The Complexity of Online Patient Education Materials About Interventional Neuroradiology Procedures Published by Major Academic Institutions

Abstract

Health literacy is an independent predictor of population health status and is directly related to the readability of available patient education material. The National Institutes of Health (NIH) and the American Medical Association have recommended that patient education materials (PEMs) be written between a fourth-and a sixth-grade education level. The authors assessed the readability of online PEMs about neurointerventional procedures that have been published by several academic institutions across the US. MethodsOnline PEMs regarding five common neurointerventional procedures, including mechanical thrombectomy for large vessel occlusion, cerebral diagnostic angiography, carotid artery stenting, endovascular aneurysm embolization, and epidural steroid injection collected from the websites of 20 top institutions in Neurology and Neurosurgery. The materials were assessed via five readability scales and then were statistically analyzed and compared to non-institutional education websites (Wikipedia.com and WebMD.com). ResultsNone of the PEMs were written at or below the NIH's recommended 6th-grade reading level. The average educational level required to comprehend the texts across all institutions, as assessed by the readability scales, was 10-11 th grade level. Some materials required a college-level education or higher. Material from non-institutional websites had significantly lower readability scores compared to the 20 institutions. ConclusionsCurrent PEMs related to neurointerventional procedures are not written at or below the NIH's recommended fourth-to sixth-grade education level. Given the complexity of those procedures, significant attention should be pointed toward an improvement in the available online materials.

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“…The Flesh-Kincaid GradeLevel (FKGL) formula is a commonly used and validated tool that evaluates the reading grade level of patient education materials [25] , [26] . The FKGL score was determined using word length, average word syllable count per word and sentence length, and average number of words per sentence; (0.39 × number of easy words) + (11.8 × average number of words per sentence) − 15.59 [27] , [28] . The FKGL score can also be determined by performing a readability analysis in Microsoft Office Word.…”

“…The Simple Measure of Gobbledygook (SMOG) Index evaluates the number of polysyllabic words and total number of sentences. The SMOG formula is 1.043 (√ total number of polysyllabic words × (30 ÷ total number of sentences) + 3.1291 [28] . The Coleman Liau Index (CLI) uses the characters per word and average number words per sentence to assess readability.…”

“…The Coleman Liau Index (CLI) uses the characters per word and average number words per sentence to assess readability. The CLI formula is [(0.0588 × average number of letters per 100 words) − (0.296 × average number of sentences per 100 words)] − 15.8 [28] . The Gunning Fog Index (GFI) measures the difficulty of a material by the average sentence length and number of complex words (words with more than 3 syllables).…”

“…The Gunning Fog Index (GFI) measures the difficulty of a material by the average sentence length and number of complex words (words with more than 3 syllables). The GFI formula is 0.4 × [(average number of words per sentence ÷ average number of sentences) + 100 (number of characters ÷ average number of words per sentence)] [28] . The Automated Readability Index (ARI) provides a score through average number of characters per word and average number of words per sentence.…”

“…The Automated Readability Index (ARI) provides a score through average number of characters per word and average number of words per sentence. The ARI formula is 4.71 × (number of characters ÷ average number of words per sentence) + 0.5 (average number of words per sentence ÷ average number of sentences) – 21.43 [28] . Five readability calculators; Readable, Microsoft, Readability Formula, WebFX and Online Utility, were utilized to determine the readability scores.…”