Most American Academy of Orthopaedic Surgeons’ Online Patient Education Material Exceeds Average Patient Reading Level

Abstract

Background Advancing health literacy has the potential to improve patient outcomes. The American Academy of Orthopaedic Surgeons' (AAOS) online patient education materials serve as a tool to improve health literacy for orthopaedic patients; however, it is unknown whether the materials currently meet the National Institutes of Health/ American Medical Association's recommended sixth grade readability guidelines for health information or the mean US adult reading level of eighth grade. Questions/purposes The purposes of this study were (1) to evaluate the mean grade level readability of online AAOS patient education materials; and (2) to determine what proportion of the online materials exceeded recommended (sixth grade) and mean US (eighth grade) reading level.Methods Reading grade levels for 99.6% (260 of 261) of the online patient education entries from the AAOS were analyzed using the Flesch-Kincaid formula built into Microsoft Word software. Results Mean grade level readability of the AAOS patient education materials was 9.2 (SD ± 1.6). Two hundred fifty-one of the 260 articles (97%) had a readability score above the sixth grade level. The readability of the AAOS articles exceeded the sixth grade level by an average of 3.2 grade levels. Of the 260 articles, 210 (81%) had a readability score above the eighth grade level, which is the average reading level of US adults. Conclusions Most of the online patient education materials from the AAOS had readability levels that are far too advanced for many patients to comprehend. Efforts to adjust the readability of online education materials to the needs of the audience may improve the health literacy of orthopaedic patients. Patient education materials can be made more comprehensible through use of simpler terms, shorter sentences, and the addition of pictures. More broadly, all health websites, not just those of the AAOS, should aspire to be comprehensible to the typical reader.

Editor's Spotlight/Take 5: Readability of Orthopaedic Patient-reported Outcome Measures: Is There a Fundamental Failure to Communicate?

“…The problem of hard-tounderstand content is, in fact, even more widespread than that. A total of 97% of the reading material on the American Academy of Orthopaedic Surgeons website was above the 6th grade reading level in one study [4]. Similar findings have been reported across disciplines and in other kinds of patient-education materials [3, 5-7, 10, 13].…”

“…They compared their results against both the Centers for Medicare & Medicaid Service's (CMS) and NIH's recommendations for reading grade levels. Given the reporting to the contrary [2,4], Dr. Ponce's group offer a surprising finding-that the vast majority of PROMs are, in fact, written at an acceptable grade level. However, there are still a small number of PROMs that are beyond the grasp of most patient's reading comprehension.…”

“…Following the explanation of our choice, we present ''Take Five,'' in which the editor goes behind the discovery with a one-on-one interview with an author of the article featured in ''Editor's Spotlight. ' [2,4] showing that orthopaedic patient material often exceeds the reading level of those patients. Why do you think your findings are so different?…”

Editor's Spotlight/Take 5: Patients With Limited Health Literacy Ask Fewer Questions During Office Visits With Hand Surgeons

“…This is similar to what one past Academy president offered in the context of a communications skills program [14]. Yet it seems to me that most providers probably think they already do this, and we also know that even the Academy has trouble delivering materials at a level patients understand [4]. Put in this context, how can we know when we're really ''doing it right''?…”

Are Patient-reported Outcome Measures in Orthopaedics Easily Read by Patients?

“…Although we know that most online patient education material from the American Academy of Orthopaedic Surgeons is incomprehensible for the average patient, it is unclear whether PROMs are [32]. If we are to continue drawing research conclusions and base future healthcare strategies on PROMs, it is pertinent to identify if patients can comprehend these questionnaires.…”