Evaluation of Web-Based Osteoporosis Educational Materials

Background Patient-reported outcome measures (PROMs) are commonly used by healthcare providers as means of assessing health-related quality of life and function at any given time. The complexity of PROMs can differ and when combined with varying degrees of adult literacy, error can be introduced if patients fail to understand questions. With an average adult literacy level of 11-year-old students in the United Kingdom, it is unclear to what degree PROMs can be read and understood by most patients (readability); to our knowledge, this has not been evaluated. Questions/purposes We wished to determine the readability of commonly used PROMs in orthopaedic surgery, as assessed by a validated tool that measures the complexity of the language in these surveys. MethodsWe performed a MEDLINE search to identify the most-commonly reported PROMs in orthopaedic research. One hundred twenty-one PROMs were identified and reviewed by 19 attending orthopaedic surgeons at our institution. Fifty-nine were selected as the most commonly used in our department. Of these, 52 (78%) were disease specific and included: 12 (20%) knee, 10 (17%) shoulder, seven (12%) spine, six (10%) hip, five (8%) foot and ankle, four (7%) elbow, three (5%) pelvis, three (5%) hand and wrist, and two (3%) lower limb. The remaining seven (12%) PROMs were general health questionnaires. The Flesch Reading Ease Score is a validated readability tool measuring average sentence length and syllables per word. It is expressed on a scale from 0 to 100 with higher scores indicating easier reading. We extracted the text from each PROM and inserted it in the same online Flesch Reading Ease Score calculator to generate a score. Results The mean readability score was 55 (range, 0-93), corresponding to text best understood by 16-to 18-year-old

Section: Discussionsupporting

confidence: 91%

Are Patient-reported Outcome Measures in Orthopaedics Easily Read by Patients?

El-Daly

Ibraheim

Rajakulendran

et al. 2016

“…According to the National Assessment of Adult Literacy [45], the mean reading level for adults in the United States is of an eighth grade level [21,22,43,51]. Moreover, even patients with stronger literacy skills prefer lower grade level online content in simpler formats [19,56]. Taken together, the AMA/NIH recommend that patient education materials not exceed a sixth grade reading level [18,22,36,59,60].…”

Section: Discussionmentioning

confidence: 99%

“…Of the adults with ''below basic health literacy,'' 20% get their health information online [33]. Consequently, most studies assess online material readability compared with mean adult reading skill level [12,14,19,25,26,34,56]. Because www.orthoinfo.org is publically accessible, the reading level of these materials should match the reading skills of any potential orthopaedic patient or the general population.…”

Section: Discussionmentioning

confidence: 99%

Most American Academy of Orthopaedic Surgeons’ Online Patient Education Material Exceeds Average Patient Reading Level

Eltorai

Sharma

Wang

et al. 2015

109

Background Advancing health literacy has the potential to improve patient outcomes. The American Academy of Orthopaedic Surgeons' (AAOS) online patient education materials serve as a tool to improve health literacy for orthopaedic patients; however, it is unknown whether the materials currently meet the National Institutes of Health/ American Medical Association's recommended sixth grade readability guidelines for health information or the mean US adult reading level of eighth grade. Questions/purposes The purposes of this study were (1) to evaluate the mean grade level readability of online AAOS patient education materials; and (2) to determine what proportion of the online materials exceeded recommended (sixth grade) and mean US (eighth grade) reading level.Methods Reading grade levels for 99.6% (260 of 261) of the online patient education entries from the AAOS were analyzed using the Flesch-Kincaid formula built into Microsoft Word software. Results Mean grade level readability of the AAOS patient education materials was 9.2 (SD ± 1.6). Two hundred fifty-one of the 260 articles (97%) had a readability score above the sixth grade level. The readability of the AAOS articles exceeded the sixth grade level by an average of 3.2 grade levels. Of the 260 articles, 210 (81%) had a readability score above the eighth grade level, which is the average reading level of US adults. Conclusions Most of the online patient education materials from the AAOS had readability levels that are far too advanced for many patients to comprehend. Efforts to adjust the readability of online education materials to the needs of the audience may improve the health literacy of orthopaedic patients. Patient education materials can be made more comprehensible through use of simpler terms, shorter sentences, and the addition of pictures. More broadly, all health websites, not just those of the AAOS, should aspire to be comprehensible to the typical reader.

“…In addition to illustrations, factors such as font size, use of color, content, and vocabulary used in the text can also influence comprehension. The Suitability Assessment of Materials (SAM) is a tool that can be used to assess the suitability of print materials including assessment of illustrations, video and audio materials [7,18,23,49]. Various factors are evaluated including content, literacy demand, graphics, layout, typography, learning stimulation, motivation and cultural appropriateness.…”

Section: How Do We Get There? Assessment Of Readabilitymentioning

confidence: 99%

“…Various factors are evaluated including content, literacy demand, graphics, layout, typography, learning stimulation, motivation and cultural appropriateness. However, SAM is relatively time consuming, inherently subjective and has not been validated as extensively as some of the other readability formulas [18,49].…”

Section: How Do We Get There? Assessment Of Readabilitymentioning

confidence: 99%

Assessing Readability of Patient Education Materials: Current Role in Orthopaedics

Badarudeen

Sabharwal²

2010

453

433

Background Health literacy is the single best predictor of an individual's health status. It is important to customize health-related education material to the individual patient's level of reading skills. Readability of a given text is the objective measurement of the reading skills one should possess to understand the written material. Questions/purposes In this article, some of the commonly used readability assessment tools are discussed and guidelines to improve the comprehension of patient education handouts are provided. Where are we now? Several healthcare organizations have recommended the readability of patient education materials be no higher than sixth-to eighth-grade level. However, most of the patient education materials currently available on major orthopaedic Web sites are written at a reading level that may be too advanced for comprehension by a substantial proportion of the population. Where do we need to go? There are several readily available and validated tools for assessing the readability of written materials. While use of audiovisual aids such as video clips, line drawings, models, and charts can enhance the comprehension of a health-related topic, standard readability tools cannot construe such enhancements. How do we get there? Given the variability in the capacity to comprehend health-related materials among individuals seeking orthopaedic care, stratifying the contents of patient education materials at different levels of complexity will likely improve health literacy and enhance patient-centered communication.