 correctly identified all health rumors and misconceptions (100% accuracy rate). For truths, the accuracy rate was 70% (7/10) and 100% (10/10), respectively. Both mostly provided widely recognized viewpoints without obvious errors. The average readability score for the health essays was 2.92 (SD 0.85) for GPT-4 and 3.02 (SD 0.84) for ERNIE Bot 4.0 (P=.65). For applicability, except for the content and cultural appropriateness category, significant differences were observed in the total score and scores in other dimensions between them (P<.05). ERNIE Bot 4.0 demonstrated similar accuracy to GPT-4 in identifying Chinese rumors. Both provided widely accepted views, despite some inaccuracies. These insights enhance understanding and correct misunderstandings. For health essays, educators can learn from readable language styles of GLLMs. Finally, ERNIE Bot 4.0 aligns with Chinese expression habits, making it a good choice for a better Chinese reading experience.

The utility of ChatGPT in gender-affirming mastectomy education

IntroductionThe integration of AI such as ChatGPT in medicine has been showing promise in enhancing patient education. Gender-affirming mastectomy (GAM) is a surgical procedure designed to help individuals transition to their self-identified gender, playing a crucial role in mitigating psychological distress for many transmasculine and non-binary (TNB) patients. With increased demand and attention towards GAM, plastic and reconstructive surgeons may rely on AI-driven chatbots as an accessible, accurate, and patient-driven model for relevant details on this procedure. Specific Aim(s)This study aimed to assess the quality and readability of information provided by ChatGPT in response to frequently asked questions (FAQs) related to GAM. MethodsInspired by online forums and physician websites, 10 frequently asked questions (FAQs) about pre- and postoperative topics were submitted to ChatGPT and assessed using validated readability score measures and expert interpretation. ResultsThe average readability score was 16.0 ± 1, indicating a college or graduate reading level. Mean accuracy, comprehensiveness, and danger scores were 8.8 ± 0.5, 7.8 ± 0.7, and 2.2 ± 0.4, respectively. Although physicians appreciated ChatGPT's tone, patient autonomy, and advice to seek professional medical and mental help, they also cited instance of generic information, misinformation, support of debated techniques, and pathologization of gender dysphoria. ConclusionEven with its promise in providing accurate and comprehensive information on GAM, ChatGPT’s current limitations suggest caution as a supplementary tool to physician consultation.

Evaluating the Readability of the iPledge Comprehension Assessment and its Impact on Isotretinoin Accessibility

ABSTRACTIsotretinoin, the standard treatment for severe nodular acne, is subject to stringent iPLEDGE regulations due to its teratogenic risks, requiring monthly assessments for patients of childbearing potential. Analysis of the iPLEDGE Comprehension Assessment (iPCA) revealed an average readability score of grade 8.5, exceeding the recommended grade 6 level for optimal patient comprehension. The complex language of iPCA may hinder patients from accessing treatment, contributing to delays and potential discontinuation, especially among female patients. While the overall number of isotretinoin‐exposed pregnancies has decreased since the inception of iPledge, several hundred pregnancies continue to be reported, and simplification of iPCA presents one avenue to improve patient comprehension, safety, and ensuring equitable access to isotretinoin.

Abstract B105: Quality and Accessibility of Online Information Regarding CAR-T Therapy in Hematologic Malignancies

Abstract Background Chimeric antigen receptor T-cell (CAR-T) therapies have changed the treatment landscape for various hematologic malignancies and are currently under development and being tested in clinical trials for multiple solid tumors. Given that patients commonly use the internet as a source of health-related information, we sought to investigate the quality, understandability, and readability of online information regarding CAR-T therapy. Methods We conducted a search in a commonly used search engine (Google) of five pre-determined search terms to identify 100 unique web pages regarding CAR-T therapy. Scientific publications were excluded. Validated instruments were used to ascertain health information quality (DISCERN), understandability (Patient Education Materials Assessment Tool; PEMAT), and readability (Flesch-Kincaid, Gunning Fog, and SMOG indices). Results were summarized using descriptive statistics. Results Among the 100 web pages reviewed, 68% originated from academic medical centers, and 64% included links to clinical trials. Only 11% of the web pages included references to primary literature. 17% of web pages were available in a language other than English, with Spanish (15%) and Arabic (7%) being the most common. Moderate-to-high quality information (DISCERN ≥ 3) was presented by 47% of web pages, and only 31% of web pages were considered understandable (PEMAT ≥ 70%). Average readability scores were 10.6 (SD = 2.09), 12.6 (SD = 2.3), and 13.1 (SD = 1.7) using the Flesch-Kincaid, Gunning Fog, and SMOG indices, respectively. Conclusion Our study highlights that online information for CAR-T therapies commonly features low-quality health information that is typically not understandable to the general population. Further, contrary to recommendations from federal agencies and medical societies, available online information requires, on average, high school reading comprehension. Healthcare teams and stakeholders should strive to improve existing content and ensure patients have access to trusted, high-quality information given the unique complexities, processes, and toxicities associated with receiving CAR-T therapy. Citation Format: Luis C. Garcia, Ana I. Velázquez. Quality and Accessibility of Online Information Regarding CAR-T Therapy in Hematologic Malignancies [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B105.

Readability and Usability of Story Books for Teaching English at Senior High School

This research us focused on the readability level of story books for teaching English, and the usability of story books from the students’ and teachers’ perspective in tenth grade students at SMA Labschool Upgris. The objectives of this research were (1) to identify the readability level of usability story books for teaching English (2) to investigates the usability of story books from the students’ perspective (3) to analyze the usability of story books from the teachers’ perspective. The objects of the research are English story books as retold by Sugeng Hariyanto entitled “Nasreddin, a man who never given up”. Flesch Reading Ease Formula used to analyze the data. This research is categorized as descriptive qualitative method of the research. The overall explanation of the results and after conducting research on usability of story books for teaching English to tenth grade students in high school, the researcher can conclude that by reading story books, students are able to improve their ability to learn to read by thinking creatively and critically. The average readability score results of this storybooks are 52,46 which can be classified as Flesch Reading Ease. This means that the readability level of the story books is fairly difficult to read by students in grades 10 to 12.

Availability and Readability Level of Online Patient Education Materials Provided by Cleft Lip and Palate Teams.

Evaluate the readability of online English and Spanish cleft lip and palate patient education materials. Review of free online materials. English and Spanish language online patient education materials on cleft lip and palate were collected from American Cleft Palate-Craniofacial Association (ACPA) approved teams. American Cleft Palate-Craniofacial Association (ACPA) approved teams. English materials were analyzed using the Flesch-Kincaid, SMOG, and Coleman-Liau readability calculators. Spanish materials were analyzed using the Fry Graph, Fernandez Huerta, and INFLESZ calculators. A one-way analysis of variance (ANOVA) was used to test for variability between the readability tools. Readability levels were examined for both sets of materials. 171 (90.5%) teams provided English language materials online, with an average readability score calculated as 10.5 ± 2.9 (10th-11th grade). A total of 44 (23.2%) teams listed Spanish language materials online, with average readability score of 7.9 ± 1.2 (8th grade). ANOVA demonstrated statistically significant variability between the readability assessment tools (P < .01). Online cleft lip and palate patient education material provided by ACPA craniofacial teams were more available in English than in Spanish. Both sets of materials demonstrated readability levels above the recommended 6th-7th grade. Refining readability is associated with lowered healthcare costs and increased patient satisfaction.

A Comparative Study of Readability, Acceptability, and the Adaptation of an Internet-based Cognitive Behavioral Therapy for Tinnitus.

Internet-based cognitive behavioral therapy has shown effectiveness in managing chronic tinnitus. Internet-based cognitive behavioral therapy is currently available in only a few languages (English, Swedish, Spanish, and German). The current study aimed to adapt, evaluate, and compare the readability and acceptability of the Turkish internet-based cognitive behavioral therapy materials compared to previous versions. Internet-based cognitive behavioral therapy materials were adapted from the preexisting American English to the Turkish population in a 4-step process: (1) cultural adaptations, (2) acceptability adaptation of materials to the Turkish-speaking population, and (3) literacy-level adjustments. Experts (n=11) and patients (n=11) rated the intervention materials and the ePlatform for acceptability, including usability, content, presentation, and suitability (4). Literacy-level adjustments generated acceptable and readability levels of the Turkish version of the internet-based cognitive behavioral therapy program. The average readability score was 76.15 ± 0.35. The Turkish internet-based cognitive behavioral therapy (Mdn: 7.00) was statistically lower compared to the Swedish (Mdn: 9.00) but higher when compared to the American English and Spanish (Mdn: 5.00) versions. There were no statistical differences between the British English and Turkish versions in readability scores. Acceptability in the internet-based cognitive behavioral therapy platform was rated favorably. The Turkish internet-based cognitive behavioral therapy was found to be user-friendly and easy to understand, with navigations that are straightforward, have clear information, and are supported by audiologists. The readability score of the Turkish internet-based cognitive behavioral therapy is within recommended limits to ensure comprehensibility. We suggest that an online cognitive behavioral therapy program is adaptable for other languages for countries with a limited number of clinicians focused on cognitive behavioral therapy and tinnitus.

The Quality, Readability, and Accuracy of the Information on Google About Cannabis and Driving: Quantitative Content Analysis

Background The public perception of driving under the influence of cannabis (DUIC) is not consistent with current evidence. The internet is an influential source of information available for people to find information about cannabis. Objective The purpose of this study was to assess the quality, readability, and accuracy of the information about DUIC found on the internet using the Google Canada search engine. Methods A quantitative content analysis of the top Google search web pages was conducted to analyze the information available to the public about DUIC. Google searches were performed using keywords, and the first 20 pages were selected. Web pages or web-based resources were eligible if they had text on cannabis and driving in English. We assessed (1) the quality of information using the Quality Evaluation Scoring Tool (QUEST) and the presence of the Health on the Net (HON) code; (2) the readability of information using the Gunning Fox Index (GFI), Flesch Reading Ease Scale (FRES), Flesch-Kincaid Grade Level (FKGL), and Simple Measure of Gobbledygook (SMOG) scores; and (3) the accuracy of information pertaining to the effects of cannabis consumption, prevalence of DUIC, DUIC effects on driving ability, risk of collision, and detection by law enforcement using an adapted version of the 5Cs website evaluation tool. Results A total of 82 web pages were included in the data analysis. The average QUEST score was 17.4 (SD 5.6) out of 28. The average readability scores were 9.7 (SD 2.3) for FKGL, 11.4 (SD 2.9) for GFI, 12.2 (SD 1.9) for SMOG index, and 49.9 (SD 12.3) for FRES. The readability scores demonstrated that 8 (9.8%) to 16 (19.5%) web pages were considered readable by the public. The accuracy results showed that of the web pages that presented information on each key topic, 96% (22/23) of them were accurate about the effects of cannabis consumption; 97% (30/31) were accurate about the prevalence of DUIC; 92% (49/53) were accurate about the DUIC effects on driving ability; 80% (41/51) were accurate about the risk of collision; and 71% (35/49) were accurate about detection by law enforcement. Conclusions Health organizations should consider health literacy of the public when creating content to help prevent misinterpretation and perpetuate prevailing misperceptions surrounding DUIC. Delivering high quality, readable, and accurate information in a way that is comprehensible to the public is needed to support informed decision-making.

How understandable are the patient education materials about flat foot on the Internet for parents?

Flat foot is a common reason for parents to visit orthopedic clinics. As the Internet has become an easy-search platform, parents often seek online educational materials before seeking out a professional. The aim of this study was to investigate the quality, readability, and understandability of such online materials for parents. An Internet search was performed for "flat foot" and "pes planus" using the Google search engine. The readability was evaluated using 6 different grading systems: Flesch Reading Ease Score, Flesch-Kincaid Grade Level, Simple Measure of Gobbledygook, Fry Readability score, Gunning Fog Index tests, and Automated Readability Index. The Patient Education Materials Assessment Tool test was used to assess the understandability. For quality assessment, the Journal of American Medical Association benchmark criteria and Health on the Net code were applied. One hundred nine websites were included and evaluated for readability, understandability, and quality. The mean readability grade for all websites was 10.5 ± 2.0. The mean Gunning Fog Index tests and Flesch-Kincaid Grade Level scores for all websites were 12.4 ± 2.2 and 9.7 ± 2.1 sequentially. The mean Coleman-Liau index score was 10.0 ± 1.5, and the average Fry Readability score was 9.9 ± 2.0. The automated readability index for all websites was 10.3 ± 2.5. The average Flesch Reading Ease score for all educational materials was 59.3 ± 10.1. The average Patient Education Materials Assessment Tool score for all educational materials was 81% (range, 70-87%). The mean Journal of American Medical Association benchmark criterion for all websites was 1.0, with a range from 1.0 and 2.0. Eighteen (16.5%) websites had Health on the Net certificates. Readability, understandability, and quality of patient education materials about flat feet on the Internet vary and are often worse than professional recommendations.

LBODP043 Analysis Of Plastic Surgery Websites And Their Recommendations For Diabetics

Abstract Diabetic patients are predisposed to adverse complications after surgery, especially when their A1c is above 8. 0% (1). Despite the heightened risk for post-operative complications such as wound dehiscence and infection (2), no formal recommendations by the American Council of Academic Plastic Surgeons (ACAPS) exist regarding preoperative A1c thresholds. This study reviews the current online recommendations for diabetic patients undergoing plastic surgery and examines the readability and technical metrics presented on these webpages. We hypothesized that these webpages would enforce stricter preoperative A1c levels (&amp;lt; 8%) in comparison to the 8% threshold put forth by Diabetes Care in 2014. An anonymous, depersonalized Google search with the search term "diabetes and plastic surgery" was run. The initial 50 results were analyzed and 11 webpages meeting inclusion criteria extracted. 45.45% (5/11) of the webpages stated specific A1c recommendations, with 4 of the webpages recommending an A1c &amp;lt;7% and one webpage recommending an A1c &amp;lt;6%. A number of the websites recommended that patients consult their primary care physician (PCP) or endocrinologist, 63.6% (7/11). 100% (11/11) of webpages discussed poor wound healing and 45% (5/11) discussed the heightened risk of postoperative infection in diabetic surgical patients. Webpage average readability scores for seven readability measures greatly exceeded the 6th grade reading level recommended for medical information. This study determined that online resources for diabetic patients undergoing plastic surgery utilized stricter than standard preoperative criteria and exceeded recommended readability levels. Standardizing requirements for diabetic patients and improving readability may help patients better understand the preoperative expectation for better surgical outcomes.

An Analysis of the Readability of Phacoemulsification Online Resources.

Introduction: Cataract is the leading cause of blindness worldwide. Phacoemulsification is now the gold standard for cataract extraction and is greatly needed in low socioeconomic status (SES) communities, rural and older patient populations, and patients with poor vision. This greatly increases the importance of high readability for online resources on this topic. This study aims to assess the readability of online information about phacoemulsification based on readability scores for each resource. Methods: We conducted a retrospective cross-sectional study. The term “phacoemulsification” was searched online, and each website was categorized by type: academic, physician, non-physician, commercial, social media, and unspecified. The readability scores for each website were calculated using six different readability tests and a composite score that reflects reading grade level was obtained. To evaluate the difference between the categories of websites, analysis of variance (ANOVA) testing was used. All test scores were compared with the 6th grade standard recommendation using a one-sample t-test.Results: A total of 20 websites were analyzed. Three websites (3/20; 15%) had a score which is correlated with a 6th grade reading level or below. Seventeen websites had a score correlated with a college reading level or above (17/20; 85%). None of the readability scores had a mean below a 6th grade reading level. No category had an average readability score at or below a 6th grade reading level. None of the mean readability scores resulted in a statistically significant difference across categories. All readability tests had an average score which was significantly different from a 6th grade reading level (p<0.001). Conclusions: This is the first study to focus on the accessibility of online English resources on phacoemulsification and implement multiple standardized readability scores with regards to cataract surgery resources. It provides further overwhelming evidence that online resources on phacoemulsification are too complex for the average patient to understand. Interventions should be implemented to improve readability.

Are we providing adequate information? patient-specific clinical trial information at NCI-designated cancer center websites.

e18602 Background: Disparities persist in the recruitment and enrollment of diverse populations to cancer clinical trials (CT). Barriers to CT participation are numerous and include structural inequities that limit access, stringent eligibility criteria, financial barriers, provider bias, and patient knowledge. While national societies recommend patient educational materials should be written ≤6th grade reading level, most CT online information available is complex. We evaluated the accessibility, readability, and content of patient-specific CT information from NCI-designated cancer center websites (CCW). Methods: We conducted a qualitative review of CT information in 64 clinical NCI CCW. We reviewed each CCW’s patient-specific CT information to evaluate content, reading level, and navigation. Readability was evaluated using validated measures [i.e., Flesch-Kincaid Grade Level (FKGL), Gunning Fog Index (GFI), Coleman-Liau Index (CLI), and Simple Measure of Gobbledygook (SMOG) Grade Level] and an average readability score. Data was summarized using descriptive statistics. Results: Most CCW made CT information easily accessible, 62 had a CT-specific website of which 61% required only 1-click from the homepage and 5% required ≥3 clicks. Common patient-specific information included definition of CT (89%), CT phases (66%), guidance on how to decide if you should enroll in a CT (59%), risks and benefits of participation (53%), informed consent (48%), and financial considerations (30%). Only 16% of CCW contained CT information for patients with limited or no English proficiency (14% Spanish, 8% Chinese). CT educational content required a reading level of ≥10th grade (Table). 44% of websites included links to outside educational resources, such as the NCI. None of the websites included CT-specific supportive resources (i.e., transportation, navigation, financial assistance, etc.). Most CCW included a CT search bar (77%), yet when searching for a specific cancer type (i.e., breast cancer) 53% yielded a top search result that was disease agnostic or for a different cancer type. 72% included CT descriptions, 58% their eligibility criteria, and 29% included pre-screening forms or links to CT-specific inquiries. Conclusions: Most NCI designated CCW contain CT information at a high literacy level with suboptimal search options and very limited resources/information in other languages. Our findings highlight missed opportunities to develop and advertise CT-specific supportive services and to disseminate CT education materials that meet the literacy and language needs of the increasingly diverse US population.[Table: see text]

Assessment of Readability Level of Reading Materials in Indonesia EFL Textbooks

The research aimed to assess the readability of reading material in two different English textbooks published by different publishers. Many pieces of research have been conducted to examine the reading materials in English textbooks, and it had been discovered that the reading materials were insufficiently adequate for the levels of students. The research applied a descriptive content analysis method to analyze, interpret, and describe the data. The Flesch Reading Ease formula was as an instrument. The research’s data were derived from the English textbook “Pathway to English” by Erlangga grade X and the English textbook “Bahasa Inggris” by The Ministry of Education and Culture grade X. Based on the findings of the research, five reading texts out of 15 match with students’ level (fairly difficult level) of grade X in the first textbook, while three texts out of 13 equal with students’ level (fairly difficult level) of grade X in the second textbook. Furthermore, the first textbook’s average readability score indicates that the texts are ‘standard’, whereas the second textbook indicates that the texts are ‘fairly difficult’. Based on the study findings, some recommendations for teachers are to use the readability formulas to provide appropriate reading material for students, as well as for other researchers to conduct a larger context about readability.

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

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

PENGEMBANGAN E-LKPD IPA BERBASIS CATUR ASRAMA KELAS V

This study aims to develop a valid and readable E-LKPD IPA based on catur asrama for the fifth grade of elementary school in the first semester. This study uses the ADDIE development model, with the following stages: analysis, design, development, implementation, and evaluation. In this study, it was only limited to the development stage with considerations of urgency, time constraints, research budget, and the ability of researchers, especially because the first semester of science material had been studied while this research was carried out in the second semester. The subjects in this study were 9 students of class V SD Negeri 2 Lemukih. This research data collection uses a validation sheet for 3 lecturers and 3 educators and a readability sheet for 9 students. The instrument used in measuring the level of validity and readability of the E-LKPD is a validation and readability sheet containing a Likert scale 4. The data were analyzed descriptively to obtain the percentage of validity and the mean score of E-LKPD readability. The percentage of E-LKPD validity is 96% with a "very high validity" level of validity and an average E-LKPD readability score of 3.9 with a "very good" readability level. Based on the results of data analysis, the E-LKPD IPA based on catur asrama for the fifth grade of elementary school in the first semester which is valid and tested for readability is suitable for use as teaching materials in learning for teachers and students in elementary school.

Online Patient Education Materials Related to Lipoprotein(a): Readability Assessment.

BackgroundLipoprotein(a) (Lp(a)) is a highly proatherogenic lipid fraction that is a clinically significant risk modifier. Patients wanting to learn more about Lp(a) are likely to use online patient educational materials (OPEMs). However, the readability of OPEMs may exceed the health literacy of the public.ObjectiveThis study aims to assess the readability of OPEMs related to Lp(a). We hypothesized that the readability of these online materials would exceed the sixth grade level recommended by the American Medical Association.MethodsUsing an online search engine, we queried the top 20 search results from 10 commonly used Lp(a)-related search terms to identify a total of 200 websites. We excluded duplicate websites, advertised results, research journal articles, or non–patient-directed materials, such as those intended only for health professionals or researchers. Grade level readability was calculated using 5 standard readability metrics (automated readability index, SMOG index, Coleman-Liau index, Gunning Fog score, Flesch-Kincaid score) to produce robust point (mean) and interval (CI) estimates of readability. Generalized estimating equations were used to model grade level readability by each search term, with the 5 readability scores nested within each OPEM.ResultsA total of 27 unique websites were identified for analysis. The average readability score for the aggregated results was a 12.2 (95% CI 10.9798-13.3978) grade level. OPEMs were grouped into 6 categories by primary source: industry, lay press, research foundation and nonprofit organizations, university or government, clinic, and other. The most readable category was OPEMs published by universities or government agencies (9.0, 95% CI 6.8-11.3). The least readable OPEMs on average were the ones published by the lay press (13.0, 95% CI 11.2-14.8). All categories exceeded the sixth grade reading level recommended by the American Medical Association.ConclusionsLack of access to readable OPEMs may disproportionately affect patients with low health literacy. Ensuring that online content is understandable by broad audiences is a necessary component of increasing the impact of novel therapeutics and recommendations regarding Lp(a).

Are English-language online patient education materials related to breast cancer risk assessment understandable, readable, and actionable?

PurposeTo evaluate the readability, understandability, and actionability of online patient education materials (OPEM) related to breast cancer risk assessment. Material and methodsWe queried seven English-language search terms related to breast cancer risk assessment: breast cancer high-risk, breast cancer risk factors, breast cancer family history, BRCA, breast cancer risk assessment, Tyrer-Cuzick, and Gail model. Websites were categorized as: academic/hospital-based, commercial, government, non-profit or academic based on the organization hosting the site. Grade-level readability of qualifying websites and categories was determined using readability metrics and generalized estimating equations based on written content only. Readability scores were compared to the recommended parameters set by the American Medical Association (AMA). Understandability and actionability of OPEM related to breast cancer high-risk were evaluated using the Patient Education Materials Assessment Tool (PEMAT) and compared to criteria set at ≥70%. Descriptive statistics and inter-rater reliability analysis were utilized. Results343 websites were identified, of which 162 met study inclusion criteria. The average grade readability score was 12.1 across all websites (range 10.8–13.4). No website met the AMA recommendation. Commercial websites demonstrated the highest overall average readability of 13.1. Of the 26 websites related to the search term breast cancer high-risk, the average understandability and actionability scores were 62% and 34% respectively, both below criteria. ConclusionsOPEM on breast cancer risk assessment available to the general public do not meet criteria for readability, understandability, or actionability. To ensure patient comprehension of medical information online, future information should be published in simpler, more appropriate terms.

Readability Analysis of Spanish Language Patient-Reported Outcome Measures in Laryngology

Laryngologists use patient-reported outcome measures (PROM) to determine the efficacy of an intervention or to evaluate a patient's symptomatology. PROMs should be developed for a diverse target audience, including patients of all literacy levels. The American Medical Association (AMA) recommends that PROMs are written at or below the sixth- grade level. In recent studies, readability scores for otolaryngology PROMs in English were above the recommended reading level. To date, there is limited data regarding the readability of Spanish PROMs. Thus, this study aims to report the readability of Spanish language PROMs in laryngology. This study analyzed nine Spanish language laryngology PROMs. The authors queried PROMs from PubMed and Google scholar based upon English language laryngology PROM systematic reviews. Common categories included voice, airway, dysphagia, and other laryngology PROMs. Only nine laryngology PROMs were translated and validated in the Spanish language and publicly available. The readability of Spanish PROMs was determined using a multi-lingual readability software by two readability indices: Fernández Huerta and INFLESZ. The mean and standard deviation (SD) Fernández-Huerta was 75.25 (27.12) and INFLESZ was 71.25 (26.98). The average readability score per PROM in Spanish was: DI (84.19), EAT-10 (11.54), MDADI (64.92), RSI (57.22), SWAL-QoL (70.98), TVQ (87.64), VFI (99.46), VHI-10 (95.04), and VRQoL (88.28). The mean readability of Spanish language laryngology PROMs was above the recommended reading level. Patient readability should be considered when developing laryngology PROMs translations and validations. Robust development and testing of novel PROMs are important to address the persistent, pervasive risks for Spanish speaking patients.

Do hospital consent forms for cardiology procedures meet health literacy standards? Evaluation of understandability and readability

ObjectivesConsent forms that are difficult to understand may jeopardize informed consent. The aim of this study was to determine whether consent documents for cardiology-related procedures could be easily read and understood by patients with low health literacy. MethodsAll 37 cardiology-related consent forms with patient information material were retrieved from a publicly available suite of documents from one state in Australia. Two raters independently assessed documents and resolved discrepancies through discussion. Understandability was assessed using the Patient Education Materials Assessment Tool for Printed materials (PEMAT-P). Readability was assessed using the Gunning Fog Index, SMOG and Flesch Reading Ease formulas. Images were assessed using the 5C Image checklist. Results were analyzed descriptively. ResultsOnly 1 of 37 forms met the general PEMAT-P threshold (70%) for being ‘understandable’. The average readability score was high, requiring a grade 10–12 level of education to understand. Most images lacked useful captions, had low visual clarity, and were not purpose-designed for the material. ConclusionsThe current format for cardiology consent forms does not meet recommended standards for understandability and readability. Practice implicationsDevelopment of consent forms would benefit from taking health literacy principles into account with patient input, and purpose-designed images should be included in all forms to reinforce text.