Readability of Patient Education Materials on the American Orthopaedic Society for Sports Medicine Website

Abstract Background: The recommended readability of patient education materials by the American Medical Association (AMA) and National Institutes of Health (NIH) should be no greater than a sixth-grade reading level. However, online resources may be too complex for some patients to understand, and poor health literacy predicts inferior health–related quality of life outcomes. Aim: This study evaluated whether the American Orthopaedic Society for Sports Medicine (AOSSM) website's patient education materials meet recommended readability guidelines for medical information. We hypothesized that the readability of these online materials would have a Flesch-Kincaid formula grade above the sixth grade. Methods: All 65 patient education entries of the AOSSM website were analyzed for grade level readability using the Flesch-Kincaid formula, a widely used and validated tool to evaluate the text reading level. Results: The average (standard deviation) readability of all 65 articles was grade level 10.03 (1.44); 64 articles had a readability score above the sixth-grade level, which is the maximum level recommended by the AMA and NIH. Mean readability of the articles exceeded this level by 4.03 grade levels (95% CI, 3.7–4.4; P < 0.0001). We found post-hoc that only 7 articles had a readability score ≤ an eighth-grade level, the average reading level of US adults. Mean readability of the articles exceeded this level by 2.03 grade levels (95% CI, 1.7–2.4; P < 0.0001). Conclusion: The readability of online AOSSM patient education materials exceeds the readability level recommended by the AMA and NIH, and is above the average reading level of the majority of US adults. This online information may be of limited utility to most patients due to a lack of comprehension. Our study provides a clear example of the need to improve the readability of specific education material in order to maximize the efficacy of multimedia sources.

[1]  E. Fontham,et al.  How does health literacy affect quality of life among men with newly diagnosed clinically localized prostate cancer? , 2012, Cancer.

[2]  D. Baker,et al.  Health literacy and the risk of hospital admission , 1998, Journal of General Internal Medicine.

[3]  S. Sabharwal,et al.  Readability of Spine-Related Patient Education Materials From Subspecialty Organization and Spine Practitioner Websites , 2009, Spine.

[4]  M. Kris,et al.  In reply [13] , 2006 .

[5]  Rudolf Franz Flesch,et al.  How to write plain English : a book for lawyers and consumers , 1979 .

[6]  B. Weiss,et al.  Relationship between health care costs and very low literacy skills in a medically needy and indigent Medicaid population. , 2004, The Journal of the American Board of Family Practice.

[7]  L. G. Doak,et al.  Strategies to improve cancer education materials. , 1996, Oncology nursing forum.

[8]  T. Davis,et al.  Patient Reading Ability: An Overlooked Problem in Health Care , 1991, Southern medical journal.

[9]  C. Bennett,et al.  Relation between literacy, race, and stage of presentation among low-income patients with prostate cancer. , 1998, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[10]  Sanjeev Sabharwal,et al.  Readability of online patient education materials on adult reconstruction Web sites. , 2012, The Journal of arthroplasty.

[11]  S. Kalichman,et al.  Functional Health Literacy Is Associated With Health Status and Health‐Related Knowledge in People Living With HIV‐AIDS , 2000, Journal of acquired immune deficiency syndromes.

[12]  Theodoros N. Arvanitis,et al.  Use of the Internet by Patients Before and After Cardiac Surgery: An Interdisciplinary Telephone Survey , 2001, Journal of medical Internet research.

[13]  S. Sabharwal,et al.  Readability of Online Patient Education Materials From the AAOS Web Site , 2008, Clinical orthopaedics and related research.

[14]  D W Baker,et al.  The relationship of patient reading ability to self-reported health and use of health services. , 1997, American journal of public health.

[15]  Daniela B. Friedman,et al.  A Systematic Review of Readability and Comprehension Instruments Used for Print and Web-Based Cancer Information , 2006, Health education & behavior : the official publication of the Society for Public Health Education.

[16]  Readability of college general biology textbooks: Revisited , 1980 .

[17]  J. S. Biermann,et al.  Internet use by patients in orthopaedic surgery. , 2003, The Iowa orthopaedic journal.

[18]  B. Coyle,et al.  Patient literacy and the readability of written cancer educational materials. , 1995, Oncology nursing forum.

[19]  J. Albright,et al.  Readability of patient education materials: implications for clinical practice. , 1996, Applied nursing research : ANR.

[20]  J. S. Biermann,et al.  Patient Internet use in a community outpatient orthopaedic practice. , 2002, The Iowa orthopaedic journal.

[21]  N. Cotugna,et al.  EVALUATION OF LITERACY LEVEL OF PATIENT EDUCATION PAGES IN HEALTH-RELATED JOURNALS , 2005, Journal of Community Health.

[22]  L. G. Doak,et al.  Teaching Patients With Low Literacy Skills , 1985 .

[23]  Doak Cc,et al.  Lowering the silent barriers to compliance for patients with low literacy skills. , 1987 .

[24]  Daniel L. McGee,et al.  Health Status Of Illiterate Adults: Relation Between Literacy And Health Status Among Persons With Low Literacy Skills , 1992, The Journal of the American Board of Family Medicine.

[25]  L. G. Doak,et al.  Lowering the silent barriers to compliance for patients with low literacy skills. , 1987, Promoting health.

[26]  J. Gazmararian,et al.  The impact of low health literacy on the medical costs of Medicare managed care enrollees. , 2005, The American journal of medicine.

[27]  Improvement,et al.  Adult literacy in America : a first look at the results of the National Adult Literacy Survey , 1993 .

[28]  M. Winker,et al.  Guidelines for medical and health information sites on the internet: principles governing AMA web sites. American Medical Association. , 2000, JAMA.

[29]  B A Brooks.  Using the Internet for patient education. , 2001, Orthopedic nursing.

[30]  J Sybil Biermann,et al.  Use of the Internet by Pediatric Orthopaedic Outpatients , 2002, Journal of pediatric orthopedics.

[31]  J. Aiman,et al.  Level of reading difficulty in The American College of Obstetricians and Gynecologsts Patient Education pamphlets , 1989, Obstetrics and gynecology.

[32]  R. Kane,et al.  Health literacy and ethnic disparities in health-related quality of life among rural women: results from a Chinese poor minority area , 2013, Health and Quality of Life Outcomes.

[33]  R. Kravitz,et al.  Health information on the Internet: accessibility, quality, and readability in English and Spanish. , 2001, JAMA.

[34]  E. Bluman,et al.  Readability of the Patient Education Section of the AOFAS Website , 2009, Foot & ankle international.

[35]  D. Schillinger,et al.  Association of health literacy with diabetes outcomes. , 2002, JAMA.

[36]  David A. Kindig,et al.  Health literacy : a prescription to end confusion , 2004 .

[37]  Evaluation of Internet use by paediatric orthopaedic outpatients and the quality of information available , 2005, Journal of pediatric orthopedics. Part B.

[38]  Tamara B Harris,et al.  Limited literacy and mortality in the elderly: the health, aging, and body composition study. , 2006, Journal of general internal medicine.

[39]  R. Frank,et al.  Readability of arthroscopy-related patient education materials from the American Academy of Orthopaedic Surgeons and Arthroscopy Association of North America Web sites. , 2013, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[40]  L. G. Doak,et al.  Improving comprehension for cancer patients with low literacy skills: Strategies for clinicians , 1998, CA: a cancer journal for clinicians.

[41]  Beall Ms rd,et al.  Patient Internet use in a community outpatient orthopaedic practice. , 2002 .

[42]  T. Einhorn,et al.  American Orthopaedic Association symposium: Evaluating the flood of orthopaedic media and marketing information. , 2005, The Journal of bone and joint surgery. American volume.

[43]  Junling Ren,et al.  Functional health literacy and the risk of hospital admission among Medicare managed care enrollees. , 2002, American journal of public health.

[44]  B. Weiss,et al.  Communicating with patients who cannot read. , 1997, The New England journal of medicine.

[45]  J. Capo,et al.  Readability and comprehensibility of patient education material in hand-related web sites. , 2009, The Journal of hand surgery.

[46]  S. Sabharwal,et al.  Readability of patient education materials from the American Academy of Orthopaedic Surgeons and Pediatric Orthopaedic Society of North America web sites. , 2008, The Journal of bone and joint surgery. American volume.