Readability Index Research Articles

Evaluating the readability of online patient-facing resources for alcohol use disorder

The goal of this study was to assess the readability of online resources pertaining to Alcohol Use Disorder (AUD) as perceived by patients seeking treatment. The National Institutes of Health (NIH) and American Medical Association (AMA) have recommended that medical resources should be written at a 6th-grade reading level. However, prior investigations in various medical fields have revealed that online materials often fail to adhere to these guidelines. An internet search was conducted to simulate the experience of patients seeking information on AUD treatment. The first 30 websites that did not require login credentials were examined using established readability tests. The main outcomes included: Flesch-Kincaid Reading Grade Level, Gunning Fog index, Simple Measure of Gobbledygook (SMOG) Readability Formula, and Coleman-Liau index. Thirty records were identified where the mean readability level was 12.37 (2.54). There were no significant differences in mean readability across readability indices or author type. None of the 30 records met the reading level recommendations as set by the NIH and AMA. In order to enhance accessibility and ultimately improve AUD health outcomes, it is recommended that patient-oriented resources be crafted with adherence to these guidelines. Consequently, future AUD resources ought to prioritize the enhancement of their readability.

Bridging the Gap Between Urological Research and Patient Understanding: The Role of Large Language Models in Automated Generation of Layperson's Summaries.

This study assessed ChatGPT's ability to generate readable, accurate, and clear layperson summaries of urological studies, and compared the performance of ChatGPT-generated summaries with original abstracts and author-written patient summaries to determine its effectiveness as a potential solution for creating accessible medical literature for the public. Articles from the top 5 ranked urology journals were selected. A ChatGPT prompt was developed following guidelines to maximize readability, accuracy, and clarity, minimizing variability. Readability scores and grade-level indicators were calculated for the ChatGPT summaries, original abstracts, and patient summaries. Two MD physicians independently rated the accuracy and clarity of the ChatGPT-generated layperson summaries. Statistical analyses were conducted to compare readability scores. Cohen's κ coefficient was used to assess interrater reliability for correctness and clarity evaluations. A total of 256 journal articles were included. The ChatGPT-generated summaries were created with an average time of 17.5 (SD 15.0) seconds. The readability scores of the ChatGPT-generated summaries were significantly better than the original abstracts, with Global Readability Score 54.8 (12.3) vs 29.8 (18.5), Flesch Kincade Reading Ease 54.8 (12.3) vs 29.8 (18.5), Flesch Kincaid Grade Level 10.4 (2.2) vs 13.5 (4.0), Gunning Fog Score 12.9 (2.6) vs 16.6 (4.1), Smog Index 9.1 (2.0) vs 12.0 (3.0), Coleman Liau Index 12.9 (2.1) vs 14.9 (3.7), and Automated Readability Index 11.1 (2.5) vs 12.0 (5.7; P < .0001 for all except Automated Readability Index, which was P = .037). The correctness rate of ChatGPT outputs was >85% across all categories assessed, with interrater agreement (Cohen's κ) between 2 independent physician reviewers ranging from 0.76-0.95. ChatGPT can create accurate summaries of scientific abstracts for patients, with well-crafted prompts enhancing user-friendliness. Although the summaries are satisfactory, expert verification is necessary for improved accuracy.

Investigating the impact of innovative AI chatbot on post-pandemic medical education and clinical assistance: a comprehensive analysis.

The COVID-19 pandemic has significantly disrupted clinical experience and exposure of medical students and junior doctors. Artificial Intelligence (AI) integration in medical education has the potential to enhance learning and improve patient care. This study aimed to evaluate the effectiveness of three popular large language models (LLMs) in serving as clinical decision-making support tools for junior doctors. A series of increasingly complex clinical scenarios were presented to ChatGPT, Google's Bard and Bing's AI. Their responses were evaluated against standard guidelines, and for reliability by the Flesch Reading Ease Score, Flesch-Kincaid Grade Level, the Coleman-Liau Index, and the modified DISCERN score for assessing suitability. Lastly, the LLMs outputs were assessed by using the Likert scale for accuracy, informativeness, and accessibility by three experienced specialists. In terms of readability and reliability, ChatGPT stood out among the three LLMs, recording the highest scores in Flesch Reading Ease (31.2 ± 3.5), Flesch-Kincaid Grade Level (13.5 ± 0.7), Coleman-Lau Index (13) and DISCERN (62 ± 4.4). These results suggest statistically significant superior comprehensibility and alignment with clinical guidelines in the medical advice given by ChatGPT. Bard followed closely behind, with BingAI trailing in all categories. The only non-significant statistical differences (P > 0.05) were found between ChatGPT and Bard's readability indices, and between the Flesch Reading Ease scores of ChatGPT/Bard and BingAI. This study demonstrates the potential utility of LLMs in fostering self-directed and personalized learning, as well as bolstering clinical decision-making support for junior doctors. However further development is needed for its integration into education.

Readability and Quality Assessment of Web-Based Information Concerning Post-Endodontic Treatment Selection

Objectives: This study aimed to unbiasedly identify the quality and readability of the written information about post-endodontic coronal restorations on Turkish websites using accepted formulas and scales by the literature.&#x0D; Methods: The study was carried out by setting national pages and national locations in the Google search engine. The terms "root canal treatment and veneer" and "root canal treatment and filling" were used as keywords. The webpages were assessed independently by two readability formulas (Flesh-Kincaid and Ateşman systems) and DISCERN quality kit. The independent statistical and correlation analysis were performed using Kolmogorov-Smirnov, Shapiro-Wilk, Spearman's rho, and Dunn's tests. The significance level was taken as p&lt;0.05.&#x0D; Results: The initial search identified 60 websites, of which eight were excluded due to non-compliance with the study criteria (n=52). According to the DISCERN score, the web pages were categorized as fair with the highest rate of 57.69%. A statistically significant positive correlation was found between Ateşman Readability Index and the Flesh-Kincaid Reading Ease score (r=0.998; p&lt;0.001). There was no statistically significant correlation between Ateşman Readability Index and DISCERN score (p=0.259). Ateşman reading ease scores of the web pages are evaluated, 80.76% of these are classified as moderately difficult.&#x0D; Conclusions: The readability distribution of the written information about post-endodontic coronal restorations on websites was acceptable to the majority. However, being readable does not indicate that it provides sufficient target technical information. In this context, it can be suggested to use readability and quality scales while preparing websites for dental patient education concerning post-endodontic coronal restorations.

Does IFRS convergence affect the readability of annual reports by Indian listed companies?

PurposeThe purpose of this study is to investigate the influence of IFRS convergence on annual report readability in an emerging market context, with an emphasis on the contents of management discussion and analysis (MD&A), notes to the accounts (Notes) and the whole annual report.Design/methodology/approachThe study performs firm-fixed effect regression on a sample of 143 Indian listed companies over a period spanning from 2012 to 2021 to examine the influence of IFRS convergence on readability. This assessment primarily focuses on broader spectrums of readability dimensions, namely annual report length and complexity, wherein complexity is measured using the Gunning Fog, Flesch Reading ease and Flesch-Kincaid grade index.FindingsAs Indian firms shift to IFRS reporting, the findings suggest that annual reports have become significantly lengthier and more complex, causing deterioration in readability. The Notes section, in particular, exhibits the most significant increase in length and complexity, followed by the entire annual report and MD&A section. Furthermore, the findings also indicate that the complexity of the Notes section is instrumental in the observed complexity growth of the whole annual report in the post-IFRS period.Research limitations/implicationsThe current study employs readability indices rather than directly taking into consideration the opinions of actual users of annual reports to determine readability. As a result, the study does not provide direct evidence on how information in annual reports affects users' readability.Practical implicationsThe findings provide insightful information to managers and policymakers about the difficulties stakeholders may encounter while reading IFRS-based annual reports, which ultimately impact their investment decisions. Thus, there is an important managerial implication from this, depending upon the severity of complexity corporations participate in while complying with IFRS in the post-IFRS period.Originality/valueAnalyzing the influence of exogenous information shock, such as IFRS convergence, on readability is critical, particularly for emerging markets like India, where a lack of financial literacy and weaker enforcement already have detrimental effects on the capital market. In light of this, the current study provides a comprehensive examination of the impact of IFRS convergence on annual report readability and contributes to the growing IFRS literature in the less explored emerging market context.

An empiric validation of linguistic features in machine learning models for fake news detection

The diffusion of fake news is a growing problem with a high and negative social impact. There are several approaches to address the detection of fake news. This work focuses on a hybrid approach based on functional linguistic features and machine learning. There are several recent works with this approach. However, there are no clear guidelines on which linguistic features are most appropriate nor how to justify their use. Furthermore, many classification results are modest compared to recent advances in natural language processing. Our proposal considers 88 features organized in surface information, part of speech, discursive characteristics, and readability indices. On a 42 677 news database, we show that the classification results outperform previous work, even outperforming state-of-the-art techniques such as BERT, reaching 99.99% accuracy. A proper selection of linguistic features is crucial for interpretability as well as the performance of the models. In this sense, our proposal contributes to the intentional selection of linguistic features, overcoming current technical issues. We identified 32 features that show differences between the type of news. The results are highly competitive in the classification and simple to implement and interpret.

Readability Analysis of Turkish Patient Informing Texts about Teeth Whitening on the Internet: Cross-Sectional Study

Objective: Considering that the texts presented on the internet will be read by people of very different education levels, it is important to examine the readability of these texts. The aim of this study was to evaluate the readability analysis of Turkish patient information texts about teeth whitening on the internet. Method: A Google search using the term “Teeth Whitening” revealed the top 100 websites. Turkish patient information texts on the 86 websites included in this study were evaluated according to the Atesman Readability Index. The information texts originated from dentists, specialist dentists, private health institutions, university hospitals, and newspapers. The Kolmogorov–Smirnov test and descriptive statistics were used for statistical evaluation. Statistical significance level was accepted as P &lt; .05. Results: Atesman Readability Index score was 59.08 ± 8.14. According to the findings obtained in the research, 0% of the websites examined were rated as very easy, 7% as easy, 86% as moderately difficult, 5.8% as difficult, and 1.2% as very difficult. When the readability levels of the texts were examined according to grade levels, the following was found: 43% were grades 11th–12th , 43% grades 9th–10th, 7% grades 7th–8th, and 5.8% grade associate degree. Conclusion: The readability of Turkish texts on teeth whitening on the internet was found to be of medium difficulty. When creating texts for the internet about teeth whitening, it would be beneficial to make them easier to read by using readability programs before they are published. Keywords: Access to information, dentists, internet, teeth whitening

Psychometric Properties and Assessment of Knowledge, Attitude, and Practice Towards ChatGPT in Pharmacy Practice and Education: a Study Protocol.

ChatGPT represents an advanced conversational artificial intelligence (AI), providing a powerful tool for generating human-like responses that could change pharmacy prospects. This protocol aims to describe the development, validation, and utilization of a tool to assess the knowledge, attitude, and practice towards ChatGPT (KAP-C) in pharmacy practice and education. The development and validation process of the KAP-C tool will include a comprehensive literature search to identify relevant constructs, content validation by a panel of experts for items relevancy using content validity index (CVI) and face validation by sample participants for items clarity using face validity index (FVI), readability and difficulty index using theFlesch-Kincaid Readability Test, Gunning Fog Index, or Simple Measure of Gobbledygook (SMOG), assessment of reliability using internal consistency (Cronbach's alpha), and exploratory factor analysis (EFA) to determine the underlying factor structures (eigenvalues, scree plot analysis, factor loadings, and varimax). The second phase will utilizethe validated KAP-C tool to conduct KAPsurveysamong pharmacists and pharmacy students in selected low- and middle-income countries (LMICs) (Nigeria, Pakistan, and Yemen). The final data will be analyzed descriptively using frequencies, percentages, mean (standard deviation) or median (interquartile range), and inferential statistics like Chi-square or regressionanalyses using IBM SPSS version 28. Ap<0.05 will be considered statistically significant.ChatGPT holds the potential to revolutionize pharmacy practice and education. This study will highlight the psychometric properties of the KAP-C tool that assesses the knowledge, attitude, and practice towards ChatGPT in pharmacy practice and education. The findings will contribute to the potential ethical integration of ChatGPT into pharmacy practice and educationin LMICs, serveasa reference to other economies, and provide valuable evidence for leveraging AI advancements in pharmacy.

Readability of auditor reports: does audit market competition matter? Empirical evidence from Iran

PurposeWhile existing research explores the impact of audit market competition on audit fees and audit quality, there is limited investigation into how competition in the audit market influences auditors' writing style. This study examines the relationship between audit market competition and the readability of audit reports in Iran, where competition is particularly intense, especially among private audit firms.Design/methodology/approachThe sample comprises 1,050 firm-year observations in Iran from 2012 to 2018. Readability measures, including the Fog index, Flesch-Reading-Ease (FRE) and Simple Measure of Gobbledygook (SMOG), are employed to assess the readability of auditors' reports. The Herfindahl–Hirschman Index (HHI) is utilized to measure audit market competition, with lower index values indicating higher auditor competition. The concentration measure is multiplied by −1 to obtain the competition measure (AudComp). Alternative readability measures, such as the Flesch–Kincaid (FK) and Automated Readability Index (ARI) are used in additional robustness tests. Data on textual features of audit reports, auditor characteristics and other control variables are manually collected from annual reports of firms listed on the Tehran Stock Exchange (TSE).FindingsThe regression analysis results indicate a significant and positive association between audit market competition and audit report readability. Furthermore, a stronger positive and significant association is observed among private audit firms, where competition is more intense compared to state audit firms. These findings remain robust when using alternative readability measures and other sensitivity checks. Additional analysis reveals that the positive effect of competition on audit report readability is more pronounced in situations where the auditor remains unchanged and the audit market size is small.Originality/valueThis paper expands the existing literature by examining the impact of audit market competition on audit report readability. It focuses on a unique audit market (Iran), where competition among audit firms is more intense than in developed countries due to the liberalization of the Iranian audit market in 2001 and the establishment of numerous private audit firms.

Online bruxism-related information: can people understand what they read? A Cross- Sectional Study.

Bruxism patients often access the web to search for information. Unfortunately, the low text readability of online material and the limited medical literacy in the general population may prevent patients' understanding of health information. We aimed to assess the home page's readability of the top 10 patients-oriented bruxism-related websites and the educational level required to approach them. Using the word bruxism in the "no country redirect" extension of Google Chrome browser (www.google.com/ncr), we identified the first 10 patient-oriented English language websites. The readability of the material was determined using six commonly recommended readability tests (1): Gunning Fog Index (GFI), Coleman Liau Index (CLI), Automated Readability Index (ARI) Simple Measure of Gobbledygook (SMOG), Flesch Kincald Grade Level (FKGL), Flesh Reasing Ease (FRE). The USA National Institutes of Health requirements, which call for websites to be readable at a 6th to 7th-grade level, were not followed by any of the most popular websites. The average consumer frequently finds the health information on the Internet to be too complex to understand, which can lead to misinterpretation, a delay in diagnosis, and poorer health consequences.

Coh-Metrix 시스템을 활용한 고등학교 영어 모의고사 읽기 지문의 학년 간 연계성 분석

The main objective of this study was to analyze the continuity of reading passages in high school English mock College Scholastic Ability Test (CAST) exams using Coh-Metrix, a multi-level text analysis tool. To achieve this, the study constructed a corpus of reading passages from the 2022 high school English mock exams and subjected them to a broad range of Coh-Metrix measures. These measures included basic measures (the number of words, the number of sentences, average word length, average sentence length), word frequencies (word frequencies for content words), word features (imageability, concreteness, age of acquisition, familiarity), lexical diversity measures (type-token ratios for content words), personal pronouns (first person pronouns, second person pronouns, third person pronouns), connectives, readability indices (Flesch Reading Ease, Flesch-Kincaid Grade Level), syntactic complexity (noun density scores, the number of words before main verbs), coreference cohesion measures, and semantic cohesion measures. The main results revealed that the continuity of high school English mock tests was well established for average word and sentence length measures, the average number of words, word frequencies, word familiarity, second person pronouns, standard readability indices, and syntactic complexity measures. These findings have implications for the development of reading passages in high school English mock exams.

Clinical Patient Summaries Not Fit for Purpose: A Study in Urology

We evaluated the comprehensibility of patient summaries provided by urology journals for the general public. The WebFX online tool was used to assess the readability of abstracts and patient summaries by scoring the text according to established readability indices. A total of 266 articles were included and statistical analysis was performed to compare the readability of abstracts and patient summaries, stratified by article type and text type. The results show that patient summaries consistently performed worse than abstracts for all readability metrics, and the readability levels for both abstracts and patient summaries were more advanced than the recommended guidelines on average. This study suggests that patient summaries provided by these urology journals may not be easily understood by the general population, and tools should be developed to help urological researchers improve the accessibility of their work. Patient summaryWe checked how easy it is to read and understand patient summaries and abstracts of research articles from four urology journals. We found that the summaries and abstracts were too hard to read. This study shows that we need to make these summaries easier to read for everyone.

Comprehensiveness of online sources for patient education on hereditary hearing impairment.

The present study aimed at investigating the readability of online sources on hereditary hearing impairment (HHI). In August 2022, the search terms "hereditary hearing impairment", "genetic deafness", hereditary hearing loss", and "sensorineural hearing loss of genetic origin" were entered into the Google search engine and educational materials were determined. The first 50 websites were determined for each search. The double hits were removed and websites with only graphics or tables were excluded. Websites were categorized into either a professional society, a clinical practice or a general health information website. The readability tests to evaluate the websites included: Flesch Reading Ease, Flesch-Kincaid grade level, Gunning-Fog Index, Simple Measure of Gobbledygook, Coleman-Liau Index, Automated Readability Index. Twentynine websites were included and categorized as from 4 professional societies, 11 from clinical practices and 14 providing general information. All analyzed websites required higher reading levels than sixth grade. On average 12-16 years of education is required to read and understand the websites focused on HHI. Although general health information websites have better readability, the difference was not statistically significant. The readability scores of every type of online educational materials on HHI are above the recommended level indicating that not all patients and parents can comprehend the information they seek for on these websites.

Readability across Time and Languages: The Case of Matthew’s Gospel Translations

We have studied how the readability of a text can change in translation by considering Matthew’s Gospel, written in Greek, translated into Latin and 35 modern languages. We have found that the deep-language parameters CP (characters per word), PF (words per sentence), IP (words per interpunctions), MF (interpunctions per sentence) and a universal readability index GU of each translation are so diverse from language to language, and even within a given language for which there are many versions of Matthew—such as in English and Spanish—that the resulting texts mathematically seem to be diverse. The several tens of versions of Matthew’s Gospel studied appear to address very diverse audiences. If a reader could understand all of them well, he/she would have the impression of reading texts written by diverse authors, although all of them tell the same story.

Readability of patient education materials for bariatric surgery.

Bariatric surgery is a successful treatment for obesity, but barriers to surgery exist, including low health literacy. National organizations recommend patient education materials (PEM) not exceed a sixth-grade reading level. Difficult to comprehend PEM can exacerbate barriers to bariatric surgery, especially in the Deep South where high obesity and low literacy rates exist. This study aimed to assess and compare the readability of webpages and electronic medical record (EMR) bariatric surgery PEM from one institution. Readability of online bariatric surgery and standardized perioperative EMR PEM were analyzed and compared. Text readability was assessed by validated instruments: Flesch Reading Ease Formula (FRE), Flesch Kincaid Grade Level (FKGL), Gunning Fog (GF), Coleman-Liau Index (CL), Simple Measure of Gobbledygook (SMOG), Automated Readability Index (ARI), and Linsear Write Formula (LWF). Mean readability scores were calculated with standard deviations and compared using unpaired t-tests. 32 webpages and seven EMR education documents were analyzed. Webpages were overall "difficult to read" compared to "standard/average" readability EMR materials (mean FRE 50.5 ± 18.3 vs. 67.4 ± 4.2, p = 0.023). All webpages were at or above high school reading level: mean FKGL 11.8 ± 4.4, GF 14.0 ± 3.9, CL 9.5 ± 3.2, SMOG 11.0 ± 3.2, ARI 11.7 ± 5.1, and LWF 14.9 ± 6.6. Webpages with highest reading levels were nutrition information and lowest were patient testimonials. EMR materials were sixth to ninth grade reading level: FKGL 6.2 ± 0.8, GF 9.3 ± 1.4, CL 9.7 ± 0.9, SMOG 7.1 ± 0.8, ARI 6.1 ± 1.0, and LWF 5.9 ± 0.8. Surgeon curated bariatric surgery webpages have advanced reading levels above recommended thresholds compared to standardized PEM from an EMR. This readability gap may unintentionally contribute to barriers to surgery and affect postoperative outcomes. Streamlined efforts are needed to create materials that are easier to read and comply with recommendations.

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.

중학교 영어 고능력 학습자 맞춤 프로그램의 효과

Purpose: This study aimed to examine a program effectiveness, focusing on creativity and languagechanges after applying an English integrated curriculum model program developed for middle schoolEnglish learners with high ability. Methods: The customized program for middle school English learners with high ability was implementedfor 14 weeks with twenty students in the experimental class participating in the English Gifted andTalented Program. The same program was not applied to twenty participants in the control class,and the existing program was conducted as it had been previously. Before and after the program,a 30-minute narrative creative writing test was given to both sets of students to examine changesin creativity scores using a creative narrative rubric to measure creativity, and the writings producedby the students were then analyzed with the Coh-Metrix. Results: Among them, as a result of a paired-sample t-test using 28 before-and-after data from 14participants in the experimental group and 32 data from 16 participants in the comparison group, theoverall creativity score showed a statistically significant difference in the experimental group. Especially,image, voice, creativity, ideation, immersion and clarity were all significantly improved. In the controlgroup, only voice and ideation from the post-test were statistically significantly improved upon comparedto the ones from the pre-test. As a result of a paired-sample t-test on the measured values obtainedby analyzing the texts produced by the experimental group with the Coh-Metrix language tool, thenumber of words representing the amount of writing increased significantly, and the difficulty of thetexts shown in a reading readability index and syntactic complexity has increased. Although the typetoken ratio, which represents lexical diversity, decreased with a statistically significant difference, thefrequency of words that students felt familiar with was low, indicating that students' actual lexicaldiversity improved. Cohesion and narrativitiy did not change significantly in either group. Conclusion: The developed program not only aroused interest in understanding and using the superficialcharacteristics of language, but also interest in idea generation and creativity, inducing a high-level creativethinking process, and through this, it was concluded that the program was effective in improving creativityand English proficiency. These results have useful implications for the field of English education.

(175) Readability Assessment of Online Men's Health Education Materials from the Sexual Medicine Society of North America, Urology Care Foundation, and European Association of Urology

Abstract Introduction The use of online health information by patients has gained considerable attention during the last decade. With this attention has come exponential adoption towards online resources. Existing literature has shown that a significant majority of patient education materials (PEM) available online exceed the literacy and comprehension of the audience reading them. The National Institute of Health (NIH) and American Medical Association (AMA) advocate the dissemination of accessible and readable resources targeted towards a fifth to seventh grade reading level. As the rise of mens health and sexual health continues to grow, understanding what resources may currently exist and how they meet or fail to meet patients needs is of growing concern. Objective We aimed to evaluate the readability of online patient resources from the Sexual Medicine Society of North America (SMSNA), American Urological Association and European Urological Association websites. Methods Content published under the web-section “SMSNA: For Patients - conditions and topics” portal (n=16) were reviewed. Identical topics published online via Urology Care Foundation (ie AUA; n=8) and the European Association of Urology (ie EAU; n=8) were also reviewed. Readability and estimated educational level required for understanding was assessed using validated readability and English language assessment tools including the Flesh Reading Ease score, Flesch Kincade, Gunning Fog, Simple Measure of Gobbledygook (SMOG), Coleman-Liau and Automated Readability index. Results SMSNA online patient education materials (PEM), on average, are written at a college sophomore reading level (14th grade). This is 6.5 and 8 grade levels higher than the average U.S. adult and recommended reading levels for PEM, respectively. Comparable AUA and EAU resources were an average of 10th (p&amp;lt;0.05) and 12th (p=0.854) grade reading levels, respectively. Conclusions Men’s sexual health PEM’s published online are written at an advanced reading level, most notably the SMSNA compared to equivalent professional sources. This could pose a barrier to patient understanding and impact patients’ engagement and health decision-making. One proposed mitigatory strategy is for PEM to provide improved readability, and appropriate user-friendly language to facilitate easier and inclusive understanding, outreach and educational support. Disclosure No

(420) Assessing the Quality and Readability of Online Content on Shockwave Therapy for Erectile Dysfunction

Abstract Introduction In our current technology-driven society, patients and healthcare professionals alike are becoming increasingly reliant on online platforms for disseminating and obtaining health information. Previous research has shown that the quality of information available on the internet about novel medical therapies is generally poor and frequently misleading. Therefore, we hypothesized that online sources regarding novel erectile dysfunction treatment options, such as shockwave therapy, would be fraught with misleading claims and unreliable health information. Objective To evaluate the quality and readability of online health information on shockwave therapy as a treatment for erectile dysfunction. Methods Websites were generated using a Google search of “shockwave therapy for erectile dysfunction” with location filters disabled. Advertisements, scientific research articles, clinical trials, and websites that required subscriptions to access information were excluded from analysis. The websites included were from universities, private clinics, and news media outlets. Readability was analyzed using the Readable software (Readable.com, Horsham, UK). The content quality was graded using the DISCERN tool, a questionnaire that assesses the quality of written information on treatment choices for a health problem. Screening was done independently by 3 reviewers. Statistical analysis was conducted using the Student’s t-test. Results 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-Kincaid reading ease index was 46.4, which is difficult. No single article was at the 6th or 8th grade reading level, as recommended by the American Medical Association (AMA) and National Institutes of Health (NIH), respectively. There was no significant difference between the overall website ratings based on the DISCERN instrument (p= 0.565). The articles had a mean DISCERN score of 3.1, which refers to moderate quality (potentially important but not serious shortcomings). Four articles were from websites of private medical practices that each offered shockwave therapy for ED with a mean DISCERN score of 2.1. Five of the nine articles were from universities (n=2) or news sources (n=3) with a significantly higher mean DISCERN score of 4.0 (p&amp;lt;0.001). While the quality of content was significantly poorer, the mean automated readability grade level remained similar (p=0.607). A separate questionnaire was implemented to evaluate website content. Only two websites mentioned radial wave therapy, and both accurately dismissed its efficacy. Five websites mentioned that men with vasculogenic ED are the only candidates that should consider shockwave therapy. Two websites either mentioned the SMSNA statement or recommended that shockwave therapy "should only be used under strict research protocol." Five websites mentioned pricing (mean: $400 per session). Conclusions Overall, the quality of online information on shockwave therapy for ED is adequate. However, while articles from private clinics are just as readable as those from universities or news media, they are significantly more biased and misleading. The current online material may not support patients in making medical decisions and garnering knowledge, necessitating closer collaboration between the sources disseminating information and urologists. Disclosure Yes, this is sponsored by industry/sponsor: National Institutes of Health Grant R01 DK130991, American Cancer Society Clinician Scientist Development Grant. Clarification Industry funding only - investigator initiated and executed study.

(318) Evaluating the Readability of Online Testosterone Search Results

Abstract Introduction Patients and physicians are increasingly utilizing online platforms to disseminate health information. With the explosive interest and growth in testosterone therapy (TTh) amongst patients, providers and business interests, online health information plays a significant role in patients' healthcare decisions. Nearly all patients engage some form of online tool, search engine or resource when learning about a condition, treatment and alternatives that may exist. While the availability of information can be helpful, left unchecked it could preclude or even obstruct accurate and timely information dissemination to the very target audience. Objective Our study evaluated the source and readability of web-based information available to patients regarding TTh found through online search engine results. Methods The first 50 web results from Google search terms “Testosterone Therapy” (TTh) and “Testosterone Replacement” (TR) were analyzed. Sources were categorized as Academic, Commercial, Institutional, or Patient Support before being evaluated using validated readability and English language text assessment tools including the Flesch Reading Ease score, Flesch Kincade, Gunning Fog, Simple Measure of Gobbledygook (SMOG), Coleman-Liau Index and Automated Readability index. Results 77 unique sources were identified. The average grade level required for understanding academic sources was 16 (college senior); commercial, institutional, and patient support sources were 13 (college freshman); 8 and 5 grade levels, respectively above the average U.S. adult. Patient support sources were most prevalent, while commercial sources were the least at 35% and 14%, respectively. The average reading ease score was 36.8, indicative of difficult-to-read material overall. Academic sources utilized 296% and 228% more words compared to commercial and institutional/patient support sources, respectively. Conclusions The most immediate online sources for TTh information grossly exceeds the average reading level and understanding of most adults within the U.S. Within the growing realm of TTh, more attention should be taken to publish accurate, accessible, and readable material in order to improve patient health literacy and empower patients. Disclosure No