Mean Flesch Reading Ease Score Research Articles

Laparoscopic Cholecystectomy: Evaluation of Web-Based Information.

IntroductionLaparoscopic cholecystectomy (LC), the gold standard treatment for symptomatic gallstone disease, is the most common procedure performed by general surgeons worldwide. The internet remains to be a popular source of medical information. Our aim was to evaluate the quality and readability of information available on the web for patients undergoing LC and to compare the information provided by the National Health Service (NHS) and non-NHS websites. MethodsWe searched for the keywords ‘laparoscopic cholecystectomy’ using the three most popular search engines (Google, Yahoo and MSN) and looked at the first 50 websites only. The readability of each document was assessed using the Flesch Reading Ease (FRE) score. We checked Health on the Net Foundation Code of Conduct (HONcode) certification status, whether the sites had been checked by an expert and when the information was last updated.ResultsFifty-five of the possible 150 sites were analysed thus excluding repetitions (n=65), irrelevant content (n=26) or inaccessible links (n=3). Only seven of those were HONcode-certified. The mean FRE score was 46 (range 0-68, SD=16.13). There were 13 NHS sites and 42 non-NHS sites. The mean FRE score for the NHS sites was significantly better compared to the non-NHS sites [58.31 (SD=5.01) vs 42.21 (SD=16.35); p=0.001]. Fifty-four per cent (54%) of the analysed websites had been checked by a medical expert and 22% were updated within the last year.ConclusionsThis study highlights the poor quality and readability of information on medical websites. The information provided by NHS sites have significantly better readability compared to non-NHS sites.

Treatment for Constipation-An Online Search. Readability and Quality of Online Patient Resources.

Aim: To evaluate the readability and quality of online patient information regarding treatment for constipation in the English language. Methods: By utilizing the Google © website, the keyword “treatment for chronic constipation” was searched. Each webpage was assessed by 2 authors independently for readability using both the Gunning Fog Index (GFI) and the Flesch Reading Ease Score (FRES). The quality of the information produced on each individual website was assessed using the DISCERN instrument. Other parameters that were recorded included the country of origin, the organization type, and whether or not the website was issued a Health on the Net (HoN) certificate. Results: This study identified a mean GFI score of 13.2 and a mean FRES score of 48.9. This result indicates poor overall readability. A mean DISCERN score of 37.9 was produced, indicating an overall weak quality of online information on this topic. This study indicated that parameters such as website organization type and the presence or absence of HoN certification impacted the quality of the information websites on this topic. Conclusion: This study indicated a poor level of quality and readability of online information on the topic of chronic constipation treatment. Further resources should be directed towards improving website readability and quality. Patients may be advised that if they wish to access online information on this topic, websites that display HoN accreditation will likely produce higher quality information.

Readability of patient education materials related to radiation safety: What are the implications for patient-centred radiology care?

BackgroundIncreasing numbers of patients and carers rely on online resources for healthcare information. Radiation safety can be misunderstood by patients and clinicians and lead to patient anxiety. We aimed to assess the readability of online patient educational materials (PEMs) related to radiation safety.MethodsA total of 84 articles pertaining to radiation safety from 14 well-known online resources were identified. PEMs were then analysed using Readability Studio Professional Edition Version 2019. Readability was assessed using eight different instruments: the Flesch-Kincaid Reading Grade Level, Raygor Estimate, SMOG, Coleman–Liau, Fry, FORCAST, Gunning Fog, and Flesch Reading Ease Score formula. The mean reading grade level (RGL) of each article was compared to the 6th and 8th grade reading level using 1-sample t-tests.ResultsThe cumulative mean RGL for all 84 articles was 13.3 (range = 8.6–17.4), and none were written at or below the 6th or 8th grade level. The cumulative mean RGL exceeded the 6th grade reading level by an average of 7.3 levels (95% CI, 6.8–7.8; p < 0.001) and the 8th grade level by an average of 5.3 grade levels (95% CI, 4.8–5.8; p < 0.001). The mean Flesch Reading Ease Score was 39/100 (‘difficult’).ConclusionCurrently available online PEMs related to radiation safety are still written at higher than recommended reading levels. Radiation safety is a topic in which the specialist training of radiologists is crucial in providing guidance to patients. Addressing the readability of online PEMs can improve radiology-patient communication and support the shift to a patient-centred model of practice.

Improving meningococcal MenACWY and 4CMenB/meningococcal group B vaccine‐related health literacy in patients: Importance of readability of pharmaceutical Patient Leaflets

Patient information leaflets (PILs) or Patient Leaflets (PLs) formally accompany dispensed medicines and are intended to provide the patient with information on how to use the medicine safely. To date, there have been no studies that have examined the readability of meningococcal vaccine patient-facing information, including information contained within the vaccine PIL. Given the role of pharmacists in presenting PILs to patients, it was, therefore, the aim of this study to quantitatively analyse the readability of Patient Leaflets, which accompany licensed meningococcal vaccines in the UK and US and to compare PILs to vaccine pharmaceutical manufacturers' summary of product characteristics (SPC), as well as other patient-facing vaccine-related information. Five sources of meningococcal vaccine information were examined for the licensed meningococcal vaccines in the UK (Bexsero, Menveo, Menitorix, Trumenba, Nimenrix & NeisVac-C) and in the United States (Bexsero, Menveo, Trumenba, Menactra, Menomune-A/C/Y/W-135, Menquadfi), including as follows: (i) SPC (Electronic Medicines Compendium, UK), (ii) Package Insert (FDA; USA), (iii) Patient Leaflet (Electronic Medicines Compendium, UK), (iv) Vaccine pharmaceutical websites and (v) government web resources. Readability was examined employing 10 readability metrics, including the Flesch Reading Ease and the Flesch-Kincaid Grade level. The information source with the greatest readability scores was the UK Patient Leaflet, which had a mean Flesch Reading Ease score of 58.1 and a mean Flesch-Kincaid Grade score of 7.3, followed by the US Department of Health & Human Services patient-facing website for vaccines (55.9 & 8, respectively), followed by the US Centers for Disease Control and Prevention Vaccine Information Statement (47.3 & 9.4, respectively). Pharmaceutical patient-facing websites for meningococcal vaccines had mean scores of 44.6 and 9.9, respectively. When compared with UK Patient Leaflets, pharmaceutical websites were statistically different with poorer readability with both Flesch Reading Ease and Flesch-Kincaid Grade Level indices (p=0.02 & p=0.04, respectively). Pharmaceutical meningococcal vaccine PILs were easily read and had statistically significant good readability scores in comparison with vaccine SPCs and US Package Inserts, pharmaceutical product websites and other government patient-facing meningococcal vaccine information. Preparation of patient-facing materials of a complex topic, such as describing meningococcal vaccines, is difficult to accomplish. Although there is a plurality of sources of information through websites and social media, PILs are one of the few sources that are provided directly to patients. This underpins the potential importance of PILs and the importance of their readability. Adoption of readability calculators and scrutiny of materials for their readability will help authors develop materials with improved understanding for vaccine recipients, potentially leading to improved health literacy and vaccine uptake. Renewed efforts should be sought to promote the information within the PIL, thereby maximizing the value of this resource with vaccine recipients, their carers and family.

Readability and Variability Among Online Sources for Patella Dislocation: What Patients are Reading

Patients frequently use the internet to obtain medical information, and the information may be misleading. Patella dislocation is a common orthopaedic injury for which patients may use the internet as a resource to better understand treatment options and recovery. The purpose of this study was to evaluate online information about patella instability in order to assess what patients are reading. A search was performed using Google, Yahoo, and Bing search engines and four similar terms related to patella dislocation (patella instability, kneecap dislocation, dislocated kneecap, and patella dislocation). A list of 37 websites were compiled. The readability of websites was analyzed using Flesch-Reading tools and content was assessed using a content scoring guide that evaluates whether the websites mentioned certain topics relevant to patella dislocation. The website content score was calculated and averaged from the evaluation of two scorers. 17 of 37 (46%) websites disclosed the author credentials, and 13 of 37 (35%) websites were authored by physicians with a M.D. degree. The mean Flesh-Kincaid Grade for all websites was 10.8 ± 3.5 and the mean Flesch Reading Ease Score was 47.6 ± 18, indicating that on average, the websites were moderately difficult to read. Websites that were written by non-physicians had the highest website content score (65.0 out of 100 points), indicating that these websites discussed most topics related to patellar dislocation. Only 8 of 37 (22%) websites had a 3rd party HON seal, which validates the quality and reliability of information on the website. The information presented online about patellar dislocation is unreliable and written at a reading level that is difficult for the average patient to understand. Patients should be aware of the potential inaccuracy of information presented online and orthopaedic surgeons should consider recommending reliable websites to patients.

Patient information on the internet for surgical management of inflammatory bowel disease: is it good enough?

Background: Our study aimed to identify the search engines and terms commonly used by inflammatory bowel disease (IBD) patients and aimed to assess the quality and readability of these resources.Methods: Patients attending IBD clinic were surveyed, regarding search engines, terms and number of websites viewed. Websites according to these predetermined criteria were identified. Website content was described and quality was assessed using DISCERN. Readability was graded using the Flesch Reading Ease Score (FRES).Results: From 33 survey responses, Google was universally utilised. Forty-two websites met the inclusion criteria (19 for Crohn’s disease (CD), 23 for ulcerative colitis (UC). Only one website originated from Australia. Websites were infrequently updated (CD 21%, UC 17%) within the previous 12 months. Overall readability was poor with a mean FRES of 35.8 (11.8, range 15.7-57.7) for CD and 35.7 (11.3, range 19.4-54.3) for UC websites. Quality was moderate to poor with only five (12%) websites being rated as high quality (2 CD, 3 UC).Conclusions: There is very little Australian based web information available on IBD surgery and overall, it is of a low readability and poor content quality. There is need for the development of patient targeted health literature to help these patients.

Osteotomy around the knee: Assessment of quality, content and readability of online information

BackgroundAs knee osteotomy surgery becomes increasingly accessible, more patients may turn to the Internet for information. This study examined the source, quality, content and readability of online information regarding osteotomy around the knee. MethodsThe first 70 websites returned by the top four search engines were identified using the key words: “knee osteotomy” and “high tibial osteotomy.” The websites were categorised by type and assessed using the DISCERN score, Journal of the American Medical Association (JAMA) benchmark criteria and a novel Knee Osteotomy-Specific Score (KOSS). The presence of the Health On the Net (HON) code accreditation seal was noted. Readability of each website was assessed using eight readability formulae. The mean reading grade level (RGL) was compared to the 6th and 8th grade reading levels. The mean RGL of each category was also compared. ResultsOf the 45 unique websites analysed, the majority were Physician (33%) and Journal websites (31%). The mean DISCERN score was 36.7 (±8.9) which is classified as ‘poor.’ The mean JAMA benchmark criteria score was 2.04 (±1.5) and Physician websites were most likely to be scored zero. The mean KOSS was 15.4 (±5.7). The highest scoring website was a Commercial site but, overall, Journal category sites provided the best quality information. Websites that bore the HONcode seal obtained higher DISCERN, JAMA benchmark criteria and Knee Osteotomy - Specific Scores.The cumulative mean RGL was 13.2 (±2.2) which exceeded the 6th grade level by an average of 7.2 grade levels and the 8th grade level by an average of 5.2 grade levels. No website (0%) was written at or below either the 6th or the 8th grade reading levels. The mean Flesch Reading Ease Score of all websites was 41.13 (±14.7) which is classified as ‘difficult.’ Journal websites had the highest RGL. ConclusionThe information available online regarding osteotomy around the knee varies tremendously in quality and completeness. Physician sites predominate, but these were among the lowest scoring of all websites. Even where high quality information is available, it is set at too high a level to be easily understood. Level of evidenceSurvey of materials – Internet.

Orthodontic temporary anchorage devices: A qualitative evaluation of Internet information available to the general public

The evaluation of online information regarding orthodontic temporary anchorage devices (TADs) is lacking despite the increase in their use by orthodontists. This cross-sectional study aimed to investigate the quality of information regarding TADs available on the Internet to the general public. Two search terms ("orthodontic temporary anchorage device" and "orthodontic miniscrew") were entered separately into a total of 5 search engines. The DISCERN instrument, Journal of the American Medical Association (JAMA) benchmarks, and Health on the Net Foundation Code of Conduct were used to evaluate the quality of information contained within Web sites that satisfied the inclusion and/or exclusion criteria. Web site readability was assessed via the Simple Measure of Gobbledygook and Flesch Reading Ease Score tools. Descriptive statistical analyses and Cohen's kappa intrarater reliability tests were performed. Thirty-one Web sites were evaluated. Most were authored by orthodontists (77.4%) and originated from the U.S. (38.7%). The mean (standard deviation [SD]) DISCERN score was 41.87 (8.45) out of 80, with a range of 27-57. Intrarater reliability testing for DISCERN scores was excellent (0.84). Four Web sites achieved all 4 JAMA benchmarks, and 2 achieved none. Referencing of content sources throughout the Web sites scored least via DISCERN (mean 1.49 out of 5 per Web site [SD, 0.77]) and JAMA (19.35% of Web sites). One Web site contained the Health on the Net Foundation Code of Conduct seal. The mean (SD) Simple Measure of Gobbledygook score was 8.75 (1.25), with a range of 6.5-11.3. The mean (SD) Flesch Reading Ease Score was 59.81 (7.17), with a range of 47.6-73.8. The quality of information related to TADs on the Internet is moderate. The usefulness of the information may be further reduced because it was beyond the readability of the average member of the general public. Web site authors should consider the use of additional expertise, quality of information tools, and readability formulas to ensure high-quality and easily readable content.

Online Kidney Stone Educational Materials Do Not Meet Recommended Readability Standards.

The prevalence of kidney stones is rising and there is an increasing demand for reliable, easy to understand information for patients. To evaluate the readability of common Internet-based resources for kidney stones, we examined whether the most popular online educational materials may be contributing to decreased health literacy for this chronic condition. Websites for readability analysis were chosen based on a Google.com search using the search term "kidney stones." The top 10 websites were chosen for analysis and their quality was assessed by the presence or absence of a HONcode certificate. Readability was determined using 6 readability assessment tools: Flesch Reading Ease, FORCAST, Fry, Gunning Fog, Raygor Estimate and Simple Measure of Gobbledygook. Each website was then analyzed by subsections, with emphasis on the treatment and prevention of kidney stones. Of the 10 websites analyzed 8 had HONcode certification. Grade level calculations ranged from 7-13.9. All 10 websites were found to have readability levels above the recommended sixth-grade reading level. Mean Flesch Reading Ease score was 59 (range 47-73). With respect to treatment and prevention sections, 6/10 and 5/10 websites had readability levels above a tenth-grade level, respectively. The most commonly accessed websites regarding kidney stones have readability scores above what is comprehensible to the general public, with most exceeding grade level recommendations from the American Medical Association. Websites pertaining to kidney stones need to be simplified to facilitate patient understanding, especially with respect to the treatment and prevention of kidney stones.

Web‐based information on orthodontic clear aligners: a qualitative and readability assessment

Data regarding the quality of information (QOI) related to orthodontic clear aligners (OCAs) on the internet are lacking. The aim of the present investigation was to assess the quality and readability of websites providing information regarding OCAs to prospective patients. Three search terms were entered separately into three search engines. Four validated QOI instruments were used to determine the QOI and readability of the content contained within the websites that satisfied predetermined criteria. Descriptive statistical analyses and intrarater testing for DISCERN scores were calculated. Forty-nine websites satisfied inclusion/exclusion criteria. General dentists (44.9%) and specialist orthodontists (26.5%) authored the majority of websites. One website contained the Health on the Net (HON) code seal. Cohen's kappa for DISCERN scores was good (0.87). The overall mean (SD) DISCERN score was 38.55 (8.00)/80, range 26-60. The websites authored by 'Direct-to-consumer' OCA providers recorded the lowest DISCERN mean score (33/80). One website contained all four Journal of the American Medical Association (JAMA) benchmarks. The mean (SD) Flesch Reading Ease score was 53.92 (9.08), range 36-82.5. The QOI of the website content related to OCAs is poor and is 'fairly difficult' to read. Website authors should consider using QOI instruments and readability tools to enable the delivery of evidence-based and easily readable information regarding OCAs to prospective patients.

Readability of web-based sources about induced abortion: a cross-sectional study

BackgroundHigh-quality information is essential if clients who request an abortion are to reach informed decisions and feel prepared for the procedure, but little is known concerning the readability of web-based sources containing such material. The aim was to investigate the readability of web-based information about induced abortion.MethodsThe search engine Google was used to identify web pages about induced abortion, written in the English language. A total of 240 hits were screened and 236 web pages fulfilled the inclusion criteria. After correcting for duplicate hits, 185 web pages were included. The readability of the text-based content of each web page was determined with Flesch Kincaid Grade Level, Gunning Fog Index, Coleman-Liau Index, Simple Measure of Gobbledygook, and Flesch Reading Ease. Data were analyzed with descriptive statistics, Pearson’s correlation coefficient and Kruskal-Wallis with Dunn’s test as post hoc analysis.ResultsAcross all grade level measures, a small minority of the web pages had a readability corresponding to elementary school (n < 3, 1%), while the majority had readability corresponding to senior high school or above (n > 153, 65%). The means of the grade level measures ranged between 10.5 and 13.1, and the mean Flesch Reading Ease score was 45.3 (SD 13.6). Only weak correlations (rho < 0.2) were found between the readability measures and search rank in the hit lists. Consistently, web pages affiliated with health care had the least difficult readability and those affiliated with scientific sources had the most difficult readability.ConclusionsOverall, web-based information about induced abortions has difficult readability. Incentives are needed to improve the readability of these texts and ensure that clients encounter understandable information so that they may reach informed decisions and feel adequately prepared when requesting an abortion.

Evaluation of Quality and Readability of Online Health Information on High Blood Pressure Using DISCERN and Flesch-Kincaid Tools

High Blood Pressure (BP) is a vital factor in the development of cardiovascular diseases worldwide. For more than a decade now, patients search for quality and easy-to-read Online Health Information (OHI) for symptoms, preventions, therapy and other medical conditions. In this paper, we evaluate the quality and readability of OHI about high BP. In order that the first 20 clicks of three top-rated search engines have been used to collect the pertinent data. Using the exclusion criteria, 25 unique websites are selected for evaluation. The quality of all included links is evaluated through DISCERN checklist, a questionnaire for assessing the quality of written information for a health problem. To enhance the reliability of evaluation, all links are separately assessed by two different groups—a group of Health Professional (HPs) and a group of Lay Subjects (LS). A readability test is performed using Flesch-Kincaid tool. Fleiss’ kappa has been calculated before considering average value of each group. After evaluation, the average DISCERN value of HPs is 49.43 ± 14.0 (fair quality) while for LS, it is 48.7 ± 12.2; the mean Flesch-Reading Ease Score (FRES) is 58.5 ± 11.1, which is fairly difficult to read and the Average Grade Level (AGL) is 8.8 ± 1.9. None of the websites scored more than 73 (90%). In both groups, only 4 (16%) websites achieved DISCERN score over 80%. Mann-Whitney and Cronbach’s alpha have been computed to check the statistical significance of the difference between two groups and internal consistency of DISCERN checklist, respectively. Normality and homoscedasticity tests have been performed to check the distribution of scores of both evaluating groups. In both groups, information category websites achieved high DISCERN score but their readability level is worse. Highest scoring websites have clear aim, succinct source and high quality of information on treatment options. High BP is a pervasive disease, yet most of the websites did not produce precise or high-quality information on treatment options.

Arteriovenous Fistula for dialysis – Let's Google it. Readability and quality of online information

BackgroundThis study evaluated the readability and quality of information regarding arteriovenous (AV) fistula for dialysis on the Internet in the English language. Study designUsing Google© search, the keywords “AV Fistula for dialysis” were searched. The top 75 ranking sites were analyzed. One website was excluded due to repetition. Each landing page was assessed independently by two authors (RB, LR) for readability using the Flesch Reading Ease Score (FRES) and Gunning Fog Index (GFI). Web site quality was assessed using the DISCERN instrument. The individual position of the top 15 websites in the search engine ranking order list was noted. The country of origin, organization type and issuance of Health on the Net (HoN) Certification was recorded. Statistical analyses were performed using unpaired t-tests and ANOVA variance. ResultsThe mean GFI score was 9.2 and the mean FRES score was 50.6, indicating poor readability. The mean DISCERN score was 48.4, indicating weak quality of websites. Website quality was influenced by the academic/healthcare organization type (p = 0.012). Organization type was not found to impact GFI and FRES scores. Presence of a HoN Certification was not found to impact the quality of information. The majority of sites originated from the United States (61%). ConclusionOur study demonstrates that internet information pertaining to AV fistula for dialysis is of poor quality necessitating improvements to readability and overall website quality to improve the patient experience. Further research into how to improve healthcare web information is needed.

Assessment of quality and readability of internet-based health information related to commonly prescribed angiotensin receptor blockers.

IntroductionHypertension is a global public health burden. Angiotensin receptor blockers (ARBs) have proven efficacy in the management of hypertension and related complications. The Internet has become a major source of health information for patients and healthcare professionals. The study aimed to assess the quality and readability of internet-based information related to selected Angiotensin Receptor Blockers (ARBs).MethodsThe three most widely used ARBs were identified from published literature, after which internet-based patient information was identified from the first five pages of three search engines (Google, Yahoo and Bing). Quality of identified websites were assessed using the DISCERN instrument, while readability was evaluated using the SMOG instrument and the Flesch-Kincaid readability algorithm. Final ratings were then calculated as described by the instruments developers. Further, inter-class correlation coefficients (ICC) were calculated using the Statistical Package for Social Sciences.ResultsThe average overall DISCERN score in this study was 2.99 (SD±1.05). No website received an excellent rating, 15% were rated good, 66% as moderate and 19% as poor. The inter-class reliability was 0.804 for losartan and 0.695 for valsartan. The mean Flesch Reading Ease score for the websites was 48.87 (SD±16.12), mean Flesch-Kincaid Reading Grade Level was 9.29 (SD±1.98) while mean SMOG value was 11.29 (SD±1.70).ConclusionOverall, patient information on the reviewed ARBs websites was found to be of moderate quality and suboptimal readability. Content providers on websites should ensure that health information is of favorable quality and easy to read by patients with varying degree of health literacy.

The informative value and design of orthodontic practice websites in The Netherlands

BackgroundThe aims of this cross-sectional study were to investigate the regulatory compliance of Dutch practice websites offering orthodontic services, readability of the available treatment information, website design as well as possible relationship with practice location and professional qualification of practitioners.MethodsA comprehensive Internet search was performed using the Google search engine and five relevant terms in Dutch. Eligibility screening of the first 50 results of each search led to the final inclusion of 111 websites. The content of the selected websites was evaluated in terms of compliance to international regulations on ethical advertising guidelines (CED), treatment information text readability using Flesch Reading Ease Score (FRES), and website design using the BDC assessment tool.ResultsReporting of websites according to CED guidelines covered on average 85% of the mandatory items. No significant differences were observed between dental and orthodontic practices, and between practices located in densely and sparsely populated regions (P > 0.05). The mean FRES of the displayed information indicated difficult-to-understand text. BDC scores of multi-location practices were significantly higher than the rest (P < 0.006).ConclusionsThe websites of orthodontic practices in The Netherlands do not fully comply with CED guidelines on ethical advertising. Readability of the displayed information and website technical performance needs to be further optimized.

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.

EHealth tool for patients with abdominal aortic aneurysm: development and initial evaluation.

Abdominal aortic aneurysm (AAA) is a prevalent condition among elderly men and may require surgical repair. Recent technical advances offer new opportunities to provide patients and next of kin with tailored and individualised information. eHealth tools have proven useful in other patient cohorts, but there are currently no validated educational eHealth tools for patients with AAA. Our aim was to develop and evaluate an eHealth tool for patients with abdominal aortic aneurysm using a participatory design process. Patients, healthcare professionals and a technical team were involved in the development of the eHealth tool. The tool was assessed for content and usability through questionnaires, validated instruments and focus group interviews. Readability was assessed using Flesch Reading Ease Score (FRE) and Flesch-Kincaid Grade Level (FKGL). Interview data were analysed using thematic content analysis. Factual content and illustrations were accurate and in line with current information routine. Readability assessments produced a mean FRE score of 42.2 (±3,7) and mean FKGL of 10 (±1), implying that the eHealth tool may be difficult to comprehend for certain users. However, participants in the focus group interviews found the tool to be understandable, relevant and easy to use. The developed eHealth tool is acceptable, understandable and usable for the potential end-users. Further evaluation of the usability of the tool and effect on outcome in clinical care is warranted. This is the first educational eHealth tool for patients with AAA and has potential to contribute to improved communication and quality of care for AAA patients.

Readability of consent forms in veterinary clinical research.

Background“Readability” of consent forms is vital to the informed consent process. The average human hospital consent form is written at a 10th grade reading level, whereas the average American adult reads at an 8th grade level. Limited information currently exists regarding the readability of veterinary general medical or clinical research consent forms.Hypothesis/ObjectivesThe goal of this study was to assess the readability of veterinary clinical trial consent forms from a group of veterinary referral centers recently involved in a working group focused on veterinary clinical trial review and consent. We hypothesized that consent forms would not be optimized for client comprehension and would be written above the National Institutes of Health‐recommended 6th grade reading level.AnimalsNone.MethodsThis was a prospective study assessing a convenience sample of veterinary clinical trial consent forms. Readability was assessed using 3 methods: the Flesch‐Kincaid (F‐K) Grade Level, Flesch Reading Ease Score (FRES), and the Readability Test Tool (RTT). Results were reported as mean (±SD) and compared across specialties.ResultsFifty‐three consent forms were evaluated. Mean FRES was 37.5 ± 6.0 (target 60 or higher). Mean F‐K Grade Level was 13.0 ± 1.2 and mean RTT grade level was 12.75 ± 1.1 (target 6.0 or lower). There was substantial agreement between F‐K and RTT grade level scores (intraclass correlation coefficient 0.8).Conclusions and Clinical ImportanceNo form evaluated met current health literacy recommendations for readability. A simple and readily available F‐K Microsoft‐based approach for evaluating grade level was in substantial agreement with other methods, suggesting that this approach might be sufficient for use by clinicians and administrators drafting forms for future studies.

Evaluation of treatment risks and the quality of information contained within the websites of specialist orthodontists

Abstract Objective To evaluate the treatment risks and the quality of information contained within the websites of specialist orthodontists in Australia. Methods The term ‘specialist orthodontic practice’ was entered into three internet search engines. Websites satisfying inclusion and exclusion criteria were evaluated for orthodontic treatment risk information against nine common treatment risks. For website reliability and quality, the DISCERN instrument was used along with the HON (health on the net) seal certification; and for readability, the Flesch Reading Ease (FRE) Test was applied. Results Of the 105 websites that met the inclusion and exclusion criteria, 4.8% reported all nine risks. No risks were reported by 17.1%. Relapse (64.8%) was the most common risk recorded on websites, followed by ‘pain/discomfort’ (63.8%). Root resorption was reported by 5.7%. The requirement for life-long retention was indicated by 22.9% of the websites and 57.1% gave advice on sports mouthguard wear. The proposed benefits of orthodontic treatment were outlined by 85.7%. The mean (standard deviation [SD]) overall DISCERN score was 43.78 (SD 6.49; range 17–59). No website displayed the HON Seal certification. The mean FRE Score was 51.71 (SD 10.19; range 30.1–74.7). Conclusions Information regarding orthodontic treatment risks contained within specialist orthodontic practice websites appears deficient. Websites were of variable reliability, quality and readability. Further development of specialist orthodontists’ websites is required to ensure the delivery of accessible, reliable and understandable evidence-based information to patients.

Consent documentation for elective orthopaedic surgery.

Currently in Ireland, there is a lack of uniformity regarding the method in which the consent process is routinely documented. The purpose of this study was to evaluate the standard consent forms used in elective orthopaedic hospitals in Ireland. In addition, this paper explores the relevant guidelines from the UK and Ireland relating to consent documentation. Standard consent forms used in the 24 public hospitals that perform elective orthopaedic surgery were analysed and compared, based on the inclusion or exclusion of 22 unique consent-related items or statements selected by the authors. In addition, each form was analysed for format, word count, and readability. Within 24 hospitals with elective orthopaedic surgery, there were 21 unique consent forms being used. There was a mean inclusion of 9.5 of the 22 unique items per form with a standard deviation of 5.1 (range 2-18), indicating a wide discrepancy. For each unique consent-related item in the analysis, the mean rate of inclusion was 43.4% (SD 26.7%). The mean Flesch Reading Ease Score was 43.3. The format varied from 1 to 4 pages, with a word count of 109 to 1041 (mean 414.7). The findings demonstrate a lack of uniformity of both format and content amongst the consent forms currently being used in elective orthopaedic hospitals in Ireland. This paper supports the use of a nationally standardised consent documentation method in order to improve the efficiency of the consent process and ensure greater protection against litigation.