Abstract
One of the goals of the American Academy of Orthopaedic Surgeons (AAOS) is to disseminate patient education materials that suit the readability skills of the patient population. According to standard guidelines from healthcare organizations, the readability of patient education materials should be no higher than the sixth-grade level. We hypothesized the readability level of patient education materials available on the AAOS Web site would be higher than the recommended grade level, regardless when the material was available online. Readability scores of all articles from the AAOS Internet-based patient information Web site, “Your Orthopaedic Connection,” were determined using the Flesch-Kincaid grade formula. The mean Flesch-Kincaid grade level of the 426 unique articles was 10.43. Only 10 (2%) of the articles had the recommended readability level of sixth grade or lower. The readability of the articles did not change with time. Our findings suggest the majority of the patient education materials available on the AAOS Web site had readability scores that may be too difficult for comprehension by a substantial portion of the patient population.
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References
Albright J, de Guzman C, Acebo P, Paiva D, Faulkner M, Swanson J. Readability of patient education materials: implications for clinical practice. Appl Nurs Res. 1996;9:139–143.
Alexa® the Web Information Company. Available at: http://www.alexa.com/data/details/traffic_details?q=orthoinfo.org&url=orthoinfo.org/ Accessed June 4, 2007.
American Academy of Orthopaedic Surgeons. Your orthopaedic connection. Available at: http://orthoinfo.aaos.org/all.cfm. Accessed February 6, 2007.
Aslam N, Bowyer D, Wainwright A, Theologis T, Benson M. Evaluation of Internet use by paediatric orthopaedic outpatients and the quality of information available. J Pediatr Orthop B. 2005;14:129–133.
Badarudeen S, Sabharwal S. Readability of patient education materials from the American Academy of Orthopaedic Surgeons and Pediatric Orthopaedic Society of North America Web sites. J Bone Joint Surg Am. 2008;90:199–204.
Baker DW, Parker RM, Williams MV, Clark WS, Nurss J. The relationship of patient reading ability to self-reported health and use of health services. Am J Public Health. 1997;87:1027–1030.
Bass L. Health literacy: implications for teaching the adult patient. J Infus Nurs. 2005;28:15–22.
Beall MS 3rd, Beall MS Jr, Greenfield ML, Biermann JS. Patient Internet use in a community outpatient orthopaedic practice. Iowa Orthop J. 2002;22:103–107.
Beall MS 3rd, Golladay GJ, Greenfield ML, Hensinger RN, Biermann JS. Use of the Internet by pediatric orthopaedic outpatients. J Pediatr Orthop. 2002;22:261–264.
Berkman ND, DeWalt DA, Pignone MP, Sheridan SL, Lohr KN, Lux L, Sutton SF, Swinson T, Bonito AJ. Literacy, Health Outcomes: Evidence Report. Rockville, MD: Agency for Healthcare Research and Quality/US Department of Health and Human Services; 2004.
Berland GK, Elliott MN, Morales LS, Algazy JI, Kravitz RL, Broder MS, Kanouse DE, Munoz JA, Puyol JA, Lara M, Watkins KE, Yang H, McGlynn EA. Health information on the Internet: accessibility, quality, and readability in English and Spanish. JAMA. 2001;285:2612–2621.
Boulos MN. British internet-derived patient information on diabetes mellitus: is it readable? Diabetes Technol Ther. 2005;7:528–535.
Brooks BA. Using the Internet for patient education. Orthop Nurs. 2001;20:69–77.
Cooley ME, Moriarty H, Berger MS, Selm-Orr D, Coyle B, Short T. Patient literacy and the readability of written cancer educational materials. Oncol Nurs Forum. 1995;22:1345–1351.
Cotugna N, Vickery CE, Carpenter-Haefele KM. Evaluation of literacy level of patient education pages in health-related journals. J Community Health. 2005;30:213–219.
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;155:807–812.
Davis TC, Mayeaux EJ, Fredrickson D, Bocchini JA Jr, Jackson RH, Murphy PW. Reading ability of parents compared with reading level of pediatric patient education materials. Pediatrics. 1994;93:460–468.
Doak CC, Doak LG, Root JH. Teaching Patients With Low Literacy Skills. 2nd ed. Philadelphia, PA: JB Lippincott; 1996.
Flesch RF. How to Write Plain English: A Book for Lawyers, Consumers. 1st ed. New York, NY: Barnes and Noble; 1981.
Fox S. Online Health Search 2006: Report. Washington, DC: Pew Internet and American Life Project; 2006.
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;33:352–373.
Friedman DB, Hoffman-Goetz L, Arocha JF. Readability of cancer information on the Internet. J Cancer Educ. 2004;19:117–122.
Graber MA, Roller CM, Kaeble B. Readability levels of patient education material on the World Wide Web. J Fam Pract. 1999;48:58–61.
Hirsch SA. Academy introduces Web-based medical education for fellows and patients. J Bone Joint Surg Am. 2000;82:1665–1667.
Hoffmann T, McKenna K. Analysis of stroke patients’ and carers’ reading ability and the content and design of written materials: recommendations for improving written stroke information. Patient Educ Couns. 2006;60:286–293.
Jackson RH, Davis TC, Bairnsfather LE, George RB, Crouch MA, Gault H. Patient reading ability: an overlooked problem in health care. South Med J. 1991;84:1172–1175.
Kincaid JP, Fishburne RP, Rogers RL, Chissom BS. Derivation of New Readability Formulas (Automated Readability Index, Fog Count, and Flesch Reading Ease Formula) for Navy Enlisted Personnel: Report. Millington, TN: Research Branch, Naval Technical Training Command; 1975.
Krempec J, Hall J, Biermann JS. Internet use by patients in orthopaedic surgery. Iowa Orthop J. 2003;23:80–82.
Kutner M, Greenburg E, Jin Y, Paulsen C. The Health Literacy of America’s Adults: Results from the 2003 National Assessment of Adult Literacy. Washington, DC: National Center for Education Statistics; 2006.
Lewiecki EM, Rudolph LA, Kiebzak GM, Chavez JR, Thorpe BM. Assessment of osteoporosis-website quality. Osteoporosis Int. 2006;17:741–752.
Ley P, Florio T. The use of readability formulas in health care. Psychol Health Med. 1996;1:7–28.
Mosenthal PB, Kirsch IS. A new measure of assessing document complexity: the PMOSE/IKIRSCH Document Readability Formula. J Adolesc Adult Lit. 1998;41:638–657.
Munro BH. Correlation. Statistical Methods for Health Care Research. 5th ed. Philadelphia, PA: Lippincott-Raven; 2005:239–258.
Murero M, D’Ancona G, Karamanoukian H. Use of the Internet by patients before and after cardiac surgery: telephone survey. J Med Internet Res. 2001;3:E27.
National Institutes of Health. MedlinePlus: How to write easy to read health materials. Available at: http://www.nlm.nih.gov/medlineplus/etr.html. Accessed May 1, 2007.
Nielsen-Bohlman L, Panzer AM, Kindig DA. Health Literacy: A Prescription to End Confusion. Washington, DC: Institute of Medicine, National Academies Press; 2004.
Wallace LS, Turner LW, Ballard JE, Keenum AJ, Weiss BD. Evaluation of Web-based osteoporosis educational materials. J Womens Health. 2005;14:936–945.
Weiss BD. Health Literacy: A Manual for Clinicians. Chicago, IL: American Medical Association, American Medical Foundation; 2003.
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We acknowledge the contributions of Caixia Zhao, MD, and Emily McClemens, PA-C, in preparation of this manuscript.
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Sabharwal, S., Badarudeen, S. & Unes Kunju, S. Readability of Online Patient Education Materials From the AAOS Web Site. Clin Orthop Relat Res 466, 1245–1250 (2008). https://doi.org/10.1007/s11999-008-0193-8
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DOI: https://doi.org/10.1007/s11999-008-0193-8