Evaluation of internet-based patient education materials from internal medicine subspecialty organizations: will patients understand them?
- 308 Downloads
The majority of Americans use the Internet daily, if not more often, and many search online for health information to better understand a diagnosis they have been given or to research treatment options. The average American reads at an eighth-grade level. The purpose of this study is to evaluate the readability of online patient education materials on the websites of 14 professional organizations representing the major internal medicine subspecialties. We used ten well-established quantitative readability scales to assess written text from patient education materials published on the websites of the major professional organizations representing the following subspecialty groups: allergy and immunology, cardiology, endocrinology, gastroenterology, geriatrics, hematology, hospice and palliative care, infectious disease, nephrology, oncology, pulmonology and critical care, rheumatology, sleep medicine, and sports medicine. Collectively the 540 articles analyzed were written at an 11th-grade level (SD 1.4 grade levels). The sleep medicine and nephrology websites had the most readable materials, written at an academic grade level of 8.5 ± 1.5 and 9.0 ± 0.2, respectively. Material at the infectious disease site was written at the most difficult level, with average readability corresponding to grades 13.9 ± 0.3. None of the patient education materials we reviewed conformed to the American Medical Association (AMA) and the National Institutes of Health (NIH) guidelines requiring that patient education articles be written at a third- to seventh-grade reading level. If these online resources were rewritten, it is likely that more patients would derive benefit from reading them.
KeywordsInternal medicine Internet Literacy Patient education Readability
Contributors: We appreciate the detailed review by Diana Winters.
Compliance with ethical standards
Conflict of interest/disclosures
Data from the American Gastroenterological Association (AGA) website is included in a separate manuscript under review at the International Journal of Colorectal Disease that discusses the readability of online gastroenterology-based patient education resources.
Statement of human and animal rights
Institutional IRB approval was not required as there were no human or animal subjects.
Informed consent was not required as there were no human subjects.
- 1.Internet & American Life Project (2011) Demographics of internet users. Pew Research Center, WashingtonGoogle Scholar
- 2.Fox S (2010) Mobile Health. Pew Internet & American Life Project, WashingtonGoogle Scholar
- 3.Fox S (2011) The Social Life of Health InformationGoogle Scholar
- 5.Hesse BW, Nelson DE, Kreps GL, Croyle RT, Arora NK, Rimer BK, Viswanath K (2005) Trust and sources of health information: the impact of the Internet and its implications for health care providers: findings from the first Health Information National Trends Survey. Arch Int Med 165(22):2618–2624. doi: 10.1001/archinte.165.22.2618 CrossRefGoogle Scholar
- 8.NCES (2008) America’s Health Literacy: Why We Need Accessible Health InformationGoogle Scholar
- 9.Covering Kids & Families (2005) Health Literacy Style ManualGoogle Scholar
- 10.Kutner M, Greenberg E, Jin Y, Paulsen C (2006) The Health Literacy of America’s Adults: Results From the 2003 National Assessment of Adult Literacy (NCES 2006–483). National Center for Education Statistics, Washington, DCGoogle Scholar
- 11.Weis BD (2003) Health Literacy: A Manual for Clinicians. American Medical Association, American Medical Foundation, Chicago, ILGoogle Scholar
- 12.Simply Put—A Guide for Creating Easy-to-Understand Materials (2009) US Department of Health and Human Services—Centers for Disease Control and Prevention (CDC), 3 edn. Atlanta, GeorgiaGoogle Scholar
- 13.National Institutes of Health How to Write Easy to Read Health Materials (2016) National Library of Medicine. http://www.nlm.nih.gov/medlineplus/etr.html. Accessed 11 Nov 2016
- 20.Feghhi DP, Agarwal N, Hansberry DR, Berberian WS, Sabharwal S (2014) Critical Review of Patient Education Materials from the American Academy of Orthopedic Surgeons. Am J Orthop 43(8):168–174Google Scholar
- 33.Caylor JS, Sticht TG, Fox LC, Ford JP (1973) Methodologies for determining reading requirements of military occupational specialties (Tech Report No. 73-5). Alexandria, VAGoogle Scholar
- 34.Fry E (1968) A readability formula that saves time. J Read 11:4Google Scholar
- 35.Gunning R (1952) The technique of clear writing. McGraw-Hill, New YorkGoogle Scholar
- 36.Chall JS (1995) Readability revisited: The new Dale-Chall readability formula. Brookline Books, Cambridge, MAGoogle Scholar
- 37.Raygor AL (1977) The Raygor readability estimate: a quick and easy way to determine difficulty. In: Pearson PD (eds) Reading: theory rap (ed) National Reading Conference. Clemson, SC, pp 259–263Google Scholar
- 38.McLaughlin GH (1969) SMOG grading: a new readability formula. J Read 12(8):8Google Scholar
- 40.US Department of Health and Human Services: Office of Disease Prevention and Health Promotion (2010) National Action Plan to Improve Health Literacy, vol 15, 2002/05/04 edn. Washington, DCGoogle Scholar