Readability evaluation of Internet-based patient education materials related to the anesthesiology field

Abstract

Study Objective

The main objective of the current investigation was to assess the readability of Internet-based patient education materials related to the field of anesthesiology. We hypothesized that the majority of patient education materials would not be written according to current recommended readability grade level.

Setting

Online patient education materials describing procedures, risks, and management of anesthesia-related topics were identified using the search engine Google (available at www.google.com) using the terms anesthesia, anesthesiology, anesthesia risks, and anesthesia care.

Design

Cross-sectional evaluation.

Interventions

None.

Measurements

Assessments of content readability were performed using validated instruments (Flesch-Kincaid Grade Formulae, the Gunning Frequency of Gobbledygook, the New Dale-Chall Test, the Fry graph, and the Flesch Reading Ease score).

Main Results

Ninety-six Web sites containing Internet patient education materials (IPEMs) were evaluated. The median (interquartile range) readability grade level for all evaluated IPEMs was 13.5 (12.0-14.6). All the evaluated documents were classified at a greater readability level than the current recommended readability grade, P < .001. Readability grades were not significantly different among different IPEM sources. Assessment by the Flesch Reading Ease test classified all but 4 IPEMs as at least fairly difficult to read.

Conclusions

Internet-based patient education materials related to the field of anesthesiology are currently written far above the recommended readability grade level. High complexity of written education materials likely limits access of information to millions of American patients. Redesign of online content of Web sites that provide patient education material regarding anesthesia could be an important step in improving access to information for patients with poor health literacy.

Introduction

Healthy literacy is defined by the Institute of Medicine by “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate decisions” [1]. It has been estimated that approximately 40% of the US population have inadequate health literacy [2]. Because poor health literacy has been repeatedly associated with poor patient outcomes [3], [4], [5], strategies to improve access and understanding of medical information by patients with inadequate health literacy are largely needed.

The Internet is currently the most used source of health-related information by surgical patients [6]. Because 50% of patients leave their doctor's office with a poor understanding of their diagnosis [7], Internet-based patient education materials are commonly used by patients in an effort to understand risks associated with medical and/or surgical interventions. In addition, optimal understanding of risk by patients is a necessary step to assure a valid informed consent process [8], [9].

The National Institute of Health, US Department of Health and Human Services, and American Medical Association recommend that the readability level of patient education materials needs to be written at or below the sixth grade level to be effectively understood by the American public [10]. Other specialties have examined the readability of Internet-based patient education materials with varying results [11], [12], [13]. In contrast, the readability content of Internet-based patient education materials in the anesthesiology field has yet to be determined. Improvement in the readability of online education materials could provide better understandability of the risks and benefits of anesthesiology-related health information to millions of American patients.

The main objective of the current investigation was to assess the readability of Internet-based patient education materials related to the field of anesthesiology. We hypothesized that the majority of patient education materials would not be written according to current recommended readability grade levels.