Assessing the Readability and Quality of Web-Based Resources on Exercise Stress Testing: A Cross-Sectional Readability and Quality Analysis (Preprint)

Abstract

BACKGROUND Health literacy is a crucial determinant and independent predictor of patient outcomes. To enhance patient understanding across diverse populations, the American Medical Association (AMA) advises that health information be written at a 6th-grade reading level. The exercise stress test is a widely used diagnostic tool, frequently ordered in outpatient settings to assess cardiovascular health. Although numerous studies have evaluated the readability of various cardiovascular health topics, there is a noticeable gap in the literature regarding the readability and quality of health information pertaining to exercise stress tests. OBJECTIVE The goal of this study was to evaluate the readability and quality of publicly available information regarding exercise stress tests on the Google and Bing search engines. METHODS Four search terms were entered into both the Google and Bing search engines, and websites containing information pertaining to exercise stress tests were assessed for their readability and quality. Web pages were classified as “academic” or “non-academic” based on whether the publishing website was affiliated with an academic institution. Readability was assessed using the Flesch-Kincade Grade Level (FKGL) and Flesch Reading Ease (FRE) scores, while quality was assessed using the DISCERN criteria. The resulting scores were calculated, and independent sample t-tests were performed to compare the individual scores of the academic and non-academic sources. RESULTS This study assessed 18 websites in total, and the mean grade level (mean ± SD, 8.36 ± 1.32) and reading ease (62.31 ± 6.65) exceeded the current AMA recommendations. Furthermore, the quality of the web pages was determined to be “fair” as per the DISCERN grading criteria. Academic sources had greater FKGL and FRE scores that were additionally found to be statistically significant in comparison to the scores of the non-academic sources with p-values of 0.032, and 0.006, respectively. CONCLUSIONS Websites containing information pertaining to exercise stress tests are written at a grade level that exceeds current recommendations, with academic sources being significantly more difficult to read when compared to non-academic sources. The quality of the web pages evaluated in this study was deemed to be fair. However, quality can be improved by including references to sources as well as additional resources for readers seeking more information. Improving readability can be challenging as medical terminology is often intrinsically complex. While substituting or omitting these terms may improve readability, it risks delivering incomplete or oversimplified information to patients.