Simple Measure Of Gobbledygook Index Research Articles

Readability and Quality of Online Patient Education Materials Concerning Posterior Cruciate Ligament Reconstruction.

Objective This study aimed to assess the quality of online patient educational materials regarding posterior cruciate ligament (PCL) reconstruction. Methods We performed a search of the top-50 results on Google® (terms: "posterior cruciate ligament reconstruction,""PCL reconstruction,""posterior cruciate ligament surgery," and "PCL surgery") and subsequently filtered to rule out duplicated/inaccessible websites or those containing only videos (67 websites included). Readability was assessed using six formulas: Flesch-Kincaid Reading Ease (FRE), Flesch-Kincaid Grade Level (FKG), Gunning Fog Score (GF), Simple Measure of Gobbledygook (SMOG) Index, Coleman-Liau Index (CLI), Automated Readability Index (ARI); quality was assessed using the JAMA benchmark criteria and recording the presence of the HONcode seal. Results The mean FRE was 49.3 (SD 11.2) and the mean FKG level was 8.09. These results were confirmed by the other readability formulae (average: GF 8.9; SMOG Index 7.3; CLI 14.7; ARI 6.5). A HONcode seal was available for 7.4 % of websites. The average JAMA score was 1.3. Conclusion The reading level of online patient materials concerning PCL reconstruction is too high for the average reader, requiring high comprehension skills. Practice implications Online medical information has been shown to influence patient healthcare decision processes. Patient-oriented educational materials should be clear and easy to understand.

Evaluating the Readability of Online Blood Cancer Education Materials Across Different Readability Measures.

Introduction The National Institutes of Health and the American Medical Association recommend patient education materials (EMs) be at or below the sixth-grade reading level. The American Cancer Society, Leukemia & Lymphoma Society, and National Comprehensive Cancer Network have accurate blood cancer EMs. Methods One hundred one (101) blood cancer EMs from the above organizations were assessed using the following: Flesch Reading Ease Formula (FREF), Flesch-Kincaid Grade Level (FKGL), Gunning Fog Index (GFI), Simple Measure of Gobbledygook Index (SMOG), and the Coleman-Liau Index (CLI). Results Only 3.96% of patient EMs scored at or below the seventh-grade reading level in all modalities. Healthcare professional education materials (HPEMs) averaged around the college to graduate level. For leukemia and lymphoma patient EMs, there were significant differences for FKGL vs. SMOG, FKGL vs. GFI, FKGL vs. CLI, SMOG vs. CLI, and GFI vs. CLI. For HPEMs, there were significant differences for FKGL vs. GFI and GFI vs. CLI. Conclusion The majority of patient EMs were above the seventh-grade reading level. A lack of easily readable patient EMs could lead to a poor understanding of disease and, thus, adverse health outcomes.Overall, patient EMs should not replace physician counseling. Physicians must close the gaps in patients' understanding throughout their cancer treatment.

Both Patients and Plastic Surgeons Prefer Artificial Intelligence-Generated Microsurgical Information.

With the growing relevance of artificial intelligence (AI)-based patient-facing information, microsurgical-specific online information provided by professional organizations was compared with that of ChatGPT (Chat Generative Pre-Trained Transformer) and assessed for accuracy, comprehensiveness, clarity, and readability. Six plastic and reconstructive surgeons blindly assessed responses to 10 microsurgery-related medical questions written either by the American Society of Reconstructive Microsurgery (ASRM) or ChatGPT based on accuracy, comprehensiveness, and clarity. Surgeons were asked to choose which source provided the overall highest-quality microsurgical patient-facing information. Additionally, 30 individuals with no medical background (ages: 18-81, μ = 49.8) were asked to determine a preference when blindly comparing materials. Readability scores were calculated, and all numerical scores were analyzed using the following six reliability formulas: Flesch-Kincaid Grade Level, Flesch-Kincaid Readability Ease, Gunning Fog Index, Simple Measure of Gobbledygook Index, Coleman-Liau Index, Linsear Write Formula, and Automated Readability Index. Statistical analysis of microsurgical-specific online sources was conducted utilizing paired t-tests. Statistically significant differences in comprehensiveness and clarity were seen in favor of ChatGPT. Surgeons, 70.7% of the time, blindly choose ChatGPT as the source that overall provided the highest-quality microsurgical patient-facing information. Nonmedical individuals 55.9% of the time selected AI-generated microsurgical materials as well. Neither ChatGPT nor ASRM-generated materials were found to contain inaccuracies. Readability scores for both ChatGPT and ASRM materials were found to exceed recommended levels for patient proficiency across six readability formulas, with AI-based material scored as more complex. AI-generated patient-facing materials were preferred by surgeons in terms of comprehensiveness and clarity when blindly compared with online material provided by ASRM. Studied AI-generated material was not found to contain inaccuracies. Additionally, surgeons and nonmedical individuals consistently indicated an overall preference for AI-generated material. A readability analysis suggested that both materials sourced from ChatGPT and ASRM surpassed recommended reading levels across six readability scores.

A Readability Study of Carpal Tunnel Release in 2023.

The National Institutes of Health (NIH) and the American Medical Association (AMA) recommend a sixth-grade reading level for patient-directed content. This study aims to quantitatively evaluate the readability of online information sources related to carpal tunnel surgery using established readability indices. Web searches for "carpal tunnel release" and "carpal tunnel decompression surgery" queries were performed using Google, and the first 20 websites were identified per query. WebFX online software tools were utilized to determine readability. Indices included Flesch Kincaid Reading Ease, Flesch Kincaid Grade Level, Coleman Liau Index, Automated Readability Index, Gunning Fog Score, and the Simple Measure of Gobbledygook Index. Health-specific clickthrough rate (CTR) data were used in order to select the first 20 search engine results page from each query. "Carpal tunnel release" had a mean readability of 8.46, and "carpal tunnel decompression surgery" had a mean readability of 8.70. The range of mean readability scores among the indices used for both search queries was 6.17 to 14.0. The total mean readability for carpal tunnel surgery information was found to be 8.58. This corresponds to approximately a ninth-grade reading level in the United States. The average readability of carpal tunnel surgery online content is three grade levels above the recommended sixth-grade level for patient-directed materials. This discrepancy indicates that existing online materials related to carpal tunnel surgery are more difficult to understand than the standards set by NIH and AMA.

Can Artificial Intelligence Improve the Readability of Patient Education Materials on Aortic Stenosis? A Pilot Study.

The advent of generative artificial intelligence (AI) dialogue platforms and large language models (LLMs) may help facilitate ongoing efforts to improve health literacy. Additionally, recent studies have highlighted inadequate health literacy among patients with cardiac disease. The aim of the present study was to ascertain whether two freely available generative AI dialogue platforms could rewrite online aortic stenosis (AS) patient education materials (PEMs) to meet recommended reading skill levels for the public. Online PEMs were gathered from a professional cardiothoracic surgical society and academic institutions in the USA. PEMs were then inputted into two AI-powered LLMs, ChatGPT-3.5 and Bard, with the prompt "translate to 5th-grade reading level". Readability of PEMs before and after AI conversion was measured using the validated Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook Index (SMOGI), and Gunning-Fog Index (GFI) scores. Overall, 21 PEMs on AS were gathered. Original readability measures indicated difficult readability at the 10th-12th grade reading level. ChatGPT-3.5 successfully improved readability across all four measures (p < 0.001) to the approximately 6th-7th grade reading level. Bard successfully improved readability across all measures (p < 0.001) except for SMOGI (p = 0.729) to the approximately 8th-9th grade level. Neither platform generated PEMs written below the recommended 6th-grade reading level. ChatGPT-3.5 demonstrated significantly more favorable post-conversion readability scores, percentage change in readability scores, and conversion time compared to Bard (all p < 0.001). AI dialogue platforms can enhance the readability of PEMs for patients with AS but may not fully meet recommended reading skill levels, highlighting potential tools to help strengthen cardiac health literacy in the future.

Readability of Spanish-Language Online Patient Educational Materials for Peripheral Artery Disease Do Not Meet Recommended Standards and Represent a Literacy Barrier to Care

Online resources are a valuable source of information for patients and have been reported to improve engagement and adherence to medical care. However, readability of online patient educational materials (OPEMs) is crucial for them to serve their intended purpose. The American Medical Association (AMA) recommends that OPEM be written at or below the sixth grade reading level. To avoid disparities in access to comprehensible health information on peripheral artery disease (PAD), it is imperative that the readability of PAD OPEM is appropriate for both English-speaking and Spanish-speaking patients. The aim of this study is to evaluate the readability of PAD OPEM in Spanish and compare to English-language OPEM. We conducted a Google search in English and Spanish using "peripheral arterial disease" and "enfermedad arterial periferica", respectively, and the top 25 patient-accessible articles were collected for each. Articles were categorized by source type: hospital, professional society, or other. Readability of English-language OPEM was measured using the Flesch Reading Ease Readability Formula, Automated Readability Index, Coleman-Liau Index, Flesch-Kincaid Grade Level, Gunning Fog, Linsear Write Formula, and the Simple Measure of Gobbledygook Index. Readability of Spanish OPEM was measured using the Fernández-Huerta Index and Índice Flesch-Szigriszt Scale. Readability of the articles was compared to the AMA recommendation, between English- and Spanish-language, and across sources using statistical tests appropriate to the data. OPEM from professional societies represented the fewest number of English- (n=7, 28%) and Spanish-language (n=6, 24%) articles. Most English-speaking (n=18, 72%) and Spanish-language (n=20, 80%) OPEM were considered difficult as measured by the Flesch Reading Ease Readability Formula and Fernández-Huerta Index, respectively, but did not significantly differ between languages (P=0.59). There were no significant differences in the average readability of all readability measurements across sources (hospital, professional society, or other). All the average readability grade levels for English-speaking and Spanish-language OPEM was significantly higher than the sixth grade reading level (P<0.01). Only 3 (6%) OPEM met the AMA recommended reading level and there was no significant difference between English-language and Spanish-language OPEM (P=1.0). Nearly all Spanish-language and English-language PAD OPEM assessed were written at a reading grade level higher than recommended by the AMA. There was no significant difference in the readability of materials from hospitals or professional societies. To prevent further widening of health disparities related to literacy, health content creators, particularly hospitals and professional societies, should prioritize, develop, and ensure that English-language and Spanish-language patient education materials are written at a level appropriate for the public.

AI-Generated Information for Vascular Patients: Assessing the Standard of Procedure-Specific Information Provided by the ChatGPT AI-Language Model.

Introduction Ensuring access to high-quality information is paramount to facilitating informed surgical decision-making. The use of the internet to access health-related information is increasing, along with the growing prevalence of AI language models such as ChatGPT. We aim to assess the standard of AI-generated patient-facing information through a qualitative analysis of its readability and quality. Materials and methods We performed a retrospective qualitative analysis of information regarding three common vascular procedures: endovascular aortic repair (EVAR), endovenous laser ablation (EVLA), and femoro-popliteal bypass (FPBP). The ChatGPT responses were compared to patient information leaflets provided by the vascular charity, Circulation Foundation UK. Readability was assessed using four readability scores: the Flesch-Kincaid reading ease (FKRE) score, the Flesch-Kincaid grade level (FKGL), the Gunning fog score (GFS), and the simple measure of gobbledygook (SMOG) index. Quality was assessed using the DISCERN tool by two independent assessors. Results The mean FKRE score was 33.3, compared to 59.1 for the information provided by the Circulation Foundation (SD=14.5, p=0.025) indicating poor readability of AI-generated information. The FFKGL indicated that the expected grade of students likely to read and understand ChatGPT responses was consistently higher than compared to information leaflets at 12.7 vs. 9.4 (SD=1.9, p=0.002). Two metrics measure readability in terms of the number of years of education required to understand a piece of writing: the GFS and SMOG. Both scores indicated that AI-generated answers were less accessible. The GFS for ChatGPT-provided information was 16.7 years versus 12.8 years for the leaflets (SD=2.2, p=0.002) and the SMOG index scores were 12.2 and 9.4 years for ChatGPT and the patient information leaflets, respectively (SD=1.7, p=0.001). The DISCERN scores were consistently higher in human-generated patient information leaflets compared to AI-generated information across all procedures; the mean score for the information provided by ChatGPT was 50.3 vs. 56.0 for the Circulation Foundation information leaflets (SD=3.38, p<0.001). Conclusion We concluded that AI-generated information about vascular surgical procedures is currently poor in both the readability of text and the quality of information. Patients should be directed to reputable, human-generated information sources from trusted professional bodies to supplement direct education from the clinician during the pre-procedure consultation process.

Internet Health Resources on Nocturnal Enuresis: A Readability, Quality, and Accuracy Analysis.

Nocturnal enuresis is a common yet quality-of-life-limiting pediatric condition. There is an increasing trend for parents to obtain information on the disease's nature and treatment options via the internet. However, the quality of health-related information on the internet varies greatly and is largely uncontrolled and unregulated. With this study, a readability, quality, and accuracy evaluation of the health information regarding nocturnal enuresis is carried out. A questionnaire was administered to parents and patients with nocturnal enuresis to determine their use of the internet to research their condition. The most common search terms were determined, and the first 30 websites returned by the most popular search engines were used to assess the quality of information about nocturnal enuresis. Each site was categorized by type and assessed for readability using the Gunning fog score, Simple Measure of Gobbledygook (SMOG) index, and Dale-Chall score; for quality using the DISCERN score; and for accuracy by comparison to the International Children's Continence Society guidelines by three experienced pediatric urologists and nephrologists. A total of 30 websites were assessed and classified into five categories: professional (n = 13), nonprofit (n = 8), commercial (n = 4), government (n = 3), and other (n = 2). The information was considered difficult for the public to comprehend, with mean Gunning fog, SMOG index, and Dale-Chall scores of 12.1 ± 4.3, 14.1 ± 4.3, and 8.1 ± 1.3, respectively. The mean summed DISCERN score was 41 ± 11.6 out of 75. Only seven (23%) websites were considered of good quality (DISCERN score > 50). The mean accuracy score of the websites was 3.2 ± 0.6 out of 5. Commercial websites were of the poorest quality and accuracy. Websites generally scored well in providing their aims and identifying treatment benefits and options, while they lacked references and information regarding treatment risks and mechanisms. Online information about nocturnal enuresis exists for parents; however, most websites are of suboptimal quality, readability, and accuracy. Pediatric surgeons should be aware of parents' health-information-seeking behavior and be proactive in guiding parents to identify high-quality resources.

Readability of Patient-Reported Outcomes in Spine Surgery and Implications for Health Literacy.

Observational study. To evaluate the readability of commonly utilized patient-reported outcome measures (PROMs) in spine surgery. Although studies have evaluated patient education materials, discharge instructions, and informed consent forms in spine surgery, there is a dearth of literature on the readability of PROMs despite widespread health illiteracy. Without knowledge of PROM readability, it is unclear whether these measures are able to be understood by the average spine patient. We analyzed all commonly utilized nonvisual PROMs within the spinal literature and uploaded PROMs into an online readability calculator. The Flesch Reading Ease Score (FRES) and Simple Measure of Gobbledygook (SMOG) Index were collected. A FRES>79 or SMOG<7 was considered readable by the general population per American Medical Association and Centers for Disease Control guidelines. A stricter threshold recommended in health care (SMOG <6 or FRES>89) was then used to further review readability. Seventy-seven PROMs were included. Based on FRES, the mean readability of all PROMs was 69.2 ± 17.2 (range, 10-96.4), indicating an average eighth to ninth-grade reading level. The mean readability score categorized by the SMOG Index was 8.12 ± 2.65 (range, 3.1-25.6), representing an eighth-grade reading level. Compared with the reading level of the general population, 49 (63.6%) PROMs are written above the United States literacy level, according to FRES. Using stricter definitions of readability, 8 PROMs were considered readable, including PROM Information System pain behavior (FRES: 96.4 and SMOG: 5.2), PROM Information System sleep disturbance (SMOG: 5.6), Neck Pain and Disability Scale (SMOG: 4.3), and Zung Depression Scale (SMOG: 3.1). Most PROMs utilized in spine surgery require an average reading competency far above the average patient's comprehension. This may have a meaningful impact on understanding PROM instruments and may affect the accuracy of complete surveys and the rates of incompletion.

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.

Pain management following total shoulder arthroplasty: what are patients reading online?

BackgroundThis study aims to assess the quality and readability of online resources regarding postoperative pain control for patients having undergone total shoulder arthroplasty (TSA), along with identifying gaps among the types of information. MethodsThree search engines were used to conduct internet searches utilizing a combination of TSA and pain management search phrases. The top 20 web pages from each search engine were gathered, reviewed, and scored by five different evaluators. Scoring was performed using 30-point criteria, integrated into an overall quality of resource (QR) score considered significant for patient education about TSA and pain management according to American Pain Society and American Academy of Orthopaedic Surgeons’ published recommendations (Table I). Domain scores (route of administration, type of analgesia, opioid-specific, and general guidance) were calculated by summing the total points and dividing by the total possible score for each domain. The reading level of the Flesch-Kinkaid grade level, the Flesch reading ease, and the simple measure of gobbledygook index was also assessed. ResultsThe overall readability was low, with a mean Flesch-Kincaid grade level score of 10.3 ± 2.0 and Simple Measure of Gobbledygook score of 9.9 ± 1.5. According to this index, only one website (2.3%) was written below the suggested 6th grade reading level. There was a mean QR score of 9.6/30 points, ranging from 2 to 22 (Table II). Most resources (90.9%) did not achieve greater than 50% of the total available points (greater than 15 out of 30). Of the domains, the mean score for route of administration was 31.8%, types of analgesia was 43.6%, opioid-specific was 11.4%, and general guidance was 43.2%. Opioid-specific scores were lower than all three other domain scores (all P < .001). ConclusionAccording to our findings, current online resources for pain management following TSA are written above the average literacy level for adults in the United States and lack educational content, especially regarding opioid-specific discussion and recommendations. Resources must target gaps in online patient education to better inform patients of postoperative pain control, convey expectations, and encourage patient-physician conversations and decision-making.

Readability of Online Patient Education Materials for Congenital Hand Differences.

The aim of the study is to assess the readability of online patient education materials (PEMs) for congenital hand differences. The top 10 online, English-language PEMs for 10 conditions (polydactyly, syndactyly, trigger finger/thumb, clinodactyly, camptodactyly, symbrachydactyly, thumb hypoplasia, radial dysplasia, reduction defect, and amniotic band syndrome) were compiled and categorized by source and country. Readability was assessed using 5 tools: Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), Gunning Fog Index (GFI), Coleman-Liau Index (CLI), and Simple Measure of Gobbledygook Index (SMOG). To account for the potential effect of each condition's name in the aforementioned formulas, the analysis was repeated after replacing the name with a monosyllabic word/s. The mean readability scores of the 100 PEMs were FRES 56.3, where the target was ≥80, FKGL 8.8, GFI 11.5, CLI 10.9, and SMOG 8.6, and the median grade score was 9.8, where the target grade was ≤6.9. Following adjustment, all readability scores improved significantly (P < .001). Postadjustment scores were FRES 63.8, FKGL 7.8, GFI 10.7, CLI 9.1, and SMOG 8.0, and the median grade score was 8.6. Only 1 webpage met the target level using all tools. Two-sample t test for country of publication (the United States and the United Kingdom) demonstrated that PEMs originating from the United Kingdom were easier to read using the preadjustment CLI (P = .009) and median grade metrics (P = .048). A 1-way analysis of variance revealed no influence of condition or source on readability. Most online PEMs for congenital hand differences are written above the recommended reading level of sixth grade, even when adjusted for the effect of the condition's name.

The Quality, Readability, and Accuracy of the Information on Google About Cannabis and Driving: Quantitative Content Analysis

Background The public perception of driving under the influence of cannabis (DUIC) is not consistent with current evidence. The internet is an influential source of information available for people to find information about cannabis. Objective The purpose of this study was to assess the quality, readability, and accuracy of the information about DUIC found on the internet using the Google Canada search engine. Methods A quantitative content analysis of the top Google search web pages was conducted to analyze the information available to the public about DUIC. Google searches were performed using keywords, and the first 20 pages were selected. Web pages or web-based resources were eligible if they had text on cannabis and driving in English. We assessed (1) the quality of information using the Quality Evaluation Scoring Tool (QUEST) and the presence of the Health on the Net (HON) code; (2) the readability of information using the Gunning Fox Index (GFI), Flesch Reading Ease Scale (FRES), Flesch-Kincaid Grade Level (FKGL), and Simple Measure of Gobbledygook (SMOG) scores; and (3) the accuracy of information pertaining to the effects of cannabis consumption, prevalence of DUIC, DUIC effects on driving ability, risk of collision, and detection by law enforcement using an adapted version of the 5Cs website evaluation tool. Results A total of 82 web pages were included in the data analysis. The average QUEST score was 17.4 (SD 5.6) out of 28. The average readability scores were 9.7 (SD 2.3) for FKGL, 11.4 (SD 2.9) for GFI, 12.2 (SD 1.9) for SMOG index, and 49.9 (SD 12.3) for FRES. The readability scores demonstrated that 8 (9.8%) to 16 (19.5%) web pages were considered readable by the public. The accuracy results showed that of the web pages that presented information on each key topic, 96% (22/23) of them were accurate about the effects of cannabis consumption; 97% (30/31) were accurate about the prevalence of DUIC; 92% (49/53) were accurate about the DUIC effects on driving ability; 80% (41/51) were accurate about the risk of collision; and 71% (35/49) were accurate about detection by law enforcement. Conclusions Health organizations should consider health literacy of the public when creating content to help prevent misinterpretation and perpetuate prevailing misperceptions surrounding DUIC. Delivering high quality, readable, and accurate information in a way that is comprehensible to the public is needed to support informed decision-making.

Readability of online monkeypox patient education materials: Improved recognition of health literacy is needed for dissemination of infectious disease information.

Health literacy is key to navigating the current global epidemic of misinformation and inaccuracy relating to healthcare. The American Medical Association (AMA) suggests health information should be written at the level of American sixth grade. With the monkeypox outbreak being declared a Public Health Emergency of International Concern (PHEIC) in July 2022, we sought to assess the readability of online patient education materials (PEMs) relating to monkeypox to see if they are at the target level of readability. A search was conducted on Google.com using the search term 'Monkeypox'. The top 50 English language webpages with patient education materials (PEMs) relating to monkeypox were compiled and categorised by country of publication and URL domain. Readability was assessed using five readability tools: Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), Gunning Fog Index (GFI), Coleman-Liau Index (CLI), and, Simple Measure of Gobbledygook Index (SMOG). Unpaired t-test for URL domain, and one-way ANOVA for country were performed to determine influence on readability. Three of the five tools (FRES, GFI, CLI) identified no webpages that met the target readability score. The FKGL and SMOG tools identified one (2%) and two (4%) webpages respectively that met the target level. County and URL domain demonstrated no influence on readability. Online PEMs relating to monkeypox are written above the recommended reading level. Based on the previously established effect of health literacy, this is likely exacerbating health inequalities. This study highlights the need for readability to be considered when publishing online PEMs.

Linguistic analysis of plain language summaries and corresponding scientific summaries of Cochrane systematic reviews about oncology interventions.

Cochrane plain language summaries (PLSs) are an important format to present high-quality healthcare evidence to patients with cancer and their families. They should be written in a way everyone can understand, since they serve as a tool in decision-making and present a bridge to overcome the gap between the healthcare users and professionals. The aim of the study was to assess the language characteristics of PLSs of Cochrane systematic reviews of oncology interventions in comparison with corresponding Cochrane scientific abstracts (SAs). In this cross-sectional study, we included all Cochrane PLSs and SAs of systematic reviews of oncology interventions available in the Cochrane Database of Systematic Reviews. We assessed text readability, measured using the Simple Measure of Gobbledygook (SMOG) index, and the prevalence of words related to different language tones (clout, authenticity, emotions and analytical tones). Two independent assessors categorized the conclusiveness of the efficacy of interventions into nine categories. The overall median SMOG index for 275 PLSs was 13.0 (95% confidence interval [CI] 12.8-13.3). Readability scores did not differ across Cochrane Review Groups. SAs had a higher readability index than the corresponding PLSs (median=16.6, 95% CI=16.4-16.8). Regarding linguistic characteristics, PLSs were shorter than SAs, with less use of analytical tone, but more use of a positive emotional tone and authenticity. Overall, the 'Unclear' category of conclusiveness was the most common among all PLSs. Also, PLSs with 'No evidence' conclusions were the shortest and had the lowest SMOG index. PLSs of Cochrane systematic reviews of oncological interventions have low readability and most give unclear conclusions about the efficacy of interventions. PLSs should be simplified so that patients and their families can benefit from appropriate health information on evidence synthesis. Further research is needed into reasons for unclear language to describe evidence from oncology trials.

POOR COMPLIANCE DOCUMENTING INFORMED CONSENT IN TRAUMA PATIENTS WITH DISTAL RADIUS FRACTURES COMPARED WITH ELECTIVE TOTAL KNEE ARTHROPLASTY

The purpose of this study was (1) to evaluate the adequacy of informed consent documentation in the trauma setting for distal radius fracture surgery compared with the elective setting for total knee arthroplasty (TKA) at a large public hospital and (2) to explore the relevant guidelines in New Zealand relating to consent documentation.Consecutive adult patients (≥16 years) undergoing operations for distal radius fractures and elective TKA over a 12-month period in a single-centre were retrospectively identified. All medical records were reviewed for the risks and complications recorded. The consent form was analysed using the Flesch Reading Ease Score (FRES) and the Simple Measure of Gobbledygook (SMOG) index readability scores.A total of 133 patients undergoing 134 operations for 135 distal radius fractures and 239 patients undergoing 247 TKA were included. Specific risks of surgery were recorded significantly less frequently for distal radius fractures than TKA (43.3% versus 78.5%, P &lt; 0.001). Significantly fewer risks were recorded in the trauma setting compared to the elective (2.35 ± 2.98 versus 4.95 ± 3.33, P &lt; 0.001). The readability of the consent form was 40.5 using the FRES and 10.9 using the SMOG index, indicating a university undergraduate level of reading.This study has shown poor compliance in documenting risks of surgery during the informed consent process in an acute trauma setting compared to elective arthroplasty. Institutions must prioritise improving documentation of informed consent for orthopaedic trauma patients to ensure a patient-centred approach to healthcare.

ODP198 Free Diabetes Apps: An Intervention to Reduce Health Disparities in our Diabetic Patients

Abstract Background 85% of Americans own a smartphone and there were 230 billion downloads in 2021. 1,2 American diabetic patients have been reported to have limited health literacy. 3 55% of Americans do not graduate from high school. 4 African American, Hispanic patients and Asian patients comprise 20%, 22% and 19% of diabetic patients, respectively, but a greater proportion of hospitalization rates. 5 Many of these patients and their families use mobile apps for health questions. The accessibility of eHealth apps is changing how patients access health information. Purpose To evaluate free diabetes health apps as an intervention to reduce health disparities in our diabetic patients. Methods Using search term, "diabetes" in GooglePlayStore(Android/AD) and AppleAppStore(iOS) to find the best, free diabetes apps. Exclusion criteria: less than 100,000 downloads (DL) on Google and&amp;lt;1600 reviews (RE) on Apple (Apple does not provide download data). The app introduction was "pasted" into readabilityformulas.com and webfx.com for analysis via Flesch-Kincaid Reading Ease (FRE), Flesch-Kincaid Grade Level Score (FGL), Simple Measure of Gobbledygook Index (SI), and the Dale-Chall Adjusted Grade Level (DCGL). Results AD(DL): 1-mySugr(1M),2-OnetouchReveal(1M),3-DiabetesBloodSugar(1M),4-BloodGlucoseTracker(500K),5-Diabetes(500K),6-Health2Sync(500K),7-DiabetesM(500K), 8-GlucoseBuddy(500K), 9-BeatDiabetes(100K), 10- Contour Diabetes App (100K);iOS(RE): 1-OnetouchReveal(87K), 2-GlucoseBuddyDiabetesTracker(21K), 3-Onedrop(20K), 4-GlucoseBloodSugarTracker(17K), 5-Livongo(13K), 6-mySugr(9.6K), 7-Sugarmate(9.4K),8-Klinio(3K), 9- Glycemic Index Load Net Carbs (2.2K), 10- Diabetes Logs (1.6K). Push notification=19/20 apps(AD=9, iOS=10). Connect users to GoodRx=0/20 apps. Connect users to professional care team/diabetes education=8/20 apps(AD=3, iOS=5). Connect users to free/discounted insulin/health products=0/20 apps. Spanish=11/20, Chinese=5/20 apps (AD=3, iOS=8, some apps have both). Only 2/20 apps were at 7-8th grade and the rest were high school and beyond. Free test strips were offered only on 1/20 apps(Livongo). Conclusion Free diabetes apps are helpful and may serve as an easily accessible educational tool for our patients. The physician can play a role in navigating the eHealth space with the patient.

ODP168 Can Virtual Assistants Help our Diverse Population of Diabetic Patients?

Abstract Background: Diabetes affects 34 million in the US and an additional 88 million are prediabetic. 1 According to the CDC, Diabetes affects Hispanic Americans (22%) and Asian Americans (19%) more than the Caucasian (12%) population. 2 Many of these patients do not speak English. In addition, 55% of US adults did not graduate from high school. 3 Health literacy is a barrier to health care. There are 4.2 billion Virtual Assistant AI devices, e. g. Amazon Echo Dot and Google Home Mini, which are used worldwide. Virtual assistant devices are used in nursing homes and assisted living facilities. 4 Purpose: To evaluate Virtual Assistant Devices, Alexa and Google, as a educational tool for our multicultural Diabetic Population Methods: Evaluation of Amazon Echo Dot (Alexa) and Google Home Mini (Google) with voice activation in English, Spanish and Mandarin was performed. Alexa did not have Mandarin Chinese speaking capability. Responses from both devices were recorded and then transcribed to text using Google Docs "speech to text" tool and assistance from native Mandarin Chinese and Spanish speakers. Transcribed English language responses were pasted into WebFx.com and readabilityformulas.com for readability analysis via Flesch-Kincaid Reading Ease (FRE), Flesch-Kincaid Grade Level Score (FGL), Simple Measure of Gobbledygook Index (SI), and the Dale-Chall Adjusted Grade Level (DCGL). Verbal Questions: 1) I have diabetes- what do I do? 2) I have Type 1 Diabetes Mellitus - What do I do? 3) I have Type 2 Diabetes - What do I do? 4) Does diabetes cause me to have problems seeing? 5) Does diabetes cause kidney problems? 6) Does diabetes cause problems with my feet? Results: Word Counts: English: Google (36.7 words +/- 10.4), Alexa (39.2 words +/- 25.2) Spanish: Google (31.2 words +/- 13.6), Alexa (45.2 words +/- 27.9) Chinese: Google (73.3 words +/- 31.6), Alexa (NA) No significant differences between the number of words for English vs. Chinese responses or English vs. Spanish responses. English Responses Readability: Avg FRE: Google (51.3 +/-12. 0), Alexa (71.1 +/- 9.9) (higher = easier reading) Avg FGL: Google (9.8 grade +/-1.7), Alexa (6.5 grade +/- 0.8) (higher = higher grade level) Avg SI: Google (9.5 +/-1.5), Alexa (6.5 +/-0.9) (higher = harder reading) Avg DCGL: Google (College), Alexa (Grades 9-10) Conclusion: Digital Voice Assistant Devices are helpful to patients who are visually impaired, have poor mobility or need language translation. Under physician guidance, these devices provide diabetes education for our patients and for the lay public.

The Risks Associated With Computed Tomography Scans: An Assessment of the Readability and Reliability of Online Text Available for Patient Information and Guidance.

Introduction Computed tomography (CT) scanninghas become a fundamental aspect of many diagnostic pathways and therapeutic procedures. However, it is not without risk. Many patients are unaware of the exposure to ionising radiation that is involved with undergoing a CT scan, as well as the associated increase in cancer risk with cumulative exposure. Controversy over which clinician is responsible for advising a patient regarding CT risk often means that patients are left uninformed and unaware. Those who choose to seek further guidance online do so with the risk of encountering poor quality, difficult-to-read medical text, which may leave them even more confused or misinformed. Aim This study aimed to assess the readability, quality, and accuracy of the information available to patients online regarding CT scans and their associated risks. Method An internet search of 180 websites was collated using three search terms, each entered into three search engines. The terms used were 'CT Risk', 'CT Harm', and 'Dangers of a CT Scan'. Unique websites generated were assessed for readability using four readability formulae: The Flesh-Kincaid Grade Level, the Flesch Reading Ease Score, the Gunning Fog Index, and the Simple Measure of Gobbledygook (SMOG) Index. The text on each website was also evaluated for quality and accuracy using the Discern tool. Mean readability scores were calculated and compared against the defined standard required for the information intended for the general public. A two-tailed t-test was also carried out to assess statistical significance. Results Of the 180 websites collated, 77 were unique.76.62% of websites (59/77) met the readability target for the Flesch-Kincaid Grade Level, and 66.23% (51/77) met the target for the Gunning Fog Index, which was for text to be readable at the Grade 8 level (or by children aged 13-14). 59.74% (46/77) met the target for the SMOG Index, which for healthcare information, was defined as Grade 6 Level, or children aged 11-12. Only 11.69% of websites (9/77) met the target for the Flesch Reading Ease score. 55.84%of websites satisfied the pre-defined standard for three out of four readability criteria, however, only 11.69% satisfied all four criteria, limited by the scores obtained by the Flesch Reading Ease formula. The websites generated a mean Discern score of 3.58, meaning the average quality of the information was deemed to be 'fair', with no serious shortcomings. Conclusion More than 50% of websites satisfied three readability criteria simultaneously. However, there is still scope for improvement, both in terms of enhancing the readability of the remaining websites, and also ensuring that all websites review the proportion of polysyllabic words in the text, which is the emphasis of the Flesh Reading Ease Score.In addition, physicians and radiologistshave a responsibility to inform patients of the risks associated with CT scans, and to direct them to supplementary good-quality information and resources.

Readability of online health information pertaining to migraine and headache in the UK.

An estimated 46% of the worldwide adult population live with an active headache disorder, and it is thought that there is a proportion of headache and migraine sufferers who do not attend for medical care, instead choosing to manage their symptoms at home. The internet continues to act as a source of online health information for self-management, however, it is important that this information can be understood by the user. Research indicates that most health information online is written at a level too difficult for much of the UK population to understand. The aim of this study was to investigate the readability of online health information pertaining to headache and migraine for a UK-based internet user accessing the top four search engines. Searches for 'headache' and 'migraine' were performed on each search engine and results from the first page were selected for analysis. Five validated readability tests were used to analyse readability; Flesch-Kincaid Grade Level, Flesch Reading Ease, Gunning Fog Index, Coleman-Liau Index and Simple Measure of Gobbledygook Index. We found that the majority of online health information about migraine and headache is too difficult for the UK adult population to read. Findings highlight work is required to ensure that information from a wider variety of sources is easier to comprehend for much of the population in order for individuals to make informed decisions about health seeking and self-management of headache and migraine. Health information providers should weave readability analysis into their content design process, incorporating shorter sentences and simpler words in their description of conditions and treatment.