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

Abstract

Background: The Internet has become a popular source of health information for patients and their families. Healthcare experts recommend that the readability of online education materials be at or below a sixth grade reading level. This translates to a standardized Flesch Reading Ease Score between 81 and 90, which is equivalent to conversational English. However, previous studies have demonstrated that the readability of online education materials of various orthopedic topics is too advanced for the average patient. To date, the readability of online education materials for pediatric spinal conditions has not been analyzed. The objective of this study was to assess the readability of online educational materials of top pediatric orthopedic hospital websites for pediatric spinal conditions. Methods: Online patient education materials from the top 25 pediatric orthopedic institutions, as ranked by the U.S. News and World Report hospitals for pediatric orthopedics, were assessed utilizing multiple readability assessment metrics including Flesch–Kincaid, Flesch Reading Ease, Gunning Fog Index, and others. Correlations between academic institutional ranking, geographic location, and the use of concomitant multimedia modalities with Flesch–Kincaid scores were evaluated using a Spearman regression. Results: Only 32% (8 of 25) of top pediatric orthopedic hospitals provided online health information at or below a sixth grade reading level. The mean Flesch–Kincaid score was 9.3 ± 2.5, Flesch Reading Ease 48.3 ± 16.2, Gunning Fog Score 10.7 ± 3.0, Coleman–Liau Index 12.1 ± 2.8, Simple Measure of the Gobbledygook Index 11.7 ± 2.1, Automated Readability Index 9.0 ± 2.7, FORCAST 11.3 ± 1.2, and Dale–Chall Readability Index 6.7 ± 1.4. There was no significant correlation between institutional ranking, geographic location, or use of video material with Flesch–Kincaid scores (p = 0.1042, p = 0.7776, p = 0.3275, respectively). Conclusion: Online educational material for pediatric spinal conditions from top pediatric orthopedic institutional websites is associated with excessively complex language which may limit comprehension for the majority of the US population. Type of study/Level of evidence: Economic and Decision Analysis/level III.

A Readability Analysis of Online Spondylolisthesis and Spondylolysis Patient Resources Among Pediatric Hospital Web Pages: A US-Based Study

“…Although this change did lower the grade level of these resources, the average of the scores was still well above the recommended level of eighth grade. Michel et al 24 found similar results when examining webpages for pediatric spinal conditions. The lower readability among webpages describing spinal conditions may be because of the complexity of spinal conditions and their treatment.…”

“…The lower readability among webpages describing spinal conditions may be because of the complexity of spinal conditions and their treatment. 24,33…”

“…The lower readability among webpages describing spinal conditions may be because of the complexity of spinal conditions and their treatment. 24,33 Improving the availability and comprehensiveness of hospital web pages provides an opportunity to address limited patient health literacy and allows hospitals to be viewed more favorably by their consumers. 35 Multiple studies have demonstrated that patients often consider the information they see online, including advertisements, into their healthcare decisions.…”

“…Many studies have evaluated the online resources for a variety of medical conditions. 12,20,24,27 However, there is a paucity of literature examining the availability and readability of online patient information among pediatric hospitals specifically for spondylolisthesis and spondylolysis. 24 The objective of this study is to assess the availability and readability of online web pages related to spondylolisthesis or spondylolysis among pediatric hospitals across the United States.…”

“…12,20,24,27 However, there is a paucity of literature examining the availability and readability of online patient information among pediatric hospitals specifically for spondylolisthesis and spondylolysis. 24 The objective of this study is to assess the availability and readability of online web pages related to spondylolisthesis or spondylolysis among pediatric hospitals across the United States. This study aims to determine whether the available pages are written below the recommended sixth grade reading level.…”