Readability assessment of patient educational materials for shoulder arthroplasty from top academic orthopedic institutions

Abstract

Background Previous studies have demonstrated that online patient educational materials are written at reading levels too advanced for the average patient. The average American reads at the eighth-grade reading level. To date, the readability of online educational material of academic centers for shoulder arthroplasty has not been analyzed. Methods Online patient educational materials from the top 25 orthopedic institutions, as ranked by U.S. News & World Report, were assessed utilizing the following readability assessments: Flesch-Kincaid (FK), Flesch Reading Ease, Gunning Fog Index, Coleman-Liau Index, Simple Measure of the Gobbledygook Index, Automated Readability Index, FORCAST, and the New Dale and Chall Readability. All of these scores, with the exception of the Flesch Reading Ease, provide an output indicating reading difficulty based on grade level. Correlations between academic institutional ranking and FK scores were evaluated using a Spearman regression. Lastly, additional factors including geographical location, private versus public institution, and use of concomitant multi-media modalities that may impact institutional readability scores (as determined by FK) were evaluated. Results Only 16.0% of the top 25 institutions included online material at or below the eighth-grade reading level. Moreover, half of the online resources evaluated (those with FK score ≥9.3) were not at a suitable reading level for more than two-thirds of the general United States population (∼70%). Overall, the composite mean scores were 9.5 ± 2.1 for FK, 52.8 ± 9. for 4 Flesch Reading Ease, 12.2 ± 2.4 for Gunning Fog, 11.6 ± 1.8 for Coleman-Liau, 12.3 ± 1.7 for Simple Measure of the Gobbledygook Index, 9.6 ± 2.6 for Automated Readability, 11.1 ± 0.6 for FORCAST, and 5.9 ± 0.6 for New Dale and Chall. There was no correlation between institutional ranking and FK scores (ρ = −0.15; P = .946). Geographical location, private versus public institution, and use of concomitant multi-media modalities were not significantly associated with readability. Conclusion Shoulder arthroplasty online patient educational material at top-ranked orthopedic institutions have poor readability and are likely not suitable for the majority of patients in the United States.

Most patient education materials on shoulder conditions from the American Academy of Orthopaedic Surgeons exceed recommended readability levels

“…Overall, the mean FK score was 9.5 and only 16% of institutions included online material at or below the eighth grade level. 24 The findings from these studies suggest that the readability of patient education materials differs by the source and topic of information. Therefore, while our study implies that the shoulder articles from the AAOS website may be more inclusive to patients [lower average FK score] when compared to the information provided by American Shoulder and Elbow Surgeons brochures and top academic centers, these comparisons should not be made given the differences in topic number and distribution.…”

“…FK score has been used to reflect the overall readability in multiple studies. 1 , 2 , 20 , 24 Even so, the validity of reading scores is accomplished with the inclusion of multiple algorithms. 1 In our study, the readability of each article was higher than recommended by Readability Pro across each algorithm.…”

“…The articles were modified to remove any images, figures, citations, references, copyright notices, disclaimers, or hyperlinks and converted to plain text in Microsoft Word as previously described. 1 , 22 , 24 Analysis of the reformatted articles was performed using Readable Pro and the following readability scores were obtained ( Table I ): Flesch Reading Ease Flesch Kincaid Grade Level Gunning Fog Score Coleman Liau Index SMOG Index Automated Readability Index Dale-Chall Readability Score FORCAST Grade Level Fry Grade Level …”

Readability assessment of patient educational materials for pediatric spinal deformity from top academic orthopedic institutions

“…However, the use of medical terminology and complex writing styles may limit comprehension of online educational materials amongst patients and parents of different educational backgrounds. Recent recommendations from the National Institutes of Health and the National Academy of Medicine recommend that patient educational materials should be written at the sixth-grade reading level or below [1,2,[8][9][10][11][12].…”

“…The formulas for these scores are found in Table 1 . Investigators have studied the readability of patient education materials across various orthopedic subspecialties including adult reconstruction [ 13 ], foot and ankle [ 14 ], shoulder and elbow [ 11 , 12 ], spine [ 3 ], hand [ 4 ], arthroscopy [ 17 ], sports medicine [ 10 , 18 ], pediatric orthopedics, and the American Academy of Orthopedics website itself [ 1 ]. However, to our knowledge, no study has evaluated the readability of online patient education materials regarding pediatric spinal deformity.…”