Assessment of the Readability of Online Patient Education Material from Major Geriatric Associations

Abstract

BACKGROUND/OBJECTIVES An increasing number of patients are using the internet to supplement information provided by medical professionals. Online geriatric patient education materials (PEMs) should be written at or below a 6th grade reading level (GRL) that takes into account barriers unique to the geriatric population. The objectives of the study are to assess PEMs of geriatric associations' websites and determine whether they are above the GRL recommended by the Centers for Disease Control and National Institutes of Health. DESIGN Descriptive and correlational methodology. PEMs from 10 major geriatric associations were assessed for their GRL using 10 scales. Eight of the scales provide a numerical GRL while two of the scales provide a visual representation of the GRLs. Analysis was conducted using Readability Studio 2019.3. SETTING Analysis was conducted February 2020. PARTICIPANTS Identified 10 geriatric associations and 884 PEMs. MEASUREMENTS GRLs were measured by 10 validated readability indices: the Degrees of Reading Power and Grade Equivalent test, Flesch–Kincaid grade level, Simple Measure of Gobbledygook test, Coleman‐Liau Index, Gunning Fog Index, New Fog Count, New Dale‐Chall readability formula, Ford, Caylor, Sticht scale, Raygor readability estimate graph, and Fry readability graph. RESULTS The mean of all PEMs using the numerical scales was 11.1 ± 2.4. Ninety‐nine percent of PEMs are above the 6th GRL. PEMs ranged from a grade 3.0 to 19.0 reading level. Analysis of variance demonstrated a significant difference between associations (P < .0001), and multiple comparison analysis identified the National Institute on Aging as the content easiest to read (9.5 ± 1.6). CONCLUSION PEMs from geriatric association websites are written above the recommended 6th GRL. As patients increasingly look toward online supplementary health information during COVID‐19, there is an opportunity for improving PEMs to enable greater comprehension by the target population.

Health Services: A Mixed Methods Assessment of Canadian Cancer Patient Education Materials Related to the 2019 Novel Coronavirus

“…Text sections of nonmedical information such as page numbers, disclaimers, contact details, tables, images, references, website addresses, and webpage navigation were excluded from assessment. 24 The specific online locations of each province’s and national cancer association’s PEMs can be found in Supplementary Table 1.…”

Knowledge translation resources to support the use of quality of life assessment tools for the care of older adults living at home and their family caregivers

“…With respect to language, it is important for reading levels to match the audience. For example, for patients and family caregivers, a Grade 6 reading level (or below) is generally recommended [54][55][56]. In addition, different audiences are familiar with different terminology, designs, and formats.…”

Assessment of the Readability and Quality of Online Patient Education Material for Chronic Medical Conditions

“…This included the alteration of bullet points. PEMs were individually edited to create high- and low-sentence documents wherein bullet points were treated as individual sentences or a single sentence, respectively, which were then subsequently averaged for numerical indices [ 21 , 22 ]. Their readability level using the eight numerical scales can be seen in Figure 1 , generated using Prism 9 software, and the two graphical scales can be seen in Supplementary Figures S1 and S2 , generated using Readability Studio.…”

“…The graphical data in Figure 1 was reported as the arithmetic mean of each numerical scale. The average of the eight numerical readability tests for each of the disease types underwent a one-way Analysis of Variance (ANOVA) with a Tukey’s test comparing the disease types [ 21 , 22 ]. A pooled standard deviation was used to calculate the standard deviation whenever disease types were combined, such as for the difficult word analysis, in order to ensure that the number of PEMs extracted for each disease cluster was taken into consideration.…”

“…Previous studies have shown that PEMs are written at a grade level above what most American adults would be able to understand [ 15 , 16 , 17 , 18 , 19 , 20 , 21 ]. Similarly, two studies assessing online patient health information from geriatric associations identified that their average grade reading level was above the recommended 6th GRL [ 22 , 23 ]. Our study aims to examine PEMs from 55 associations that provide information on specific chronic health conditions common to older adults, based on 10 validated readability scales with disease cluster specific recommendations [ 24 ].…”