Osteosarcoma Health Literacy: A Quantitative Assessment of the Understandability and Readability of Web-based Patient Education Material (Preprint)

Abstract

BACKGROUND Patients often turn to online resources following the diagnosis of osteosarcoma. To be fully understood by the average American adult, the American Medical Association (AMA) and National Institutes of Health (NIH) recommend online health information to be written at a 6th grade level or lower. Previous analyses of osteosarcoma resources have not measured whether text is written such that readers can process key information (understandability) or identify available actions to take (actionability). The Patient Education Materials Assessment Tool (PEMAT) is a validated measurement of understandability and actionability. OBJECTIVE The purpose of this study was to evaluate osteosarcoma online resources utilizing measures of readability, understandability, and actionability. METHODS Using the search term “osteosarcoma”, two independent searches (Google.com) were performed and the top 50 results were collected. Websites were included if directed at providing patient education on osteosarcoma. Readability was quantified using validated algorithms: Flesh-Kincaid Grade Ease (FKGE), Flesch-Kincaid Grade-Level (FKGL). A higher FKGE score represents the material is easier to read. All other readability scores represent the US school grade level. Two independent PEMAT assessments were performed with independent scores assigned for both understandability and actionability. A PEMAT score of 70% or below is considered poorly understandable and/or poorly actionable. Statistical significance was defined as p≤0.05. RESULTS Of 53 unique websites, 37 websites (69.8%) met inclusion criteria. The mean FKGE was 40.8±13.6. The mean FKGL grade level was 12.0±2.4. No (0%) websites scored within the acceptable NIH/AHA recommended reading level. Overall, only 10.8% (n=4) and 2.7% (n=1) met the acceptable understandability and actionability threshold. CONCLUSIONS Overall, osteosarcoma online patient educational materials scored poorly with respect to readability, understandability, and actionability. None of the online resources scored at the recommended reading level. Only four met the appropriate score to considered understandable by the general public. Future efforts should be made to improve online resources in order to support patient understanding.