Advertisement

Emergency Radiology

, Volume 25, Issue 2, pp 147–152 | Cite as

Quantitative analysis of the level of readability of online emergency radiology-based patient education resources

  • David R. HansberryEmail author
  • Michael D’Angelo
  • Michael D. White
  • Arpan V. Prabhu
  • Mougnyan Cox
  • Nitin Agarwal
  • Sandeep Deshmukh
Original Article

Abstract

Purpose

The vast amount of information found on the internet, combined with its accessibility, makes it a widely utilized resource for Americans to find information pertaining to medical information. The field of radiology is no exception. In this paper, we assess the readability level of websites pertaining specifically to emergency radiology.

Methods

Using Google, 23 terms were searched, and the top 10 results were recorded. Each link was evaluated for its readability level using a set of ten reputable readability scales. The search terms included the following: abdominal ultrasound, abdominal aortic aneurysm, aortic dissection, appendicitis, cord compression, CT abdomen, cholecystitis, CT chest, diverticulitis, ectopic pregnancy, epidural hematoma, dural venous thrombosis, head CT, MRI brain, MR angiography, MRI spine, ovarian torsion, pancreatitis, pelvic ultrasound, pneumoperitoneum, pulmonary embolism, subarachnoid hemorrhage, and subdural hematoma. Any content that was not written for patients was excluded.

Results

The 230 articles that were assessed were written, on average, at a 12.1 grade level. Only 2 of the 230 articles (1%) were written at the third to seventh grade recommended reading level set forth by the National Institutes of Health (NIH) and American Medical Association (AMA). Fifty-two percent of the 230 articles were written so as to require a minimum of a high school education (at least a 12th grade level). Additionally, 17 of the 230 articles (7.3%) were written at a level that exceeded an undergraduate education (at least a 16th grade level).

Conclusions

The majority of websites with emergency radiology-related patient education materials are not adhering to the NIH and AMA’s recommended reading levels, and it is likely that the average reader is not benefiting fully from these information outlets. With the link between health literacy and poor health outcomes, it is important to address the online content in this area of radiology, allowing for patient to more fully benefit from their online searches.

Keywords

Health literacy Readability Websites 

Notes

Compliance with ethical standards

Competing interests statement

The authors declare that they have no conflict of interest.

References

  1. 1.
    Demographics of Internet Users (2011) In Internet and American Life Project. Pew Research Center, Washington D.CGoogle Scholar
  2. 2.
    Berkman ND et al (2011) Health literacy interventions and outcomes: an updated systematic review. Evid Rep Technol Assess (Full Rep) 199:1–941Google Scholar
  3. 3.
    (CDC), U.D.o.H.a.H.S.-C.f.D.C.a.P (2009) Simply put: A Guide for Creating Easy-to-Understand Materials. Atlanta, GAGoogle Scholar
  4. 4.
    BD, W (2003) Health literacy: a manual for clinicians, ed. A.M. foundation, Chicago: American Medical AssociationGoogle Scholar
  5. 5.
    How to Write Easy-to-Read Health Materials. [cited 2017 03/02]; Available from: https://www.nlm.nih.gov/medlineplus/etr.html
  6. 6.
    Prabhu, A.V., et al. Online palliative care and oncology patient education resources through Google: do they meet national health literacy recommendations? Practical Radiat OncolGoogle Scholar
  7. 7.
    Prabhu AV, Hansberry DR, Agarwal N, Clump DA, Heron DE (2016) Radiation oncology and online patient education materials: deviating from NIH and AMA recommendations. Int J Radiat Oncol Biol Phys 96(3):521–528.  https://doi.org/10.1016/j.ijrobp.2016.06.2449 CrossRefPubMedGoogle Scholar
  8. 8.
    Hansberry DR, Ramchand T, Patel S, Kraus C, Jung J, Agarwal N, Gonzales SF, Baker SR (2014) Are we failing to communicate? Internet-based patient education materials and radiation safety. Eur J Radiol 83(9):1698–1702.  https://doi.org/10.1016/j.ejrad.2014.04.013 CrossRefPubMedGoogle Scholar
  9. 9.
    Hansberry DR, Agarwal N, Baker SR (2014) Health literacy and online educational resources: an opportunity to educate patients. Am J Roentgenol 204(1):111–116CrossRefGoogle Scholar
  10. 10.
    Agarwal N, Chaudhari A, Hansberry DR, Tomei KL, Prestigiacomo CJ (2013) A comparative analysis of neurosurgical online education materials to assess patient comprehension. J Clin Neurosci 20(10):1357–1361.  https://doi.org/10.1016/j.jocn.2012.10.047 CrossRefPubMedGoogle Scholar
  11. 11.
    Agarwal N, Sarris C, Hansberry DR, Lin MJ, Barrese JC, Prestigiacomo CJ (2013) Quality of patient education materials for rehabilitation after neurological surgery. NeuroRehabilitation 32(4):817–821.  https://doi.org/10.3233/NRE-130905 PubMedGoogle Scholar
  12. 12.
    Hansberry DR, Agarwal N, Shah R, Schmitt PJ, Baredes S, Setzen M, Carmel PW, Prestigiacomo CJ, Liu JK, Eloy JA (2014) Analysis of the readability of patient education materials from surgical subspecialties. Laryngoscope 124(2):405–412.  https://doi.org/10.1002/lary.24261 CrossRefPubMedGoogle Scholar
  13. 13.
    Prabhu AV, Kim C, Crihalmeanu T, Hansberry DR, Agarwal N, DeFrances MC, Trejo Bittar HE (2017) An online readability analysis of pathology-related patient education articles: an opportunity for pathologists to educate patients. Hum Pathol 65:15–20.  https://doi.org/10.1016/j.humpath.2017.04.020 CrossRefPubMedGoogle Scholar
  14. 14.
    Hansberry DR, Donovan AL, Prabhu AV, Agarwal N, Cox M, Flanders AE (2017) Enhancing the radiologist-patient relationship through improved communication: a quantitative readability analysis in spine radiology. AJNR Am J Neuroradiol 38(6):1252–1256.  https://doi.org/10.3174/ajnr.A5151 CrossRefPubMedGoogle Scholar
  15. 15.
    Hansberry DR, Agarwal N, John ES, John AM, Agarwal P, Reynolds JC, Baker SR (2017) Evaluation of internet-based patient education materials from internal medicine subspecialty organizations: will patients understand them? Intern Emerg Med 12(4):535–543.  https://doi.org/10.1007/s11739-017-1611-2 CrossRefPubMedGoogle Scholar
  16. 16.
    Hansberry DR, Patel SR, Agarwal P, Agarwal N, John ES, John AM, Reynolds JC (2017) A quantitative readability analysis of patient education resources from gastroenterology society websites. Int J Color Dis 32(6):917–920.  https://doi.org/10.1007/s00384-016-2730-3 CrossRefGoogle Scholar
  17. 17.
    Agarwal N, Feghhi DP, Gupta R, Hansberry DR, Quinn JC, Heary RF, Goldstein IM (2014) A comparative analysis of minimally invasive and open spine surgery patient education resources. J Neurosurg Spine 21(3):468–474.  https://doi.org/10.3171/2014.5.SPINE13600 CrossRefPubMedGoogle Scholar
  18. 18.
    Hansberry DR, Agarwal N, Gonzales SF, Baker SR (2014) Are we effectively informing patients? A quantitative analysis of on-line patient education resources from the American Society of Neuroradiology. AJNR Am J Neuroradiol 35(7):1270–1275.  https://doi.org/10.3174/ajnr.A3854 CrossRefPubMedGoogle Scholar
  19. 19.
    Agarwal N, Hansberry DR, Singh PL, Heary RF, Goldstein IM (2014) Quality assessment of spinal cord injury patient education resources. Spine (Phila Pa 1976) 39(11):E701–E704.  https://doi.org/10.1097/BRS.0000000000000308 CrossRefGoogle Scholar
  20. 20.
    Hansberry DR, John A, John E, Agarwal N, Gonzales SF, Baker SR (2014) A critical review of the readability of online patient education resources from RadiologyInfo.Org. AJR Am J Roentgenol 202(3):566–575.  https://doi.org/10.2214/AJR.13.11223 CrossRefPubMedGoogle Scholar
  21. 21.
    Hansberry DR, Kraus C, Agarwal N, Baker SR, Gonzales SF (2014) Health literacy in vascular and interventional radiology: a comparative analysis of online patient education resources. Cardiovasc Intervent Radiol 37(4):1034–1040.  https://doi.org/10.1007/s00270-013-0752-6 CrossRefPubMedGoogle Scholar
  22. 22.
    Hansberry DR, Suresh R, Agarwal N, Heary RF, Goldstein IM (2013) Quality assessment of online patient education resources for peripheral neuropathy. J Peripher Nerv Syst 18(1):44–47.  https://doi.org/10.1111/jns5.12006 CrossRefPubMedGoogle Scholar
  23. 23.
    Prabhu, A.V., et al. Radiology online patient education materials provided by major university hospitals: do they conform to NIH and AMA guidelines? Current problems in diagnostic radiologyGoogle Scholar
  24. 24.
    Prabhu AV, Gupta R, Kim C, Kashkoush A, Hansberry DR, Agarwal N, Koch E (2016) Patient education materials in dermatology: addressing the health literacy needs of patients. JAMA Dermatol 152(8):946–947.  https://doi.org/10.1001/jamadermatol.2016.1135 CrossRefPubMedGoogle Scholar
  25. 25.
    Crihalmeanu, T., et al. Readability of online allergy and immunology educational resources for patients: implications for physicians. J Allergy Clin Immunol: In PracticeGoogle Scholar
  26. 26.
    Morrison AK, Brousseau DC, Brazauskas R, Levas MN (2015) Health literacy affects likelihood of radiology testing in the pediatric emergency department. J Pediatr 166(4):1037–1041 e1.  https://doi.org/10.1016/j.jpeds.2014.12.009 CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Flesch R (1948) A new readability yardstick. J Appl Psychol 32(3):221–233.  https://doi.org/10.1037/h0057532 CrossRefPubMedGoogle Scholar
  28. 28.
    J.P., K (1975) Deviation of new readability formulas (Automated Readability Index, Fog Count and Flesch Reading Ease Formula) for Navy enlisted personnel, N.T.I. Service, Editor. Springfield, VAGoogle Scholar
  29. 29.
    G.H., M., SMOG grading (1969) A new readability formula. J Read 12:639–646Google Scholar
  30. 30.
    Coleman M (1975) A.L.T.L., a computer readability formula for machine scoring. J Appl Psychol 60(2):283–284.  https://doi.org/10.1037/h0076540 CrossRefGoogle Scholar
  31. 31.
    R., G (1952) The technique of clear writing. Mcgraw-Hill, New YorkGoogle Scholar
  32. 32.
    J.S., C., Readability revisited (1995) The new Dale-Chall readability formula, ed. B.B. Cambridge. Northampton, MAGoogle Scholar
  33. 33.
    Caylor J.S., S.T.G, Fox L.C., et al. (1973) Methodologies for determining reading requirements of military occupational specialties, H.R.R. Organization, Editor: Alexandria, VAGoogle Scholar
  34. 34.
    E., F (1968) A readability formula that saves time. J Read 11:513–578Google Scholar
  35. 35.
    A.L., R (1977) The Raygor readability estimate: A quick and easy way to determine difficulty, in National Reading Conference. Clemson, SCGoogle Scholar
  36. 36.
    Hansberry DR, Ayyaswami V, Sood A, Prabhu AV, Agarwal N, Deshmukh SP (2017) Abdominal imaging and patient education resources: enhancing the radiologist-patient relationship through improved communication. Abdom Radiol (NY) 42(4):1276–1280.  https://doi.org/10.1007/s00261-016-0977-3 CrossRefGoogle Scholar
  37. 37.
    Smith-Bindman R, Miglioretti DL, Larson EB (2008) Rising use of diagnostic medical imaging in a large integrated health system. Health Aff (Millwood) 27(6):1491–1502.  https://doi.org/10.1377/hlthaff.27.6.1491 CrossRefGoogle Scholar
  38. 38.
    Korley FK, Pham JC, Kirsch TD (2010) Use of advanced radiology during visits to US emergency departments for injury-related conditions, 1998–2007. JAMA 304(13):1465–1471.  https://doi.org/10.1001/jama.2010.1408 CrossRefPubMedGoogle Scholar
  39. 39.
    Christensen H, Griffiths K (2000) The Internet and mental health literacy. Aust N Z J Psychiatry 34(6):975–979.  https://doi.org/10.1080/000486700272 CrossRefPubMedGoogle Scholar
  40. 40.
    Schillinger D, Grumbach K, Piette J, Wang F, Osmond D, Daher C, Palacios J, Sullivan GD, Bindman AB (2002) Association of health literacy with diabetes outcomes. JAMA 288(4):475–482.  https://doi.org/10.1001/jama.288.4.475 CrossRefPubMedGoogle Scholar
  41. 41.
    Juzych MS, Randhawa S, Shukairy A, Kaushal P, Gupta A, Shalauta N (2008) Functional health literacy in patients with glaucoma in urban settings. Arch Ophthalmol 126(5):718–724.  https://doi.org/10.1001/archopht.126.5.718 CrossRefPubMedGoogle Scholar
  42. 42.
    Badarudeen S, Sabharwal S (2010) Assessing readability of patient education materials: current role in orthopaedics. Clin Orthop Relat Res 468(10):2572–2580.  https://doi.org/10.1007/s11999-010-1380-y CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Baker DW, Parker RM, Williams MV, Clark WS, Nurss J (1997) The relationship of patient reading ability to self-reported health and use of health services. Am J Public Health 87(6):1027–1030.  https://doi.org/10.2105/AJPH.87.6.1027 CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Sarkar U, Karter AJ, Liu JY, Adler NE, Nguyen R, López A, Schillinger D (2010) The literacy divide: health literacy and the use of an internet-based patient portal in an integrated health system-results from the diabetes study of northern California (DISTANCE). J Health Commun 15(Suppl 2):183–196.  https://doi.org/10.1080/10810730.2010.499988 CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Sudore RL, Mehta KM, Simonsick EM, Harris TB, Newman AB, Satterfield S, Rosano C, Rooks RN, Rubin SM, Ayonayon HN, Yaffe K, for the Health, Aging and Body Composition Study (2006) Limited literacy in older people and disparities in health and healthcare access. J Am Geriatr Soc 54(5):770–776.  https://doi.org/10.1111/j.1532-5415.2006.00691.x CrossRefPubMedGoogle Scholar
  46. 46.
    Gutierrez N, Kindratt TB, Pagels P, Foster B, Gimpel NE (2014) Health literacy, health information seeking behaviors and internet use among patients attending a private and public clinic in the same geographic area. J Community Health 39(1):83–89.  https://doi.org/10.1007/s10900-013-9742-5 CrossRefPubMedGoogle Scholar
  47. 47.
    Eichler K, Wieser S, Brugger U (2009) The costs of limited health literacy: a systematic review. Int J Public Health 54(5):313–324.  https://doi.org/10.1007/s00038-009-0058-2 CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Berland GK, Elliott MN, Morales LS, Algazy JI, Kravitz RL, Broder MS, Kanouse DE, Muñoz JA, Puyol JA, Lara M, Watkins KE, Yang H, McGlynn EA (2001) Health information on the internet: accessibility, quality, and readability in English and Spanish. JAMA 285(20):2612–2621.  https://doi.org/10.1001/jama.285.20.2612 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© American Society of Emergency Radiology 2017

Authors and Affiliations

  • David R. Hansberry
    • 1
    Email author
  • Michael D’Angelo
    • 2
  • Michael D. White
    • 2
  • Arpan V. Prabhu
    • 3
  • Mougnyan Cox
    • 1
  • Nitin Agarwal
    • 2
  • Sandeep Deshmukh
    • 1
  1. 1.Department of RadiologyThomas Jefferson University HospitalsPhiladelphiaUSA
  2. 2.Department of Neurological SurgeryUniversity of Pittsburgh Medical CenterPittsburghUSA
  3. 3.Department of Radiation OncologyUniversity of Pittsburgh Hillman Cancer InstitutePittsburghUSA

Personalised recommendations