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Assessment of Online Patient Education Material About Dysphagia

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Abstract

To examine quality, readability, understandability, and actionability of English-language online educational materials about dysphagia. A Google search of “dysphagia” and related terms was conducted. Web page quality and accountability were measured using HON and URAC certification seals, the DISCERN instrument, and JAMA benchmark criteria. Understandability and actionability were assessed with the Patient Education Materials Assessment Tool for Printed Material (PEMAT-P). Readability was assessed using the Flesch Reading Ease (FRE), Flesch–Kincaid Grade Level (F-KGL), Gunning Fog (FOG), and the Simple Measure of Gobbledygook (SMOG) scores using dedicated readability software. Fifty web pages were analyzed. Seventeen web pages displayed a HON or URAC seal. DISCERN scores ranged from 17 to 50 (Mdn = 25.00; IQR = 32.25–21.00). Of the JAMA benchmark criteria, 88% of web pages met the disclosure criterion, while only 22% met the authorship, 20% met the attribution, and 16% met the currency criteria. PEMAT-P understandability and actionability scores were 69.38% ± 11.14% and 28.58% ± 22.19%, respectively. Readability scores, on average, exceeded the recommended grade reading levels for health information (FRE 46.34 ± 13.59, F-KGL 10.26 ± 2.29, FOG 12.11 ± 2.08, and SMOG 12.38 ± 1.70). Online materials about dysphagia can be improved by obtaining quality certificates and by including content that is more readable and easier to understand and act upon.

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  1. University of Central Florida, 4364 Scorpius St., Suite 101, Orlando, FL, 32816, USA

    Sarah M. Steiner & Richard I. Zraick

  2. University of Central Missouri, 415 E. Clark St, Warrensburg, MO, 64093, USA

    Bonnie K. Slavych

  3. Missouri State University, 901 S. National Ave, Springfield, MO, 65897, USA

    Bonnie K. Slavych

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Appendix

Appendix

Measure

Algorithm

Scoring output

Interpretation

F–K

F–K = 0.39 (TW/TSEN) + 11.8 (TSYL/TW)—15.59

Calculates grade level based on word length and sentence length

Grade level indicates level of difficulty of reading material, e.g., 5.6 = 5th grade

FRE

FRE = 206.835—1.015 (TW/TSEN)—84.6 (TSYL/TW)

Calculates index score based on sentence length

Index score indicates level of difficulty. The higher the index score, the easier the reading material

Conversion chart: 90—100 = 5th grade; 80—90 = 6th grade; 70—80 = 7th grade; 60—70 = 8th & 9th; 50—60 = 10th to 12th; 30—50 college; 10–30 college grad; and 0–10 professional (Flesch)

FOG

FOG = 0.4 x [(total words/total sentences) + 100 (complex words/total words)]

Complex words = three or more syllables

Calculates grade level based on word count, sentence count, and word complexity

Grade level indicates level of difficulty of reading material, e.g., 5.6 = 5th grade

SMOG

SMOG = 3 +  \(\sqrt{polysyllable count}\)

Polysyllable count = words with three or more syllables

Calculates grade level based on word complexity

Grade level indicates level of difficulty of reading material, e.g., 5.6 = 5th grade

Description of each readability formula, including their respective algorithm, scoring method, and results interpretation.

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Steiner, S.M., Slavych, B.K. & Zraick, R.I. Assessment of Online Patient Education Material About Dysphagia. Dysphagia 38, 990–1000 (2023). https://doi.org/10.1007/s00455-022-10524-3

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