Readability assessment of American Shoulder and Elbow Surgeons patient brochures with suggestions for improvement

Schumaier, Adam P.; Kakazu, Rafael; Minoughan, Chelsea E.; Grawe, Brian M.

doi:10.1016/j.jses.2018.02.003

Cited by 14 publications

(22 citation statements)

References 22 publications

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“…Importantly, academic orthopedic centers are one of the primary contributors to accurate online information for patients. Expectedly, previous studies have analyzed the readability of educational resources from leading orthopedic organizations 4 , 5 , 11 , 13 , 16 , 20 , 24 and orthopedic academic centers for various pathologies. 15 , 19 However, to the authors’ knowledge, no previous study has investigated the readability of educational materials of academic centers for shoulder arthroplasty.…”

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confidence: 99%

Readability assessment of patient educational materials for shoulder arthroplasty from top academic orthopedic institutions

Stelzer¹,

Wellington²,

Trudeau³

et al. 2022

JSES International

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Background Previous studies have demonstrated that online patient educational materials are written at reading levels too advanced for the average patient. The average American reads at the eighth-grade reading level. To date, the readability of online educational material of academic centers for shoulder arthroplasty has not been analyzed. Methods Online patient educational materials from the top 25 orthopedic institutions, as ranked by U.S. News & World Report, were assessed utilizing the following readability assessments: Flesch-Kincaid (FK), Flesch Reading Ease, Gunning Fog Index, Coleman-Liau Index, Simple Measure of the Gobbledygook Index, Automated Readability Index, FORCAST, and the New Dale and Chall Readability. All of these scores, with the exception of the Flesch Reading Ease, provide an output indicating reading difficulty based on grade level. Correlations between academic institutional ranking and FK scores were evaluated using a Spearman regression. Lastly, additional factors including geographical location, private versus public institution, and use of concomitant multi-media modalities that may impact institutional readability scores (as determined by FK) were evaluated. Results Only 16.0% of the top 25 institutions included online material at or below the eighth-grade reading level. Moreover, half of the online resources evaluated (those with FK score ≥9.3) were not at a suitable reading level for more than two-thirds of the general United States population (∼70%). Overall, the composite mean scores were 9.5 ± 2.1 for FK, 52.8 ± 9. for 4 Flesch Reading Ease, 12.2 ± 2.4 for Gunning Fog, 11.6 ± 1.8 for Coleman-Liau, 12.3 ± 1.7 for Simple Measure of the Gobbledygook Index, 9.6 ± 2.6 for Automated Readability, 11.1 ± 0.6 for FORCAST, and 5.9 ± 0.6 for New Dale and Chall. There was no correlation between institutional ranking and FK scores (ρ = −0.15; P = .946). Geographical location, private versus public institution, and use of concomitant multi-media modalities were not significantly associated with readability. Conclusion Shoulder arthroplasty online patient educational material at top-ranked orthopedic institutions have poor readability and are likely not suitable for the majority of patients in the United States.

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confidence: 99%

Readability assessment of patient educational materials for shoulder arthroplasty from top academic orthopedic institutions

Stelzer¹,

Wellington²,

Trudeau³

et al. 2022

JSES International

View full text Add to dashboard Cite

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“…A 2014 study compared reading level of the AAOS handouts from 2008 with the revised patient-directed website and found that 84% of web pages remained above the eighth grade reading level ( 20 ). Multiple studies have found the reading level of content provided by professional associations to be higher than recommended by the NIH ( 9 – 12 , 21 – 24 ).…”

Section: Discussionmentioning

confidence: 99%

“…For this study, we copied the content from each handout into a Microsoft Word document and determined reading level by the Flesch-Kincaid reading level. The DISCERN score was one of the first standardized quality indexes for consumer health information and can help categorize information as excellent (63-75), good (51-62), fair (39-50), poor (27-38), and very poor (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26) (8,13). The PEMAT Understandability and Actionability tools help measure whether patients with varying levels of health literacy can process information from handouts and whether they are able to act on the information provided.…”

Section: Methodsmentioning

confidence: 99%

Misinformation in Patient Handouts About Upper Extremity Conditions

O’Connor

Kortlever

Ring

2020

Journal of Patient Experience

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This study investigated handouts regarding common upper extremity problems for inaccuracies, distracting information, and concepts that reinforce common unhelpful cognitive biases. We reviewed handouts on upper extremity conditions from 2 electronic medical records and 2 professional associations. We categorized information as inaccurate, distracting, and risk of reinforcing common unhelpful cognitive biases. Reading level, quality, and the ability of patients to process and take action was also rated. We found an average rate of inaccurate statements of 1.9 per 100 words, distracting statements of 0.73 per 100 words, and statements reinforcing common unhelpful cognitive biases of 2.1 per 100 words. Handouts from electronic medical records were rated higher quality and had higher reading grade level, but on average were constructed for better understandability. Patient handouts have a notable rate of inaccuracies, distractions, and information that may reinforce less adaptive cognitions. Greater attention is merited to making patient handouts readable, understandable, hopeful, and enabling.

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“…Using previously described methodology, multiple readability formulae were used to improve the reliability of measures, with scores averaged to form a composite readability score for individual websites (18,(21)(22)(23)(24)(25)(26)(27)(28). A cutoff of an 8th-grade or lower reading level (#8.9 grade level) was chosen to define readability.…”

Section: Readabilitymentioning

confidence: 99%

Quality, Trustworthiness, Readability, and Accuracy of Medical Information Regarding Common Pediatric Emergency Medicine-Related Complaints on the Web

Rothrock

Rothrock²,

Swetland³

et al. 2019

The Journal of Emergency Medicine

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Background: The Internet is a universal source of information for parents of children with acute complaints. Objectives: We sought to analyze information directed at parents regarding common acute pediatric complaints. Methods: Authors searched three search engines for four complaints (child + fever, vomiting, cough, stomach pain), assessing the first 20 results for each query. Readability was evaluated using: Flesch-Kincaid Grade Level, Gunning Fog, Simple Measure of Gobbledygook, and the Coleman-Liau Index. Two reviewers independently evaluated Journal of the American Medical Association (JAMA) Benchmark Criteria and National Library of Medicine (NLM) Trustworthy scores. Two physicians (emergency medicine/EM, pediatric EM) analyzed text accuracy (number correct divided by total number of facts). Disagreements were settled by a third physician. Accuracy was defined as $ 95% correct, readability as an 8th-grade reading level, high quality as at least three JAMA criteria, and trustworthiness as an NLM score $ 3. Accurate and inaccurate websites were compared using chi-squared analysis and Mann-Whitney U test. Results: Eighty-seven websites (60%) were accurate (k = 0.94). Sixty (42%) of 144 evaluable websites were readable, 38 (26%) had high-quality JAMA criteria (kappa/k = 0.68), and 44 (31%) had reliable NLM trustworthy scores (k = 0.66). Accurate websites were more frequently published by professional medical organizations (hospitals, academic societies, governments) compared with inaccurate websites (63% vs. 33%, p < 0.01). There was no association between accuracy and physician authorship, search rank, quality, trustworthiness, or readability. Conclusion: Many studied websites had inadequate accuracy, quality, trustworthiness, and readability. Measures should be taken to improve web-based information related to acute pediatric complaints.

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Readability assessment of American Shoulder and Elbow Surgeons patient brochures with suggestions for improvement

Cited by 14 publications

References 22 publications

Readability assessment of patient educational materials for shoulder arthroplasty from top academic orthopedic institutions

Readability assessment of patient educational materials for shoulder arthroplasty from top academic orthopedic institutions

Misinformation in Patient Handouts About Upper Extremity Conditions

Quality, Trustworthiness, Readability, and Accuracy of Medical Information Regarding Common Pediatric Emergency Medicine-Related Complaints on the Web

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