An Evaluation of Readability of Information on the Internet Regarding Total Ankle Replacement

Abstract

Background:Health literacy is defined as the ability to understand basic health information with such competence as to be able to use this information to enhance health. Lower health literacy is associated with increased post-operative complications, reduced satisfaction and compliance. To ensure accessibility and comprehension by the general public, many international health organisations suggest that health literature has a reading grade level equivalent to the American sixth grade. However, previous studies show that this rarely occurs.Total ankle replacement (TAR) technology has rapidly progressed with new prosthesis showing increasingly improving outcomes. However, TAR remains a complex procedure which may be challenging to explain to the patient. Thus, many patients will turn to the internet for more information and as a ‘quasi-second opinion’. If the health education materials provided on the internet is not accessible to patients, it can leave them overwhelmed and confused. The aim of the study is to evaluate the readability of information on the internet with regards to Total Ankle ReplacementMethods: 110 websites from the two main search engines (Google and Bing) were assessed using the terms ‘total ankle replacement’ and ‘total ankle arthroplasty’. Once duplicates had been removed and exclusion criteria were applied, 36 unique websites were categorised and underwent analysis using readability software (WEB FX readability tool). The websites were assessed for readability using the Fleisch Reading Ease Score (FRES) and the Reading Grade Level (RGL). A score of greater than 65 for FRES and an RGL of six or less were considered acceptable. Differential and Inferential statistical analysis was performed using SPSS.Results:The mean FRES score was 54.95 (SD: ± 13.2); this was significantly below the recognised acceptable standard score of 65 (P<.0001). An ANOVA conducted showed significant difference between FRES scores based on categories (P=.041) with post-hoc testing showing that the difference between commercial and non-physician scores was the most significant (P=.016; CI:3.84-61.66).The mean RGL was 8.31 (SD: ± 1.95). One-way t-tests showed that these scores were significantly higher than the acceptable standard (P<.0001; CI: 1.64-2.97). ANOVA testing showed a significant difference based on category (P=.028) with post hoc testing showing significant difference between non physician and commercial scores (P=.012, CI: 0.71-9.33).Conclusion:The majority of the websites pertaining to total ankle replacement are significantly beyond the comprehension levels of the general public. This will affect the patient’s ability to discern the complexities and potential complications of total ankle arthroplasty, with serious ramifications for consent as well as post-operative rehabilitation and compliance.Level of Evidence: not applicable

A Comprehensive Evaluation of the Readability of Online Healthcare Materials Regarding Distal Radius Fractures

“…Instead, these patients and their families will peruse the internet as a 'quasi-second opinion' in an attempt 1 2 to gain more understanding of their injury and treatment [5]. Considering that internet penetrance is due to reach approximately 97% by 2023, and that research shows that 90% of patients believe the internet to be a reliable source of health care education and information, it can therefore be concluded that it is of the utmost important for the information on the internet to be as inclusive and accessible if we are, as physicians and health advocates, to ensure adequate health literacy [3][4][5][6][7]. Previous research in this area has shown that this is often not the case, orthopaedic related information in particular presented on the internet has been shown to vary widely in terms of accuracy, quality and readability levels.…”

“…Health literacy is defined as the comprehension of basic health information to a level of competence that allows the patient to use the information provided to make decisions that improve their health [8]. Previous studies in this field have comprehensively shown that lower levels of health literacy are keenly associated with increased post-operative complications and reduced rehabilitation compliance [6,7,[9][10][11][12]. Patients with poorer health literacy are also more likely to re-present to the hospital, have increased inpatient stay lengths, increased postoperative morbidity and mortality and lower post operative satisfaction [6,7,[9][10][11][12].…”

“…Previous studies in this field have comprehensively shown that lower levels of health literacy are keenly associated with increased post-operative complications and reduced rehabilitation compliance [6,7,[9][10][11][12]. Patients with poorer health literacy are also more likely to re-present to the hospital, have increased inpatient stay lengths, increased postoperative morbidity and mortality and lower post operative satisfaction [6,7,[9][10][11][12]. All of these negative associated outcomes result in increased healthcare costs [13][14][15].…”

“…Previous health literacy guidelines have been published by the United States Departments of Health and Human Services (USDHSS) and by the National Institute of Health (NIH) [6,7,[15][16]. According to these institutions, over 88% of Americans are unable to fully understand the information provided to them regarding their health [6,7].…”

“…Previous health literacy guidelines have been published by the United States Departments of Health and Human Services (USDHSS) and by the National Institute of Health (NIH) [6,7,[15][16]. According to these institutions, over 88% of Americans are unable to fully understand the information provided to them regarding their health [6,7]. In a bid to combat the negative outcomes and high costs that may be associated with this health 'illiteracy', the USDHSS recommends that all patient education materials be written at a reading grade level (RGL) of no higher than the sixth grade [6,7,15].…”