A Readability Analysis of Online Cardiovascular Disease-Related Health Education Materials

Ayyaswami, Varun; Padmanabhan, Divya; Patel, Manthan; Prabhu, Arpan V.; Hansberry, David R.; Agarwal, Nitin; Magnani, Jared W.

doi:10.3928/24748307-20190306-03

Cited by 26 publications

(31 citation statements)

References 29 publications

(37 reference statements)

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“…National organisations encourage the composition of Internet-based patient educational materials at the fifth-to sixth-grade level. 26 Numerous studies in the medical field have shown that Internet-based patient educational materials do not comply with national readability recommendations. [6][7][8]16,19 To our knowledge, this study is the first to evaluate readability in the field of paediatric cardiology.…”

Section: Discussionmentioning

confidence: 99%

The quality, understandability, readability, and popularity of online educational materials for heart murmur

et al. 2019

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Objective:Murmurs are abnormal audible heart sounds produced by turbulent blood flow. Therefore, murmurs in a child may be a source of anxiety for family members. Families often use online materials to explore possible reasons for these murmurs, given the accessibility of information on the Internet. In this study, we evaluated the quality, understandability, readability, and popularity of online materials about heart murmur.Methods:An Internet search was performed for “heart murmur” using the Google search engine. The global quality score (on a scale of 1 to 5, corresponding to poor to excellent quality) and Health on the Net code were used to measure the quality of information presented. The understandability of the web pages identified was measured using the Patient Education Materials Assessment Tool (score range from 0 to 100%, scores below 70% reflect poor performance). The readability of each web pages was assessed using four validated indices: the Flesch Reading Ease Score, the Flesch–Kincaid Grade Level, the Gunning Frequency of Gobbledygook, and the Simple Measure of Gobbledygook. The ALEXA traffic tool was used to reference domains’ popularity and visibility.Results:We identified 230 English-language patient educational materials that discussed heart murmur. After exclusion, a total of 86 web pages were evaluated for this study. The average global quality score was 4.34 (SD = 0.71; range from 3 to 5) indicating that the quality of information of most websites was good. Only 14 (16.3%) websites had Health on the Net certification. The mean understandability score for all Internet-based patient educational materials was 74.6% (SD = 12.8%; range from 31.2 to 93.7%). A score suggesting these Internet-based patient educational materials were “easy to understand”. The mean readability levels of all patient educational materials were higher than the recommended sixth-grade reading level, according to all indices applied. This means that the level of readability is difficult. The average grade level for all web pages was 10.4 ± 1.65 (range from 7.53 to 14.13). The Flesch–Kincaid Grade level was 10 ± 1.81, the Gunning Frequency of Gobbledygook level was 12.1 ± 1.85, and the Simple Measure of Gobbledygook level was 9.1 ± 1.38. The average Flesch Reading Ease Score was 55 ± 9.1 (range from 32.4 to 72.9).Conclusion:We demonstrated that web pages describing heart murmurs were understandable and high quality. However, the readability level of the websites was above the recommended sixth-grade reading level. Readability of written materials from online sources need to be improved. However, care must be taken to ensure that the information of web pages is of a high quality and understandable.

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Section: Discussionmentioning

confidence: 99%

The quality, understandability, readability, and popularity of online educational materials for heart murmur

et al. 2019

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“…These results are in line with previous studies on a wide array of health conditions ranging from pancreatic cancer to carpal tunnel syndrome. 6,[13][14][15][16][17][18][19][20][21][22][23][24][25] In our study, 28 total websites were each evaluated by 9 readability tests, for a total of 252 individual evaluations. We found only 18 (7.14%) of the 252 individually graded websites were rated at an eighthgrade reading level, and none (0/252) were graded at a seventhgrade reading level or lower.…”

Section: Discussionmentioning

confidence: 99%

“…11,12 Examination of patient-directed health information from a wide variety of specialties has consistently found that the materials exceeded the reading-level recommendations of the NIH and AMA. 6,[13][14][15][16][17][18][19][20][21][22][23][24][25] In addition, health information must be understandable or presented in a way that makes sense to the patient and inform appropriate decisions regarding care.…”

Section: Introductionmentioning

confidence: 99%

Readability and Understandability Analysis of Online Materials Related to Abdominal Aortic Aneurysm Repair

Scott

Johnson

Doval

et al. 2019

Vasc Endovascular Surg

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Background: Patients commonly use online materials as a source of health information. Since poor health literacy has been shown to correlate with negative outcomes, it is recommended that patient-directed materials be written at a sixth-grade reading level. This study evaluates the readability and understandability of commonly accessed online materials pertaining to both endovascular and open repair of abdominal aortic aneurysm. Methods: Searches for “endovascular repair abdominal aortic aneurysm” and “open repair abdominal aortic aneurysm” were performed on both Google and Bing, and the top 10 websites from each search engine were identified. Relevant websites (total N = 28, endovascular n = 15, open n = 15, and 2 redundant sites) with patient-directed content were analyzed. Readability was assessed using 9 established methods, and understandability was assessed using the Patient Education Materials Assessment Tool scoring system. Results: The average reading grade level for all sites was 12.8. Endovascular sites averaged a reading grade level of 13.6 with a range from 11.5 to 15.6. Open-repair websites had a grade-level average of 12.1 with a range from 9.9 to 14.1. Readability was found to be inversely related to understandability, with a Pearson correlation coefficient of −0.551 ( P = .003). No website was written at or below the recommended sixth-grade reading level. Conclusions: Patient-directed online health information pertaining to open and endovascular repair of abdominal aortic aneurysm exceeds the recommended sixth-grade reading level. Increasing complexity of health literature correlates with poor understandability. Modifications such as shorter sentences, fewer words with more than 6 letters, and increasing usage of clear visual aids can increase readability and understandability.

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“…A minority of CAD websites included in our study (13/54, 24%) received a GFI score of less than twelve, corresponding with a reading level at or below that of a high school senior. A recent study also found that 99.5% of online cardiovascular disease-related health education materials recommended by the AMA were written above the fifth to sixth-grade level [29]. Our study found that the CAD websites' readability was higher than recommended, which could have far-reaching implications for patients' health literacy [29].…”

Section: Renderxmentioning

confidence: 53%

“…A recent study also found that 99.5% of online cardiovascular disease-related health education materials recommended by the AMA were written above the fifth to sixth-grade level [29]. Our study found that the CAD websites' readability was higher than recommended, which could have far-reaching implications for patients' health literacy [29]. However, it is important to note that readability is only one element of literacy.…”

Section: Renderxmentioning

confidence: 54%

Carotid Endarterectomy Versus Carotid Artery Stenting: Survey of the Quality, Readability, and Treatment Preference of Carotid Artery Disease Websites

Strauss¹,

Yacob²,

Bhandari³

et al. 2020

Interact J Med Res

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Background The internet is becoming increasingly more important in the new era of patient self-education. Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are recognized interventions to treat patients with carotid artery stenosis. Using the Google search platform, patients encounter many websites with conflicting information, which are sometimes difficult to understand. This lack of accessibility creates uncertainty or bias toward interventions for carotid artery disease. The quality, readability, and treatment preference of carotid artery disease (CAD) websites have not yet been evaluated. Objective This study aimed to explore the quality, readability, and treatment preference of CAD websites. Methods We searched Google Canada for 10 CAD-related keywords. Returned links were assessed for publication date, medical specialty and industry affiliation, presence of randomized controlled trial data, differentiation by symptomatic status, and favored treatment. Website quality and readability were rated by the DISCERN instrument and Gunning Fog Index. Results We identified 54 unique sites: 18 (33.3%) by medical societies or individual physicians, 11 (20.4%) by government organizations, 9 (16.7%) by laypersons, and 1 (1.9%) that was industry-sponsored. Of these sites, 26 (48.1%) distinguished symptomatic from asymptomatic CAD. A majority of sites overall (57.4%) and vascular-affiliated (72.7%) favored CEA. In contrast, radiology- and cardiology-affiliated sites demonstrated the highest proportion of sites favoring CAS, though they were equally likely to favor CEA. A large proportion (21/54, 38.9%) of sites received poor quality ratings (total DISCERN score <48), and the majority (41/54, 75.9%) required a reading level greater than a high school senior. Conclusions CAD websites are often produced by government organizations, medical societies, or physicians, especially vascular surgeons. Sites ranged in quality, readability, and differentiation by symptomatic status. Google searches of CAD-related terms are more likely to yield sites favoring CEA. Future research should determine the extent of website influence on CAD patients’ treatment decisions.

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A Readability Analysis of Online Cardiovascular Disease-Related Health Education Materials

Cited by 26 publications

References 29 publications

The quality, understandability, readability, and popularity of online educational materials for heart murmur

The quality, understandability, readability, and popularity of online educational materials for heart murmur

Readability and Understandability Analysis of Online Materials Related to Abdominal Aortic Aneurysm Repair

Carotid Endarterectomy Versus Carotid Artery Stenting: Survey of the Quality, Readability, and Treatment Preference of Carotid Artery Disease Websites

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