Grade Reading Research Articles

Readability of Online Spanish Materials for Breast Reconstruction Using Deep Inferior Epigastric Perforator Flaps.

Background The internet has become an increasingly popular tool for patients to find information pertaining to medical procedures. Although the information is easily accessible, data shows that many online educational materials pertaining to surgical subspecialties are far above the average reading level in the United States. The aim of this study was to evaluate the English and Spanish online materials for the deep inferior epigastric perforator (DIEP) flap reconstruction procedure. Methods The first eight institutional or organizational websites that provided information on the DIEP procedure in English and Spanish were included. Each website was evaluated using the Patient Education and Materials Assessment Tool (PEMAT), Cultural Sensitivity Assessment Tool (CSAT), and either Simplified Measure of Gobbledygook (SMOG) for English websites or Spanish Orthographic Length (SOL) for Spanish websites. Results The English websites had a statistically lower CSAT score compared to the Spanish websites (p=0.006). However, Spanish websites had a statistically higher percentage of complex words compared to English sources (p<0.001). An analysis of reading grade levels through SMOG and SOL scores revealed that Spanish websites had statistically lower scores (p<0.001). There were no statistically significant differences in the understandability or actionability scores between the English and Spanish websites. Conclusions Online educational materials on the DIEP flap reconstruction procedure should be readable, understandable, actionable, and culturally sensitive. Our analysis revealed that improvements can be made in understandability and actionability on these websites.Plastic surgeons should be aware of what constitutes a great online educational resource and what online educational materials their patients will have access to.

Implementation of the School Literacy Movement as an Effort to Grow Interest in Reading in Grade 2 Students of SD Negeri 2 Tegal Maja for the 2023/2024 Academic Year

This research aims to describe the implementation of the school literacy movement as an effort to foster interest in reading in grade 2 students at SD Negeri 2 Tegal Maja. This research was conducted at SD Negeri 2 Tegal Maja, Tegal Hamlet, Tanjung Village, Tanjung Klu District. This research is descriptive qualitative research. Data collection techniques were carried out using interviews, observation and documentation. The results of the research show that the implementation of the School Literacy Movement (GLS) carried out by SDN 2 Tegal Maja has been running since 2019, where this program is running very well because all school members support and participate with each other in the program in order to create a literate school community throughout life. The GLS applied really helps students to understand, read, write and listen in teaching and learning activities. GLS at SDN 2 Tegal Maja is implemented through several activities, including: providing libraries, creating reading corners, educational classroom walls and reading subject books before teaching and learning activities begin. The supporting factor in implementing GLS at SDN 2 Tegal Maja is that when the highest leadership of the institution is committed to carrying out a task, it will be carried out well. The enthusiasm of teachers, students and managers of School Literacy Movement activities, the availability of reading corner facilities. The obstacle is the limited number of suitable books/reading materials.

Examining the Academic Achievement of Latinx Students from an Early Lifespan and Intersectional Perspective

ABSTRACT The present study examined Latinx school readiness and 3rd grade student achievement, considering differences based on social categories of gender, race, ethnicity, and home language. The sample included 683 racially diverse children (Mage = 4.94; SD = .57) of Dominican- or Mexican-origin from Spanish-English or Spanish-only proficient homes. Baseline data included a test of school readiness and mother and teacher ratings of behavior. Follow-up data included the 3rd grade New York State test. Results show that 74% of Latinx children were not proficient in 3rd grade reading, with boys and children from Spanish-only homes less likely to be at grade level. School readiness predicted achievement for all groups. On the whole, Latinx students, and especially boys and non-English speakers, appear to be marginalized in U.S. public education systems.

Post-Pandemic Assessment of Fundamental Reading, Writing and Arithmetic Skills of Grade 5 Learners

This study investigated the proficiency in fundamental reading, writing and arithmetic skills of grade 5 learners in Davao Region, Philippines during a post-pandemic assessment conducted in April 2024. A quantitative descriptive design was used, utilizing data from 195 grade 5 learners randomly selected by DepEd – Bureau of Education Assessment (DepEd - BEA) from six school divisions. Validated test questions aligned with the K to 12 curriculum and Southeast Asia-Primary Learning Metrics (SEA-PLM) Band of specification were utilized for reading, writing, and arithmetic assessments. Point-by-serial analysis confirmed acceptable internal consistency for reading (0.32) and arithmetic (0.30) skills tests. Results revealed low proficiency in both reading (mean score = 18.13%, overall proficiency = 37.15%) and arithmetic (mean score = 5.45%, overall proficiency = 34.50%). Writing analysis showed 65% of students scoring in Band 2, which revealed limited writing skills with fragmented ideas and vocabulary. Run-on sentences and dangling modifiers suggest a lack of focus on coherence and correctness. While the pandemic introduced unprecedented challenges, the study revealed that it does not solely account for the decrease in the academic performance of grade 5 learners. These findings highlighted the need to strengthen intervention programs in reading, writing, and arithmetic across all key stages of the K to 12 curriculums. Implementing a wider variety of assessment formats beyond multiple-choice questions may also be beneficial. This study contributes to the growing body of research on the pandemic's effect on educational attainment and underscores the importance of evidence-based interventions to support student recovery.

The effect of modality on reading comprehension of struggling and typical readers in the second and third grades

AbstractBackground“Screen inferiority” refers to a well‐established phenomenon observed among adults and teenagers, wherein they demonstrate higher reading comprehension when reading from paper compared to screens. However, there is limited research focusing on readers in the initial stages of reading development. The current study aims to investigate reading comprehension in both screen and paper settings, as well as modality preferences, among young typical and struggling readers in the second and third grades.MethodsThe study included 342 second graders and 284 third‐grade Hebrew readers. Their reading comprehension performance in both modalities and their preferences for a particular modality were assessed.ResultsThe results suggested no differences in reading comprehension between the two modalities in the second and third grades. The only group that showed numerically higher performance on paper over computer was struggling readers in the second grade. The numeric proportion of modality preferences was higher on the computer rather than on paper.ConclusionsThe current study did not find an effect of modality on reading comprehension in the second and third grades. We did find that children in these grades prefer to read on screens. It is essential to examine the specific characteristics of the digital task to determine when it benefits young readers and when it may be detrimental to them.

Exploring the relationship between extensive graded book reading and writing performance among third-grade students: a correlation analysis

This study examines the impact of long-term extensive book reading activities on students’ writing skills in a distinct context lacking prior research. Employing technology to monitor students’ reading, the research focuses on first language long-term reading activities, a domain unexplored in Taiwan’s education system. Tracking book reading over three years, the study unveils the gradual fulfillment of reading goals and explores the connection between extensive book reading and writing performance. The investigation also found that graded reading and Bridge Books’ roles in enhancing students’ reading and writing outcomes. Employing rigorous data analysis, the study offers a comprehensive understanding of the intricate relationship between extensive book reading and writing performances. Findings reveal Picture Books and Basic Books as popular reading categories, influencing writing quality and word count during the revision process. However, there are potential trade-offs between quantity and quality of the writing performances, specifically observed in Bridge Books’ impact on initial draft and revision quality. The complex interplay between different grades of the book and writing performance emerges, suggesting implications for educational interventions and further research in enhancing writing performances through extensive reading.

Quality of Popular Online Resources About Vestibular Migraine.

To evaluate the readability, understandability, actionability, and accuracy of online resources covering vestibular migraine (VM). Cross-sectional descriptive study design. Digital collection of websites appearing on Google search. Google searches were conducted to identify common online resources for VM. We examined readability using the Flesch Reading Ease(FRE) and Flesch-Kincaid Grade Level scores, understandability and actionability using the Patient Education Materials Assessment Tool (PEMAT), and accuracy by comparing the website contents to the consensus definition of "probable vestibular migraine." Eleven of the most popular websites were analyzed. Flesch-Kincaid Grade Level averaged at a 13th-gradelevel (range: 9th-18th). FRE scores averaged 35.5 (range: 9.1-54.4). No website had a readability grade level at the USAgency for Healthcare Research and Quality recommended 5th-grade level or an equivalent FRE score of 90 or greater. Understandability scores varied ranging from 49% to 88% (mean 70%). Actionability scores varied more, ranging from 12% to 87% (mean 44%). There was substantial inter-rater agreement for both PEMAT understandability scoring (mean κ = 0.76, SD = 0.08) and actionability scoring (mean κ = 0.65, SD = 0.08). Three sites included all 3 "probable vestibular migraine" diagnostic criteria as worded in the consensus statement. The quality of online resources for VM is poor overall in terms of readability, actionability, and agreement with diagnostic criteria.

Assessing the Readability of Patient Education Materials on Cardiac Catheterization From Artificial Intelligence Chatbots: An Observational Cross-Sectional Study.

Artificial intelligence (AI) is a burgeoning new field that has increased in popularity over the past couple of years, coinciding with the public release of large language model (LLM)-driven chatbots. These chatbots, such as ChatGPT, can be engaged directly in conversation, allowing users to ask them questions or issue other commands. Since LLMs are trained on large amounts of text data, they can also answer questions reliably and factually, an ability that has allowed them to serve as a source for medical inquiries. This study seeks to assess the readability of patient education materials on cardiac catheterization across four of the most common chatbots: ChatGPT, Microsoft Copilot, Google Gemini, and Meta AI. A set of 10 questions regarding cardiac catheterization was developed using website-based patient education materials on the topic. We then asked these questions in consecutive order tofour of the most common chatbots: ChatGPT, Microsoft Copilot, Google Gemini, and Meta AI. The Flesch Reading Ease Score (FRES) was used to assess the readability score. Readability grade levels were assessed using six tools: Flesch-Kincaid Grade Level (FKGL), Gunning Fog Index (GFI), Coleman-Liau Index (CLI), Simple Measure of Gobbledygook (SMOG) Index, Automated Readability Index (ARI), and FORCAST Grade Level. The mean FRES across all four chatbots was 40.2, while overall mean grade levels for the four chatbots were 11.2, 13.7, 13.7, 13.3, 11.2, and 11.6 across the FKGL, GFI, CLI, SMOG, ARI, and FORCAST indices, respectively. Mean reading grade levels across the six tools were 14.8 for ChatGPT, 12.3 for Microsoft Copilot, 13.1 for Google Gemini, and 9.6 for Meta AI. Further, FRES values for the four chatbots were 31, 35.8, 36.4, and 57.7, respectively. This study shows that AI chatbots are capable of providing answers to medical questions regarding cardiac catheterization. However, the responses across the four chatbots had overall mean reading grade levels at the 11th-13th-grade level, depending on the tool used. This means that the materials were at the high school and even college reading level, which far exceeds the recommended sixth-grade level for patient education materials. Further, there is significant variability in the readability levels provided by different chatbots as, across all six grade-level assessments, Meta AI had the lowest scores andChatGPT generally had the highest.

Optimizing Readability of Patient-Facing Hand Surgery Education Materials Using Chat Generative Pretrained Transformer 3.5

To address patient health literacy, the American Medical Association and the National Institutes of Health recommend that readability of patient education materials should not exceed an eighth grade reading level. However, patient-facing materials often remain above the recommended average reading level. Current online calculators provide readability scores; however, they lack the ability to provide text-specific feedback, which may streamline the process of simplifying patient materials. The purpose of this study was to evaluate Chat Generative Pretrained Transformer (ChatGPT) 3.5 as a tool for optimizing patient-facing hand surgery education materials through reading level analysis and simplification. The readability of 18 patient-facing hand surgery education materials was compared by a traditional online calculator for reading level and ChatGPT 3.5. The original excerpts were then entered into ChatGPT 3.5 and simplified by the artificial intelligence tool. The simplified excerpts were scored by the same calculators. The readability scores for the original excerpts from the online calculator and ChatGPT 3.5 were similar. The simplified excerpts' scores were lower than the originals, with a mean of 7.28, less than the maximum recommended8. The use of ChatGPT 3.5 for the purpose of simplification and readability analysis of patient-facing hand surgery materials is efficient and may help facilitate the conveyance of important health information. ChatGPT 3.5 rendered readability scores comparable with traditional readability calculators, in addition to excerpt-specific feedback. It was also able to simplify materials to the recommended grade levels. By confirming ChatGPT3.5's ability to assess and simplify patient education materials, this study offers a practical solution for potentially improving patient comprehension, engagement, and health outcomes in clinical settings.

Readability and Information Quality in Cancer Information From a Free vs Paid Chatbot

The mainstream use of chatbots requires a thorough investigation of their readability and quality of information. To identify readability and quality differences in information between a free and paywalled chatbot cancer-related responses, and to explore if more precise prompting can mitigate any observed differences. This cross-sectional study compared readability and information quality of a chatbot's free vs paywalled responses with Google Trends' top 5 search queries associated with breast, lung, prostate, colorectal, and skin cancers from January 1, 2021, to January 1, 2023. Data were extracted from the search tracker, and responses were produced by free and paywalled ChatGPT. Data were analyzed from December 20, 2023, to January 15, 2024. Free vs paywalled chatbot outputs with and without prompt: "Explain the following at a sixth grade reading level: [nonprompted input]." The primary outcome measured the readability of a chatbot's responses using Flesch Reading Ease scores (0 [graduate reading level] to 100 [easy fifth grade reading level]). Secondary outcomes included assessing consumer health information quality with the validated DISCERN instrument (overall score from 1 [low quality] to 5 [high quality]) for each response. Scores were compared between the 2 chatbot models with and without prompting. This study evaluated 100 chatbot responses. Nonprompted free chatbot responses had lower readability (median [IQR] Flesh Reading ease scores, 52.60 [44.54-61.46]) than nonprompted paywalled chatbot responses (62.48 [54.83-68.40]) (P < .05). However, prompting the free chatbot to reword responses at a sixth grade reading level was associated with increased reading ease scores than the paywalled chatbot nonprompted responses (median [IQR], 71.55 [68.20-78.99]) (P < .001). Prompting was associated with increases in reading ease in both free (median [IQR], 71.55 [68.20-78.99]; P < .001)and paywalled versions (median [IQR], 75.64 [70.53-81.12]; P < .001). There was no significant difference in overall DISCERN scores between the chatbot models, with and without prompting. In this cross-sectional study, paying for the chatbot was found to provide easier-to-read responses, but prompting the free version of the chatbot was associated with increased response readability without changing information quality. Educating the public on how to prompt chatbots may help promote equitable access to health information.

Accuracy, readability, and quality of websites about metastatic renal cell carcinoma treatment

ObjectivesPatients with metastatic renal cell carcinoma (mRCC) face complex treatment decisions and frequently turn to the Internet for treatment information. The content of patient educational websites about mRCC treatment has not been evaluated. This study evaluated the accuracy, readability, and quality of websites about the treatment of mRCC. MethodsA total of 2,700 Internet queries were performed. Across 3 Internet search engines, 25 links of 36 permutations of mRCC keywords and their synonyms were screened for eligibility. Eligible websites were English-language websites containing information about mRCC treatments. Sponsored, social media, provider-facing, and news websites were excluded. Accuracy of eligible websites was evaluated in 2 domains: (1) Completeness by calculating the percentage of mRCC facts included in websites using an investigator-created checklist based on the NCI's RCC Treatment (PDQ®)–patient version, and (2) Correctness by identifying incorrect statements that were inconsistent with guidelines. Websites containing ≥60% of checklist items had a “passing” completeness score. Incorrect statements were tallied and qualitatively categorized. Readability was evaluated using the Fry and SMOG formulae, which calculate reading grade levels. Quality was evaluated using validated instruments that appraise health information quality: QUEST (scored 0–28), which focuses on online information, and DISCERN (scored 16–80), which focuses on treatment choices. ResultsThirty-nine websites were analyzed. Mean completeness score was 30% (range 0%–69%); only 2 (5%) websites had a passing score. Twelve (31%) websites had ≥1 incorrect statement, such as listing homeopathy or hormone therapy as mRCC treatment options, or including outdated statements. Mean readability levels were 11th and 12th grades for the Fry and SMOG methods, respectively. No website had a reading level lower than 9th grade. Mean QUEST score was 19 (range 9–28); authorship, complementarity, and currency items had the lowest scores. Mean DISCERN score was 56 (range 42–76), with 7 (18%) websites rated “excellent”, 22 (56%) rated “good”, and 10 (26%) rated fair. ConclusionsMany websites about mRCC treatment have incomplete, inaccurate, and unreadable information. Quality is highly variable. Efforts to improve accuracy, readability, and quality are needed to ensure that patients with mRCC can make well-informed treatment decisions and avoid harm from misinformation.

The Effect of PA Intervention through Remote Collaboration for CCK

Objectives: This study aimed to examine the effects of a phonological awareness and phonics intervention through remote collaboration between SLPs and teachers on the decoding skills of children from multicultural families with poor reading in the lower grades of elementary school. Methods: In this study, a multi-probe design was used to verify the effect of the intervention. The subjects were 3 multicultural children with poor reading skills (grades 1-2) and 3 teachers for each child. Their reading skills were examined through tests of phonological awareness and decoding (word level) in the baseline, intervention, and maintenance phases. Additionally, tests of decoding (sentence level) were conducted in the generalization phase to examine generalization at the sentence level. In this study, SLPs provided instruction to each child twice a week and also provided guide videos to each teacher once a week for 2 months. Results: All children were found to have high improvements in decoding skills (word level) and phonological awareness skills. Additionally, as a result of standardized reading and writing test (QRW), all children’s post-intervention raw scores were improved in all areas. In the generalization phase, all children showed improvements in decoding skills (sentence level). In the maintenance phase, all children were found to have a large effect size. Conclusion: The results show that phonological awareness and phonics intervention through remote collaboration between two experts had positive effects on the decoding skills of multicultural children with poor reading. Also, this intervention improved teachers’ teaching efficacy. Thus, the implementation of studies for collaboration between experts is suggested.

Quality and readability of online information and materials on post-surgery breast seroma.

Aims/Background Seroma formation is the most common complication following breast surgery. However, there is little evidence on the readability of online patient education materials on this issue. This study aimed to assess the accessibility and readability of the relevant online information. Methods This systematic review of the literature identified 37 relevant websites for further analysis. The readability of each online article was assessed through using a range of readability formulae. Results The average Flesch-Reading Ease score for all patient education materials was 53.9 (± 21.9) and the average Flesch-Kincaid reading grade level was 7.32 (± 3.1), suggesting they were 'fairly difficult' to read and is higher than the recommended reading level. Conclusion Online patient education materials regarding post-surgery breast seroma are at a higher-than-recommended reading grade level for the public. Improvement would allow all patients, regardless of literacy level, to access such resources to aid decision-making around undergoing breast surgery.

Explicit instructional moves in teaching reading in grade one: Observations from four Amharic classrooms

Explicit instructional moves in teaching reading in grade one: Observations from four Amharic classrooms

Enhancing early grade reading development: A call for education reform and innovation

Enhancing early grade reading development: A call for education reform and innovation

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%.

A Content and Readability Analysis of Genitourinary and Sexual Health-Related Patient-Reported Outcome Measures in Gender-Affirming Care

ObjectivesTo the evaluate the readability and comprehensiveness of genitourinary and sexual health-related patient-reported outcomes (PROMs) used in gender-affirming care. MethodsCommon PROMs that measure genitourinary and sexual health-related outcomes in gender-affirming care literature were identified from six recent systematic reviews. Readability analysis was completed at the level of individual items and full scale using established readability assessment tool, including Flesch Kincaid Grade Level (FKGL), Gunning Fog Score (GF), Coleman Liau Index (CLI), and Simple Measure of Gobbledygook (SMOG) Index. The concepts measured by the PROMs were evaluated for comprehensiveness. Results25 PROMs were included, of which 12 assessed genitourinary outcomes and 13 assessed sexual health outcomes. A total of seven genitourinary domains and eight sexual health domains were identified during concept mapping. Readability analysis showed a median PROM grade level of 9.0 and 9.5 in genitourinary and sexual PROMs, respectively. The Patient-Reported Outcomes Measurement Information System Sexual Function and Satisfaction v2.0 had the lowest median reading grade level of 5.7, and the Female Sexual Function Index has the highest median reading grade level of 13.9. No single PROM was found to be comprehensive. Multiple PROMs contained double-barreled items or used outdated terminology. ConclusionsMost PROMs used in the genital gender-affirming literature failed to meet the readability recommendations for patient-facing material and were culturally unfit for use in transgender and gender-diverse individuals. None of the PROMs were found to be comprehensive for evaluating outcomes of gender-affirming care. Validated gender-affirming care-specific PROMs that are comprehensible, comprehensive, and relevant are urgently needed.

Spelling development of children with and without reading difficulties throughout elementary grades: evidence from the Greek orthography.

The purpose of this longitudinal study was to examine the development of spelling in a large sample (N = 503, boys: N = 219) of Greek-speaking children with (N = 41) and without (N = 462) reading difficulties. Children were initially tested in Grades 2-4 and then at five consecutive measurement points over a 3-year period, focusing on how initial reading ability, grade, and gender may moderate the rate of spelling growth. Individual growth curve modeling revealed continuous growth of spelling performance in the total sample, although the growth rate decreased over time for children first tested in Grades 3-4. Spelling growth rate was also significantly slower among children with reading difficulties between Grades 2-4 and 3-5. The two reading groups displayed similar growth rates between Grades 4 and 6. Spelling growth rates did not vary significantly with gender. Overall, our study highlights the persistence of spelling difficulties even after 6years of systematic teaching in children with reading difficulties. The severe and persistent spelling deficits of Greek-speaking children with reading difficulties may be attributed to the rich morphological system of the Greek language, the intermediate Greek orthographic transparency (in the direction of writing), and their limited experience with print.

Assessing parental comprehension of online resources on childhood pain.

We aimed to examine the patient education materials (PEMs) on the internet about "Child Pain" in terms of readability, reliability, quality and content. For our observational study, a search was made on February 28, 2024, using the keywords "Child Pain," "Pediatric Pain," and "Children Pain" in the Google search engine. The readability of PEMs was assessed using computer-based readability formulas (Flesch Reading Ease Score [FRES], Flesch-Kincaid Grade Level [FKGL], Automated readability index (ARI), Gunning Fog [GFOG], Coleman-Liau score [CL], Linsear Write [LW], Simple Measure of Gobbledygook [SMOG]). The reliability and quality of websites were determined using the Journal of American Medical Association (JAMA) score, Global Quality Score (GQS), and DISCERN score. 96 PEM websites included in our study. We determined that the FRES was 64 (32-84), the FKGL was 8.24 (4.01-15.19), ARI was 8.95 (4.67-17.38), GFOG was 11 (7.1-19.2), CL was 10.1 (6.95-15.64), LW was 8.08 (3.94-19.0) and SMOG was 8.1 (4.98-13.93). The scores of readability formulas showed that, the readability level of PEMs was statistically higher than sixth-grade level with all formulas (P = .011 for FRES, P < .001 for GFOG, P < .001 for ARI, P < .001 for FKGL, P < .001 for CL and P < .001 for SMOG), except LW formula (P = .112). The websites had moderate-to-low reliability and quality. Health-related websites had the highest quality with JAMA score. We found a weak negative correlation between Blexb score and JAMA score (P = .013). Compared to the sixth-grade level recommended by the American Medical Association and the National Institutes of Health, the readability grade level of child pain-related internet-based PEMs is quite high. On the other hand, the reliability and quality of PEMs were determined as moderate-to-low. The low readability and quality of PEMs could cause an anxious parent and unnecessary hospital admissions. PEMs on issues threatening public health should be prepared with attention to the recommendations on readability.

Hakikat Membaca di Kelas Tinggi di Tingkat SD/MI

In the world of education, reading skills are very fundamental. Apart from all learning processes that are based on reading and writing activities, reading proficiency is a stepping stone for every person's success, both in the school context and in life in society. This research aims to find out more about the nature of reading in higher grades at the SD/MI level. The method used in this research is a qualitative method based on literature analysis studies. Reading is the ability to use thoughts and actions to carry out visual activities by pronouncing a series of letters into words and sentences, mastering reading techniques and understanding the content of the reading correctly. The aim of reading in higher grades is to develop critical and creative reading skills. Students are not only required to capture information, but also analyze, assess and use information. Based on the research results, it can be concluded that understanding the nature of reading in higher grades has a great influence on students' understanding of advanced reading.