Grade Level Test Research Articles

Assessing the accuracy and readability of ChatGPT-4 and Gemini in answering oral cancer queries—an exploratory study

Aim: This study aims to evaluate the accuracy and readability of responses generated by two large language models (LLMs) (ChatGPT-4 and Gemini) to frequently asked questions by lay persons (the general public) about signs and symptoms, risk factors, screening, diagnosis, treatment, prevention, and survival in relation to oral cancer. Methods: The accuracy of each response given in the two LLMs was rated by four oral cancer experts, blinded to the source of the responses. The accuracy was rated as 1: complete, 2: correct but insufficient, 3: includes correct and incorrect/outdated information, and 4: completely incorrect. Frequency, mean scores for each question, and overall were calculated. Readability was analyzed using the Flesch Reading Ease and the Flesch-Kincaid Grade Level (FKGL) tests. Results: The mean accuracy scores for ChatGPT-4 responses ranged from 1.00 to 2.00, with an overall mean score of 1.50 (SD 0.36), indicating that responses were usually correct but sometimes insufficient. Gemini responses had mean scores ranging from 1.00 to 1.75, with an overall mean score of 1.20 (SD 0.27), suggesting more complete responses. The Mann-Whitney U test revealed a statistically significant difference between the models’ scores (p = 0.02), with Gemini outperforming ChatGPT-4 in terms of completeness and accuracy. ChatGPT generally produces content at a lower grade level (average FKGL: 10.3) compared to Gemini (average FKGL: 12.3) (p = 0.004). Conclusions: Gemini provides more complete and accurate responses to questions about oral cancer that lay people may seek answers to compared to ChatGPT-4, although its responses were less readable. Further improvements in model training and evaluation consistency are needed to enhance the reliability and utility of LLMs in healthcare settings.

Cultural adaptation and validation of the French version of the Antwerp pelvic floor knowledge questionnaire

AimsThe Antwerp Pelvic Floor Knowledge Questionnaire (APFK-Q) is a self-administered tool used for assessing women’s knowledge of the pelvic floor, an essential element of pelvic health education initiatives. The aim of this study was to validate the French version of the APFK-Q and to assess its psychometric properties. MethodsAcceptability of the cultural adaptation of APFK-Q in French (translation/back-translation) was assessed in two groups of women: one group not working in the healthcare sector (non-healthworkers, n = 112), and another of student midwives (n = 29). Twenty-three of the non-healthworkers agreed to take part in a test–retest step to assess reproducibility. Agreement of responses was measured for each question using Cohen’s kappa coefficient. Sensitivity to change was assessed before and after a pelvic-floor health education workshop. The proportion of correct answers was compared before and after the workshop using McNemar’s Chi2 test. Readability and the reading level required for optimal comprehension were assessed using the Flesch Reading Ease Score (FRES) and Flesch-Kincaid Grade Level test, respectively. ResultsSeventy percent (n = 72) of the non-healthworkers and 72 % (n = 21) of the students reported no comprehension difficulties. Agreement was very good (k > 0.8) for 46 % of the items and good (0.6–0.8) for 25 %. The proportion of correct answers was significantly higher for 72 % of the items after the pelvic-floor health education workshop. The French version of the APFK-Q was judged to be easy to understand according to the FRES test, with a score of 60.6. The school level required for optimal comprehension was estimated at 8th grade. ConclusionThe French version of the APFK-Q is an acceptable, reproducible, and easily understandable questionnaire that provides a broad description of women’s knowledge of the pelvic-floor sphere. Sensitivity to change was confirmed for most items, making it a useful tool for assessing the impact of pelvic-floor health education initiatives.

Development, validation, user testing of patient information leaflet to improve awareness of metabolic side effects in patients on atypical antipsychotics

BackgroundMetabolic adverse effects of second-generation antipsychotics (SGAs) have been well-documented in literature. This study aimed to develop, validate, and evaluate the usefulness of patient information leaflet (PIL) by user testing method to improve metabolic monitoring for psychiatric patients prescribed with SGAs. MethodsThe study included out-patients above 18 years of age diagnosed with schizophrenia, schizoaffective, bipolar disorders prescribed with SGAs. Database such as micromedex, guidelines on developing PIL and factsheets on antipsychotics were used to prepare the content of the leaflet and was given to experts for validation. The PIL covered information on definition of antipsychotic and its types, metabolic syndrome and its prevention such as lifestyle modifications and regular monitoring. Readability of the PIL was assessed using Flesch reading ease (FRE), Flesch Kincaid grade level (FK-GL) and user testing in 20 similar patient population. ResultsThe BALD scores on layout and design of the PILs was found to be 29. The FRE readability test score was found to be 63.5 and FKGL test score was found to be 7.6. Among the 20 patients, 5 of them favoured English PILs, while 15 chose Kannada PILs. The overall pre and post user-testing mean scores for knowledge assessment significantly increased from 60.62 ± 23.39 to 91.25 ± 11.54. Overall, about 85 % of patients gave the PIL leaflets a good rating. ConclusionPatient education materials of high quality that are created with pictures may aid in a better knowledge of the treatment for psychiatric patients who are on long term SGA therapy.

Assessing the Responses of Large Language Models (ChatGPT-4, Gemini, and Microsoft Copilot) to Frequently Asked Questions in Breast Imaging: A Study on Readability and Accuracy.

Background Large language models (LLMs), such as ChatGPT-4, Gemini, and Microsoft Copilot, have been instrumental in various domains, including healthcare, where they enhance health literacy and aid in patient decision-making. Given the complexities involved in breast imaging procedures, accurate and comprehensible information is vital for patient engagement and compliance. This study aims to evaluate the readability and accuracy of the information provided by three prominent LLMs, ChatGPT-4, Gemini, and Microsoft Copilot, in response to frequently asked questions in breast imaging, assessing their potential to improve patient understanding and facilitate healthcare communication. Methodology We collected the most common questions on breast imaging from clinical practice and posed them to LLMs. We then evaluated the responses in terms of readability and accuracy. Responses from LLMs were analyzed for readability using the Flesch Reading Ease and Flesch-Kincaid Grade Level tests and for accuracy through a radiologist-developed Likert-type scale. Results The study found significant variations among LLMs. Gemini and Microsoft Copilot scored higher on readability scales (p < 0.001), indicating their responses were easier to understand. In contrast, ChatGPT-4 demonstrated greater accuracy in its responses (p < 0.001). Conclusions While LLMs such as ChatGPT-4 show promise in providing accurate responses, readability issues may limit their utility in patient education. Conversely, Gemini and Microsoft Copilot, despite being less accurate, are more accessible to a broader patient audience. Ongoing adjustments and evaluations of these models are essential to ensure they meet the diverse needs of patients, emphasizing the need for continuous improvement and oversight in the deployment of artificial intelligence technologies in healthcare.

Evaluating Quality, Credibility, and Readability of Online Over-the-Counter Hearing Aid Information.

With over-the-counter hearing aids being recently approved by the United States Food and Drug Administration, the accuracy and usefulness of online information has not yet been examined. This study evaluates the quality, credibility, readability, and accessibility of online over-the-counter hearing aids education materials. Google was queried using the search term "over-the-counter hearing aids". The top 50 results were categorized into healthcare versus non-healthcare authored resources. The Flesch Reading Ease Score (FRES) and Flesch-Kincaid Grade Level (FKGL) tests were utilized to assess readability, whereas the Currency, Relevance, Authority, Accuracy, and Purpose (CRAAP) test and DISCERN instruments were used to assess quality and credibility. The number of clicks taken to access relevant information on each website was used to assess accessibility. There was no significant difference in FRES or FKGL readability scores between healthcare and non-healthcare authored websites (p = 0.5548, p = 0.5981, respectively), but both readability scores were higher than that of the recommended reading level for patient education materials. There was no significant difference in CRAAP and DISCERN scores between both groups (p = 0.5746, p = 0.1699, respectively). The number of clicks did not significantly differ between healthcare and non-healthcare authored resources (p = 0.4932). This study highlights poor readability and accessibility of virtual healthcare information regarding OTC hearing aids. Although credibility in articles authored by healthcare and non-healthcare professionals was adequate, readability was greatly compromised due to the written information exceeding the recommended United States reading level. Accessibility posed a similar issue, as many sites required multiple clicks to access product information. NA Laryngoscope, 134:3302-3309, 2024.

Reading between the lines: the association between education, literacy, and dementia in a cohort of older South African adults

AbstractBackgroundThe relationship between education and cognitive function in later life has been widely studied, yet it remains uncertain whether the association is due to a true protective effect of education or to test‐taking skills developed through formal education. Literacy, as an objective measure of learning, may clarify this relationship, particularly in low‐ and middle‐income countries (LMIC) where the effect of education may be influenced by school attendance and quality. This study aimed to investigate: 1) the concordance between subjective and objective literacy measures and educational attainment, and 2) the ability of literacy to predict cognitive outcomes.MethodThis study utilized data from Wave 2 of the Health and Aging in Africa: a Longitudinal Study of an INDEPTH Community in South Africa (HAALSI), a population‐based study in Agincourt, South Africa, and its dementia sub‐study (n = 559), collected in 2019‐2020 and 2018‐2019, respectively. Three measures of literacy (self‐report, short sentence reading, reading grade level test) were compared using Cohen’s kappa statistic. Multivariable seemingly unrelated regression (SUR) models were used to examine the association of literacy with cognitive test scores, adjusting for age, sex, and educational attainment. Additionally, multivariable logistic regression models were conducted to assess the independent effect of literacy on dementia risk, controlling for educational attainment.ResultThe Cohen’s kappa score between the three literacy measures was 0.615, indicating substantial agreement. The Cohen’s kappa score between the literacy measures and educational attainment was 0.608. SUR models revealed a statistically significant relationship (p‐value&lt;0.05) between literacy and z‐standardized cognitive test scores in most tests. Literacy was associated with reduced risk of dementia beyond education, with a relative risk ratio of 0.13 (p‐value&lt;0.001) for the literate vs. illiterate groups without education.ConclusionThis study highlights the importance of utilizing objective reading tests to measure literacy in populations, rather than relying solely on self‐reported literacy status. Results indicate that literacy is significantly associated with cognitive function, independent of educational attainment. This suggests that literacy skills acquired outside of formal education may reflect underlying protective factors, such as motivation and resilience, against dementia.

The distribution of cognates and their impact on response accuracy in the EIKEN tests

Although there is abundant evidence for the use of first-language (L1) knowledge by bilinguals when using a second language (L2), investigation into the impact of L1 knowledge in large-scale L2 language assessments and discussion of how such impact may be controlled has received little attention in the language assessment literature. This study examines these issues through investigating the use of L1-Japanese loanword knowledge in test items targeting L2-English lexical knowledge in the Reading section of EIKEN grade-level tests, which are primarily taken by Japanese learners of English. First, the proportion of English target words that have loanwords in Japanese was determined through analysis of corpus-derived wordlists, revealing that the distribution of such items is broadly similar to that in language in general. Second, the impact of loanword frequency in Japanese (and cognate status) was demonstrated through statistical analysis of response data for the items. Taken together, the findings highlight the scope and impact of such cognate items in large-scale language assessments. Discussion centers on how test developers can and/or should deal with the inclusion of cognate words in terms of context validity and test fairness.

“My knee is cracking” – What information is available on the internet about it? A systematic appraisal of the credibility, readability and accuracy of online information about knee crepitus

ObjectivesTo summarise and systematically appraise the credibility, readability, and accuracy of the online information about knee crepitus. DesignSystematic appraisal of online information. MethodThe top 20 URLs of two search engines (Google and Bing) for the following terms were screened for eligibility ‘knee crepitus’, ‘knee sound’, and ‘knee crackling’ (N ​= ​120 websites). Two reviewers assessed the websites for credibility (JAMA benchmark) and readability (Flesch Reading Ease and Flesch-Kincaid Grade Level tests). For accuracy, we performed a qualitative analysis creating thematic units based on the website's content and explored whether they were supported by evidence. ResultsFifty-one websites were included. There was a large variation in the overall credibility of websites, with more than half of the websites lacking credible information. The median Flesch reading ease was 62 (range ​= ​42–88) and Flesch–Kincaid grade level was 8 (range ​= ​3–12). Six key thematic units emerged from our qualitative analysis all with sub-themes within them. The main topics covered by websites were: (i) What is knee crepitus? (ii) Is knee crepitus a problem? (iii) What is the cause of knee crepitus? (iv) How to manage knee crepitus? (v) What are the health consequences of having knee crepitus? (vi) Who should I seek if I have knee crepitus? ConclusionPatients and clinicians should take caution when seeking web-based information about knee crepitus. Websites about knee crepitus lack credibility, present a large variation in readability outcomes, and there was no research evidence available to support most of their information.

Online information for incisional hernia repair: What are patients reading?

PurposePatients increasingly access online materials for health-related information. Using validated assessment tools, we aim to assess the quality and readability of online information for patients considering incisional hernia (IH) repair. MethodsThe top three online search engines (Google, Bing, Yahoo) were searched in July 2022 for “Incisional hernia repair” and “Surgical hernia repair”. Included websites were classified as academic, hospital-affiliated, commercial, and unspecified. The quality of information was assessed using the Journal of the American Medical Association (JAMA) benchmark criteria (0–4), DISCERN instrument (16–80), and the presence of Health On the Net code (HONcode) certification. Readability was assessed using the Flesch Reading Ease (FRE) and Flesch-Kincaid Grade Level (FKGL) tests. Results25 unique websites were included. The average JAMA and DISCERN scores of all websites were 0.68 ± 1.02 and 36.50 ± 10.91, respectively. Commercial sites showed a significantly higher DISCERN mean score than academic sites (p = 0.034), while no significant difference was demonstrated between other website categories. 3 (12%) websites reported HONcode certification and had significantly higher JAMA (p = 0.016) and DISCERN (p = 0.045) mean scores than sites without certification. Average FRE and FKGL scores were 39.84 ± 13.11 and 10.62 ± 1.76, respectively, corresponding to college- and high school-level comprehensibility. ConclusionsOur findings suggest online patient resources on IH repair are of poor overall quality and may not be comprehensible to the public. Patients accessing internet resources for additional information on IH repair should be made aware of these inadequacies and directed to sites bearing HONcode certification.

Knowledge Measure for Ovarian Cancer Research (KnoMOR): Development and psychometric testing results of a patient-centered knowledge measure (029)

<b>Objectives:</b> Knowledge is a prerequisite to informed choice. There are no validated measures of ovarian cancer (OC) to assess patients' knowledge systematically. Through efforts to create shared medical decision tools for OC, we sought to develop and validate an OC knowledge measure with sub-scales focusing on general knowledge and maintenance therapy (MT) to assess patients' understanding of their disease and treatment. <b>Methods:</b> Gaps in OC and MT knowledge were identified from qualitative interviews with patients and non-medical caregivers. Content experts supplemented these gaps with key facts that OC patients should know. Sample questions were drafted, iteratively refined with feedback from content experts, and cognitively tested with nine patients. The knowledge measure (true/false/not sure and multiple choice) was administered to women with OC and then re-administered 30 days later to assess test-retest reliability. "Not sure" answers were coded as incorrect. Reading level was assessed by the Flesch-Kincaid Grade Level test. Item difficulty (% of correct responses) and item uncertainty (% of "not sure" responses) were calculated for each question. Internal consistency reliability was assessed using the Kuder-Richardson Formula 20 (KR-20). Test-retest reliability was estimated with the intraclass correlation coefficient (ICC). Physicians were recruited from a national convenience sample to test for known-group validity. The percentage of correct responses to the OC and MT scales were compared for physicians and patients with an independent samples t-test. <b>Results:</b> The 31-item (14 OC general knowledge, 17 MT knowledge) measure was completed by 146 OC patients, 65 newly diagnosed and 81 with recurrent disease recruited between October 2020 and June 2021. A total of 27 physicians participated. Two items were dropped due to ceiling effects or overlapping constructs, resulting in a 29-item knowledge measure (12-item general OC knowledge; 17-item MT knowledge scales) with a reading level of grade 11.3. Additional items with high item uncertainty were retained due to their importance in informed decision-making and potential to be impacted by decision support interventions. Internal consistency reliability of the final scale was acceptable (OC scale, KR-20: 0.80, MT scale, KR-20: 0.76). Test-retest reliability was good (OC scale, ICC: 0.70, MT scale, ICC: 0.79). There were significant differences in knowledge between patients and physicians on the OC scale (patients' mean correct responses, 58.7%; physicians' mean correct responses, 88.1%; p<0.001). Similarly, patients answered 43.9% of MT questions correctly compared to 84% of physicians (p<.001). <b>Conclusions:</b> We developed a brief, valid, and reliable indicator of ovarian cancer patients' knowledge of key concepts central to making an informed decision about MT. The patient-centered measure is a simple and convenient tool that can be incorporated into a broader assessment of the quality of patients' decision-making about ovarian cancer.

Comprehensiveness, accuracy, quality, credibility and readability of online information about knee osteoarthritis.

People are increasingly using the Internet to retrieve health information about chronic musculoskeletal conditions, yet content can be inaccurate and of variable quality. To summarise (i) comprehensiveness, (ii) accuracy and clarity, iii) quality of information about treatment choices, (iv) credibility and (v) readability of online information about knee osteoarthritis. Systematic appraisal of website content. Searches for "knee osteoarthritis" and "knee arthritis" were performed using Google and Bing (October 2020). The top 20 URLs of each search were screened for eligibility. Comprehensiveness, accuracy and clarity of content were matched against 14 pre-defined topic descriptors. DISCERN and HONcode were used to measure quality of information about treatment choices and website credibility, respectively. Flesch Reading Ease and Flesch-Kincaid Grade Level tests were used to assess readability. Thirty-five websites were included. Websites were generally comprehensive (median, range = 12, 0-14/14) with descriptors available for 67% (n = 330/490) of topics across all websites, but only 35% (n = 116/330) were accurate and clear. Quality of information about treatment choices was generally low (median DISCERN score, range = 40, 16-56/80). Credibility descriptors were present for 65% (n = 181/280) of items, with 81% (n = 146/181) of descriptors being clear. Median Flesch reading ease was 53 (range = 21-74), and Flesch-Kincaid grade level was 8 (range = 5-11). Few websites provide accurate and clear content aligned to key research evidence. Quality of information about treatment choices was poor, with large variation in comprehensiveness, credibility and readability. Careful consideration is required by clinicians to identify what online information people with knee osteoarthritis have accessed and to address misinformed beliefs.

Exploring Particular Learner Factors Associated with South African Mathematics Learners’ Achievement: Gender Gap or Not

Mathematics is a gateway to science-related careers and all stakeholders want to improve the achievement levels in mathematics. In this study we use data from the Trends in International Mathematics and Science Study 2015 to investigate the association between the learner situational factors of gender, grade level age appropriateness, school location and test language familiarity with the mathematics achievement. We are particularly interested in whether gender can predict mathematics achievement, after taking into account these learner situational factors. The study used multiple regression to investigate the association between the variables where the mathematics achievement scores were calculated out of a possible 1000 scale points, with a mean of 500. The average score for the South African participants was 372. The regression predicts that learners who attend school in a rural and small village school are expected to achieve 63 and 48 points lower, respectively, than their counterparts from a similar background. In terms of the age effect, the regression predicts overall that a learner who is above the expected age for Grade 9 will get 60 points lower than a learner who is at the appropriate age the grade from a similar background. Furthermore the results show that if school location, familiarity with the test and age appropriateness are held constant, boys do better on average than girls by seven points and this is a significant effect. This result is unexpected since in the original data, the mean of the girls’ scores was on average higher than that of the boys. The study illustrates that gendered differences can only be adequately understood when other situational factors are considered. In order to improve the equity of the outcomes, targeted systemic interventions are necessary, which focus on improving the effectiveness of instruction and quality of learning opportunities so as to mediate the effect of these situational factors.

Patient-reported outcome measures in ophthalmology: too difficult to read?

ObjectivePatient-reported outcome measures (PROMs) are commonly used in clinical trials and research. Yet, in order to be effective, a PROM needs to be understandable to respondents. The aim of this...

Improved readability and functions needed for mHealth apps targeting patients with heart failure: An app store review

To maintain their quality of life and avoid hospitalization and early mortality, patients with heart failure must recognize and respond to symptoms of exacerbation. A promising method for engaging patients in their self-care is through mobile health applications (mHealth apps). However, for mHealth to have its greatest chance for improving patient outcomes, the app content must be readable, provide useful functions and be based in evidence. The study aimed to determine: (1) readability, (2) types of functions, and (3) linkage to authoritative sources of evidence for self-care focused mHealth apps targeting heart failure patients that are available in the Apple and Google Play Stores. We systematically searched for mHealth apps targeting patients with heart failure in the Apple and Google Play Stores and applied selection criteria. Readability of randomly selected informational paragraphs were determined using Flesch-Kincaid grade level test tool in Microsoft Word. Ten mHealth apps met our criteria. Only one had a reading grade level at or below the recommended 6th grade reading level (average 9.35). The most common functions were tracking, clinical data feedback, and non-data-based reminders and alerts. Only three had statements that clearly linked the mHealth app content to trustworthy, evidence-based sources. Only two had interoperability with the electronic health record and only one had a communication feature with clinicians. Future mHealth designs that are tailored to patients' literacy level and have advanced functions may hold greater potential for improving patient outcomes.

An Intelligent Recommender System for Personalized Test Administration Scheduling With Computerized Formative Assessments

The introduction of computerized formative assessments in schools has enabled the monitoring of students’ progress with more flexible test schedules. Currently, the timing and frequency of computerized formative assessments are determined based on districts and school authorities’ agreements with testing organizations, the teachers’ judgment of students’ progress, and grade-level testing guidelines recommended by researchers. However, these practices often result in a rigid test scheduling that disregards the pace at which students acquire knowledge. Furthermore, students are likely to experience the loss of instructional time due to frequent testing. To administer computerized formative assessments efficiently, teachers should be provided systematic guidance on finding an optimal testing schedule based on each student’s progress. In this study, we aim to demonstrate the utility of intelligent recommender systems (IRSs) for generating individualized test schedules for students. Using real data from a large sample of students in grade 2 (n = 355,078) and grade 4 (n = 390,336) who completed the Star Math assessment during the 2017-2018 school year, we developed an IRS and evaluated its performance in finding a balance between data quality and testing frequency. Results indicated that the IRS was able to recommend a fewer number of test administrations for both grade levels, compared with standard practice. Further, the IRS was able to maximize the score difference from one test administration to another by eliminating the test administrations in which students’ scores did not change significantly. Implications for generating personalized schedules to monitor student progress and recommendations for future research are discussed.

Evaluation of the reading level of commonly used medication‐related patient education sources

AbstractIntroductionTo improve comprehension of medical care, the Joint Commission recommends that patient education materials (PEMS) be written at a fifth‐grade reading level or below.ObjectivesThe purpose of this study was to evaluate the compliance of commonly used tertiary drug references to Joint Commission standards.MethodsPEMs for the top 100 most prescribed medications in 2017 were obtained from commonly used drug information tertiary references (Lexi‐comp patient drug information, Micromedex Care Notes, Micromedex Med Essential Fact Sheets, Medline Plus, and Drugs.com) to evaluate readability. The grade reading level of each medication‐related PEM was evaluated using the Flesch‐Kincaid Grade Level test and compared with a one‐way analysis of variance using correlated samples and Tukey's post‐hoc test for significance between groups.ResultsThe mean grade reading levels of Lexi‐comp, Micromedex Care Notes, Micromedex Med Essential Fact Sheets, Medline Plus, and Drugs.com were 4.2, 7.5, 7.8, 9.3, and 10.4, respectively. Lexi‐comp achieved a reading level at or below fifth grade for 99% of medications while Micromedex Med Essential Fact sheets was the next highest at 33%. No other reference contained drug information at or below a fifth‐grade reading level.ConclusionLexi‐comp patient drug information consistently met the Joint Commission recommendation for medical information at or below a fifth‐grade reading level, whereas Micromedex Med Essential Fact Sheets met this recommendation approximately one‐third of the time. When providing drug information resources to patients, health‐care providers should be diligent in selecting sources that meet the Joint Commission recommendations.

Preparation, validation and user-testing of patient information leaflet on cancer

Summary Introduction Patient information leaflet contains specific information regarding the medical conditions, medications as well as the lifestyle modifications required to be followed by the patients. The information collected for the leaflet should be in the simplest form possible so that it can be easily interpreted by the targeted population. Objective The present study aims to develop and validate patient information leaflet for cancer patients. Materials and methods The information for the leaflet was gathered from various primary, secondary and tertiary resources. The content of the leaflet was validated by 10 members including general physicians, medical oncologists, academic pharmacists and clinical pharmacists. Readability of the patient information leaflets was assessed using Flesch Reading Ease test, Flesch-Kincaid Grade Level test and user readability method. User opinion on the content, layout and design was also obtained from the enrolled patients. Results and discussion The FRE and FK-GL scores of English version of patient information leaflet were 61.2 and 7.9 respectively. The overall user readability score of English, Kannada and Malayalam versions of PIL improved significantly from a pre-test score of 41.80 ± 23.18 to a post-test score of 70.40 ± 23.03. Ninety percent of the total patients enrolled in the study recorded good opinion about the leaflet in terms of its content, layout and design. Conclusion Patient information leaflet based education had a significant impact in improving the knowledge level of cancer patients.

Health Literacy Gaps in Online Resources for Cirrhotic Patients.

The average readability level in the USA is a sixth grade level and for patients with chronic disease it is lower. Cirrhosis is a prevalent chronic disease that requires complex knowledge and instructions to manage. No research has been done about the understandability of online educational content for cirrhotic patients. Patients can find online materials curated by both general health platforms and high-volume liver transplant centers, and thus these materials were analyzed. After determining exclusion criteria, the websites of the top 20 general health platform results and the websites of the top 20 high-volume hepatology centers were analyzed. Readability was assessed using the Patient Education Materials Assessment Tool (Audiovisual Materials) (PEMAT-A/V), Flesch-Kincaid Grade Level tests, word counts, sentence counts, words per sentence, and time for an average sixth grader to read. The mean grade level readabilities were 12.3 and 11.3 for the general resources and the transplant center resources, respectively. The online resources ranged from 9 to 389 sentences requiring an average of 9.8 min to read. The mean PEMAT-A/V scores were 70.05% for the general resources and 72.45% for the transplant center resources. There was a statistically significant difference in the Flesch-Kincaid grade level, sentence number, words per sentence, word count, and time for an average sixth grader to read the general resources and transplant center resources (P < 0.05). The online resources both from health platforms and hepatology centers available to patients with cirrhosis are too long and complex and underscore the need for simpler and shorter resources.

Quality and Readability of Online Information on In-Office Vocal Fold Injections.

Vocal fold injection augmentations are increasingly being performed in the office setting on awake patients, as opposed to the operating room. These procedures thus require patient cooperation and education. As the Internet is a widely-used resource for patients, our aim was to assess the quality and readability of online resources on in-office awake vocal fold injections. An online Google search using the terms "office vocal fold injection medialization" and "awake vocal fold injection" was conducted. The first 50 English-language websites were categorized into professional- and patient-targeted, and major and minor sources. They were analyzed using the Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL) test, and DISCERN quality score. Fifty websites were evaluated, and the overall DISCERN score was 2.60 ± 1.01, the mean FRES was 32.16 ± 19.10, and the mean FKGL was 13.76 ± 4.12. Between the 25 professional-targeted and 25 patient-targeted websites, professional-targeted sites had significantly higher DISCERN (P < .05) and FKGL (P < .05) scores, and lower FRES (P < .05) scores. Between the 30 major and 20 minor websites, major websites had significantly lower FRES (P < .05) and higher FKGL (P < .05) scores, and there was a trend toward significance for higher DISCERN scores (P = .052). Our study shows that half of the top Google results for our topic were not written for patient education, but rather for health care professionals. The reading level of this information exceeds the recommended grade level for patient education materials, and may be less comprehensible than intended. While patient-targeted materials are easier to read than professional-targeted sites, they are of lower quality. The quality of the available online information on this topic is suboptimal for both patients and health care providers. This research highlights the need for more appropriate patient education materials given low health literacy rates.

Orofacial granulomatosis and dietary interventions: health information on the internet

To assess the content, quality, and readability of health information on the internet for patients with orofacial granulomatosis, including material on benzoate and cinnamon-free diets. The first 100 websites drawn from searches using 8 key terms (2400 websites) across 3 search engines (Yahoo, Google, and Bing) were analysed. Duplicates or websites with unrelated information were excluded, which brought the number of websites included in the study to 12. To assess the quality of the information, we used the DISCERN questionnaire, Journal of the American Medical Association (JAMA) Benchmark Criteria, and Health on Net Seal. The readability was then analysed by applying the Flesch-Kincaid Reading Ease and Grade Level tests, the Automated Readability Index, and global traffic ranking (ALEXA). Separate assessment for both orofacial granulomatosis, and its management with a benzoate and cinnamon-free diet, showed that most websites (75%) were either ‘very poor’ or ‘poor’ in quality, with a mean DISCERN score of 31.4 out of 80. No website met all four JAMA benchmarks. Only two websites displayed the HONcode seal. Generally, health information was considered difficult to read, with a FRES ranging from 21.5 to 68, with a mean score of 48 (±13.2). To comprehend this information, readers would need to have, on average, a 10th grade US level education. The quality and readability of online information on orofacial granulomatosis is poor and difficult to read.