Online Patient Education Resources Research Articles

Barriers to Health Care Communication: Patient Education Resource Readability and Spanish Translation for Slipped Capital Femoral Epiphysis

BackgroundThe American Medical Association (AMA) and the National Institutes of Health (NIH) recommend that patient education resources be written at 6th and 8th grade reading levels, respectively. However, many existing resources are written above this level. In addition, the majority of patient education resources are only available in English, despite the significant Spanish-speaking population in the United States. The purpose of this study was to determine the availability and readability of online patient education resources for Slipped Capital Femoral Epiphysis (SCFE) provided by the top-ranked pediatric orthopaedic hospitals and major pediatric orthopedic professional societies. MethodsWe performed a cross-sectional analysis to determine the availability of English and Spanish language resources for SCFE provided by the top pediatric orthopaedic hospitals and major professional societies. We then assessed the readability of available patient education materials via three measures of readability. Statistical analysis was performed using descriptive, univariate, and correlation analyses. ResultsIn total, 79.6% (39/49) of hospitals and 66.7% (2/3) of professional societies provided English language resources for SCFE. In contrast, Spanish language resources were provided by 34.7% (17/49) and 33% (1/3) hospitals and professional societies. English language resources scored significantly lower than Spanish language resources using the Flesch-Kincaid and Fernandez-Huerta reading ease scales, respectively (60.32 vs. 65.89, p<0.05). There was no difference in grade level calculated by Fry Graph/Gilliam-Peña-Mountain (9.5 vs. 8.5, p>0.05), but English language resources had a significantly higher grade level calculated by SMOG/SOL (11.9 vs. 10.4, p<0.01). There was greater availability of Spanish language resources in states with >20% primary Spanish- speakers (p<0.05). ConclusionThe majority of top-ranked hospitals and professional societies provide online educational materials on SCFE in English; however, only a third provide similar materials in Spanish. Additionally, the average reading level of English and Spanish language resources is above the recommendations from the AMA and NIH. Additional effort and resources should be allocated toward improving SCFE patient education materials to increase accessibility to broader patient and caregiver populations. LEVEL OF EVIDENCELevel III KEY CONCEPTS(1)Online patient education resources for Slipped Capital Femoral Epiphysis (SCFE) are written above the recommended reading grade level for both English and Spanish.(2)There is limited availability of Spanish-language patient education recourses for SCFE, despite a significant Spanish-speaking population in the United States.(3)There is greater availability of Spanish-language resources for SCFE in states with a primary Spanish-speaking population greater than 20%.

Gender-affirming vaginoplasty online resources exceed patient health literacy: A readability analysis

PurposeEnsuring that educational materials geared toward transgender and gender-diverse patients are comprehensible can mitigate barriers to accessing gender-affirming care and understanding postoperative care. This study evaluates the readability of online patient resources related to gender-affirming vaginoplasty. MethodsOnline searches for vaginoplasty were conducted in January 2023 using two search engines. The readability scores of the top ten websites and their associated hyperlinked webpages were derived using ten validated readability tests. ResultsA total of 40 pages were assessed from the vaginoplasty searches. The average reading grade level for all the webpages with relevant educational materials was 13.3 (i.e., college level), exceeding the American Medical Association's recommended 6th grade reading level. ConclusionComplex patient resources may impede patients’ understanding of gender-affirming vaginoplasty. Online patient education resources should be created that are more accessible to patients with diverse reading comprehension capabilities.

Autonomy and Its Limits

Autonomy and Its Limits

Assessing the readability and quality of online information on benign paroxysmal positional vertigo.

Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vertigo. It can have a significant impact on quality of life, with individuals often seeking information online for reassurance and education. The aim of this study is to assess the readability and quality of online information on BPPV. The terms 'benign paroxysmal positional vertigo' and 'BPPV' were entered into Google. The first 50 websites generated for each search term were screened. Readability was assessed using the Flesch-Kincaid Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG) Index and Gunning Fog Index (GFOG). Quality was assessed using the DISCERN instrument. Spearman's correlation between quality and readability was calculated. A total of 39 websites met the inclusion criteria. The mean and 95% confidence intervals for the FRES, FKGL, SMOG, GFOG and DISCERN scores were 50.2 (46.1-54.3), 10.6 (9.87-11.4), 10.1 (9.5-10.7), 13.6 (12.7-14.4) and 36.7 (34.6-38.7), respectively. Weak correlation was noted between DISCERN and FRES (rs = -0.23, p = 0.17). Online information on BPPV is generally of poor quality and low readability. It is essential that healthcare professionals inform their patients of this limitation and advocate for improved online patient education resources that are both high quality and easy to comprehend.

A critical appraisal of online patient education resources for the management of sick day episodes in adrenal insufficiency

A critical appraisal of online patient education resources for the management of sick day episodes in adrenal insufficiency

Assessing the Readability of Online Patient Education Resources Related to Neophallus Reconstruction

IntroductionOnline patient education materials (PEMs) often exceed the recommended 6th grade reading level. This can negatively affect transmasculine patients’ understanding of treatment plans, increasing barriers to care and worsening health outcomes and patient satisfaction. This study assessed the readability of online English and Spanish PEMs regarding phalloplasty and urethroplasty. MethodsThe English and Spanish terms for phalloplasty and urethroplasty were queried on Google. The first fifty results were grouped into institutional (government, medical school, teaching hospital), noninstitutional (private practice, news channel, blog, etc.), and academic (journal articles, book chapters) categories. Readability scores were generated using the Simple Measure of Gobbledygook and Spanish Simple Measure of Gobbledygook scales. ResultsAll PEMs exceeded recommended reading levels. For both procedures, English PEMs had an average reading level approximately of a university sophomore and Spanish PEMs had an average reading level approximately of a high school junior. For both procedures, English PEMs were harder to read than Spanish PEMs overall (P < 0.001) and when compared across the three categories between the two languages (P < 0.001). For Spanish urethroplasty PEMs, noninstitutional PEMs were more difficult to read than institutional PEMs (P < 0.05). ConclusionsOnline information for phalloplasty and urethroplasty should be revised and/or standardized materials should be created by trans-affirming health-care providers and national organizations in order to more fully educate the public and prospective patients prior to intervention. A well-informed patient population will improve patient decision-making and surgeon-patient communication, ultimately leading to better health outcomes.

152 Assessment of Quality and Readability of Online Patient Education Materials Relating to Dog Bites

Abstract Aim Dog bites are common injuries which can result in significant morbidity and comprise a large workload for plastic surgery. We aimed to assess the quality and readability of online patient education resources related to dog bites. Method We entered the search term ‘dog bite’ into Google and assessed the top 50 results for quality and readability. Quality was measured using the DISCERN questionnaire, benchmark criteria published by the Journal of the American Medical Association (JAMA), and accreditation by the HONcode (Health On the Net code). Readability was measured with the Flesch-Kincaid reading grade (FKRG), Flesch reading ease score, Gunning's fog index, and the Coleman-Liau index (CLI). Results The mean JAMA and DISCERN scores were 2/4 and 35.7/80 respectively suggesting average quality. Only 3 sites were HONcode certified (7%). The mean Flesch reading ease score was 11.3 suggesting that the materials were very difficult to read and best understood by those with tertiary education. This corresponded with the high Gunning's fog score of 14.2. The FKRG and CLI indicated similar results. Conclusions Online materials relating to dog bites are of average quality and poor readability, especially in the context of the UK's reading age of 9. Avoidance of medical jargon and use of shorter words and sentences would improve readability. Timely review of websites, improved information on authorship and references could improve quality. Improved quality and readability would make it easier for patients to understand what to do following a dog bite, how to seek help if appropriate and what treatment to expect.

Evaluating patient education resources for supporting treatment decisions in latent tuberculosis infection

Objective: People with latent tuberculosis infection (LTBI) are required to make complex treatment decisions, which require an understanding of personal risk and associated benefits. However, many people with LTBI in the United Kingdom are at risk of low health literacy and can also experience language barriers, which can affect decision making. Patient education resources can support understanding but must meet the needs of the target population. The aim of this study was to evaluate the accessibility, readability and content of LTBI patient education resources. Design: Review and descriptive analysis of online LTBI patient education resources. Setting: UK-based online patient education resources. Method: We searched UK public health and charitable organisations for online LTBI patient education resources. Resources were evaluated in terms of accessibility (availability of translated versions); readability (Flesch–Kincaid Reading Ease [FKE], Flesch–Kincaid Grade Level [FKG] and Simplified Measure of Gobbledygook [SMOG]), theoretical content (Extended Common-Sense Model) and principles of shared decision making. Results: Seventeen out of 60 articles identified in the search met the prespecified criteria for inclusion. Translated materials were available for 7 of them. The overall mean ± SD readability scores and corresponding reading ages were FKE 63.51 ± 8.81 (13–15 years), FKG 9.14 ± 8.95 (13–15 years) and SMOG 8.27 ± 1.51 (13–14 years). No resources met Health Education England recommended readability levels for health-related information. Dimensions of cognitive representations of illness and treatment most commonly addressed included treatment control, cause and identity (symptom and label); no resources addressed emotional identity. Conclusion: Current and future LTBI patient education resources would benefit from greater consideration of the needs of non-English language speakers, readability and theoretical content to improve patient illness experience and support informed treatment decision making.

Depression in cancer: quality assessment of online patient education resources.

Psychiatric comorbidities are common among cancer patients. However, little is known about the quality of online information regarding these conditions. This study uses a validated tool to systematically determine the strengths and limitations of websites addressing depression in cancer patients. The term "depression in cancer patients" was searched online using the search engines Google, Yippy, and Dogpile. A set of predetermined inclusion/exclusion criteria was applied to all search results, which yielded 48 websites for inclusion. A validated rating tool was used to score the websites based on the six domains of Affiliation, Accountability, Interactivity, Structure & Organization, Readability, and Content Quality. The results were analyzed using descriptive statistics. Of the 48 websites evaluated, 50% were commercial. 63% of websites identified authorship, 54% cited reliable sources, 37% provided links, and 38% were updated within the last 2 years. 94% of websites featured a search engine and 60% had at least four structural tools. Average readability was at a grade 12.3 level using the Flesch-Kincaid scale and 11.3 using the Simple Measure of Gobbledygook Index. The most completely and accurately covered topics of depression were symptoms and treatment-83% and 73% respectively. Its prevention and prognosis were not covered by any of the websites. A validated rating tool was applied to evaluate the quality of online information for depression in cancer patients. Website accountability was poor, readability was often at a level that is too difficult for the lay audience, and the topics of prevention and prognosis were seldom covered.

Assessing the Readability of Online Patient Education Resources Related to Gynecomastia.

The Internet has a plethora of online patient education resources for many symptoms and diseases. National medical governing bodies recommend that patient education materials are written at or below the eighth-grade level, and the literature suggests that health literacy has been linked to increased adherence to treatment regimens and improved outcomes. The primary aim of the study is to assess the readability of online patient materials relating to gynecomastia and ascertain the availability of patient materials in non-English languages. The readability of patient education materials relating to gynecomastia for academic-based websites and nonacademic websites was assessed using the Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (FKGL), and Simple Measure of Gobbledygook (SMOG). The prevalence of non-English patient education materials was assessed for both academic-based and nonacademic websites. Fifty-eight documents were collected across academic websites. Overall median values were 10.7 for the FKGL, 47.0 for the FRE, and 11.4 for the SMOG. For the 10 nonacademic institutions, the overall median values were 10.6 for the FKGL, 45.2 for the FRE, and 10.8 for the SMOG. No appreciable differences were observed for readability when stratified by region or source. The prevalence of non-English patient materials was 19.1% across institutions. None of the noninstitutional materials had information in non-English languages. The readability of patient education materials related to gynecomastia is at higher levels than recommended by national organizations. There are limited non-English patient education materials. Future efforts should focus on improving the readability and accessibility of patient materials.

143: Depression in Cancer: An Evaluation of Online Patient Education Resources

143: Depression in Cancer: An Evaluation of Online Patient Education Resources

Reliability and quality of online patient education videos for lateral lumbar interbody fusion.

There is an increasing trend among patients and their families to seek medical knowledge on the internet. Patients undergoing surgical interventions, including lateral lumbar interbody fusion (LLIF), often rely on online videos as a first source of knowledge to familiarize themselves with the procedure. In this study the authors sought to investigate the reliability and quality of LLIF-related online videos. In December 2018, the authors searched the YouTube platform using 3 search terms: lateral lumbar interbody fusion, LLIF surgery, and LLIF. The relevance-based ranking search option was used, and results from the first 3 pages were investigated. Only videos from universities, hospitals, and academic associations were included for final evaluation. By means of the DISCERN instrument, a validated measure of reliability and quality for online patient education resources, 3 authors of the present study independently evaluated the quality of information. In total, 296 videos were identified by using the 3 search terms. Ten videos met inclusion criteria and were further evaluated. The average (± SD) DISCERN video quality assessment score for these 10 videos was 3.42 ± 0.16. Two videos (20%) had an average score above 4, corresponding to a high-quality source of information. Of the remaining 8 videos, 6 (60%) scored moderately, in the range of 3-4, indicating that the publication is reliable but important information is missing. The final 2 videos (20%) had a low average score (2 or below), indicating that they are unlikely to be of any benefit and should not be used. Videos with intraoperative clips were significantly more popular, as indicated by the numbers of likes and views (p = 0.01). There was no correlation between video popularity and DISCERN score (p = 0.104). In August 2019, the total number of views for the 10 videos in the final analysis was 537,785. The findings of this study demonstrate that patients who seek to access information about LLIF by using the YouTube platform will be presented with an overall moderate quality of educational content on this procedure. Moreover, compared with videos that provide patient information on treatments used in other medical fields, videos providing information on LLIF surgery are still exiguous. In view of the increasing trend to seek medical knowledge on the YouTube platform, and in order to support and optimize patient education on LLIF surgery, the authors encourage academic neurosurgery institutions in the United States and worldwide to implement the release of reliable video educational content.

Trends in e-literature on cardiovascular diseases: A bibliometric analysis with reference to ClinicalKey (2015 -2019)

ClinicalKey is a clinical search engine that helps doctors and other health professionals to make better decisions anywhere, anytime, in any patient scenario. ClinicalKey database provides access to thousands of online resources such as online medical books, e-journals, drug monographs, guidelines, patient education, clinical overviews and multimedia resources. This paper aims to describe the bibliometric study published in ClinicalKey from 2015 to 2019 on e-literature on cardiovascular diseases (CVDs) and to explore publishing trends in the relevant field. For the study, the literature was extracted in terms of full-text research articles from ClinicalKey covering the period from January 2015 to December 2019. This quantitative study includes the bibliometric methods to analyze original articles and the data has been analyzed using statistical techniques in MS Excel and SPSS. During the period of study, a total of 8193 research articles were published, giving an average of 1639 pieces of literature per year. Results of this study revealed that the year-wise distribution of articles has a mean relative growth rate of 0.90 articles per annum and a doubling time of 2.27 years for the publications at the aggregate level. In the same way, month-wise results for the year 2015 and 2019 are, mean relative growth rate 0.45 and 0.41 articles per month and the doubling time 10.34 and 10.49 months respectively. Relative growth rate and doubling time of retrieved literature from 2015 to 2019 is stable and indicates an exponential growth of literature in the field. The analysis shows that there is a nucleus zone of journals (core journals) publishing cardiovascular diseases research output which is scattered among journals in cardiovascular diseases literature confirm to the Bradford’s law of scattering.

Assessment of the Readability, Adequacy, and Suitability of Online Patient Education Resources for Benign Vascular Tumours Using the DISCERN Instrument.

This study aims to assess the quality and readability of Internet-based patient resources for vascular tumours in order to understand which areas require improvement. A World Wide Web search was performed, in addition to a literature review using PubMed, Ovid MEDLINE, and EMBASE. Any material that contained information on vascular tumours pertaining to patient education was included. We evaluated resources with DISCERN and Flesch Reading Ease scores when applicable. The language of publication was restricted to English and French. This review was registered with PROSPERO (CRD42018087885). A total of 117 online resources were screened, with 73 resources included in the final analysis. The overall DISCERN rating for the patient resources was 1.8 (0.8). The majority of online resources failed to depict the entire spectrum of benign vascular tumours. The mean Flesch score was 36 (19), which translates to a college-level readability. The majority of resources were not adequate or comprehensive and were written at a much higher level than the average reader would be expected to comprehend.

What can we do about Dr. Google? Using the electronic medical record (EMR) to prescribe reliable online patient education

ObjectiveThe project enabled clinicians to utilize the electronic medical record (EMR) to easily prescribe preapproved online patient education resources to their patients.BackgroundPhysicians and other clinicians are concerned about the wide use of “Dr. Google” and the difficulties of responding to patients who demand unproven or unnecessary tests and therapies they found out about on the Internet.Setting/Participants/ResourcesParticipants were providers at a large health system using Epic EMR. The institution maintains a web-based database that links to print and electronic patient education materials that have been vetted by content experts.MethodsClinicians worked with librarians to create web pages that link to the resources they recommend for their patients. Librarians collaborated with the information technology (IT) department to implement a solution that enables clinicians to quickly and easily send the uniform resource locator (URL) to the after visit summary (AVS) or as a message via the patient portal.ResultsThis solution has been implemented in more than 20 units across the institution. Analytics data demonstrate that the majority of patients in a surgery clinic visited recommended resources.ConclusionThis simple solution is effective in directing patients to reliable resources. It can be easily adapted by other institutions using an EMR system such as EPIC or Cerner.

Comparative Readability Analysis of Online Patient Education Resources on Inflammatory Bowel Diseases.

Background The National Institutes of Health recommend a readability grade level of less than 7th grade for patient directed information. In this study, we use validated readability metrics to analyze patient information from prominent websites pertaining to ulcerative colitis and Crohn's disease. Methods The terms “Crohn's Disease,” “Ulcerative Colitis,” and “Inflammatory Bowel Disease” were queried on Google and Bing. Websites containing patient education material were saved as a text file and then modified through expungement of medical terminology that was described within the text. Modified text was then divided into subsections that were analyzed using six validated readability scales. Results None of the websites analyzed in this study achieved an estimated reading grade level below the recommended 7th grade. The median readability grade level (after modification) was 11.5 grade levels for both Crohn's disease and ulcerative colitis. The treatment subsection required the highest level of education with a median readability grade of 12th grade (range of 6.9 to 17). Conclusion Readability of online patient education material from the analyzed popular websites far exceeds the recommended level of being less than 7th grade. Patient education resources should be revised to achieve wider health literacy.

Developing and testing an electronic literacy resource for Arab patients before experiencing radiology procedures

Radiological examinations require prior preparation that patients should be informed about. Radiologists and radiologic technologists have limited time and resources to do so. Therefore, the internet is a valuable and accessible resource for patient education, but the information may not be reliable, especially that in Arabic language. This study aimed to develop online patient education resources about imaging procedures in Arabic. It also evaluated the understandability and actionability of the source materials. The study was conducted at the University of Sharjah between October 2014 and July 2015. A website containing texts and audiovisuals for 21 medical imaging procedures was created. Bilingual (Arabic and English) radiology experts evaluated the materials with automatic score calculation using the Patient Education Materials Assessment Tool. Two procedures were pilot tested by one evaluator, followed by completion of 28 evaluations by 15 selected experts. Nineteen of 21 procedures were randomly evaluated. For printable materials, the mean understandability score was 92.37 (SD=8.355) and actionability score was 92.11 (SD=13.157). For audiovisual materials, the mean understandability score was 97.63 (SD=13.157) and the percentage for all actionability scores was 100%. The minimum acceptable percentage is 70%. The high percentages scored for the online materials indicate that the evaluators were satisfied with the materials included and that the information would be easy for patients to understand and follow. The higher scores for the audiovisual materials indicate that they were considered more effective for improving patient knowledge patient knowledge.

Radiation Oncology and Online Patient Education Materials: Deviating From NIH and AMA Recommendations

Physicians encourage patients to be informed about their health care options, but much of the online health care-related resources can be beneficial only if patients are capable of comprehending it. This study's aim was to assess the readability level of online patient education resources for radiation oncology to conclude whether they meet the general public's health literacy needs as determined by the guidelines of the United States National Institutes of Health (NIH) and the American Medical Association (AMA). Radiation oncology-related internet-based patient education materials were downloaded from 5 major professional websites (American Society for Radiation Oncology, American Association of Physicists in Medicine, American Brachytherapy Society, RadiologyInfo.org, and Radiation Therapy Oncology Group). Additional patient education documents were downloaded by searching for key radiation oncology phrases using Google. A total of 135 articles were downloaded and assessed for their readability level using 10 quantitative readability scales that are widely accepted in the medical literature. When all 10 assessment tools for readability were taken into account, the 135 online patient education articles were written at an average grade level of 13.7±2.0. One hundred nine of the 135 articles (80.7%) required a high school graduate's comprehension level (12th-grade level or higher). Only 1 of the 135 articles (0.74%) met the AMA and NIH recommendations for patient education resources to be written between the third-grade and seventh-grade levels. Radiation oncology websites have patient education material written at an educational level above the NIH and AMA recommendations; as a result, average American patients may not be able to fully understand them. Rewriting radiation oncology patient education resources would likely contribute to the patients' understanding of their health and treatment options, making each physician-patient interaction more productive and efficient.

IBD, I Barely Discern: A Comparative Analysis of Online Patient Education Resources Relating to Inflammatory Bowel Disease

IBD, I Barely Discern: A Comparative Analysis of Online Patient Education Resources Relating to Inflammatory Bowel Disease

Lifetime cardiac reinterventions following the Fontan procedure.

Patients with single ventricle physiology face significant morbidity and mortality following the Fontan procedure resulting in the need for additional cardiac reinterventions. Online patient education resources provide limited information on the reinterventions performed in single ventricle patients following the Fontan procedure. We sought to determine cardiac surgical and percutaneous reintervention rates and factors affecting reinterventions following the Fontan procedure. Databases from a single tertiary care center were retrospectively reviewed for all patients who underwent a Fontan procedure between 1978 and 2002. The number and type of cardiac surgical and percutaneous interventions following the Fontan procedure were determined, and relationships between need for reintervention and clinical variables were sought. A total of 91 patients (55 males) underwent the Fontan procedure at a median age of 5.50 years (IQR: 3.33-9.50 years). Median age at last follow-up, death, or transplant was 21.89 years (IQR: 10.87-25.51 years). Following the Fontan procedure, 60 (66%) patients required an additional 144 median sternotomies and 61 (67%) required 139 percutaneous cardiac interventions. Pacemaker system placement/replacement was the most common intervention following the Fontan procedure. The median time to first cardiac surgery following the Fontan was 1.96 years (IQR: 0.06-8.42 years) while the median time to the first percutaneous intervention was 7.63 years (IQR: 0.65-15.89 years). Families of single ventricle patients should be counseled on the likelihood of requiring additional cardiac interventions following the Fontan procedure.