Readability Assessment of Online Ophthalmic Patient Information

Abstract

IMPORTANCE Patients increasingly use the Internet to access information related to their disease, but poor health literacy is known to impact negatively on medical outcomes. Multiple agencies have recommended that patient-oriented literature be written at a fourth-to sixth-grade (9-12 years of age) reading level to assist understanding. The readability of online patient-oriented materials related to ophthalmic diagnoses is not yet known. OBJECTIVE To assess the readability of online literature specifically for a range of ophthalmic conditions. DESIGN AND SETTING Body text of the top 10 patient-oriented websites for 16 different ophthalmic diagnoses, covering the full range of ophthalmic subspecialties, was analyzed for readability, source (United Kingdom vs non-United Kingdom, not for profit vs commercial), and appropriateness for sight-impaired readers. MAIN OUTCOMES AND MEASURES Four validated readability formulas were used: Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG), and Gunning Fog Index (GFOG). Data were compared with the Mann-Whitney test (for 2 groups) and Kruskal-Wallis test (for more than 2 groups) and correlation was assessed by the Spearman r. RESULTS None of the 160 webpages had readability scores within published guidelines, with 83% assessed as being of "difficult" readability. Not-for-profit webpages were of significantly greater length than commercial webpages (P = .02) and UK-based webpages had slightly superior readability scores compared with those of non-UK webpages (P = .004 to P < .001, depending on the readability formula used). Of all webpages evaluated, only 34% included facility to adjust text size to assist visually impaired readers. CONCLUSIONS AND RELEVANCE To our knowledge, this is the first study to assess readability of patient-focused webpages specifically for a range of ophthalmic diagnoses. In keeping with previous studies in other medical conditions, we determined that readability scores were inferior to those recommended, irrespective of the measure used. Although readability is only one aspect of how well a patient-oriented webpage may be comprehended, we recommend the use of readability scoring when producing such resources in the future. Minimum readability policies and inclusion of facilities within webpages to maximize viewing potential for visually impaired readers are important to ensure that online ophthalmic patient information is accessible to the broadest audience possible.

Readability Assessment of Online Patient Education Material on Congestive Heart Failure

“…To our knowledge, this is one of few studies to use these five readability assessment tools to assess the readability of online patient education information relating specifically to congestive heart failure. The readability of web-based literature has been assessed in many healthcare arenas such as colorectal surgery, ophthalmology, dermatology, nephrology, orthopedics, psychiatry, and endocrinology [5, 22–27]. …”

“…While having a nearly unlimited knowledge base can be empowering, the unfiltered nature of the Internet can result in patient misinformation and anxiety due to medical jargon and difficult readability of the patient education materials. Guidelines set forth by American Medical Association (AMA) and the US Department of Health and Human Services (USDHHS) dictate that patient reading material should be no higher than a fifth- or sixth-grade reading level in order to be more accessible and comprehensible to the general public [5]. …”

Assessment of Online Patient Education Materials From Major Ophthalmologic Associations

“…3,28 Our analysis of PEMs from major ophthalmologic association websites is consistent with previous studies of ophthalmology-related online PEMs that have shown that readability exceeds the reading level of the average American. 9,29,30 Analyses using the FKGL, SMOG, CLI, GFI, NDC, NFC, and FORCAST numerical scales showed that PEMs were written at mean grade ranges all greater than the American Medical Association-and National Institutes of Health-recommended fourth-to sixth-grade reading level. The FRE score corresponded to a difficult level to read.…”

“…9 None of the webpages examined had a readability score within any of the recommended guidelines. There were several limitations to that study, however.…”

An Alternative to Print-Centric Design for Online Health Literacy: The Redevelopment of a Cancer Information Portal

“…Using the Flesch-Kincaid Formulae is relatively easy and inexpensive -a fact that has made it and other readability formulae quite popular among health literacy scholars. It is not uncommon to read articles with methods that that amount to copying the text from a Web site, pasting it into Microsoft Word, and running spell checker to generate readability scores (e.g., Cochrane, Gregory, and Wilson 2012;Edmunds, Barry, and Denniston 2013;Grewal and Alagartnam 2013;Rhee et al 2013;Sanghvi et al 2012). Further quantitative or qualitative analysis is rare.…”