Assessment of the Readability of Web-Based Patient Education Material From Major Canadian Pediatric Associations: Cross-sectional Study

Abstract

Background Web-based patient education materials (PEMs) are frequently written above the recommended reading level in North America. Poor PEM readability limits the accessibility of medical information for individuals with average literacy levels or lower. Pediatric hospital and association websites have not only been shown to be a preferred source of information among caregivers but have also become a necessity during the COVID-19 pandemic. The readability of Canadian pediatric association websites has not yet been assessed. Objective The aim of this study is to determine if the content of PEMs from Canadian pediatric associations is written at a reading level that the majority of Canadians can understand. Methods A total of 258 PEMs were extracted from 10 Canadian pediatric associations and evaluated for their reading level using 10 validated readability scales. The PEMs underwent a difficult word analysis and comparisons between PEMs from different associations were conducted. Results Web-based PEMs were identified from 3 pediatric association websites, where the reading level (calculated as a grade level) was found to be an average of 8.8 (SD 1.8) for the Caring for Kids website, 9.5 (SD 2.2) for the Pediatric Endocrine Group website, and 13.1 (SD 2.1) for the Atlantic Pediatric Society website. The difficult word analysis identified that 19.9% (SD 6.6%) of words were unfamiliar, with 13.3% (SD 5.3%) and 31.9% (SD 6.1%) of words being considered complex (≥3 syllables) and long (≥6 letters), respectively. Conclusions The web-based PEMs were found to be written above the recommended seventh-grade reading level for Canadians. Consideration should be made to create PEMs at an appropriate reading level for both patients and their caregivers to encourage health literacy and ultimately promote preventative health behaviors and improve child health outcomes.

Assessment of online patient education material for eye cancers: A cross-sectional study

“…If a document was a pdf, then they were manually converted to plain text for further analysis. Text sections of nonmedical information were removed from each of the PEMs before analysis, as described previously [22][23][24][25][26].…”

“…A readability assessment was then performed as described previously [22][23][24][25][26]. The software package Readability Studio professional edition version 2019.3 (Oleander Software, Ltd) was utilized to determine the GRL of the PEMs through eight numerical scales and two graphical scales.…”

“…The two graphical scales included the Raygor Readability Estimate Graph (RREG) and the Fry Readability Graph (FRG). These ten scales are externally validated and are frequently used to evaluate the readability of medical text [22][23][24][25][26]. Multiple readability scales were utilized to provide a holistic understanding of the PEM's readability and to ensure no single parameter skewed the GRL of…”

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“…Furthermore, with the recent COVID-19 pandemic making direct contact between health-care professionals and patients/public difficult, there has been a growing demand for online patient education material. 14 Patient education via YouTube is considered to be a common practice. Several medical organizations in Japan, including the Japan Hypertension Society, 15 Japan Association for Diabetes Education and Care, 16 and Japan Society for Transplantation, 17 provide videos for patients and the general public.…”

“…Furthermore, with the recent COVID‐19 pandemic making direct contact between health‐care professionals and patients/public difficult, there has been a growing demand for online patient education material 14 . Patient education via YouTube is considered to be a common practice.…”