Recommended Reading Level Research Articles

Assessment of Canadian patient education material for oncology pharmaceutics.

Health literacy is an individual's ability to access, understand, and utilize information in order to create an informed decision regarding their health. Readability plays an integral role in health literacy as complex health information may be inaccessible to those with low health literacy. The aim of this study is to determine the readability of Canadian patient education material (PEM) for oncology related pharmaceutics. Eighty PEMs from Cancer Care Ontario (CCO) and BC Cancer (BCC) were evaluated for their reading level using a Ford, Caylor, Sticht (FORCAST) analysis. Twenty therapies were then randomly selected and converted to plain text to be analyzed further using the Flesch-Kincaid Grade Level (FKGL), the Simple Measure of Gobbledygook (SMOG) Index, the Coleman-Liau Index (CLI), and the Gunning Fog Index (GFI). Both PEMs from CCO and BCC were above the recommended reading level with PEMs from CCO, on average, requiring a higher reading level. Within the text, the section which describes side effects was found to be the most complex section of the representative PEMs from BCC. PEMs from BCC which described antibody-based therapies were, on average, more difficult to read than small molecule-based therapies regardless from which section the PEM was being analyzed. These observations were not seen in CCO PEMs. Overall, online PEMs from major Canadian cancers associations were written above the recommended reading level. Consideration should be given to revision of these materials, with emphasis on the therapies' side effects, to allow for greater comprehension amongst a wider target audience.

The readability of online Canadian radiotherapy patient educational materials

Introduction/backgroundIt is not clear if online radiotherapy patient educational materials that are published by the Canadian Cancer Society (CCS) and the various provincial health authorities meet the appropriate readability levels. The aim of this study is to determine the readability of online Canadian radiotherapy patient educational materials. MethodsThe publicly available educational materials were acquired from the provincial health authorities' and the CCS's websites. Only English language materials were included. Documents which mainly contained instructions or were part of interactive modules were excluded. The materials were transferred to Microsoft Word documents and labelled by source and category. Editing was then performed and the readability scores were acquired for each document. ResultsA total of 67 documents were included and 4 were excluded. The overall mean Flesch-Kincaid Grade Level from all sources was 7.5 (range, 3.6–13.2; 95% confidence interval [CI] 7.1–7.9), while the overall mean Flesch Reading Ease from all sources was 64.0 (range, 44.2–78.1; 95% confidence interval [CI] 62.0–66.1). The mean Flesch-Kincaid Grade Level scores from all sources were higher than the grade 6 recommended reading level for patient educational materials. This difference was found to be statistically significant (p ≤ 0.05) for Alberta, New Brunswick, Quebec, and Nova Scotia. Discussion/conclusionsOverall, the readability levels of online Canadian radiotherapy patient educational materials exceed the recommended grade 6 readability for patient educational resources. It is hoped that the findings of this study would inform and guide the future development and distribution of materials that meet the appropriate readability standards.

Assessment of online patient education materials designed for people with age-related macular degeneration

BackgroundAge-related macular degeneration (AMD) is a chronic eye condition that leads to permanent vision loss in the central visual field. AMD makes reading challenging and inefficient. People with AMD often find it difficult to access, process and understand written patient education materials (PEMs). To promote health literacy, the demands of written PEMs must match the literacy capacities of the target audience. This study aims to evaluate the readability (grade level) and suitability (appropriateness) of online PEMs designed for people with AMD.MethodsOnline PEMs were sourced from websites of national organizations providing patient education materials designed for people with AMD. The Flesch-Kincaid Grade Level formula and the Suitability Assessment of Materials instrument were used to assess the readability and suitability of PEMs. Descriptive statistics were used to compare online PEMs by organization based on national guidelines for readability level (≤ sixth grade) and the recommended suitability score (≥ 70%) for “superior” material.ResultsOne hundred online PEMs were evaluated from websites of 16 professional organizations. The mean readability level was 9.3 (range 5.0–16.6). The mean suitability score was 53% (range 18–78%). Only six (6%) of PEMs achieved the recommended guidelines for readability level and suitability score.ConclusionThe majority of online PEMs designed for people with AMD were written above the recommended readability level, and below the suggested suitability score. To promote health literacy, the demands of written health information must match the reading capacities of the target audience. Heeding to evidence-based guidelines for providing written information to patients with low health literacy and low vision is beneficial for both patients and health care providers. Future research is warranted.

Quality and Content of Online Patient Resources for Celiac Disease.

Patient-directed information on celiac disease has been reported to be of variable quality. We assessed the quantity and quality of information on blogs and Web sites intended to inform the layperson of celiac disease information. We performed a cross-sectional study analyzing celiac disease blogs and Web sites intended for the layperson. We searched from 20 cities, resulting in 55 Web sites. These sites were analyzed for 38 criteria that considered relevant clinical information for people with celiac disease. Claims were classified as true, false, or not proven. The readability level of each Web site was determined. The 55 Web sites were categorized as national organizations, personal blogs, recipe-based blogs, or commercial/marketing Web sites. Only 40% of Web sites contained more than 50% of criteria. Of 212 claims assessed, 97% were found to be accurate. National organizations included the most criteria, followed by recipe-based blogs, then personal blogs, and lastly commercial/marketing Web sites. Additionally, national organizations had the highest proportion of accurate claims, followed by personal blogs, then commercial/marketing Web sites, and recipe-based blogs with the most inaccurate information. The average readability level of overall was 9.7, above the recommended readability level for patient education materials. A significant number of online claims regarding celiac disease were true, but the majority of patient-facing Web sites are missing large amounts of relevant information. This warrants efforts to improve the quality of medical information published online.

Quality Assessment of Online Patient Information for Cosmetic Botulinum Toxin.

In an era of widespread Internet access, patients increasingly look online for health information. Given the frequency with which cosmetic botulinum toxin injection is performed, there is a need to provide patients with high-quality information about this procedure. The aim of this study was to examine the quality of printed online education materials (POEMs) about cosmetic botulinum toxin. An Internet search was performed to identify 32 websites of various authorship types. Materials were evaluated for accuracy and inclusion of key content points. Readability was measured by Flesch Reading Ease and Flesch-Kincaid Grade Level. Understandability and actionability were assessed with the Patient Education Materials Assessment Tool for Printed Materials. The effect of authorship was measured by undertaking analysis of variance between groups. The mean [standard deviation] accuracy score among all POEMs was 4.2 [0.7], which represents an accuracy of 76% to 99%. Mean comprehensiveness was 47.0% [16.4%]. Mean Flesch-Kincaid Grade Level and Flesch Reading Ease scores were 10.7 [2.1] and 47.9 [10.0], respectively. Mean understandability and actionability were 62.8% [18.8%] and 36.2% [26.5%], respectively. There were no significant differences between accuracy (P > 0.2), comprehensiveness (P > 0.5), readability (P > 0.1), understandability (P > 0.3), or actionability (P > 0.2) by authorship. There is wide variability in the quality of cosmetic botulinum toxin POEMs regardless of authorship type. The majority of materials are written above the recommended reading level and fail to include important content points. It is critical that providers take an active role in the evaluation and endorsement of online patient education materials.

Understood? Evaluating the readability and understandability of intranasal corticosteroid delivery instructions.

Allergic rhinitis is a widespread disease that has significant quality-of-life ramifications. Symptoms include rhinorrhea, nasal obstruction, cough, and postnasal drip. Intranasal corticosteroids are a hallmark of treatment of allergic rhinitis. However, the benefits of treatment are dependent on correct nasal spray technique, of which many patients are not aware. Patient instructions are included with the purchase of these medications. The readability and understandability for these educational materials has been minimally assessed in the medical literature. The aim of this study was to evaluate the readability and understandability of commonly used intranasal steroids. Three readability measures (Gunning Fog, Simple Measure of Gobbledygook [SMOG], and FORCAST) and an understandability assessment (Patient Education Materials Assessment Tool for Printable Materials [PEMAT-P]) were used to evaluate the instructions for use of commonly prescribed intranasal steroids. Instructions with 6th grade readability level or lower were considered to meet health literacy experts' recommendations. Higher understandability values correlate to easier understandability. Instructions for 10 intranasal corticosteroid brands were reviewed. Gunning Fog consistently estimated easiest readability, whereas FORCAST estimated most difficult readability. Twenty percent (20%) of analyzed instructions met National Institutes of Health and health literacy experts' recommended reading levels. Understandability of instructions ranged from 33% to 90%, with an average of 66%. The benefit of intranasal corticosteroids is contingent on correct use by patients. However, the prepackaged instructions provided are most often above recommended reading levels and are difficult to understand. Future development of intranasal steroid instructions should meet recommended readability levels and be understandable to maximize their utility.

Readability and lexical sophistication of colon cancer websites – a corpus-assisted assessment of online educational materials for patients

The aim of this paper is to check whether the information for colon cancer patients available on top websites devoted to this disease is comprehensible for the readers or whether, due to high saturation with special medical terms, it is beyond the recommended readability level of an average internet user. Two main criteria of analysis were involved in the study: readability and lexical sophistication. The methods used in the study include 8 readability tests (ARI, Colemen-Liau, New Dale-Chall, Flesch-Kincid, Fry, Gunning Fog, Raygor Estimate, and SMOG), TAALES software and Lexical Complexity Analyser used to examine syntactic and lexical parameters of texts, and a corpus-assisted web-based tool used for lexical sophistication called VocabProfile. The study has shown that none of the 30 websites under scrutiny meets the demand of the recommended readability level, and that higher lexical sophistication involves a lower readability level.

Readability and lexical sophistication of colon cancer websites – a corpus-assisted assessment of online educational materials for patients

The aim of this paper is to check whether the information for colon cancer patients available on top websites devoted to this disease is comprehensible for the readers or whether, due to high saturation with special medical terms, it is beyond the recommended readability level of an average internet user. Two main criteria of analysis were involved in the study: readability and lexical sophistication. The methods used in the study include 8 readability tests (ARI, Colemen-Liau, New Dale-Chall, Flesch-Kincid, Fry, Gunning Fog, Raygor Estimate, and SMOG), TAALES software and Lexical Complexity Analyser used to examine syntactic and lexical parameters of texts, and a corpus-assisted web-based tool used for lexical sophistication called VocabProfile. The study has shown that none of the 30 websites under scrutiny meets the demand of the recommended readability level, and that higher lexical sophistication involves a lower readability level

The Quality of Online Orthopaedic Oncology Information.

Background:“Cancer” is one of the top three health-related Internet searches, yet research shows over 30% of patients are confused after searching for medical information. The quality and accuracy of Internet oncology literature varies widely and can affect patient perceptions or seeking of care.Purpose:This study hypothesizes that online patient resources for orthopaedic oncology are often inconsistent, inaccurate, or incomprehensible by the standard patient and examines the readability, quality, and accuracy of common orthopaedic oncology websites.Methods:Three common search terms were searched in three popular search engines. The first 25 nonsponsored websites were identified for each term; randomized to search term; and evaluated via a 25-question quality score, DISCERN treatment-based score, predetermined accuracy score, and Flesch-Kincaid reading level.Results:Forty-eight websites were included. Website quality, DISCERN score, accuracy score, and reading level were not statistically different based on search term. Quality and DISCERN scores were markedly higher from websites without commercial gain. Websites were consistently written above the recommended reading level.Discussion:Online orthopaedic oncology literature is frequently confusing and complicated. The orthopaedic surgeon should be aware that patients frequently access this information and should ensure that patients receive accurate primary source material relevant to their care.

Readability of Patient-Reported Outcome Measures for Head and Neck Oncology.

Patient-reported outcome measures (PROMs) are communication tools to help patients convey their disease experience to medical providers and guide management decisions. However, the utility of healthcare outcome measures is dependent on patient literacy and readability of PROMs. If written for a more advanced literacy level, they can misestimate symptoms and add significant barriers to care, especially in the underserved. However, readability of head and neck (H&N) oncology PROMs has not been assessed. The aim of this study was to evaluate the readability of H&N oncology PROMs to assess whether they meet recommended readability levels. Bibliometric review. Three readability measures: Gunning Fog, Simple Measure of Gobbledygook, and FORCAST were used to evaluate the readability level of commonly used H&N PROMs. PROMs with sixth grade readability level or lower were considered to meet the recommendations of health literacy experts. Eight H&N oncology PROMs were reviewed. None of H&N PROMs met health literacy experts' and National Institutes of Health recommended reading levels. Gunning Fog consistently estimated easiest readability and FORCAST the most difficult. PROMs are important clinical tools that drive patient-centric care in H&N oncology. All H&N PROMs are written above recommended reading levels and do not meet suggested standards. Future PROMs should be written with easier readability to accurately convey patients' H&N oncology disease experiences. 4 Laryngoscope, 2020.

Quality of Patient Education Sections on Otitis Media Across Different Website Platforms.

To determine the quality, content, and readability of patient education materials pertaining to otitis media across several popular online platforms focused on otolaryngology and pediatric primary care education. Online patient materials related to otitis media and directed toward parents were collected from the American Association for Family Practice (AAFP), ENT-Health section of the American Academy of Otolaryngology-Head and Neck Surgery, Healthychildren.org from the American Academy of Pediatrics, KidsHealth from Nemours, WebMD, and Wikipedia. Materials were analyzed for quality, content, and readability. The DISCERN instrument was used to score quality. A unique content score was generated based on the information provided on each website and on the medical and surgical management of otitis media. Readability scores were calculated using the Flesch-Kincaid Grade Level, Flesch Reading Ease Score, Gunning-Fog Index, Simple Measure of Gobbledygook, Coleman-Liau Index, and Automated Readability Index. Overall, content was well-balanced. Information from AAFP and Healthychildren.org was focused more on medical management than other sources. The average DISCERN scores showed all sources to be of good quality with minimal shortcomings. The AAFP and KidsHealth websites had some readability scores around the 8th-grade reading level, the National Institute of Health's upper limit recommended for public health information; however, most websites were above this recommended reading level. Patient education materials related to otitis media on academic and certain popular internet sites are good sources to obtain high-quality information on the topic. Patient educational background, prior knowledge and understanding of otitis media, and physician-patient partnership goals should be taken into account when referring patients to online materials.

Readability of pelvic floor dysfunction questionnaires.

The National Institutes of Health and Center for Disease Control recommend the readability of self-administered patient questionnaires to be written at or below a sixth to eight grade reading level. The aim of this study is to evaluate the readability of commonly used urinary incontinence (UI), pelvic organ prolapse (POP), overactive bladder (OAB), and benign prostate hyperplasia (BPH) questionnaires. Eighteen validated urologic questionnaires were analyzed using four readability assessment tools. A mean grade-level needed to comprehend each questionnaire was calculated. For UI questionnaires, three out of five questionnaires required a reading level of 10th grade or higher, two grade levels above recommendations. Only one POP questionnaire met recommendations with a mean readability score of 5.9, whereas the other questionnaires required a ninth-grade reading level or higher. For the OAB questionnaires, three out of five questionnaires met reading recommendations. Readability scores for BPH questionnaires ranged from 6.4 to 11.2, with only the International Prostate Symptom Score questionnaire in compliance with recommendations. The majority of currently available pelvic floor dysfunction questionnaires do not comply with recommended reading levels, suggesting that these questionnaires are written at a level too advanced for a large proportion of the population. This limits their effectiveness in accurately assessing symptom severity and impact on quality of life.

An Appraisal of Printed Online Education Materials on Spasmodic Dysphonia

The use of the Internet for seeking health-related information has increased exponentially. We aimed to comprehensively appraise the readability, understandability, actionability, and quality of printed online education materials (POEMs) pertaining to Spasmodic Dysphonia (SD). Descriptive, correlational study. POEMs were identified using the Google search engine with the phrase "spasmodic dysphonia." The first 50 websites meeting criteria were included. Accreditation of POEMs was evaluated using Health on the Net Foundation Code of Conduct (HONcode) toolbar. Readability of the content was analyzed using the Flesch-Kincaid Grade Level (FKGL) and Flesch Reading Ease (FRE) tests. Understandability and actionability was evaluated using the Patient Education Material Assessment Tool for Printed Materials. Overall quality of POEMs was appraised using the DISCERN instrument. The overall mean [SD] FKGL and mean [SD] FRE score was 11.5 [2.5] and 42.1 [12.8], respectively. The mean understandability score was 65% [14], while the mean [SD] actionability score was only 17% [12]. The overall mean [SD] quality score for all websites was 43.5 [13]. Only four websites (8%) were HONcode certified. A moderately positive correlation was discovered between understandability and overall quality of POEMs (r=0.38, P 0.01) CONCLUSIONS: POEMs pertaining to SD are written above recommended reading levels with subsequent poor understandability and actionability. We recommend that authors assess POEMs prior to publication to ensure alignment with the needs of the target audience.

Readability of Online Neuro-Oncology–Related Patient Education Materials from Tertiary-Care Academic Centers

The Internet has become a popular resource for patients to research diagnosed or suspected medical diseases. Medical institutions provide comprehensive online education resources about various conditions to the general public. The U.S. National Institutes of Health and American Medical Association recommend that patient education materials aimed at the general population should be written at or below eighth-grade reading level. The goal of this study is to assess the readability of patient education materials for central nervous system tumors across tertiary-care institutions. Patient education materials were collected from National Cancer Institute designated cancer centers in October 2019. Materials were analyzed by Flesch-Kincaid Grade Level (FKGL) and Flesch Reading Ease (FRE) score using Microsoft Office Word software. Subgroups were formed based on regions in the United States (Northeast, Southeast, Midwest, Southwest, and West) as well as diagnostic and treatment information. A total of 180 documents were collected across 50 institutions. Overall median FKGL was 12.5, and median FRE was 38.2. Median FKGL for diagnostic information was 11.6 and FRE was 43.0, whereas median FKGL for treatment information was 12.9 and median FRE was 34.3. No statistically significant differences were seen for both FKGL and FRE among geographic regions (P > 0.05). Online neuro-oncology patient education materials from tertiary institutions are written above recommended reading levels. Future efforts should be taken to improve the readability of brain tumor-specific patient education materials, particularly with information relating to treatment.

Readability of patient-reported outcome measures for chronic rhinosinusitis and skull base diseases.

Outcome measures in healthcare that presume a higher level of patient health and overall literacy may inadequately estimate the disease experiences of less-educated patients and further disadvantage them. Patient-Reported Outcome Measures (PROMs) are widely used communication tools for clinical practice and are often used to evaluate and guide management for chronic rhinosinusitis (CRS) and skull base diseases. However, their readability and subsequent incomprehensibility for patients have not been assessed. The aim of this study is to evaluate the readability of commonly used PROMs for these conditions and whether they meet recommended readability levels. Three readability measures, Gunning Fog, Simple Measure of Gobbledygook (SMOG), and FORCAST were used in the evaluation of commonly used PROMs for CRS and skull base disease. PROMs with sixth-grade readability level or lower were considered to meet health literacy experts' recommendations. A total of 11 PROMs were reviewed (8 CRS, 3 skull base). Gunning Fog consistently estimated the easiest readability, whereas FORCAST the most difficult. One hundred percent of CRS and 67% of skull base PROMs were above National Institutes of Health and health literacy experts' recommended reading levels. PROMs developed more recently had easier readability. PROMs are important clinical tools in otolaryngology that help guide management of disease for improved patient-centered care. Like many other fields of medicine, those used in otolaryngology are beyond recommended reading levels. Development of PROMs in the future should meet recommended readability levels to fully assess the disease experience of our patients. 4 Laryngoscope, 130:2305-2310, 2020.

Readability of Information Material in Obstetrics

Up-to-date health care implies users' autonomous decision-making on diagnostic and therapeutic measures (informed consent). Patients depend on comprehensible information material to be able to understand an intervention and its consequences. Informed consent sheets on cesarean section, other obstetrical measures, and anesthesia methods were assessed for readability using tools including the G-SMOG, Flesch Index, Amstad Formula, and LIX. In addition, comparative material on the same topics, e. g., from the Internet, was assessed. The assessment tools developed for the German language proved to be useful for readability screening. Most texts were found to be difficult or very difficult to read. Especially the included informed consent sheets were assessed as clearly above the recommended readability level. Efforts need to be made to prepare readable and comprehensible information material, e. g., by using the "Hamburg Model of Comprehensibility."

Readability and quality of online eating disorder information-Are they sufficient? A systematic review evaluating websites on anorexia nervosa using DISCERN and Flesch Readability.

Evaluate the quality and readability of United Kingdom-based websites on anorexia nervosa. First-page search results of three search engines (with search term "anorexia nervosa") were consulted. Websites were excluded if they were pro-ana, duplications, advertisements, Wikipedia, nonwritten/video, invalid addresses, non-English, book links, articles/news pages, and discussion forums. Fifteen websites were evaluated on information quality using DISCERN, and on readability using the Flesch Reading Ease (FRE) Scale. Spearman's correlations between quality and readability were calculated. DISCERN-scores ranged from 34 to 71 (M = 49.27, SD = 9.16), representing "fair" information quality. FRE-scores ranged from 28 to 64 (M = 42.7, SD = 13.43), representing "difficult" readability. The Royal College of Psychiatrists website (https://www.rcpsych.ac.uk/) received the only "excellent" quality rating and was the only website that met the recommended reading level. The other websites' quality varied, and their reading levels ranged from fairly to very difficult. Website quality scores varied. Oftentimes, information about treatment risks and benefits was lacking, and texts were too complex. Website quality seals could prove beneficial, and web developers should use quality and readability measures to ensure information accessibility. Future research should utilize DISCERN and FRE to evaluate quality and readability of websites pertaining to other eating disorders too. Video abstract: https://www.youtube.com/watch?v=a9DKS7qISSA&feature=youtu.be.

130 Focusing With a New Lens: Analyzing the Quality of Internet Literature Related to the Gut Microbiome

INTRODUCTION: The study of intestinal microbiota and its potential impact on human disease is an emerging field of research. Investigations initially focused on gastrointestinal disorders, but have expanded to include issues related to metabolic, immune, and neurologic function. Since individuals increasingly use electronic resources for medical decisions, assessment of available information is important. This study evaluated the readability, quality and use of evidence-based support of readily accessible online information about intestinal microbiota. METHODS: The search terms “gut microbiome” were inputted into Google. Exclusion criteria included websites that were non-accessible, included videos without transcripts, provided veterinary information or were duplicates. Sites were categorized by intended audience, either patient or professional. Readability was determined using the validated Flesch-Kincaid Grade Level Calculation. Websites were reviewed for inclusion of references, provision of additional links for further reading, and the acknowledgement of areas of uncertainty. Statistical analysis using a two-tailed Fisher's Exact Test and a Two-Sample T-test were used with a P-value set at < 0.05. RESULTS: 100 websites were assessed with 87 meeting criteria for inclusion. 46 (52.9%) were intended for patients and 41 (47.1%) were for medical professionals. The average Flesch-Kincaid Grade level was 14.1, with significant difference (P < 0.0001) between patient (12.6 grade level) and professional (15.8 grade level) websites. 58.6% (25 patient; 26 professional) of websites provided additional links for further information. While 36.7% (12 patient, 20 professional) of all websites acknowledged areas of uncertainty, patient websites significantly more often (P = 0.04) acknowledged areas of uncertainty compared to professional. Patient sources were significantly (P < 0.0001) less likely to provide references (34.7%) as compared to non-patient sources (87.8%). CONCLUSION: Online resources on gut microbiome are readily accessible for patient and professional audiences. However, the readability of patient information exceeded the NIH 6th grade recommended reading level. Additionally resources infrequently provided references, links for additional information or acknowledged areas of uncertainty. As the gut microbiome becomes increasingly studied, it is critical that online information be readable and supported by evidence based research.

Social Media: Is the Message Reaching the Plastic Surgery Audience?

The aim of this study was to assess readability of articles shared on Twitter and analyze differences between them to determine whether messages and written posts are at reading levels comprehended by the general public. Top-rated #PlasticSurgery tweets (per Twitter algorithm) in January of 2017 were reviewed retrospectively. Text from tweeted links to full, open-access, and society/institutional patient information articles were extracted. Readability was analyzed using the following established tests: Coleman-Liau, Flesch-Kincaid, FORCAST Readability Formula, Fry Graph, Gunning Fog Index, New Dale-Chall Formula, New Fog Count, Raygor Readability Estimate, and Simple Measure of Gobbledygook Readability Formula. Ease-of-reading was analyzed using the Flesch Reading Ease Index. Of 234 unique articles, there were 101 full journal (43 percent), 65 open-access journal (28 percent), and 68 patient information (29 percent) articles. When compared using the Simple Measure of Gobbledygook Readability Formula, full and open-access journal articles attained similar mean reading levels of 17.7 and 17.5, respectively (p = 0.475). In contrast, patient information articles had a significantly lower mean readability level of 13.9 (p < 0.001). Plastic surgeons posted 128 articles (55 percent) and non-plastic surgeon individuals posted 106 articles (45 percent). Mean readability levels between the two were 16.2 and 16.9, respectively (p < 0.001). All tweeted articles were above the sixth-grade recommended reading level. Readability of #PlasticSurgery articles may not be appropriate for many American adults. Consideration should be given to improving readability of articles targeted toward the general public to optimize delivery of social media messages.

Assessment of the Quality, Content, and Readability of Freely Available Online Information for Patients Regarding Diabetic Retinopathy

Diabetic retinopathy is a global leading cause of blindness. Patients increasingly use the internet to search for health-related information that may affect medical decision-making, but to date, no standard exists across published websites. To assess the quality, content, and readability of information found online for diabetic retinopathy. This cross-sectional study analyzed 11 medical sites with information on diabetic retinopathy. Twenty-six questions were composed to include information most relevant to patients, and each website was independently evaluated by 1 vitreoretinal surgeon and 2 vitreoretinal fellows. Readability was analyzed using an online readability tool. The JAMA benchmarks were used to evaluate the quality of each site. Data were collected from December 2018 to January 2019 and analyzed in February 2019. A 26-question survey, JAMA benchmarks, Flesch reading ease score, Flesch-Kincaid grade level, Gunning Fog Index, Coleman Liau Index, and Simple Measure of Gobbledygook Index. The mean (SD) questionnaire score for all websites was 55.76 (13.38) (95% CI, 47.85-63.67) of 104 possible points. There was a difference between the content quality of the websites (H = 25.811, P = .004). The mean (SD) reading grade for all websites was 11.30 (1.79; 95% CI, 10.24-12.36). No correlation was found between content accuracy and the mean reading grade (r = 0.445, P = .17) or Google rank (r = -0.260, P = .43). No website achieved the full 4 JAMA benchmarks, and only 1 website achieved 3 of the 4 JAMA benchmarks. No correlation was found between the accuracy of the content of the website and JAMA benchmarks (r = 0.422, P = .20). The interobserver reproducibility was similar among the 3 observers (r = 0.87 between observers 1 and 2, r = 0.83 between observers 1 and 3, and r = 0.84 between observers 2 and 3, P < .001). These findings suggest that freely available information online about diabetic retinopathy varies by source but is generally of low quality. The material presented seems difficult to interpret and exceeds the recommended reading level for health information. Most websites reviewed did not provide sufficient information using the grading scheme used to support the patient in making medical decisions.