Mean Flesch Reading Ease Score Research Articles

From technical to understandable: Artificial Intelligence Large Language Models improve the readability of knee radiology reports.

The purpose of this study was to evaluate the effectiveness of an Artificial Intelligence-Large Language Model (AI-LLM) at improving the readability of knee radiology reports. Reports of 100 knee X-rays, 100 knee computed tomography (CT) scans and 100 knee magnetic resonance imaging (MRI) scans were retrieved. The following prompt command was inserted into the AI-LLM: 'Explain this radiology report to a patient in layman's terms in the second person:[Report Text]'. The Flesch-Kincaid reading level (FKRL) score, Flesch reading ease (FRE) score and report length were calculated for the original radiology report and the AI-LLM generated report. Any 'hallucination' or inaccurate text produced by the AI-LLM-generated report was documented. Statistically significant improvements in mean FKRL scores in the AI-LLM generated X-ray report (12.7 ± 1.0-7.2 ± 0.6), CT report (13.4 ± 1.0-7.5 ± 0.5) and MRI report (13.5 ± 0.9-7.5 ± 0.6) were observed. Statistically significant improvements in mean FRE scores in the AI-LLM generated X-ray report (39.5 ± 7.5-76.8 ± 5.1), CT report (27.3 ± 5.9-73.1 ± 5.6) and MRI report (26.8 ± 6.4-73.4 ± 5.0) were observed. Superior FKRL scores and FRE scores were observed in the AI-LLM-generated X-ray report compared to the AI-LLM-generated CT report and MRI report, p < 0.001. The hallucination rates in the AI-LLM generated X-ray report, CT report and MRI report were 2%, 5% and 5%, respectively. This study highlights the promising use of AI-LLMs as an innovative, patient-centred strategy to improve the readability of knee radiology reports. The clinical relevance of this study is that an AI-LLM-generated knee radiology report may enhance patients' understanding of their imaging reports, potentially reducing the responder burden placed on the ordering physicians. However, due to the 'hallucinations' produced by the AI-LLM-generated report, the ordering physician must always engage in a collaborative discussion with the patient regarding both reports and the corresponding images. Level IV.

Usefulness and Accuracy of Artificial Intelligence Chatbot Responses to Patient Questions for Neurosurgical Procedures.

The Internet has become a primary source of health information, leading patients to seek answers online before consulting health care providers. This study aims to evaluate the implementation of Chat Generative Pre-Trained Transformer (ChatGPT) in neurosurgery by assessing the accuracy and helpfulness of artificial intelligence (AI)-generated responses to common postsurgical questions. A list of 60 commonly asked questions regarding neurosurgical procedures was developed. ChatGPT-3.0, ChatGPT-3.5, and ChatGPT-4.0 responses to these questions were recorded and graded by numerous practitioners for accuracy and helpfulness. The understandability and actionability of the answers were assessed using the Patient Education Materials Assessment Tool. Readability analysis was conducted using established scales. A total of 1080 responses were evaluated, equally divided among ChatGPT-3.0, 3.5, and 4.0, each contributing 360 responses. The mean helpfulness score across the 3 subsections was 3.511 ± 0.647 while the accuracy score was 4.165 ± 0.567. The Patient Education Materials Assessment Tool analysis revealed that the AI-generated responses had higher actionability scores than understandability. This indicates that the answers provided practical guidance and recommendations that patients could apply effectively. On the other hand, the mean Flesch Reading Ease score was 33.5, suggesting that the readability level of the responses was relatively complex. The Raygor Readability Estimate scores ranged within the graduate level, with an average score of the 15th grade. The artificial intelligence chatbot's responses, although factually accurate, were not rated highly beneficial, with only marginal differences in perceived helpfulness and accuracy between ChatGPT-3.0 and ChatGPT-3.5 versions. Despite this, the responses from ChatGPT-4.0 showed a notable improvement in understandability, indicating enhanced readability over earlier versions.

Readability of postoperative discharge instructions is associated with complication rate in companion animals undergoing sterilisation.

Readability of client communications is a commonly overlooked topic in veterinary medical education. In human medicine, it has been advised that the readability of patient materials should be at USA schooling sixth-grade level or below. We hypothesised that student written discharge instructions would be of an inappropriate readability level, and discharges scored with higher reading grade levels would be associated with more complications. The cohort comprised 149 dogs and cats presenting for sterilisation. The readability of discharge instructions was assessed using the Flesch Reading Ease (FRE) and Flesch-Kincaid Grade Level (FKGL) formulas. Records were examined for evidence of postoperative complications. The mean FRE score of the discharge instructions was 61.97, with 30.87% being classified as 'difficult' or 'fairly difficult', 60.4% as 'standard' and 8.72% as 'fairly easy'. The mean FKGL was 8.64, with 98% being above reading level 6. Overall, there was an association between FKGL and complication occurrence (p = 0.005). Stratification by species demonstrated FRE and FKGL to be associated with complication occurrence in dogs (FRE score, p = 0.038; FKGL, p = 0.002), but not cats (FRE score, p = 0.964; FKGL, p = 0.679). Due to the retrospective nature of the study, there were difficulties associated with extracting relevant complication information from the medical records. Only 2% of owner-directed discharge instructions were written at readability levels aligning with the recommendations set forth in the human guidelines.

Improving health literacy of passengers of cruise ships: readability of passenger-facing COVID-19 information provided by commercial cruise lines-an infodemiology study.

Readability of COVID-19 information from 35 cruise lines was examined. Mean Flesch Reading Ease and Flesch-Kincaid Grade Level scores (±standard error of mean) were 46.6 ± 1.3 (target ≥60) and 10.9 ± 0.3 (target ≤ 8.0), respectively. Two (6%) cruise lines met readability reference targets. Readability tools may aid in preparing more easily read passenger-facing health-related information on existing infections, including COVID-19, other respiratory infections, as well as gastroenteritis (e.g. norovirus), as well as providing a methodology for improving the readability of information prepared for newly emerging infectious diseases.

Improving Health Literacy of Domestic Household Disinfection Use: Readability of Consumer-Facing Information on Domestic Household Disinfectant Products on Sale in the UK—An Infodemiology Study

Disinfectants purchased from retail outlets form the cornerstone of infection control and prevention within the domestic household. The growing utilisation of the concept of “hospital-at-home” places greater emphasis on domestic disinfection by the householder in helping to prevent the acquisition of infections within the home. No reports or data exist that indicate how readable the information provided on disinfectants is, which would help householders use disinfectants optimally. The aim of this study was therefore to quantitatively examine the readability (Flesch Reading Ease; Flesch–Kinkaid Grade Level; text metrics) of consumer (public)-facing information (n = 108) of domestic household disinfectants sourced from (i) UK high street supermarket chains (n = 4) and (ii) disinfectant manufacturers (n = 6). The readability of all supermarket and manufacturer information (n = 108) gave a mean Flesch Reading Ease score of 51.7 (target ≥ 60) and a Flesch–Kinkaid Grade Level score of 8.1 (target ≤ 8), thereby failing to achieve readability reference target values. Authors preparing information on the domestic use of disinfectants should be aware of the value of quantitative readability metrics and online tools to help support their writing of such information in order to produce materials which are within target readability values, thereby further supporting health literacy in this population and disinfectant efficacy.

Readability of Online Information on the Latarjet Procedure.

Introduction A common complication of first-time or recurrent shoulder dislocations is bone loss at the humeral head and glenoid. Recurrent shoulder instability is often a result of bony defects in the glenoid following shoulder dislocations. In the setting of glenoid bone loss, surgical interventions are generally required to restore stability. The Latarjet procedure is a challenging operation and, due to its complexity, may be associated with operative complications. It can be difficult to explain the procedure to patients in a manner that is easily comprehensible, which may lead to confusion or being overwhelmed with information. Hence, it is important that the information available to patients is easily accessible and perceivable to allow for adequate health literacy. Health literacy is defined as the ability to make health decisions in the context of everyday life. Methods The search engines Google and Bing were accessed on a single day in the month of July 2023, searching the terms "Latarjet surgery" and "Latarjet procedure." For each term on both search engines, the first three pages were evaluated, resulting in a total of 114 websites for review. Out of these, 25 websites met the inclusion criteria and underwent further in-depth analysis through the online readability software, WEB FX. This software generated a Flesch Reading Ease Score (FRES) and a Reading Grade Level (RGL) for each website. Results In our study, the mean FRES was 50.3 (SD ±12.5), categorizing the data as 'fairly difficult to read.' The mean RGL score was 8.12 (SD ±2.35), which exceeds the recommended target. Conclusion In conclusion, the results of this study have demonstrated that the material available on the Internet about the Latarjet procedure is above the recommended readability levels for the majority of the population. Our findings align with similar studies assessing the readability of online patient information. Based on these findings, physicians should provide patients with vetted information to facilitate a better understanding of the procedure, thereby enabling patients to make more informed decisions regarding their health.

Otosclerosis online: a critical analysis of quality, reliability, readability and content of otosclerosis information.

Several therapeutic options are usually discussed for otosclerosis management. Patients seek medical advice from an ENT specialist but are also increasingly using the internet for medical issues. This study intends to assess readability and quality of websites with information on otosclerosis. This is a cross-sectional study performed in a tertiary care centre. The results of the first two pages of a Google search with the keyword "otosclerosis" were reviewed by two independent investigators. Readability was assessed with the Flesch-Kincaid Grade Level (FKGL), Flesch Reading Ease Score (FRES) and Gunning Fog Index. For quality and reliability assessment, the 16-item DISCERN instrument was used. Spearman's coefficient was used for correlations, and multivariate analyses of variance were used to assess differences. Inter-rater agreement was evaluated with concordance correlation coefficient. 18 websites were included. Two websites (11.0%) were authored by academic institutions, 5/18 (28%) by government agencies, 6/18 (33%) by professional organisations and 5/18 (28%) were medical information websites. The mean DISCERN score of the 18 websites was 40.8 ± 6.7/80 (range 28.7-51.7), corresponding to "fair" quality. The mean FRES score was 43.27 ± 10.6, and the mean FKGL was 11.43 ± 2.30, corresponding to "difficult to read". The mean Gunning Fog index was 12.90 ± 2.19 (range 9.81-18.20), corresponding to a "college freshman" level. This study shows that internet information on otosclerosis has an overall low readability, while the quality is heterogeneous and varies from "poor" to "good". Efforts should be made to improve the readability of otosclerosis websites.

Online health information on sinonasal inverted papillomas: An assessment on readability and quality.

Sinonasal inverted papilloma (IP) is a rare but serious diagnosis, with a paucity of patient-centred information regarding this condition. As more patients are seeking healthcare information online, the quality and comprehensibility of this information becomes ever more important. The aim of the study was to investigate the readability and quality of websites on inverted papilloma. The term IP and seven of its synonyms were inputted into the three of the most commonly used search engines in the English-speaking world (Google, Yahoo and Bing). The first 20 results returned for each search term were then screened with our exclusion criteria. The remaining websites were assessed for their readability using the using the Flesch Reading Ease Score (FRES) and average grade level (AGL). Quality was assessed using the DISCERN questionnaire. Of the 480 websites returned using our search strategy, 410 were excluded using our screening criteria. Removal of duplicates from the remaining 70 websites left 14 for inclusion in the final analysis. The mean FRES score of the remaining websites was 30.5 ± 10 and the mean AGL was 15.2 ± 1.1, corresponding to a reading age of a 21-year-old. The median DISCERN score was 33.5 (30.5-36.5), a score which falls within the 'poor quality' range. The readability and quality of online patient information on IP is far below the expected standard. Healthcare providers have a responsibility to direct patients to appropriate sources of information or consider producing new material should a lack of appropriate sources exist.

Reliability and Readability of Patient-Oriented Internet-Based Information Regarding Gingival Recession

The study aimed to assess the quality and readability of web-based information regarding the gingival recession. An internet search was done using two engines (Google and Bing) with the terms “gingival recession,” “gum recession,” and “receding gums.” Each search engine’s top 100 results for each query were filtered out. The websites’ reliability and level of quality were evaluated using the JAMA and DISCERN scores, respectively. Readability was analyzed by the Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), Gunning Fog index (GFI), Simple Measure of Gobbledygook (SMOG) index, the Coleman-Liau score (CL), the Linsear Write (LW) readability formula and the Automated Readability Index (ARI), via an online readability tool. Of the 151 websites, 81.5% were private dental clinics, 9.3% were advertising sites, 4.6% were national health services, and 4.6% were nonprofit organizations. 11.3% of the websites achieved all four JAMA benchmarks, and the JAMA average of all websites was 2.06. The mean FRES was 54.48, and the mean GFI was 12.82. The mean DISCERN scores for all websites were 43.64 and the DISCERN scores of the websites prepared by periodontologists were statistically significantly higher than the others. The online health information regarding gingival recession has fair reliability and difficult readability. It is essential to produce website information free from commercial bias and simple for patients to understand fully.

Online resources for information on shoulder arthroplasty: an assessment of quality and readability.

Many patients use online resources to educate themselves on surgical procedures and make well-informed healthcare decisions. The aim of our study was to evaluate the quality and readability of online resources exploring shoulder arthroplasty. An internet search pertaining to shoulder arthroplasty (partial, anatomic, and reverse) was conducted using the three most popular online search engines. The top 25 results generated from each term in each search engine were included. Webpages were excluded if they were duplicates, advertised by search engines, subpages of other pages, required payments or subscription, or were irrelevant to our scope. Webpages were classified into different source categories. Quality of information was assessed by HONcode certification, Journal of the American Medical Association (JAMA) criteria, and DISCERN benchmark criteria. Webpage readability was assessed using the Flesch reading ease score (FRES). Our final dataset included 125 web pages. Academic sources were the most common with 45 web pages (36.0%) followed by physician/private practice with 39 web pages (31.2%). The mean JAMA and DISCERN scores for all web pages were 1.96±1.31 and 51.4±10.7, respectively. The total mean FRES score was 44.0±11.0. Only nine web pages (7.2%) were HONcode certified. Websites specified for healthcare professionals had the highest JAMA and DISCERN scores with means of 2.92±0.90 and 57.96±8.91, respectively (P<0.001). HONcode-certified webpages had higher quality and readability scores than other web pages. Web-based patient resources for shoulder arthroplasty information did not show high-quality scores and easy readability. When presenting medical information, sources should maintain a balance between readability and quality and should seek HONcode certification as it helps establish the reliability and accessibility of the presented information. Level of evidence: IV.

Evaluating the Effectiveness of Artificial Intelligence-powered Large Language Models Application in Disseminating Appropriate and Readable Health Information in Urology.

The Internet is a ubiquitous source of medical information, and natural language processors are gaining popularity as alternatives to traditional search engines. However, suitability of their generated content for patients is not well understood. We aimed to evaluate the appropriateness and readability of natural language processor-generated responses to urology-related medical inquiries. Eighteen patient questions were developed based on Google Trends and were used as inputs in ChatGPT. Three categories were assessed: oncologic, benign, and emergency. Questions in each category were either treatment or sign/symptom-related questions. Three native English-speaking Board-Certified urologists independently assessed appropriateness of ChatGPT outputs for patient counseling using accuracy, comprehensiveness, and clarity as proxies for appropriateness. Readability was assessed using the Flesch Reading Ease and Flesh-Kincaid Reading Grade Level formulas. Additional measures were created based on validated tools and assessed by 3 independent reviewers. Fourteen of 18 (77.8%) responses were deemed appropriate, with clarity having the most 4 and 5 scores (P = .01). There was no significant difference in appropriateness of the responses between treatments and symptoms or between different categories of conditions. The most common reason from urologists for low scores was responses lacking information-sometimes vital information. The mean (SD) Flesch Reading Ease score was 35.5 (SD=10.2) and the mean Flesh-Kincaid Reading Grade Level score was 13.5 (1.74). Additional quality assessment scores showed no significant differences between different categories of conditions. Despite impressive capabilities, natural language processors have limitations as sources of medical information. Refinement is crucial before adoption for this purpose.

Web-based patient educational material on chimeric antigen receptor T-cell therapy: Quantitative assessment of readability.

11040 Background: Chimeric antigen receptor (CAR) T-cell therapy is another paradigm-shifting advancement for hematologic malignancies, creating unprecedented treatment options. However, there is still a lack of knowledge and understanding among patients regarding this novel therapy. Most patients turn to online resources, ranging from social media to federal websites, to gather health information to supplement decision-making. Given that the average American adult reads between the sixth- and eighth-grade levels, national organizations recommend that patient resources be written at the sixth-grade level or below. The purpose of this study was to evaluate web-based patient educational material on CAR -T cell therapy resources using measures of readability and compare it to national guidelines. Methods: Online patient information on CAR-T cell therapy from the top 20 U.S Cancer center as per US news ranking was collected. We analyzed the content by six of the most common readability tests- Flesch Reading Ease score (FRE), Gunning Fog (GF), Flesch-Kincaid Grade Level (FKGL), Coleman-Liau Index (CLI), Simple Measure of Gobbledygook (SMOG) Index, and the Automated Readability Index (ARI). The text from each article was carefully reviewed and analyzed using the software Readable, and the readability scores with standard deviation (SD) were obtained. Results: The mean score FRE score was 48.5 (SD: 6.7), which corresponds to college level and is difficult to read. The mean GF score was 8.7(SD: 1.5), which represents the writing of an 8th grader. The FKGL score was 8.6 (SD: 1.1), which represents a level of 8th grade or above. The mean CLI score was 11.5(SD: 1.3), which is the text level for high school juniors. The mean SMOG index was 10.9 (SD: 1), which is the level of a 12th grader. The ARI score was 7.8 (SD: 1.3), indicating a 7th-grade level. Conclusions: Overall, web-based CAR- T cell therapy patient educational materials scored poorly and does not meet the national recommendations. Authors of patient resources should incorporate readability criteria and prompt a revision or creation of new educational materials including videos and audio to support general patient understanding. By making CAR-T therapy information easily understandable, internet users can be better informed about their treatment decisions.

The Capability of ChatGPT in Predicting and Explaining Common Drug-Drug Interactions.

Background Drug-drug interactions (DDIs) can have serious consequences for patient health and well-being. Patients who are taking multiple medications may be at an increased risk of experiencing adverse events or drug toxicity if they are not aware of potential interactions between their medications. Many times, patients self-prescribe medications without knowing DDI. Objective The objective is to investigate the effectiveness of ChatGPT, a large language model, in predicting and explaining common DDIs. Methods A total of 40 DDIs lists were prepared from previously published literature. This list was used to converse with ChatGPT with a two-stage question. The first question was asked as "can I take X and Y together?" with two drug names. After storing the output, the next question was asked. The second question was asked as "why should I not take X and Y together?" The output was stored for further analysis. The responses were checked by two pharmacologists and the consensus output was categorized as "correct" and "incorrect." The "correct" ones were further classified as "conclusive" and "inconclusive." The text was checked for reading ease scores and grades of education required to understand the text. Data were tested by descriptive and inferential statistics. Results Among the 40 DDI pairs, one answer was incorrect in the first question. Among correct answers, 19 were conclusive and 20 were inconclusive. For the second question, one answer was wrong. Among correct answers, 17 were conclusive and 22 were inconclusive. The mean Flesch reading ease score was 27.64±10.85 in answers to the first question and 29.35±10.16 in answers to the second question, p = 0.47. The mean Flesh-Kincaid grade level was 15.06±2.79 in answers to the first question and 14.85±1.97 in answers to the second question, p = 0.69. When we compared the reading levels with hypothetical 6th grade, the grades were significantly higher than expected (t = 20.57, p < 0.0001 for first answers and t = 28.43, p < 0.0001 for second answers). Conclusion ChatGPT is a partially effective tool for predicting and explaining DDIs. Patients, who may not have immediate access to the healthcare facility for getting information about DDIs, may take help from ChatGPT. However, on several occasions, it may provide incomplete guidance. Further improvement is required for potential usage by patients for getting ideas about DDI.

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.

Evaluating the readability, quality, and reliability of online information on sjogren's syndrome

Background: There are concerns over the reliability and comprehensibility of health-related information on Internet. The goal of our research was to analyze at the readability, reliability, and quality of information obtained from websites associated with Sjogren's syndrome (SS). Methods: In this cross-sectional study, the term “Sjogren's Syndrome” was used to perform a search on Google, and 75 eligible websites were identified on September 15, 2021. The Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level, and Gunning Fog (GFOG) were used to evaluate the readability of the website. The Journal of American Medical Association (JAMA) score was used to assess the websites' reliability, the DISCERN score, the Health on the Net Foundation code of conduct (HONcode) was used to assess quality, and Alexa was used to analyze their popularity. Results: The results revealed that the mean FRES was 42.25 ± 17.11 (difficult), and the mean GFOG was 14.80 ± 3.56 years (very difficult). According to the JAMA scores, 24% of the websites had a high-reliability rating and 26.7% adhered to the HONcode. The readability was found to significantly differ from the reliability of the websites (P < 0.001). Moreover, websites with scientific content were found to have higher readability and reliability scores (P < 0.001). Conclusion: The readability of SS-related information on the Internet was found to be considerably higher than that recommended by the National Health Institute's Grade 6, with moderate reliability and fair quality. We believe that online information should have some level of readability and must have reliable content that is appropriate to educate the public, particularly for websites that provide with patient education material.

“Quality, Readability, and Understandability of Online Posterior Glottic Stenosis Information”

To assess the quality, readability, and understandability of posterior glottic stenosis (PGS) information available to patients online. The top 50 Google search results for "posterior glottic stenosis" were categorized based on website affiliation and target audience (patient or provider). Readability was assessed using the Flesch-Kincaid Grade Level (FKGL) and the Flesch Reading Ease (FRE) scores. The DISCERN tool was used to assess quality and the Patient Education Assessment Tool for Printed Materials (PEMAT-P) was used to assess understandability and actionability. Simple descriptive statistics were used to analyze the data. 36 of the top 50 results were eligible for scoring. 17% (6 of 36) were classified as patient-focused while 83% (30 of 36) were provider-focused. Patient-focused materials had a higher mean FRE score (36.9) than provider-focused materials (15.5) (P < 0.001). Patient-focused materials had an average reading level of 12.5 compared to 15.8 for provider-focused materials (P < 0.001). There was a significant correlation between overall PEMAT-P and DISCERN (r=0.63, P < 0.001), PEMAT-P understandability and DISCERN (r=0.63, P < 0.001) and FRES and FKGL (r=-0.67, P < 0.001). From this, we can infer that higher quality sites are easier to understand but not necessarily tailored to a certain reading level. Shared decision making in PGS management is crucial as patients must be aware of how treatment modalities affect airway, voice, and swallowing. However, this study shows that patient targeted PGS information is limited, and the readability, quality, and understandability is generally low. We suggest the development of web pages with PGS information tailored for patient education and search optimization to make this information appear earlier in Google search results. Furthermore, future studies should seek to characterize the link between online health information and socioeconomic-based health disparities.

Assessing the quality and readability of online content on shock wave therapy for erectile dysfunction.

Patients are becoming increasingly reliant on online platforms for obtaining health information. Previous research has shown that the quality of information available on the internet regarding novel medical therapies is generally poor and frequently misleading. Shock wave therapy represents a novel restorative therapy for erectile dysfunction (ED) that has recently gained attention. We hypothesised that online sources regarding shock wave therapy for ED would be fraught with misleading claims and unreliable health information. Our objective was to evaluate the quality and readability of online medical information on shock wave therapy as a treatment for ED. Websites were generated using a Google search of 'shock wave therapy for erectile dysfunction' with location filters disabled. Readability was analysed using the Readable software (Readable.com, Horsham, United Kingdom). Quality was assessed independently by three reviewers using the DISCERN tool. Articles were subdivided into those from private clinic websites and those from universities or news media websites. Statistical analysis was conducted using the Student's t test. Nine articles that resulted from the Google search had mean readability scores as follows: Flesch-Kincaid grade level (10.8), Gunning-Fog Index (13.67), Coleman-Liau Index (12.74), Simple Measure of Gobbledygook (SMOG) Index (13.33), FORCAST Grade Level (11.33), and Automated Readability Index (11.08). The mean Flesch Reading Ease score was 46.4. The articles had a mean DISCERN score of 3.1, suggesting 'moderate quality' content. Articles from universities (n=2) or news sources (n=3) had significantly higher DISCERN scores than articles from private medical practices (n=4). There was no difference in readability scores between the groups. Articles from private clinics are just as readable as those from universities or news media, but they are significantly more biased and misleading. The current online material relating to shock wave therapy for ED may not adequately inform patients in their medical decisions making, thereby necessitating closer collaboration between the sources disseminating information and urologists.

Creating concise and readable patient information sheets for interventional studies in Australia: are we there yet?

BackgroundParticipant information sheets and consent forms (PICFs) used in interventional studies are often criticised for being hard to read and understand. We assessed the readability and its correlates of a broad range of Australian PICFs.MethodsWe analysed the participant information sheet portion of 248 PICFs. Readability scores were measured using three formulae: the Flesch Reading Ease, the Flesch-Kincaid Grade Level, and the Simple Measure of Gobbledygook (SMOG). We investigated how various features (including sponsor type and PICF type) correlated with PICF length and readability and examined compliance with other measures known to improve readability.ResultsFor a sample of 248 PICFs, the mean (standard deviation) Flesch Reading Ease score was 49.3 (5.7) and for the Flesch-Kincaid Grade Level 11.4 (1.1). The mean (SD) SMOG score was 13.2 (0.9). The median document length was 3848 words (8 pages). Commercial PICFs were more than twice as long as non-commercial, but statistically more readable (p = 0.03) when analysed using the SMOG formula. Subgroup analyses indicated that PICFs for self-consenters were statistically more readable than those for proxy consenters. The use of tables, but not the use of illustrations was associated with better readability scores.ConclusionsThe PICFs in our sample are long and complex, and only 3 of the 248 achieved the recommended readability score of grade 8 or below. The broader use of best practice principles for writing health information for consumers and the development of more context-sensitive templates could improve their utility.

Evaluating the readability, quality and reliability of online information on Behçet's disease.

There are concerns over the reliability and comprehensibility of health-related information on the internet. The goal of our research was to analyze the readability, reliability, and quality of information obtained from websites associated with Behçet's disease (BD). On September 20, 2021, the term BD was used to perform a search on Google, and 100 eligible websites were identified. The Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), and Gunning Fog (GFOG) were used to evaluate the readability of the website. The JAMA score was used to assess the websites' reliability, the DISCERN score and the Health on the Net Foundation code of conduct (HONcode) were used to assess quality, and Alexa was used to analyze their popularity. Sections of the text were evaluated, and the results revealed that the mean FRES was 35.49±14.42 (difficult) and the mean GFOG was 14.93±3.13 years (very difficult). According to the JAMA scores, 36% of the websites had a high reliability rating and 20% adhered to the HONcode. The readability was found to significantly differ from the reliability of the websites (p<0.05). Moreover, websites with scientific content were found to have higher readability and reliability (p<0.05). The readability of BD-related information on the Internet was found to be considerably higher than that recommended by the National Health Institute's Grade 6, with moderate reliability and good quality. We believe that online information should have some level of readability and must have reliable content that is appropriate to educate the public, particularly for websites that provide with patient education material.

Non-Compliance of Fertility Patients with the Ejaculatory Abstinence Period: The Influence of Confusing Online Fertility Information

Background: Findings from a Western Australian fertility clinic show that male patients may often disregard ejaculatory abstinence directives prior to providing a semen sample. This practise may lead to the production of low quality spermatozoa. Aim: This study explores the readability and accessibility of online patient information from fertility clinics across Australia as a reason why patients may not adhere to instructions surrounding this behaviour. Method: A content analysis was conducted of patient information from the websites of 86 registered fertility clinics in Australia. The reading complexity of information found on these websites was determined through calculating the Flesch Reading Ease Scores and Flesch-Kincaid Grade Levels of excerpts retrieved. The presence and diversity of information provided in multilingual formats was recorded. Online instructions regarding ejaculatory abstinence were also compared within and between clinics to identify contradictory information. Results: The mean Flesch Reading Ease Score across all websites was 47.54 (s.d. 8.18) and the mean Flesch-Kincaid Grade Level was 11.09 (s.d. 1.11), indicating that the information presented exceeds the average Australian’s reading abilities. Information was also rarely presented in languages other than English (1/36 clinic websites, 2.8%) and ejaculatory abstinence recommendations were frequently contradictory (11/24 clinic websites, 45.8%). Conclusion: The provision of confusing and inaccessible online fertility information by fertility clinics to patients may represent a potential barrier to ejaculatory abstinence adherence. It is recommended that fertility clinics revise their online information to ensure readability.