Skip to main content

Advertisement

SpringerLink
Log in

Assessing the readability of patient-targeted online information on musculoskeletal radiology procedures

  • Scientific Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Objective

To assess the readability of patient-targeted online information on musculoskeletal radiology procedures.

Methods

Eleven common musculoskeletal radiology procedures were queried in three online search engines (Google, Yahoo!, Bing). All unique patient-targeted websites were identified (n = 384) from the first three pages of search results. The reading grade level of each website was calculated using 6 separate validated metrics for readability assessment. Analysis of word and sentence complexity was also performed. Results were compared between academic vs. non-academic websites and between websites found on different pages of the search results. Statistics were performed using a t test.

Results

The mean reading grade level across all procedures was 10th–14th grade. Webpages for nerve block were written at a higher reading grade level on non-academic websites (p = 0.025). There was no difference in reading grade levels between academic and non-academic sources for all other procedures. There was no difference in reading grade levels between websites found on the first page of search results compared with the second and third pages. Across all websites, 16–22% of the words used had 3+ syllables and 31–43% of the words used had 6+ characters (complex words); 13–24% of the sentences used had 22+ words (complex sentences).

Conclusion

Patient-targeted online information on musculoskeletal radiology procedures are written at the 10th–14th grade reading level, which is well beyond the AMA and NIH recommendation. Readability can be lowered by decreasing text complexity through limitation of high-syllable words and reduction in word and sentence length.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. America’s Health Literacy: Why We Need Accessible Health Information. U.S. Department of Health and Human Services (HHS) 2008.

  2. Dewalt DA, Berkman ND, Sheridan S, Lohr KN, Pignone MP. Literacy and health outcomes: a systematic review of the literature. J Gen Intern Med. 2004;19(12):1228–39.

    Article  Google Scholar 

  3. Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011;155(2):97–107.

    Article  Google Scholar 

  4. Sudore RL, Yaffe K, Satterfield S, Harris TB, Mehta KM, Simonsick EM, et al. Limited literacy and mortality in the elderly: the health, aging, and body composition study. J Gen Intern Med. 2006;21(8):806–12.

    Article  Google Scholar 

  5. Weiss BD. Health literacy: a manual for clinicians. In: Foundation AMAaAM, ed. Chicago 2003.

  6. How to write easy-to-read health materials. National Institutes of Health.

  7. Hansberry DR, John A, John E, Agarwal N, Gonzales SF, Baker SR. A critical review of the readability of online patient education resources from RadiologyInfo.Org. AJR Am J Roentgenol. 2014;202(3):566–75.

    Article  Google Scholar 

  8. Miles RC, Baird GL, Choi P, Falomo E, Dibble EH, Garg M. Readability of online patient educational materials related to breast lesions requiring surgery. Radiology. 2019;291(1):112–8.

    Article  Google Scholar 

  9. Prabhu AV, Donovan AL, Crihalmeanu T, Hansberry DR, Agarwal N, Beriwal S, et al. Radiology online patient education materials provided by major university hospitals: do they conform to NIH and AMA guidelines? Curr Probl Diagn Radiol. 2018;47(2):75–9.

    Article  Google Scholar 

  10. Trofimova A, Vey BL, Safdar NM, Duszak R Jr, Kadom N. Radiology report readability: an opportunity to improve patient communication. J Am Coll Radiol. 2018;15(8):1182–4.

    Article  Google Scholar 

  11. Hoermann S, Doering S, Richter R, Walter MH, Schussler G. Patients' need for information before surgery. Psychother Psychosom Med Psychol. 2001;51(2):56–61.

    Article  CAS  Google Scholar 

  12. Top 5 Search Engines in the United States on March 2020. StatCounter Global Stats: StatCounter 2020.

  13. Flesch R. A new readability yardstick. J Appl Psychol. 1948;32:221–33.

    Article  CAS  Google Scholar 

  14. Kincaid JP, R Flesch, Rogers RL, Chissom BS. Derivation of new readability formulas) automated readability index, fog count and Flesch reading ease formula) for navy enlisted personnel: Institute for Simulation and Training, 1975.

  15. Gunning R. The Fog Index after twenty years. J Bus Commun. 1969;6:3–13.

    Article  Google Scholar 

  16. Fry E. A readability formula that saves time. J Read. 1968;11(7):513–6 575-578.

    Google Scholar 

  17. Raygor AL. The Raygor readability estimate: a quick and easy way to determine difficulty. In: Pearson PD, ed. Reading: Theory Rap: National Reading Conference, Clemson; 1977:259–263.

  18. Harry GLM. SMOG grading-a new readability formula. J Read. 1969;12:639–46.

    Google Scholar 

  19. McEnteggart GE, Naeem M, Skierkowski D, Baird GL, Ahn SH, Soares G. Readability of online patient education materials related to IR. J Vasc Interv Radiol. 2015;26(8):1164–8.

    Article  Google Scholar 

  20. Roberts H, Zhang D, Dyer GS. The readability of AAOS patient education materials: evaluating the progress since 2008. J Bone Joint Surg Am. 2016;98(17):e70.

    Article  Google Scholar 

  21. Williams AM, Muir KW, Rosdahl JA. Readability of patient education materials in ophthalmology: a single-institution study and systematic review. BMC Ophthalmol. 2016;16:133.

    Article  Google Scholar 

  22. D’Alessandro DM, Kingsley P, Johnson-West J. The readability of pediatric patient education materials on the World Wide Web. Arch Pediatr Adolesc Med. 2001;155(7):807–12.

    Article  Google Scholar 

  23. Kutner M. The Health Literacy of America’s Adults: results from the 2003 National Assessment of Adult Literacy. Washington: U.S. Department of Education, National Center for Education Statistics; 2006.

    Google Scholar 

  24. Chang ME, Baker SJ, Dos Santos Marques IC, Liwo AN, Chung SK, Richman JS, et al. Health literacy in surgery. Health Lit Res Pract. 2020;4(1):e46–65.

    PubMed  PubMed Central  Google Scholar 

  25. Simply Put: A guide for creating easy-to-understand materials. In: Prevention CfDCa, ed. 3 ed 2010.

  26. Davis TC, Bocchini JA Jr, Fredrickson D, Arnold C, Mayeaux EJ, Murphy PW, et al. Parent comprehension of polio vaccine information pamphlets. Pediatrics. 1996;97(6 Pt 1):804–10.

    CAS  PubMed  Google Scholar 

  27. "Bone Biopsy ". RadiologyInfo.org for Patients (January 17, 2020). www.radiologyinfo.org/en/info.cfm?pg=bonebiopsy. Accessed on June 1, 2020.

  28. "Direct Arthrography". RadiologyInfo.org for Patients (July 17, 2019). www.radiologyinfo.org/en/info.cfm?pg=arthrog. Accessed on July 12, 2020.

  29. Eaton ML, Holloway RL. Patient comprehension of written drug information. Am J Hosp Pharm. 1980;37(2):240–3.

    CAS  PubMed  Google Scholar 

  30. Bange M, Huh E, Novin SA, Hui FK, Yi PH. Readability of patient education materials from RadiologyInfo.org: has there been Progress over the past 5 years? AJR Am J Roentgenol. 2019;213(4):875–9.

    Article  Google Scholar 

  31. Davis TC, Fredrickson DD, Arnold C, Murphy PW, Herbst M, Bocchini JA. A polio immunization pamphlet with increased appeal and simplified language does not improve comprehension to an acceptable level. Patient Educ Couns. 1998;33(1):25–37.

    Article  CAS  Google Scholar 

  32. Davis TC, Holcombe RF, Berkel HJ, Pramanik S, Divers SG. Informed consent for clinical trials: a comparative study of standard versus simplified forms. J Natl Cancer Inst. 1998;90(9):668–74.

    Article  CAS  Google Scholar 

  33. Mehta MP, Swindell HW, Westermann RW, Rosneck JT, Lynch TS. Assessing the readability of online information about hip arthroscopy. Arthroscopy. 2018;34(7):2142–9.

    Article  Google Scholar 

  34. Eysenbach G, Kohler C. How do consumers search for and appraise health information on the world wide web? Qualitative study using focus groups, usability tests, and in-depth interviews. BMJ. 2002;324(7337):573–7.

    Article  Google Scholar 

  35. van Deursen AJ. Internet skill-related problems in accessing online health information. Int J Med Inform. 2012;81(1):61–72.

    Article  Google Scholar 

  36. Houts PS, Witmer JT, Egeth HE, Loscalzo MJ, Zabora JR. Using pictographs to enhance recall of spoken medical instructions II. Patient Educ Couns. 2001;43(3):231–42.

    Article  CAS  Google Scholar 

  37. Schenker Y, Fernandez A, Sudore R, Schillinger D. Interventions to improve patient comprehension in informed consent for medical and surgical procedures: a systematic review. Med Decis Mak. 2011;31(1):151–73.

    Article  Google Scholar 

  38. Friedman DB, Hoffman-Goetz L. A systematic review of readability and comprehension instruments used for print and web-based cancer information. Health Educ Behav. 2006;33(3):352–73.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Musculoskeletal Radiology, New York Presbyterian Hospital–Columbia University Irving Medical Center, 622 W 168th Street, New York, NY, 10032, USA

    Phuong T. Duong, Matthew P. Moy & Tony T. Wong

  2. Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA

    F. Joseph Simeone & Connie Y. Chang

Authors
  1. Phuong T. Duong
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Matthew P. Moy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. F. Joseph Simeone
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Connie Y. Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tony T. Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tony T. Wong.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest

Ethical approval

N/A. IRB exempt.

Informed consent

N/A. IRB exempt.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(DOCX 14 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Duong, P.T., Moy, M.P., Simeone, F.J. et al. Assessing the readability of patient-targeted online information on musculoskeletal radiology procedures. Skeletal Radiol 50, 1379–1387 (2021). https://doi.org/10.1007/s00256-020-03562-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-020-03562-1

Keywords

Search

Navigation