An analysis of state health department COVID-19 information for the public (Preprint)

Abstract

BACKGROUND In response to the current COVID-19 crisis, public health departments across the U.S. have created, distributed, and shared COVID-19 health information. The extent to which information is understandable and actionable can be examined by use of validated health literacy and readability tools. Health information must be actionable, simple, and straightforward, particularly for health messages in times of urgency or during a health crisis. OBJECTIVE This study aimed (1) to use three validated health literacy tools to assess the understandability, actionability, clarity, and readability of COVID-19 health information created for the public by U.S. state public health departments; (2) to examine the correlations between understandability, actionability, clarity, readability, and material types; (3) to propose potential strategies to improve public health messaging. METHODS Based on CDC statistics on June 30, 2020, we identified the top 10 U.S. states with the highest number of COVID-19 cases. We visited the 10 state public health department websites and selected materials related to COVID-19 prevention according to a pre-defined eligibility criteria. Two raters independently assessed the materials by Patient Education and Materials Assessment Tool (PEMAT) and Clear Communication Index (Index). One rater generated the Flesch-Kincaid Grade Level (FKGL) score. Statistical analyses included (1) interrater reliability (IRR) by Cohen’s kappa; (2) the mean, median, standard deviation, range, minimum, maximum, and frequency scores associated with PEMAT, Index, and FKGL; (3) statistical significance of the correlation between PEMAT, Index, FKGL, and Material Type. RESULTS Of 42 materials in this study, (1) inter-rater reliability was 0.94. (2) The mean PEMAT (n=42) understandability was 88.67% (SD±17.69%), with a media of 94% and a range between 21% and 100%; the mean of PEMAT actionability was 88.48% (SD±14.3%), with a media of 100% and a range between 40% and 100%; the mean Index scores was 78.32 (SD±13.03), with a media of 78.35 and a range between 50 and 100. The mean of FKGL of the materials (n=34) was 7.11 (SD±2.60), with a media of 7.3 and a range between 1.7 and 12.5. (3) Correlations were significant (P<0.01) and positive between PEMAT understandability and actionability, PEMAT understandability and Index scores, PEMAT actionability and Index scores, PEMAT understandability and Material Type, PEMAT actionability and Material type. Correlations were significant (P<0.01) and negative between PEMAT understandability and FKGL scores, PEMAT actionability and FKGL scores, Index and FKGL scores, and FKGL and Material Types. No correlation was detected between Index scores and Material types (P>0.05). CONCLUSIONS COVID-19 health information provided by states for the public were easy to understand and act upon but could be improved in terms of readability and clear communication. The positive correlation identified between material types and PEMAT understandability/PEMAT actionability/Index scores respectively led to our recommendation on using more infographics and video format for public health messaging. CLINICALTRIAL N/A