Web-Based Health Information Following the Renewal of the Cervical Screening Program in Australia: Evaluation of Readability, Understandability, and Credibility

Abstract

Background Three main changes were implemented in the Australian National Cervical Screening Program (NCSP) in December 2017: an increase in the recommended age to start screening, extended screening intervals, and change from the Papanicolaou (Pap) test to primary human papillomavirus screening (cervical screening test). The internet is a readily accessible source of information to explain the reasons for these changes to the public. It is important that web-based health information about changes to national screening programs is accessible and understandable for the general population. Objective This study aimed to evaluate Australian web-based resources that provide information about the changes to the cervical screening program. Methods The term cervical screening was searched in 3 search engines. The first 10 relevant results across the first 3 pages of each search engine were selected. Overall, 2 authors independently evaluated each website for readability (Flesch Reading Ease [FRE], Flesch-Kincaid Grade Level, and Simple Measure of Gobbledygook [SMOG] index), quality of information (Patient Education Materials Assessment Tool [PEMAT] for printable materials), credibility (Journal of the American Medical Association [JAMA] benchmark criteria and presence of Health on the Net Foundation code of conduct [HONcode] certification), website design, and usability with 5 simulation questions to assess the relevance of information. A descriptive analysis was conducted for the readability measures, PEMAT, and the JAMA benchmark criteria. Results Of the 49 websites identified in the search, 15 were eligible for inclusion. The consumer-focused websites were classed as fairly difficult to read (mean FRE score 51.8, SD 13.3). The highest FRE score (easiest to read) was 70.4 (Cancer Council Australia Cervical Screening Consumer Site), and the lowest FRE score (most difficult to read) was 33.0 (NCSP Clinical Guidelines). A total of 9 consumer-focused websites and 4 health care provider–focused websites met the recommended threshold (sixth to eighth grade; SMOG index) for readability. The mean PEMAT understandability scores were 87.7% (SD 6.0%) for consumer-focused websites and 64.9% (SD 13.8%) for health care provider–focused websites. The mean actionability scores were 58.1% (SD 19.1%) for consumer-focused websites and 36.7% (SD 11.0%) for health care provider–focused websites. Moreover, 9 consumer-focused and 3 health care provider–focused websites scored above 70% for understandability, and 2 consumer-focused websites had an actionability score above 70%. A total of 3 websites met all 4 of the JAMA benchmark criteria, and 2 websites displayed the HONcode. Conclusions It is important for women to have access to information that is at an appropriate reading level to better understand the implications of the changes to the cervical screening program. These findings can help health care providers direct their patients toward websites that provide information on cervical screening that is written at accessible reading levels and has high understandability.

Getting the timing right: Women’s views on the best time to announce changes to cancer screening policy recommendations

“…Although not until close to implementation, the Australian government focused their efforts on digital advertising through social media and sent information, posters and brochures to general practice. Many more resources are now available to women in Australia, with the most accessible website hosted by the Cancer Council ( Mac et al, 2020 , Cancer Council Australia, 2020 ).…”

Predicting Writing Styles of Web-Based Materials for Children’s Health Education Using the Selection of Semantic Features: Machine Learning Approach

“…Key assessment criteria of PEMAT include health information understandability, relevance, and actionability [8,9]. Much of the current research has focused on exploring these assessment dimensions separately using long-standing readability tools [10][11][12][13] or machine learning algorithms of natural language features [14][15][16] using features such as general medical vocabularies, consumer medical vocabulary, natural language features such as a part of speech features [17][18][19], and other metadata [20]. Furthermore, many of these data-intensive and data-driven studies did not consider insights from research fields directly relevant to health educational resource development and evaluation.…”

Pap Smear Readability on Google: An Analysis of Online Articles Regarding One of the Most Routine Medical Screening Tests

“…As few studies of this nature have been performed in the field of obstetrics and gynecology (OB/GYN), the effect of this work is expected to be particularly insightful to both providers and patients. [17][18][19] Expecting consistency with prior readability studies, the hypothesis of this work is that the grade-level readability of online material on Pap smears is written at a grade level greater than what is recommended by the AMA. [20][21][22][23]…”

“…[20][21][22][23] There appears to be a paucity of research on similar topics in OB/GYN, however. [17][18][19] When evaluating the first seven URLs, the average grade-level readability is more than two grade levels above what is recommended. This could imply that a number of patients are not finding readable information online about a topic that is of significant importance to women worldwide.…”