Assessing the Readability of Online Patient Education Materials in Obstetrics and Gynecology Using Traditional Measures: Comparative Analysis and Limitations (Preprint)

Abstract

BACKGROUND Patient education materials (PEMs) can be vital sources of information for the general population. However, despite American Medical Association (AMA) and National Institute of Health (NIH) recommendations to make PEMs easier to read for patients with low health literacy, they often do not adhere to these recommendations. The readability of online PEMs in the Obstetrics and Gynecology (OB/GYN) field, in particular, has not been thoroughly investigated. OBJECTIVE The study sampled online OB/GYN PEMs and aimed to examine agreeability across traditional readability measures (RMs), adherence of online PEMs to AMA and NIH recommendations, and whether readability level of online PEMs varied by publication source and medical topic. METHODS A total of 1,576 online OB/GYN PEMs were collected via three major search engines. Ninety-three were excluded due to shorter content (less than 100 words), yielding 1,483 PEMs for analysis. Each PEM was scored by four traditional readability measures (TRMs), including Flesch-Kincaid Grade Level (FKGL), Gunning-Fog Index (GFI), Simple Measure of Gobbledygook (SMOG), and the Dale-Chall (DCL). The PEMs were categorized based on publication source and medical topic by two research team members. The readability scores of the categories were compared statistically. RESULTS Results indicated that the four TRMs did not agree with each other, leading to the use of an averaged readability (composite) score for comparison. The composite scores across all online PEMs were not normally distributed and had a median at the 11th grade. Governmental PEMs had the lowest readability level amongst source categorization and PEMs about menstruation had the highest readability. CONCLUSIONS This study found that online OB/GYN PEMs did not meet the AMA and NIH readability recommendations and would be difficult to read and comprehend for patients with low health literacy. Both findings connected well to the literature. This study highlights the need to improve the readability of OB/GYN PEMs to help patients make informed decisions. While research has been done to create more sophisticated readability measures for medical and health documents. Once validated, these tools need to be utilized by online content creators of health education materials.