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Cordray H, Wright EA, Patel C, Raol N, Prickett KK. A Mobile Application for Child-Focused Tonsillectomy Education: Development and User-Testing. Laryngoscope 2024; 134:2455-2463. [PMID: 37983833 DOI: 10.1002/lary.31198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/17/2023] [Accepted: 11/07/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE Patient education is central to Enhanced Recovery After Surgery protocols, but child-focused materials are lacking. We developed and piloted a mobile application to support accessible, interactive patient and caregiver education about pediatric tonsillectomy. METHODS Thirty children ages 5-12 who were preparing for tonsillectomy, their caregivers, and six attending otolaryngologists participated in a user-testing trial of a web-based prototype. The trial measured feasibility, fidelity, and patient-centered outcomes. Patients and caregivers rated usability/likeability on the mHealth App Usability Questionnaire. Otolaryngologists rated quality on the Mobile App Rating Scale. The full mobile application, "Ready for Tonsillectomy," was then developed for iOS and Android. RESULTS Enrollment was 88.2%, retention was 90.0%, and use was 96.3%. Mean (SD) patient ratings for usability/likeability were 6.3 (1.1) out of 7; caregiver ratings were 6.5 (1.1). In common themes from open-ended feedback, patients described the application as helpful and appealing, and caregivers described it as informative, easy to understand, calming, and easy to use. Among caregivers who used the application during recovery, 92.3% reported that it helped them manage their child's pain. Providers would recommend the application to many or all of their patients (mean [SD]: 4.7 [0.5] out of 5). Mean provider ratings for domains of engagement, functionality, aesthetics, information quality, subjective quality, and app-specific value ranged from 4.1 to 4.8 out of 5. CONCLUSION Feasibility and fidelity were high. Families and otolaryngologists endorsed the resource as an engaging, informative tool that supports positive coping. Our mobile application offers a patient-centered solution readily scalable to other surgeries. LEVEL OF EVIDENCE NA Laryngoscope, 134:2455-2463, 2024.
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Affiliation(s)
- Holly Cordray
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Emily A Wright
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Chhaya Patel
- Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nikhila Raol
- Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kara K Prickett
- Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
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Williamson AJ, Cain BT, Hoggan TJ, Larsen MW, Kimball ER, Bloomquist K, Galyean P, Zickmund S, Cohan JN. Challenges and Opportunities in the Elective Management of Diverticulitis: Perspectives From a National Sample of Colorectal Surgeons. Dis Colon Rectum 2024; 67:264-272. [PMID: 37787524 PMCID: PMC10841111 DOI: 10.1097/dcr.0000000000002941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
BACKGROUND Diverticulitis is a complex, heterogeneous disease process that affects a diverse population of patients. In the elective management of this disease, treatment guidelines have shifted toward patient-centered, individualized decision-making. It is not known what challenges surgeons face as they approach these nuanced treatment decisions in practice. OBJECTIVE This study aimed to identify opportunities to support colorectal surgeons in elective diverticulitis treatment. DESIGN This was a qualitative study using standardized, semistructured interviews to explore the perspectives of 29 colorectal surgeons recruited using a purposive sampling technique. Data were analyzed using an "open-coding" approach. SETTINGS Interviews with a national sample of colorectal surgeons were conducted from a single center using an online video platform. PATIENTS This study did not involve patients. MAIN OUTCOME MEASURES Interviews explored surgeons' experiences treating diverticulitis in the elective setting, focusing on perceived challenges in providing patient-centered care as well as opportunities to improve treatment decisions. RESULTS Our qualitative analysis identified an overarching challenge in elective diverticulitis management for surgeons: difficulty ensuring adequate patient understanding of the risks and benefits of various treatments. This was thought to be due to 1) preexisting patient expectations about treatment and 2) lack of data regarding long-term treatment outcomes. Surgeons identified 2 potential opportunities to combat these challenges: 1) patient education and 2) additional research regarding treatment outcomes, with potential for the development of diverticulitis-specific decision support tools. LIMITATIONS These results are based on a national sample of colorectal surgeons, but they capture qualitative data that is not intended to provide generalizable findings. CONCLUSIONS As surgeons work toward providing individualized care for diverticulitis patients, they find it difficult to adequately counsel patients regarding the patient-specific risks of various treatments. The results of this study identify specific contributors to this problem as well as potential targets for intervention, which can guide future efforts to support surgeons in providing patient-centered care. See Video Abstract . DESAFOS Y OPORTUNIDADES EN EL MANEJO ELECTIVO DE LA DIVERTICULITIS PERSPECTIVAS DE UNA MUESTRA NACIONAL DE CIRUJANOS COLORRECTALES ANTECEDENTES:La diverticulitis es un proceso patológico complejo y heterogéneo que afecta a una población diversa de pacientes. En el manejo electivo de esta enfermedad, las pautas de tratamiento se han desplazado hacia una toma de decisiones individualizada y centrada en el paciente. No se sabe qué desafíos enfrentan los cirujanos al abordar estas decisiones de tratamiento matizadas en la práctica.OBJETIVO:Identificar oportunidades para apoyar a los cirujanos colorrectales en el tratamiento electivo de la diverticulitis.DISEÑO:Este fue un estudio cualitativo que utilizó entrevistas semiestructuradas estandarizadas para explorar las perspectivas de 29 cirujanos colorrectales reclutados mediante una técnica de muestreo intencional. Los datos se analizaron utilizando un enfoque de "codificación abierta".ESCENARIO:Las entrevistas con una muestra nacional de cirujanos colorrectales se realizaron desde un solo centro utilizando una plataforma de video en línea.PRINCIPALES MEDIDAS DE RESULTADO:Las entrevistas exploraron las experiencias de los cirujanos en el tratamiento de la diverticulitis en el entorno electivo, centrándose en los desafíos percibidos en la prestación de atención centrada en el paciente, así como en las oportunidades para mejorar las decisiones de tratamiento.RESULTADOS:Nuestro análisis cualitativo identificó un desafío general en el manejo de la diverticulitis electiva para los cirujanos: la dificultad para asegurar que el paciente comprenda adecuadamente los riesgos y beneficios de los diversos tratamientos. Se pensó que esto se debía a 1) las expectativas preexistentes del paciente sobre el tratamiento y 2) la falta de datos sobre los resultados del tratamiento a largo plazo. Los cirujanos identificaron dos oportunidades potenciales para combatir estos desafíos: 1) educación del paciente y 2) investigación adicional sobre los resultados del tratamiento, con potencial para el desarrollo de herramientas de apoyo a la toma de decisiones específicas para la diverticulitis.LIMITACIONES:Estos resultados se basan en una muestra nacional de cirujanos colorrectales, pero capturan datos cualitativos que no pretenden proporcionar hallazgos generalizables.CONCLUSIONES:A medida que los cirujanos trabajan para brindar atención individualizada a los pacientes con diverticulitis, les resulta difícil aconsejar adecuadamente a los pacientes sobre los riesgos específicos de los pacientes para los diversos tratamientos. Los resultados de este estudio identifican contribuyentes específicos a este problema, así como objetivos potenciales para la intervención, que pueden guiar los esfuerzos futuros para ayudar a los cirujanos a brindar atención centrada en el paciente. (Traducción-Dr. Felipe Bellolio ).
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Affiliation(s)
| | - Brian T. Cain
- Division of General Surgery, University of Utah, Salt Lake City, Utah
| | | | | | - Elisabeth R. Kimball
- Qualitative Research Core, Division of Epidemiology, University of Utah, Salt Lake City, Utah
| | - Kennedi Bloomquist
- Qualitative Research Core, Division of Epidemiology, University of Utah, Salt Lake City, Utah
| | - Patrick Galyean
- Qualitative Research Core, Division of Epidemiology, University of Utah, Salt Lake City, Utah
| | - Susan Zickmund
- Qualitative Research Core, Division of Epidemiology, University of Utah, Salt Lake City, Utah
| | - Jessica N. Cohan
- Division of General Surgery, University of Utah, Salt Lake City, Utah
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Tran AX, Barriera P, Xiong D, Knackstedt T. Racial-Ethnic, Education, and Socioeconomic Differences in the Treatment of Head and Neck Melanoma in situ: A Surveillance Epidemiology and End Results Population-Based Analysis. Dermatol Surg 2023; 49:1134-1138. [PMID: 37962949 DOI: 10.1097/dss.0000000000004005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
BACKGROUND Incidence and treatment disparities for cutaneous melanomas have been documented among racial and sociodemographic minorities. However, the association between treatment types, race, and socioeconomic status remains unknown. OBJECTIVE To characterize treatment differences for head and neck melanoma in situ (MIS) and lentigo maligna (LM) based on race and sociodemographic variables. MATERIALS AND METHODS A population-based retrospective cohort study of the Surveillance Epidemiology and End Results database (1998-2016) was performed. Univariate and multivariate logistic regression modeling evaluated the association of race and US census-reported sociodemographic factors with Mohs micrographic surgery (MMS) utilization. RESULTS A total of 76,328 adult patients with head and neck MIS/LM were included. MMS accounted for 11.8% of total cases, with increased utilization observed since 1998-2002. Compared with areas with greater percentages of individuals completing high school (first quartile), patients living in the second (Odds ratio [OR] 0.71; 95% confidence interval [CI] 0.64-0.80; p < .001), third (OR 0.74; 95% CI 0.63-0.86; p < .001), and fourth quartiles (OR 0.44; 95% CI 0.35-0.55; p < .001) were less likely to undergo MMS for their MIS/LM. CONCLUSION Educational efforts and awareness can bridge the knowledge gaps of appropriate treatment in patients with head and neck MIS/LM.
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Affiliation(s)
- Andrew X Tran
- Department of Dermatology, MetroHealth System, Cleveland, Ohio
| | - Paola Barriera
- Department of Dermatology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - David Xiong
- Department of Dermatology, University Hospitals, Cleveland, Ohio
| | - Thomas Knackstedt
- Department of Dermatology, Case Western Reserve School of Medicine, Cleveland, Ohio
- Department of Dermatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
- Pinehurst Dermatology & Mohs Surgery Center, Pinehurst, North Carolina
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van Ballegooie C, Wen J. Assessment of online patient education material for eye cancers: A cross-sectional study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001967. [PMID: 37844025 PMCID: PMC10578596 DOI: 10.1371/journal.pgph.0001967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/31/2023] [Indexed: 10/18/2023]
Abstract
The objective of this study was to assess online American patient education material (PEM) related to eye cancers in order to determine the quality of the content and appropriateness of the contents' reading level as it relates to the American population. PEMs were extracted from fifteen American cancer and ophthalmology associations and evaluated for their reading level using ten validated readability scales. PEMs then had all words extracted and evaluated for their difficulty and familiarity. The quality of the PEMS were assessed according to DISCERN, Heath On the Net Foundation Code of Conduct (HONCode), and JAMA benchmarks. Overall, online PEMs from the associations were written at a 11th grade reading level, which is above the recommended 6th grade reading level. The difficult word analysis identified that 26% of words were unfamiliar. Only one of the fifteen association held a HONCode certification while no organization met the standards of all four JAMA benchmarks. The average score for DISCERN was 2.4 out of a total of 5 for the fifteen questions related to treatment option information quality. Consideration should be made to create PEMs at an appropriate grade reading level to encourage health literacy and ultimately promote health outcomes. Associations should also focus on incorporating easily identifiable quality indicators to allow patients to better identify reputable resources.
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Affiliation(s)
- Courtney van Ballegooie
- Experimental Therapeutics, BC Cancer, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Chemistry, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Jasmine Wen
- Department of Science, University of Western Ontario, Western University, London, Ontario, Canada
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Park A, Sayed F, Robinson P, Elopre L, Ge Y, Li S, Grov C, Sullivan PS. Health Information on Pre-Exposure Prophylaxis From Search Engines and Twitter: Readability Analysis. JMIR Public Health Surveill 2023; 9:e48630. [PMID: 37665621 PMCID: PMC10507523 DOI: 10.2196/48630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/21/2023] [Accepted: 06/26/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) is proven to prevent HIV infection. However, PrEP uptake to date has been limited and inequitable. Analyzing the readability of existing PrEP-related information is important to understand the potential impact of available PrEP information on PrEP uptake and identify opportunities to improve PrEP-related education and communication. OBJECTIVE We examined the readability of web-based PrEP information identified using search engines and on Twitter. We investigated the readability of web-based PrEP documents, stratified by how the PrEP document was obtained on the web, information source, document format and communication method, PrEP modality, and intended audience. METHODS Web-based PrEP information in English was systematically identified using search engines and the Twitter API. We manually verified and categorized results and described the method used to obtain information, information source, document format and communication method, PrEP modality, and intended audience. Documents were converted to plain text for the analysis and readability of the collected documents was assessed using 4 readability indices. We conducted pairwise comparisons of readability based on how the PrEP document was obtained on the web, information source, document format, communication method, PrEP modality, and intended audience, then adjusted for multiple comparisons. RESULTS A total of 463 documents were identified. Overall, the readability of web-based PrEP information was at a higher level (10.2-grade reading level) than what is recommended for health information provided to the general public (ninth-grade reading level, as suggested by the Department of Health and Human Services). Brochures (n=33, 7% of all identified resources) were the only type of PrEP materials that achieved the target of ninth-grade reading level. CONCLUSIONS Web-based PrEP information is often written at a complex level for potential and current PrEP users to understand. This may hinder PrEP uptake for some people who would benefit from it. The readability of PrEP-related information found on the web should be improved to align more closely with health communication guidelines for reading level to improve access to this important health information, facilitate informed decisions by those with a need for PrEP, and realize national prevention goals for PrEP uptake and reducing new HIV infections in the United States.
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Affiliation(s)
- Albert Park
- Department of Software and Information Systems, University of North Carolina Charlotte, Charlotte, NC, United States
| | - Fatima Sayed
- Department of Software and Information Systems, University of North Carolina Charlotte, Charlotte, NC, United States
| | - Patrick Robinson
- Department of Public Health Sciences, University of North Carolina Charlotte, Charlotte, NC, United States
| | - Latesha Elopre
- Division of Infectious Disease, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Yaorong Ge
- Department of Software and Information Systems, University of North Carolina Charlotte, Charlotte, NC, United States
| | - Shaoyu Li
- Department of Mathematics and Statistics, University of North Carolina Charlotte, Charlotte, NC, United States
| | - Christian Grov
- Department of Community Health and Social Sciences, City University of New York, New York City, NY, United States
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Wasir AS, Volgman AS, Jolly M. Assessing readability and comprehension of web-based patient education materials by American Heart Association (AHA) and CardioSmart online platform by American College of Cardiology (ACC): How useful are these websites for patient understanding? AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2023; 32:100308. [PMID: 38510202 PMCID: PMC10946022 DOI: 10.1016/j.ahjo.2023.100308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/06/2023] [Accepted: 07/06/2023] [Indexed: 03/22/2024]
Abstract
Cardiovascular diseases (CVD) are a leading cause of morbidity & mortality worldwide. Patient education materials help patients understand the disease and its management. Health literacy is an important challenge that may contribute to health inequities and disparities. The National Institute of Health and American Medical Association recommend patient education materials to be ≤6th-grade reading level. Objective To evaluate readability and comprehension of patient education materials related to CVD, available at the American Heart Association (AHA) & CardioSmart web platform by the American College of Cardiology (ACC) websites. Method We examined the readability and comprehension of 63 patient education materials (accessed June 2022) using: (a) Flesch Kincaid Readability Ease (FKRE): measures readability (0-100, goal > 70), (b) Flesch Kincaid Grade Level (FKGL) (goal = grade 7). We compared the AHA and ACC scores using descriptive and t-tests. P-value ≤ 0.05 was significant. Results Sixty-three web pages of patient education materials (AHA 24, ACC 39) were reviewed in June 2022. Mean ± standard deviation (SD) FKRE was 54.9 ± 6.8 for all the web pages. FKRE 50-60 equates to "fairly difficult to read." Mean ± SD FKGL was 10.0 ± 1.3. AHA patient education materials content was significantly more difficult to read and comprehend, were longer, and had more complex words than ACC patient education materials. Conclusions CVD-related patient education materials available online through leading national organizations are not congruent with the recommendations from national healthcare organizations. They are not as user-friendly as they can be. Urgent recognition of the gaps and unmet needs are indicated to optimize patient health literacy.
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Affiliation(s)
| | | | - Meenakshi Jolly
- Division of Rheumatology, Rush University Medical Center, Chicago, IL, USA
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Gajjar AA, Le AHD, Jacobs R, Mooney JH, Lavadi RS, Kumar RP, White MD, Elsayed GA, Agarwal N. Patient perception of spinal cord injury through social media: An analysis of 703 Instagram and 117 Twitter posts. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2023; 14:288-291. [PMID: 37860020 PMCID: PMC10583803 DOI: 10.4103/jcvjs.jcvjs_87_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 08/13/2023] [Indexed: 10/21/2023] Open
Abstract
Introduction Social media has developed exponentially over the last decade as a means for individuals and patients to connect to others and has provided a unique opportunity for physicians to provide broader information to the general public to attempt to positively modify health behavior. The purpose of this study was to assess the patient's perception of spinal cord injury (SCI) on social media. Methods Instagram and Twitter social media platforms were analyzed to determine posts written by patients with SCI. The initial search for Instagram posts tagged with "#spinalcordinjury" yielded over 270,000 posts in April 2021. Posts pertaining to the patient's experience were retrospectively collected from January 2020 to April 2021. Twitter posts that included "#spinalcordinjury," "@spinalcordinjury," and "spinal cord injury" were retrospectively collected in April 2021. One hundred seventeen tweets were found that were directly from a patient with SCI. Themes associated with patients' experiences living with SCI were coded. Results The most common theme on Instagram was spreading positivity and on Twitter was the appearance of the wheelchair (75.8% and 37.3%, respectively). Other common themes on Instagram were the appearance of a wheelchair (71.8%), recovery or rehabilitation (29.9%), and life satisfaction (29.0%). Prevalent themes on Twitter included spreading positivity (23.2%) and recovery or rehabilitation (21.3%). Conclusion The prevalence of themes of positivity and awareness may indicate the utilization of social media as a support mechanism for patients living with SCI. Identification of prevalent themes is important for the holistic treatment of SCI survivors.
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Affiliation(s)
- Avi A. Gajjar
- Department of Neurosurgery, Albany Medical College, Albany, NY, USA
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Kansas City, Missouri, USA
| | - Anthony Huy Dinh Le
- Department of Neurosurgery, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Rachel Jacobs
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Kansas City, Missouri, USA
| | - James H. Mooney
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Raj Swaroop Lavadi
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Kansas City, Missouri, USA
| | - Rohit Prem Kumar
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Kansas City, Missouri, USA
| | - Michael D. White
- Department of Neurological Surgery, Barrow Neurologic Institute, Phoenix, Arizona, USA
| | - Galal A. Elsayed
- Department of Neurosurgery, Weill Cornell Medical College, New York, NY, USA
| | - Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Kansas City, Missouri, USA
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Samuel L, Fera J, Basch CH. Readability Analysis of Online Health Information on Gestational Diabetes. JOURNAL OF CONSUMER HEALTH ON THE INTERNET 2023. [DOI: 10.1080/15398285.2023.2171240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Lalitha Samuel
- Department of Health Promotion and Nutrition Sciences, Lehman College, The City University of New York, Bronx, NY, USA
| | - Joseph Fera
- Department of Mathematics, Lehman College, The City University of New York, Bronx, NY, USA
| | - Corey H. Basch
- Department of Public Health, William Paterson University, Wayne, NJ, USA
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van Ballegooie C, Heroux D, Hoang P, Garg S. Assessing the Functional Accessibility, Actionability, and Quality of Patient Education Materials from Canadian Cancer Agencies. Curr Oncol 2023; 30:1439-1449. [PMID: 36826071 PMCID: PMC9955234 DOI: 10.3390/curroncol30020110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 01/08/2023] [Accepted: 01/13/2023] [Indexed: 01/22/2023] Open
Abstract
Patient education materials (PEM)s were extracted from provincial cancer agencies to determine their organizational health literacy by evaluating the quality, actionability, and functional accessibility (e.g., readability and understandability) of their PEMs. PEMs from 10 provincial agencies were assessed for their grade reading level (GRL), using eight numerical and two graphical readability scales, and underwent a difficult word analysis. The agencies were assessed for PEM quality using two methods (JAMA benchmarks and DISCERN), while actionability and understandability were assessed using the Patient Education Materials Assessment Tool (PEMAT). Seven hundred and eighty-six PEMs were analyzed. The overall average GRL was 9.3 ± 2.1, which is above the recommended 7th GRL for health information. The difficult word analysis showed that 15.4% ± 5.1% of texts contained complex words, 35.8% ± 6.8% of texts contained long words, and 24.2% ± 6.6% of texts contained unfamiliar words. Additionally, there was high overlap between the most frequently identified difficult words in the PEMs and the most frequently misunderstood words by cancer patients identified in the literature. Regarding quality indicators, no agency displayed all four indicators according to the JAMA benchmarks and DISCERN scores ranged between 38 (poor) to 66 (excellent). PEMAT scores ranged between 68% to 88% for understandability and 57% to 88% for actionability. PEMs continue to be written at a level above the recommended GRL across all provinces, and there was overall high variability in the quality, understandability, and actionability of PEMs among provincial agencies. This represents an opportunity to optimize materials, thus ensuring understanding by a wider audience and improving health literacy among Canadian cancer patients.
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Affiliation(s)
- Courtney van Ballegooie
- Experimental Therapeutics, BC Cancer Research Institute, Vancouver, BC V5Z 1L3, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Faculty of Chemistry, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - Devon Heroux
- Experimental Therapeutics, BC Cancer Research Institute, Vancouver, BC V5Z 1L3, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Correspondence:
| | - Peter Hoang
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, BC M5T 2S8, Canada
| | - Sarthak Garg
- Experimental Therapeutics, BC Cancer Research Institute, Vancouver, BC V5Z 1L3, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
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Vallabhaneni A, Eskander PN, Martin K, Eisenstein K, Dyer J. Assessing and optimizing readability of dermatology patient education materials (PEMs). Pediatr Dermatol 2022; 39:382-384. [PMID: 34989037 DOI: 10.1111/pde.14901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Patient education materials (PEMs) are a powerful tool to improve patient understanding; however, inadequate health literacy is a well-established barrier for PEMs to serve their purpose. The average American reads at an 8th grade level and the National Institute of Health (NIH) recommendation for PEMs is at the 6th grade level. The purpose of this study was to assess and optimize PEMs to identify changes that are most effective at lowering the reading level without diluting its educational content. Edits that decrease the number of syllables per word were most effective at improving readability without diminishing educational content when compared to edits involving the total number of words.
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Affiliation(s)
| | - Peter N Eskander
- School of Medicine, University of Missouri-Columbia, Columbia, Missouri, USA
| | - Kari Martin
- Department of Dermatology, University of Missouri-Columbia, Columbia, Missouri, USA
| | - Kimberly Eisenstein
- Department of Dermatology, University of Missouri-Columbia, Columbia, Missouri, USA
| | - Jonathan Dyer
- Department of Dermatology, University of Missouri-Columbia, Columbia, Missouri, USA
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Ikwuegbuenyi CA, Umutoni A, Atabe Ngwene NN, Ngoma P, Nyalundja AD, Nteranya DS, Olobatoke TA, Ogunfolaji O, Sichimba D, Najjuma J, Sebopelo LA, Ndajiwo A, Bamimore MA, Adegboyega G, Kanmounye US. Public awareness, knowledge of availability, and willingness to use neurosurgical care services in Sub-Saharan Africa: A cross-sectional study. PLoS One 2022; 17:e0264955. [PMID: 35298488 PMCID: PMC8929639 DOI: 10.1371/journal.pone.0264955] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 02/20/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Low- and middle-income countries bear the majority of neurosurgical disease burden and patients face significant barriers to seeking, reaching, and receiving care. We aimed to understand barriers to seeking care among adult Africans by evaluating the public perception, knowledge of availability, and readiness to use neurosurgical care services. Methods An e-survey was distributed among African adults who are not in the health sector or pursuing a health-related degree. Chi-square test and ANOVA were used for bivariate analysis and the alpha value was set at 0.05. Odds ratios and their 95% confidence intervals were calculated. Results Six hundred and sixty-two adults from 16 African countries aged 25.4 (95% CI: 25.0, 25.9) responded. The majority lived in urban settings (90.6%) and were English-speaking (76.4%) men (54.8%). Most respondents (76.3%) could define neurosurgery adequately. The most popular neurosurgical diseases were traumatic brain injury (76.3%), congenital brain and spine diseases (67.7%), and stroke (60.4%). Unwillingness to use or recommend in-country neurosurgical services was associated with rural dwelling (β = -0.69, SE = 0.31, P = 0.03), lack of awareness about the availability of neurosurgeons in-country (β = 1.02, SE = 0.20, P<0.001), and believing neurosurgery is expensive (β = -1.49, SE = 0.36, P<0.001). Conclusion Knowledge levels about neurosurgery are satisfactory; however, healthcare-seeking is negatively impacted by multiple factors.
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Affiliation(s)
| | - Alice Umutoni
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | | | - Placide Ngoma
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | | | | | - Tunde A. Olobatoke
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | | | - Dawin Sichimba
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Joanitor Najjuma
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | | | - Aliyu Ndajiwo
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Michael A. Bamimore
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Gideon Adegboyega
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
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12
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Kelly B, O’Donoghue A, Parvanta S, Boudewyns V, Oguntimein O, Bann C, West S, Tzeng J, Chandler C, Madson G, McCormack L. Effects of additional context information in prescription drug information sheets on comprehension and risk and efficacy perceptions. J Pharm Policy Pract 2022; 15:15. [PMID: 35232474 PMCID: PMC8887124 DOI: 10.1186/s40545-021-00386-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 11/26/2021] [Indexed: 12/04/2022] Open
Abstract
Objective To determine how additional explanatory text (context) about drug side effects in a patient medication information handout affected comprehension and perceptions of risk and efficacy. Methods We conducted an online experiment with a national sample of 1,119 U.S. adults with rheumatoid arthritis and related conditions, sampled through random-digit dialing, address-based sampling, and online ads. We randomized participants to receive one of several versions of a patient information handout for a fictitious drug, either with or without additional context, then measured comprehension and other outcomes. Results Additional qualitative context about warnings and side effects resulted in lower comprehension of side effect information, but not information about uses of the drug or warnings. The effect of additional context on risk perceptions depended on whether the medication handout was delivered online or through the mail. Those who received a hardcopy of the handout with additional context had higher perceived risk of side effects than those who saw the version without additional context. Conclusion More clarifying information is not always better and may lead to cognitive overload, inhibiting comprehension. Practice implications Additional research should further explore effects of context in online vs. hard-copy formats before practice implications can be determined. Supplementary Information The online version contains supplementary material available at 10.1186/s40545-021-00386-9.
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Hoang PM, van Ballegooie C. Assessment of the Readability and Quality of Online Patient Education Material for Chronic Medical Conditions. Healthcare (Basel) 2022; 10:healthcare10020234. [PMID: 35206850 PMCID: PMC8872454 DOI: 10.3390/healthcare10020234] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/20/2022] [Accepted: 01/21/2022] [Indexed: 11/20/2022] Open
Abstract
Patient education materials (PEMs) were assessed from chronic health condition associations to determine their quality and if they were above the 6th grade reading level (GRL) recommended by the Centers for Disease Control and National Institutes of Health. PEMs from 55 associations were assessed for their GRL using ten readability scales and underwent a difficult word analysis. The associations had their quality assessed using two methods: the Journal of the American Medical Association (JAMA) Benchmarks and Health on the Net Foundation Code of Conduct certification (HONCode). Two thousand five hundred and ninety PEMs, collected between June and November 2021, were analyzed. The overall GRL average was 10.8 ± 2.8, with a range of 0 to 19. Difficult word analysis showed that 15.8% ± 4.8 contained complex words of 3 or more syllables and 25.7% ± 6.3 contained words which were unfamiliar. No association displayed all four indicators of quality according to JAMA Benchmarks or held an up-to-date HONCode certification. The PEM readability continues to be written at a level above the recommended GRL. Additionally, the lack of quality indicators from the associations’ websites may make it difficult for older adults to identify the sources as credible. This represents an opportunity to optimize materials that would be understood by a wider audience.
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Affiliation(s)
- Peter Minh Hoang
- Department of Internal Medicine, Cumming School of Medicine, Calgary, AB T2N 4N1, Canada
- Correspondence:
| | - Courtney van Ballegooie
- Experimental Therapeutics, BC Cancer Research Institute, Vancouver, BC V5Z 1L3, Canada;
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
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Medland JE, Marks SL, Intile JL. Discharge summaries provided to owners of pets newly diagnosed with cancer exceed recommended readability levels. J Am Vet Med Assoc 2022; 260:657-661. [DOI: 10.2460/javma.21.09.0410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
OBJECTIVE
To analyze the readability of discharge summaries distributed to owners of pets newly diagnosed with cancer.
SAMPLE
118 discharge summaries provided to pet owners following initial consultation.
PROCEDURES
A database search identified records of new patients that had been presented to the North Carolina State Veterinary Hospital medical oncology service between June 2017 and January 2019. Owner-directed portions of the summaries provided at the time of discharge were copied and pasted into a document and stripped of all identifying information. Readability of summaries was assessed with the use of 2 previously established readability calculators: the Flesch-Kincaid Grade Level (FKGL) and Flesch Reading Ease (FRE) tests.
RESULTS
Mean ± SD FKGL was 11.9 ± 1.1 (median, 11.9; range, 8.6 to 15.5; target ≤ 6), and the mean ± SD FRE score was 43 ± 5.9 (median, 42.7; range, 25.5 to 58.1; target ≥ 60). There were no significant differences in FKGL or FRE scores among discharge summaries for patients with the 4 most common tumor types diagnosed or the described treatment options. Ninety-three percent (110/118) of summaries were scored as difficult or very difficult to read.
CLINICAL RELEVANCE
Owner-directed written information regarding a diagnosis of cancer at a single teaching hospital exceeded readability levels recommended by the American Medical Association and NIH and was above the average reading level of most US adults. Efforts to improve readability are an important component of promoting relationship-centered care and may improve owner compliance and patient outcomes.
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Affiliation(s)
- Julia E. Medland
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC
| | - Steven L. Marks
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC
| | - Joanne L. Intile
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC
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15
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Bombana M, Wensing M, Müller G, Ullrich C, Heinzel-Gutenbrunner M, Wittek M. Media use in gynecological and obstetric care and women’s perceived level of education received of lifestyle-related risks: A cross-sectional study. WOMEN'S HEALTH 2022; 18:17455057221090116. [PMID: 35394375 PMCID: PMC9016562 DOI: 10.1177/17455057221090116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The application of media on lifestyle-related risk factors (LRRFs) by healthcare providers to educate women may improve women’s adherence, health literacy, and awareness of LRRFs, as well as offspring’s health outcomes. This study investigated whether exposure to media-based education in gynecological and obstetric care is associated with LRRFs perceived levels of education received during pregnancy and lactation. Methods: We conducted a cross-sectional, observational study across 14 randomly generated sample points in the 12 most populated cities in Baden-Württemberg, southwest Germany. Women were recruited from gynecological and obstetric institutions. Participants were 219 women who met our inclusion criteria and completed the quantitative questionnaire. We applied ordinal logistic regression analyses to calculate odds ratios (ORs) and 95% confidence intervals (CIs) of women’s perceived level of education received related to healthcare providers’ exposure to media-based education. Results: Media-based education on LRRFs during pregnancy through gynecologists and/or midwives were significantly associated with women’s perceived level of education received (gynecologists: OR = 4.26 (95% CI: 2.04, 8.90; p < .001); midwives: OR = 3.86 (95% CI: 1.66, 8.98; p = .002)). Similar results were found for media-based education through gynecologists and/or midwives on LRRFs during lactation and its association with women’s self-assessed level of perceived level of education received (gynecologists: OR = 4.76 (95% CI: 2.15, 10.56; p < .001); midwives: OR = 7.61 (95% CI: 3.13, 18.53; p < .001)). Conclusions: This study suggests that the exposure to media-based education in gynecological and obstetric care increases women’s perceived level of education received of LRRFs during pregnancy and lactation. Therefore, it is recommendable to apply media in gynecological and obstetric care settings.
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Affiliation(s)
- Manuela Bombana
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
- Department of Health Promotion, AOK Baden-Württemberg, Stuttgart, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Gerhard Müller
- Department of Health Promotion, AOK Baden-Württemberg, Stuttgart, Germany
| | - Charlotte Ullrich
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Maren Wittek
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
- Institute of Gerontology, Heidelberg University, Heidelberg, Germany
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16
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Cordray H, Patel C, Prickett KK. Reducing Children's Preoperative Fear with an Educational Pop-up Book: A Randomized Controlled Trial. Otolaryngol Head Neck Surg 2021; 167:366-374. [PMID: 34699270 DOI: 10.1177/01945998211053197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Preoperative education empowers children to approach surgery with positive expectations, and providers need efficient, child-focused resources. This study aimed to evaluate an interactive pop-up book as a tool for explaining surgery, managing preoperative anxiety, and strengthening coping strategies. STUDY DESIGN Prospective randomized controlled trial. SETTING Pediatric outpatient surgery center. METHODS Patients ages 5 to 12 undergoing outpatient surgery read a pop-up book about anesthesia (intervention) or received standard care (control). Patients self-reported their preoperative fear, pain expectations, views of the procedure and preoperative explanations, and coping strategies. Outcomes also included observer-rated behavioral anxiety and caregiver satisfaction. RESULTS In total, 148 patients completed the study. The pop-up book had a significant, large effect in reducing patients' fear of anesthesia induction (Cohen's d effect size = 0.94; P < .001). Intervention patients also expected less pain than control patients from the anesthesia mask and during surgery (d = 0.60-0.80; P < .001). The book encouraged more positive views of the procedure and preoperative explanations (P < .005). Furthermore, the book prepared patients to cope adaptively: intervention patients were significantly more likely to generate positive active coping strategies, distraction strategies, and support-seeking strategies (P < .001). Observer-rated behavioral anxiety at anesthesia induction did not differ between groups (P = .75). Caregivers in the intervention group were significantly more satisfied with each aspect of the surgical experience (P≤ .02). CONCLUSION The educational pop-up book offers a child-focused resource that helps alleviate children's preoperative fears, encourages positive coping, and improves caregivers' perceptions of the experience. This study was registered at ClinicalTrials.gov (NCT04796077).
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Affiliation(s)
- Holly Cordray
- Children's Healthcare of Atlanta at Egleston, Atlanta, Georgia, USA.,Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Chhaya Patel
- Children's Healthcare of Atlanta at Egleston, Atlanta, Georgia, USA.,Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kara K Prickett
- Children's Healthcare of Atlanta at Egleston, Atlanta, Georgia, USA.,Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
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17
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Delaney FT, Doinn TÓ, Broderick JM, Stanley E. Readability of patient education materials related to radiation safety: What are the implications for patient-centred radiology care? Insights Imaging 2021; 12:148. [PMID: 34674063 PMCID: PMC8531160 DOI: 10.1186/s13244-021-01094-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/22/2021] [Indexed: 01/19/2023] Open
Abstract
Background Increasing numbers of patients and carers rely on online resources for healthcare information. Radiation safety can be misunderstood by patients and clinicians and lead to patient anxiety. We aimed to assess the readability of online patient educational materials (PEMs) related to radiation safety. Methods A total of 84 articles pertaining to radiation safety from 14 well-known online resources were identified. PEMs were then analysed using Readability Studio Professional Edition Version 2019. Readability was assessed using eight different instruments: the Flesch-Kincaid Reading Grade Level, Raygor Estimate, SMOG, Coleman–Liau, Fry, FORCAST, Gunning Fog, and Flesch Reading Ease Score formula. The mean reading grade level (RGL) of each article was compared to the 6th and 8th grade reading level using 1-sample t-tests. Results The cumulative mean RGL for all 84 articles was 13.3 (range = 8.6–17.4), and none were written at or below the 6th or 8th grade level. The cumulative mean RGL exceeded the 6th grade reading level by an average of 7.3 levels (95% CI, 6.8–7.8; p < 0.001) and the 8th grade level by an average of 5.3 grade levels (95% CI, 4.8–5.8; p < 0.001). The mean Flesch Reading Ease Score was 39/100 (‘difficult’). Conclusion Currently available online PEMs related to radiation safety are still written at higher than recommended reading levels. Radiation safety is a topic in which the specialist training of radiologists is crucial in providing guidance to patients. Addressing the readability of online PEMs can improve radiology-patient communication and support the shift to a patient-centred model of practice. Supplementary Information The online version contains supplementary material available at 10.1186/s13244-021-01094-3.
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Affiliation(s)
- Francis T Delaney
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland.
| | - Tiarnán Ó Doinn
- Department of Trauma and Orthopaedic Surgery, Tallaght University Hospital, Dublin, Ireland
| | - James M Broderick
- Department of Trauma and Orthopaedic Surgery, Tallaght University Hospital, Dublin, Ireland
| | - Emma Stanley
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
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18
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Xiao Y, Wallace J, Ahad M, van Gemert C, Thompson AJ, Doyle J, Lam HY, Chan K, Bennett G, Adamson E, Yussf N, Tang A, Pedrana A, Stoove M, Hellard M, Howell J. Assessing the feasibility, acceptability and impacts of an education program on hepatitis B testing uptake among ethnic Chinese in Australia: results of a randomised controlled pilot study. BMC Public Health 2021; 21:1861. [PMID: 34654385 PMCID: PMC8518279 DOI: 10.1186/s12889-021-11916-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 10/01/2021] [Indexed: 01/07/2023] Open
Abstract
Background In Australia, Chinese migrants are among the populations most affected by hepatitis B virus (HBV) infection but often experience late diagnosis or access to clinical care. This study aims to explore approaches to increase HBV testing in Australia’s Chinese community and inform evaluation planning, specifically to i) assess the feasibility and acceptability of HBV educational programs, and ii) compare HBV testing uptake in people receiving a tailored education resource focussing on liver cancer prevention compared with a standard HBV education package. Methods This is a pre-post mixed-methods pilot and feasibility study. People of Chinese ethnicity and unsure of their HBV infection or immunity status were recruited from ten community sites in Melbourne, Australia in 2019–2020. Participants were randomised to receive an education package (comprised of a leaflet and in-person one-on-one educational session) with a focus on either 1) standard HBV-related information, or 2) liver cancer prevention. Participants completed a baseline questionnaire prior to receiving the intervention and were followed up at 6 months’ time for a questionnaire and an opt-in semi-structured interview. Primary study outcomes included feasibility of study procedures, measured by recruitment, participation, and retention rates; acceptability of the education program assessed by acceptability scores; and HBV testing uptake rate in each arm. Secondary outcomes include HBV-related knowledge change, assessed by pre-post comparison; and factors affecting participants’ testing behaviour analysed using qualitative data. Results Fifty-four participants received an education package; baseline and follow-up data from 33 (61%) were available. The study procedures of recruitment and retention were feasible; the acceptability of the education program was moderate with improved HBV-related knowledge observed. Four participants self-reported being tested: one (1/15, 7%) in the standard HBV information group and three (3/18, 17%) in the liver cancer prevention information group. Factors identified as affecting testing included perceived relevance and seriousness of HBV, healthcare access and costs of testing, and perceptions of the role of primary care providers in HBV-related care. Conclusion A tailored education program targeting ethnic Chinese in Australia was feasible with moderate acceptability. A larger study is required to determine if a liver cancer prevention message would improve HBV testing uptake in Chinese community than standard HBV education message. Supports from healthcare providers, community-based testing programs, and public health education programs are likely needed to motivate diagnostic testing among Chinese people at risk of HBV infection. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11916-0.
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Affiliation(s)
- Yinzong Xiao
- Burnet Institute, Melbourne, Victoria, 3004, Australia.,Department of Gastroenterology, St Vincent's Hospital, Fitzroy, Victoria, 3065, Australia.,University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Jack Wallace
- Burnet Institute, Melbourne, Victoria, 3004, Australia.,La Trobe University, Bundoora, Victoria, 3086, Australia.,Centre for Social Research in Health, UNSW Australia, Kensington, New South Wales, 2052, Australia
| | - Marvad Ahad
- Burnet Institute, Melbourne, Victoria, 3004, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, 3004, Australia
| | - Caroline van Gemert
- Burnet Institute, Melbourne, Victoria, 3004, Australia.,University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Alexander J Thompson
- Department of Gastroenterology, St Vincent's Hospital, Fitzroy, Victoria, 3065, Australia.,University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Joseph Doyle
- Burnet Institute, Melbourne, Victoria, 3004, Australia.,Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Victoria, 3004, Australia
| | - Ho Yin Lam
- Burnet Institute, Melbourne, Victoria, 3004, Australia
| | - Kico Chan
- Burnet Institute, Melbourne, Victoria, 3004, Australia
| | - Gabrielle Bennett
- Department of Gastroenterology, St Vincent's Hospital, Fitzroy, Victoria, 3065, Australia
| | - Emily Adamson
- Burnet Institute, Melbourne, Victoria, 3004, Australia.,Cancer Council Victoria, Melbourne, Victoria, 3004, Australia
| | - Nafisa Yussf
- Cancer Council Victoria, Melbourne, Victoria, 3004, Australia.,The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, 3000, Australia
| | - Aurora Tang
- Hepatitis Victoria, North Melbourne, Victoria, 3051, Australia
| | - Alisa Pedrana
- Burnet Institute, Melbourne, Victoria, 3004, Australia
| | - Mark Stoove
- Burnet Institute, Melbourne, Victoria, 3004, Australia
| | - Margaret Hellard
- Burnet Institute, Melbourne, Victoria, 3004, Australia. .,University of Melbourne, Parkville, Victoria, 3010, Australia. .,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, 3004, Australia. .,Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Victoria, 3004, Australia. .,The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, 3000, Australia.
| | - Jessica Howell
- Burnet Institute, Melbourne, Victoria, 3004, Australia. .,Department of Gastroenterology, St Vincent's Hospital, Fitzroy, Victoria, 3065, Australia. .,University of Melbourne, Parkville, Victoria, 3010, Australia. .,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, 3004, Australia.
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Abstract
BACKGROUND With an ever-growing reliance on technology, patients are increasingly resorting to websites for their medical information. This study evaluates the readability, quality, and reliability of online information available on rhinoplasty provided by academic centers or impartial reference sources and private practice websites. METHODS A cross-sectional study from July to August 2019 was performed looking at the first 42 informational websites on a Google search for the term nose job. Websites were categorized as belonging to impartial sources and academic centers or private practices. Two independent reviewers evaluated websites on their quality, readability, reliability, and technical qualities using several validated measures. The Health on the Net code (HONcode) and DISCERN questionnaire were used to assess the quality and reliability of the information presented on the websites. Significance tests were performed using SPSS Version 25. RESULTS Of the 42 websites, 23 were impartial sources or academic centers (54.8%) and 19 were private practice websites (47.6%). The mean (±SD) for the HONcode and DISCERN scores were 5.7 (±2.8) and 2.6 (±0.7), respectively. The mean (SD) HONcode scores for impartial sources and private practice websites were 7.1 (±2.9) and 4.1 (±1.5), respectively (P < 0.001). The mean (±SD) DISCERN scores were 2.9 (±0.7) and 2.3 (±0.5), respectively (P = 0.009). There was no statistically significant difference in scores for readability and technical qualities. CONCLUSIONS While impartial sources and academic centers score higher on quality and reliability scores, their scores were also low. These findings are concerning as many consumers use the information provided by online websites to guide decisions regarding their health.
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20
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Zraick RI, Azios M, Handley MM, Bellon-Harn ML, Manchaiah V. Quality and readability of internet information about stuttering. JOURNAL OF FLUENCY DISORDERS 2021; 67:105824. [PMID: 33316553 DOI: 10.1016/j.jfludis.2020.105824] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 10/05/2020] [Accepted: 12/01/2020] [Indexed: 06/12/2023]
Abstract
PURPOSE We examined the quality and readability of English-language Internet information about stuttering and evaluated the results considering recommendations by experts in health literacy. METHOD A search of Internet websites containing information about stuttering was conducted. Three key words (i.e., stuttering, stammering, speech disfluency) were entered into five country-specific versions of the most commonly used Internet search engine. A total of 79 websites were assessed. Their origin (commercial, non-profit, government, personal or university), quality [Health On the Net (HON) certification and DISCERN scores], and readability [Flesch Reading Ease (FRE) score, Flesch-Kincaid Grade Level Formula (F-KGL), and Simple Measure of Gobbledygook (SMOG)] were assessed. RESULTS Of the 79 websites, 38 % were of commercial, 42 % were of nonprofit organization, 15 % were of government and 5% were of university origins, respectively. Only 13 % had obtained HON certification and the mean DISCERN scores was 3.10 in a 5-point scale. The mean reading grade levels were at 13th and 14th grade and 100 % of the websites exceeded the recommended 5th to 6th reading grade level for health information. CONCLUSIONS The quality of Internet-based health information about the treatment of stuttering is generally adequate, but actual usability of the sites examined in this study may be limited due to poor readability levels. This is problematic in persons with poor literacy skills. Since the Internet can be readily accessed as a valuable consumer information resource, speech-language pathologists and other healthcare professionals have an opportunity to direct consumers to websites that provide readable information of good quality.
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Affiliation(s)
- Richard I Zraick
- School of Communication Sciences and Disorders, College of Health Professions and Sciences, University of Central Florida, Orlando, FL, USA.
| | - Michael Azios
- Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX, USA
| | - Melanie M Handley
- Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX, USA
| | | | - Vinaya Manchaiah
- Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX, USA; Department of Speech and Hearing, School of Allied Health Sciences, Manipal University, Manipal, Karnataka, India
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Tater KC. Veterinary allergy information has lower health readability than human allergy information: a comparative analysis of allergy education materials for pets and people. Vet Dermatol 2021; 32:144-e33. [PMID: 33403713 DOI: 10.1111/vde.12934] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/13/2020] [Accepted: 11/13/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pet owners frequently consult online sources of veterinary health information. However, there are limited data on the readability of these resources and whether the readability is appropriate for pet owner education levels. OBJECTIVES To evaluate the education level of the US pet-owning population, and determine the readability of pet allergy information and compare the readability of online pet allergy information with online human allergy information. ANIMALS/SUBJECTS A subpopulation of 4,933 adults, representative of a population of 208,525,282, answering National Health and Nutrition Examination Survey (NHANES) demographic and pet questions. Allergy information in 54 articles (28 veterinary, 26 human) from six health websites (three veterinary, three human). METHODS AND MATERIALS An analysis was performed on 10,294 NHANES questionnaire responses to identify the subpopulation of 4,933 pet-owning adults. Flesch Reading Ease Scores and Flesch-Kincaid Grade Level Scores were calculated on the pet and human allergy information to evaluate readability. RESULTS The age-adjusted prevalence of high school graduation was higher for adults with pets (85.8 ± 1.33%) compared to adults without pets (78.5 ± 1.5%, P < 0.0001). Allergy information on veterinary websites was more difficult to read (P = 0.0052) and written at a higher grade level (P = 0.0047) than that on human health websites. The average veterinary health information readability score was 45.9 ± 8.7 ("difficult to read") and written at an 11th grade level or above (range: 8th grade-college level). CONCLUSIONS Allergy information on veterinary websites was less readable than allergy information on human health websites. Online veterinary information may be written at a reading level that is inappropriate for pet owners.
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Para A, Thelmo F, Rynecki ND, Zelman B, Gupta R, Coban D, Ayyaswami V, Prabhu AV, Ippolito JA, Agarwal N, Moore JM, Beebe KS. Evaluating the Readability of Online Patient Education Materials Related to Orthopedic Oncology. Orthopedics 2021; 44:38-42. [PMID: 33141234 DOI: 10.3928/01477447-20201012-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 01/20/2020] [Indexed: 02/03/2023]
Abstract
The internet is increasingly used to access patient education materials. The average American reading level has been found to be that of a 7th- to 8th-grade student, prompting the National Institutes of Health (NIH) and the American Medical Association (AMA) to advise that patient education materials be written between the 4th- to 6th-grade reading level. The purpose of this study was to evaluate the reading level of current patient education materials for the most common musculoskeletal oncological tumors. A Google search was performed with all location filters off to account for geographic variability for patient education materials related to 28 orthopedic primary or secondary tumors. All patient education articles from the first 10 website hits for each tumor type were analyzed. Patient education materials from these websites were evaluated using 8 validated readability scales. Patient resources were found to be written at an average grade level nearly double the NIH and AMA recommendation. Patient education materials for soft tissue chondromas were written at the highest level (14.8±1.9), whereas education materials for chordomas (10.1±1.0) most closely approached national recommendations, despite still being written at a readability level nearly 4 grade levels higher than has been recommended. The Flesch Reading Ease assessment provided a mean score of 46.5±7.7, corresponding with a "difficult to read" result. Current patient education materials regarding oncological musculoskeletal-related patient education materials are written significantly above the recommended reading level. Further modification of these resources is warranted to ensure adequate comprehension and informed decision making in the clinical setting. [Orthopedics. 2021;44(1):38-42.].
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van Ballegooie C, Hoang P. Health Services: A Mixed Methods Assessment of Canadian Cancer Patient Education Materials Related to the 2019 Novel Coronavirus. Cancer Control 2021; 28:1073274821989709. [PMID: 33563050 PMCID: PMC8482715 DOI: 10.1177/1073274821989709] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The 2019 novel coronavirus (COVID-19) pandemic has prompted the reorganization in the scheduling and method of care for many patients, including patients diagnosed with cancer. Cancer patients, who have an immunocompromised status, may be at a higher risk of severe symptoms from infection with COVID-19. While information is rapidly evolving regarding COVID-19, Canada, both nationally and provincially, has been conveying new information to patients online. We assessed the content and readability of COVID-19-related online Canadian patient education material (PEM) for cancer patients to determine if the content of the material was written at a grade reading level that the majority of Canadians can understand. PEMs were extracted from provincial cancer agencies and the national Canadian Cancer Society, evaluated using 10 readability scales, qualitatively analyzed to identify their themes and difficult word content. Thirty-eight PEMs from both national and provincial cancers associations were, on average, written above the recommended 7th grade level. Each of the associations' average grade levels were: BC Cancer (11.00 95% confidence interval [CI] 8.27-13.38), CancerControl Alberta (10.46 95% CI 8.29-12.62), Saskatchewan Cancer Agency (11.08 95% CI 9.37-12.80), Cancer Care Manitoba (9.55 95% CI 6.02-13.01), Cancer Care Ontario (9.35 95% CI 6.80-11.90), Cancer Care Nova Scotia (10.95 95% CI 9.86-12.04), Cancer Care Eastern Health Newfoundland and Labrador (10.14 95% CI 6.87-13.41), and the Canadian Cancer Society (10.06 95% CI 8.07-12.05). Thematic analysis identified 4 themes: public health strategy, information about COVID-19, patient instructions during COVID-19, and resources. Fifty-three percent of the complex words identified were medical jargon. This represents an opportunity to improve PEM readability, to allow for greater comprehension amongst a wider target audience.
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Affiliation(s)
- Courtney van Ballegooie
- Experimental Therapeutics, BC Cancer Research Institute, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Courtney van Ballegooie, Department of Experimental Therapeutics, BC Cancer Research Institute, 675 West 10th Avenue, Vancouver, British Columbia, Canada V5Z 1L3.
| | - Peter Hoang
- Department of Internal Medicine, Cumming School of Medicine, Calgary, Alberta, Canada
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Perez OD, Swindell HW, Herndon CL, Noback PC, Trofa DP, Vosseller JT. Assessing the Readability of Online Information About Achilles Tendon Ruptures. Foot Ankle Spec 2020; 13:470-477. [PMID: 31771353 DOI: 10.1177/1938640019888058] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The American Medical Association (AMA) and National Institutes of Health (NIH) currently suggest that health care materials be written at a sixth-grade reading level. Our study investigates the readability of online information on Achilles rupture and reconstruction. Achilles tendon rupture, Achilles tendon repair, and Achilles tendon reconstruction were queried using advanced search functions of Google, Bing, and Yahoo!. Individual websites and text from the first 3 pages of results for each search engine were recorded and categorized as physician based, academic, commercial, government and nongovernmental organization, or unspecified. Individual readability scores were calculated via 6 different indices: Flesch-Kincaid grade level, Flesch Reading Ease, Gunning Fog, SMOG, Coleman-Liau index, and Automated Readability Index along with a readability classification score and average grade level. A total of 56 websites were assessed. Academic webpages composed the majority (51.8%), followed by physician-based sources (32.1%). The average overall grade level was 10.7 ± 2.54. Academic websites were written at the highest-grade level (11.5 ± 2.77), significantly higher than physician-based websites (P = .040), and only 2 were written at, or below, a sixth-grade reading level. Currently, online information on Achilles tendon rupture and reconstruction is written at an inappropriately high reading level compared with recommendations from the AMA and NIH.Level of Evidence: Level IV.
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Affiliation(s)
- Olivia D Perez
- Department of Orthopedics, Columbia University Medical Center, New York (ODP, HWS, CLH, PCN, JTV).,Shoulder and Elbow Center, Sports Medicine Center, OrthoCarolina, Charlotte, North Carolina (DPT)
| | - Hasani W Swindell
- Department of Orthopedics, Columbia University Medical Center, New York (ODP, HWS, CLH, PCN, JTV).,Shoulder and Elbow Center, Sports Medicine Center, OrthoCarolina, Charlotte, North Carolina (DPT)
| | - Carl L Herndon
- Department of Orthopedics, Columbia University Medical Center, New York (ODP, HWS, CLH, PCN, JTV).,Shoulder and Elbow Center, Sports Medicine Center, OrthoCarolina, Charlotte, North Carolina (DPT)
| | - Peter C Noback
- Department of Orthopedics, Columbia University Medical Center, New York (ODP, HWS, CLH, PCN, JTV).,Shoulder and Elbow Center, Sports Medicine Center, OrthoCarolina, Charlotte, North Carolina (DPT)
| | - David P Trofa
- Department of Orthopedics, Columbia University Medical Center, New York (ODP, HWS, CLH, PCN, JTV).,Shoulder and Elbow Center, Sports Medicine Center, OrthoCarolina, Charlotte, North Carolina (DPT)
| | - J Turner Vosseller
- Department of Orthopedics, Columbia University Medical Center, New York (ODP, HWS, CLH, PCN, JTV).,Shoulder and Elbow Center, Sports Medicine Center, OrthoCarolina, Charlotte, North Carolina (DPT)
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van Ballegooie C, Hoang P. Assessment of the Readability of Online Patient Education Material from Major Geriatric Associations. J Am Geriatr Soc 2020; 69:1051-1056. [PMID: 33236778 DOI: 10.1111/jgs.16960] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 11/09/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND/OBJECTIVES An increasing number of patients are using the internet to supplement information provided by medical professionals. Online geriatric patient education materials (PEMs) should be written at or below a 6th grade reading level (GRL) that takes into account barriers unique to the geriatric population. The objectives of the study are to assess PEMs of geriatric associations' websites and determine whether they are above the GRL recommended by the Centers for Disease Control and National Institutes of Health. DESIGN Descriptive and correlational methodology. PEMs from 10 major geriatric associations were assessed for their GRL using 10 scales. Eight of the scales provide a numerical GRL while two of the scales provide a visual representation of the GRLs. Analysis was conducted using Readability Studio 2019.3. SETTING Analysis was conducted February 2020. PARTICIPANTS Identified 10 geriatric associations and 884 PEMs. MEASUREMENTS GRLs were measured by 10 validated readability indices: the Degrees of Reading Power and Grade Equivalent test, Flesch-Kincaid grade level, Simple Measure of Gobbledygook test, Coleman-Liau Index, Gunning Fog Index, New Fog Count, New Dale-Chall readability formula, Ford, Caylor, Sticht scale, Raygor readability estimate graph, and Fry readability graph. RESULTS The mean of all PEMs using the numerical scales was 11.1 ± 2.4. Ninety-nine percent of PEMs are above the 6th GRL. PEMs ranged from a grade 3.0 to 19.0 reading level. Analysis of variance demonstrated a significant difference between associations (P < .0001), and multiple comparison analysis identified the National Institute on Aging as the content easiest to read (9.5 ± 1.6). CONCLUSION PEMs from geriatric association websites are written above the recommended 6th GRL. As patients increasingly look toward online supplementary health information during COVID-19, there is an opportunity for improving PEMs to enable greater comprehension by the target population.
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Affiliation(s)
- Courtney van Ballegooie
- Experimental Therapeutics, BC Cancer Research Center, Vancouver, British Columbia, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter Hoang
- Department of Internal Medicine, Cumming School of Medicine, Calgary, Alberta, Canada
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van Ballegooie C. Assessment of Canadian patient education material for oncology pharmaceutics. J Oncol Pharm Pract 2020; 27:1578-1587. [DOI: 10.1177/1078155220960823] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Health literacy is an individual’s ability to access, understand, and utilize information in order to create an informed decision regarding their health. Readability plays an integral role in health literacy as complex health information may be inaccessible to those with low health literacy. The aim of this study is to determine the readability of Canadian patient education material (PEM) for oncology related pharmaceutics. Methods Eighty PEMs from Cancer Care Ontario (CCO) and BC Cancer (BCC) were evaluated for their reading level using a Ford, Caylor, Sticht (FORCAST) analysis. Twenty therapies were then randomly selected and converted to plain text to be analyzed further using the Flesch-Kincaid Grade Level (FKGL), the Simple Measure of Gobbledygook (SMOG) Index, the Coleman-Liau Index (CLI), and the Gunning Fog Index (GFI). Results Both PEMs from CCO and BCC were above the recommended reading level with PEMs from CCO, on average, requiring a higher reading level. Within the text, the section which describes side effects was found to be the most complex section of the representative PEMs from BCC. PEMs from BCC which described antibody-based therapies were, on average, more difficult to read than small molecule-based therapies regardless from which section the PEM was being analyzed. These observations were not seen in CCO PEMs. Conclusions Overall, online PEMs from major Canadian cancers associations were written above the recommended reading level. Consideration should be given to revision of these materials, with emphasis on the therapies’ side effects, to allow for greater comprehension amongst a wider target audience.
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Affiliation(s)
- Courtney van Ballegooie
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Experimental Therapeutics, BC Cancer Research Center, Vancouver, BC, Canada
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Conlon L, Baig Z, Moser MAJ. What Information Are Patients Receiving from the Internet about the Operative and Nonoperative Management of Acute Appendicitis? Dig Surg 2020; 37:480-487. [PMID: 32971522 DOI: 10.1159/000510383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/19/2020] [Indexed: 12/10/2022]
Abstract
INTRODUCTION Recent studies suggest that nonoperative management of appendicitis (NOMA) may be a reasonable option for managing uncomplicated acute appendicitis. We examined the Internet to see if patients are likely to find the information they need to make an informed decision between the 2 options. METHODS A list of 29 search terms was established by a focus group and then entered into Google, resulting in 49 unique webpages, each reviewed by 3 reviewers. Consensus was obtained for bias (surgery, NOMA, or balanced), webpage type, JAMA score, reading grade, and DISCERN score, a measure of quality of written information for patients. RESULTS Thirty of the 49 websites (61%) favored surgery, while 13 (27%) favored NOMA, and 6 sites (12%) provided balanced information. Twelve of 49 sites (24%) did not list NOMA as an option. The majority of patient-directed (11/12 = 92%) and physician-directed (7/9 = 78%) webpages favored surgery, whereas academic webpages presented a more balanced distribution. Academic and physician-directed webpages ranked higher than commercial and news webpages (median ranks 3 and 4 vs. 7.5 and 8). Only 8/49 sites (16%) mentioned that the presence of a fecalith predicts the failure of NOMA. Reading grades were almost all well above the recommended grade 8 level. CONCLUSION Most of the webpages available on the Internet do not provide enough information, nor are they sufficiently understandable to allow most patients to make an informed decision about the current options for the management of acute appendicitis.
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Affiliation(s)
- Luke Conlon
- School of Medicine, The Royal College of Surgeons, Dublin, Ireland
| | - Zarrukh Baig
- Department of Surgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Michael A J Moser
- Department of Surgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada,
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Miles A, Hayden S, Carnell S, Halan S, Lok B. What do speech pathology students gain from virtual patient interviewing? A WHO International Classification of Functioning Disability and Health (ICF) analysis. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2020; 7:239-245. [DOI: 10.1136/bmjstel-2020-000616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/25/2020] [Indexed: 11/03/2022]
Abstract
BackgroundVirtual patients have an established place in medical education but do virtual patient interviews train holistic clinicians or just diagnosticians? This study explored speech pathology students’ virtual patient interviews using WHO International Classification of Functioning Disability and Health (ICF).MethodsEighteen speech pathology students in their final year of training participated. Students interviewed virtual patients with dysphagia (swallowing difficulties) as part of their curriculum. Student questions and patient responses were coded using established ICF coding. Codes were tallied and compared under categories of body structures, body functions, activities/participation and environmental factors. Flesch Reading Ease was calculated as a measure of health literacy.ResultsConversational turns primarily focused on the ICF component—activity and participation in both student questions and virtual patient responses: 0.03% body structures, 30% body functions—swallowing, 7% body functions—associated, 43% activities/participation and 19% environmental factors. Personal factors such as gender, ethnicity, age or socio-economic situation were not mentioned by student or patient. Patients commented on social impact on self and/or family, sometimes in the absence of targeted student questions. Student and virtual patient Flesch Reading Ease scores were congruent.ConclusionSpeech pathology students naturally matched their virtual patient’s health-literacy level and asked a range of medical and daily living questions. Virtual patients readily offered social impact information to student questions. Computer science: healthcare teams should consider creating virtual patients who challenge students to practise asking sensitive questions and in doing so develop holistic thinkers with competent communication skills.
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Patient Education and Engagement Through Multimedia: A Prospective Pilot Study on Health Literacy in Patients with Cerebral Aneurysms. World Neurosurg 2020; 138:e819-e826. [DOI: 10.1016/j.wneu.2020.03.099] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 03/16/2020] [Accepted: 03/17/2020] [Indexed: 11/23/2022]
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Ye MJ, Alwani MM, Harper JL, Buren LMV, Bandali EH, Illing EA, Shipchandler TZ, Ting JY. Readability of Printed Online Education Materials on Pituitary Tumors: Untangling a Web of Complexity. Am J Rhinol Allergy 2020; 34:759-766. [PMID: 32460599 DOI: 10.1177/1945892420927288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Patients are increasingly turning to the internet for health education. Due to the complex pathophysiology, clinic-diagnostic profile, and management spectrum of pituitary tumors, an evaluation of the readability of printed online education materials (POEMs) regarding this entity is warranted. OBJECTIVE (1) To apply established readability assessment tools to internet search results on the topic of pituitary tumors. (2) To identify sources of complexity in order to guide the creation POEMs that are in line with the reading level of the target audience.Methodology: After independent, neutral internet search for the phrase "pituitary tumor," the first 100 results were subjected to inclusion criteria matching. Analysis was performed using 5 readability assessment tools including Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (FKGL), Gunning-Fog Score (GFS), Coleman-Liau Index (CLI), and Simple Measure of Gobbledygook (SMOG). RESULTS A total of 82 websites met inclusion criteria. All websites were found to be at a higher reading level (P < .01) than the United States Department of Health and Human Services (USDHHS) recommended sixth-grade level. Mean readability scores were as follows: FRE, 38.79; FKGL, 11.27; GFS, 12.83; CLI, 17.31; SMOG, 12.12. Intergroup comparison between FKGL, GFS, CLI, and SMOG yielded that CLI was significantly higher (P < .03). No significant differences in readability were noted between academic and other websites. CONCLUSION There is a significant misalignment between the reading level of patients and the readability of pituitary tumor POEMs. This may lead patients to misconceive their diagnoses, management options, and prognosis.
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Affiliation(s)
- Michael J Ye
- Indiana University School of Medicine, Indianapolis, Indiana.,Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Mohamedkazim M Alwani
- Indiana University School of Medicine, Indianapolis, Indiana.,Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | | | | | - Elhaam H Bandali
- Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana
| | - Elisa A Illing
- Indiana University School of Medicine, Indianapolis, Indiana.,Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Taha Z Shipchandler
- Indiana University School of Medicine, Indianapolis, Indiana.,Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jonathan Y Ting
- Indiana University School of Medicine, Indianapolis, Indiana.,Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana.,Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana
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Felipe L, Beukes EW, Fox BA, Manchaiah V. Quality and readability of English-language Internet information for vestibular disorders. J Vestib Res 2020; 30:63-72. [PMID: 32333571 PMCID: PMC9249283 DOI: 10.3233/ves-200698] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND: The Internet has become a powerful, accessible resource for many patients to use for their own medical management and knowledge. Vestibular disorders are prevalent, especially in the elderly. As the Internet is increasingly a major source of health-related information to the general public, it is often used to search for information regarding dizziness and vertigo. Ensuring that the information is accessible, unbiased, and appropriate can aid informed decision-making. OBJECTIVE: To evaluate the quality and readability of English-language Internet information related to vestibular disorders. METHODS: A cross-sectional website search using three keywords (nausea, dizziness, and vertigo) in five country-specific versions of the most commonly used Internet search engine was conducted in March 2018. The language was limited to English for all websites. Quality was assessed by presence of Health on the Net (HON) certification and DISCERN scores. Readability was assessed using the Flesch Reading Ease (FRE) score, Flesch-Kincaid Grade Level Formula (F-KGL), and Simple Measure of Gobbledygook (SMOG). RESULTS: In total, 112 websites were included and analyzed. The majority were commercial (61%) websites. A total of 42% had obtained HON certification. No association was found between the presence of HON certification and the resource of the website. The DISCERN scores had a mean of 2.52 (SD 1.1). Readability measures indicated that an average of 14–18 years of education was required to read and understand the Internet information provided regarding vestibular disorders. CONCLUSIONS: To ensure the accessible to the general population, it is necessary to improve the quality and readability of Internet-based information regarding vestibular disorders.
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Affiliation(s)
- Lilian Felipe
- Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX, USA.,Department of Speech and Hearing, Fluminense Federal University, Niteroi, Rio de Janeiro, Brazil
| | - Eldré W Beukes
- Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX, USA.,Department of Vision and Hearing Sciences, Anglia Ruskin University, Cambridge, United Kingdom
| | - Baylie A Fox
- Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX, USA
| | - Vinaya Manchaiah
- Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX, USA.,Department of Speech and Hearing, School of Allied Health Sciences, Manipal University, Manipal, Karnataka, India
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Rooney MK, Golden DW, Byun J, Lukas RV, Sonabend AM, Lesniak MS, Sachdev S. Evaluation of patient education materials for stereotactic radiosurgery from high-performing neurosurgery hospitals and professional societies. Neurooncol Pract 2020; 7:59-67. [PMID: 32257285 DOI: 10.1093/nop/npz031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Little is known about the readability and utility of patient education materials for stereotactic radiosurgery (SRS). Therefore, the goal of this investigation was to evaluate such materials from high-performing neurosurgery hospitals and professional societies through an analysis of readability and educational content. Methods In this cross-cross sectional study, 61 websites associated with the top 50 neurosurgery and neurology hospitals according to U.S. News & World Report (USNWR) and 11 predetermined professional medical societies were queried. Identified SRS education materials were analyzed by 6 readability indices. Educational content was assessed by 10 criteria based on surveys of patients' perspectives about SRS. Results Fifty-four materials were identified from the target population (45 from USNWR hospital websites and 9 from professional society websites). Mean readability of materials ranged from 11.7 to 15.3 grade level, far more difficult than national recommendations of sixth and eighth grade. Materials were found to have deficiencies in educational content. Compared with high-performing hospitals, materials from websites of professional societies were longer (P = .002), and more likely to discuss risks and benefits specific to SRS (P = .008), alternative treatment options (P = .05) and expected outcomes or postprocedure descriptions (P = .004). Hospital materials were also more likely to favor brand-specific terminology (eg, GammaKnife) over generic terminology (eg, radiosurgery; P = .019). Conclusion Publicly available online patient educational materials for SRS are written at reading levels above national recommendations. Furthermore, many lack information identified as important by patients. Reevaluation and improvement of online SRS educational materials on a national scale are warranted.
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Affiliation(s)
- Michael K Rooney
- College of Medicine, University of Illinois at Chicago.,Department of Radiation Oncology, Northwestern University, Chicago, IL
| | - Daniel W Golden
- Department of Radiation and Cellular Oncology, University of Chicago, IL
| | - John Byun
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick
| | - Rimas V Lukas
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL.,Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Adam M Sonabend
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Maciej S Lesniak
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sean Sachdev
- Department of Radiation Oncology, Northwestern University, Chicago, IL
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Reading Level of Online Patient Education Materials From Major Obstetrics and Gynecology Societies. Obstet Gynecol 2020; 133:987-993. [PMID: 30969212 DOI: 10.1097/aog.0000000000003214] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To assess whether the readability of online patient education materials provided by eight nationally recognized obstetrics and gynecology societies is in accordance with the recommended 6th-grade reading level outlined by the American Medical Association, National Institute of Health, and United States Department of Health and Human Services. METHODS An analysis of 410 online patient education materials from the American Association of Gynecologic Laparoscopists, the American College of Obstetricians and Gynecologists, the American Society for Reproductive Medicine, the American Urogynecologic Society, the Association of Reproductive Health Professionals, the Society of Gynecologic Oncology, the Society for Maternal-Fetal Medicine, and Voices for Pelvic Floor Disorders was completed, and the readability scores using the Flesch-Kincaid Grade Level, Flesch Reading Ease, Gunning Fog Scale, and Simple Measure of Gobbledygook readability scales were calculated. These scales are used to assess print and web-based written material across a wide range of medical specialties and are endorsed by the National Institutes of Health. All four scales are computer-based assessments of readability that consider word count, number of syllables, and length of sentences when calculating a score that corresponds to grade level. RESULTS Majority of the patient education materials across all eight obstetrics and gynecology societies had readability scores above the recommended 6th-grade reading level. The average reading level for the 69 obstetrics-related articles ranged from 9th to 12th grade. The mean grade level for the 341 gynecology articles had a similar range across the four readability scales. CONCLUSION Online patient education materials provided by major obstetrics and gynecology societies do not currently adhere to recommended readability guidelines. Continued efforts to provide accessible and informative patient education materials is recommended to help improve health literacy for women.
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Nesari M, Olson JK, Nasrabadi AN, Norris C. Registered Nurses' Knowledge of and Experience with Health Literacy. Health Lit Res Pract 2019; 3:e268-e279. [PMID: 31893259 PMCID: PMC6901361 DOI: 10.3928/24748307-20191021-01] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 03/07/2019] [Indexed: 11/20/2022] Open
Abstract
Background Limited skill in health literacy is a global issue. Variation in health literacy skills within societies is a source of health inequality unless health care providers apply health literacy practices to effectively communicate with all clients. Objective This study examined Iranian registered nurses' knowledge of and experience with health literacy practices. Methods: This cross-sectional study provides a quantitative description of knowledge of and experience with health literacy practices. Using a rigorous process, we adapted the Health Literacy Knowledge and Experience Survey to collect data from the participants, who were 190 registered nurses working in Tehran, Iran. Key Results Findings identify gaps in participants' knowledge and experience with health literacy practices. Knowledge deficits are most noticeable in standards to create written materials, screening tools to identify limited health literacy, and the Teach-Back strategies to determine people's understanding. Limited experience is prominent in using health literacy screening tools, evaluating written health information, and applying technologies to provide health information. Our multivariate analysis suggests participants who reported more interaction with health care professionals for personal reasons scored higher in knowledge of health literacy practices. Conclusions This study indicated that registered nurses in Iran do not have adequate knowledge and experience regarding health literacy practices. Addressing this issue is fundamental to promoting health equity. Future investigations should identify both barriers and facilitators for nurses to apply health literacy practices. [HLRP: Health Literacy Research and Practice. 2019;3(4):e268-e279.]. Plain Language Summary Health literacy practices enable health care professionals to offer understandable health information to all people and contribute to health equity. We surveyed 190 registered nurses in Iran to assess their knowledge of and experience with health literacy practices. The findings will be a guide to create interventions to improve registered nurses' knowledge of these practices and to use them to communicate clearly with clients.
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Affiliation(s)
- Maryam Nesari
- Address correspondence to Maryam Nesari, PhD, RN, Faculty of Medicine and Dentistry, University of Alberta, 4-284, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, Canada, T6G 1C9;
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Mobile health applications for atrial fibrillation: A readability and quality assessment. Int J Cardiol 2019; 293:288-293. [PMID: 31327518 DOI: 10.1016/j.ijcard.2019.07.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 07/08/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND Mobile health applications may improve patient education and self-care for a complex condition such as atrial fibrillation (AF). Little is known about the accessibility of mobile health applications ("apps") and their readability. We evaluated the readability and quality of available apps for AF. METHODS We searched the Apple and Google Play app stores with the terms "atrial fibrillation" and "afib." We downloaded English-language apps (up to n = 100 for each term) and categorized them by name, App store, cost, content, uploading agency (heath care associated [HCA] versus non-HCA), target audience (health care professional [HCP] versus non-HCP), scientific validity (i.e., citation of peer-reviewed or validated medical information), and user ratings. We analyzed the text of apps intended for a non-HCP target audience for readability with 10 established measures. RESULTS Of the 206 downloaded apps, 50.5% were excluded as unrelated to AF, inaccessible, or non-English language. The majority of apps contained information about AF (63.2% Apple, 52.2% Google Play) and AF detection (52.6% Apple, 56.5% Google Play). A minority of non-HCP apps contained scientifically validated content (Apple, 15.8%; Google Play, 13.0%; P = NS). App mean readability was grade 12.1 ± 2.6. CONCLUSIONS Most AF apps lacked scientific validation and were written at excessively high reading-grade levels. Our results suggest caution with mobile health apps, particularly for users with limited health literacy. There is potential opportunity for a multi-disciplinary effort by regulatory agencies, healthcare organizations, and app stores to improve relevance, scientific validity, and readability of AF apps for patients with this complex and morbid disease.
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Rooney MK, Sachdev S, Byun J, Jagsi R, Golden DW. Readability of Patient Education Materials in Radiation Oncology-Are We Improving? Pract Radiat Oncol 2019; 9:435-440. [PMID: 31228657 DOI: 10.1016/j.prro.2019.06.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/10/2019] [Accepted: 06/12/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Prior research suggests that patient education materials on radiation therapy from various professional groups are written at reading levels above national recommendations of sixth to eighth grade. Since publication of these initial findings, many materials from these sources have been updated or newly created. However, the extent to which readability was considered in the design of these new documents remains unknown. Therefore, the goal of this investigation was to evaluate readability of online education materials for radiation therapy, comparing readability of updated materials with those included in the previous study. METHODS AND MATERIALS Patient education materials related to radiation oncology were identified from websites of the 3 professional societies used in the original investigation (the American College of Radiology, the American Cancer Society, and the American Society for Radiation Oncology). The documents included in the first analysis were used as a comparator. To allow for accurate evaluation across groups, materials were matched by content; when necessary, documents were combined from the original cohort to create topically equivalent materials to reflect those currently available on society websites. Identified materials were analyzed using 7 validated readability indices, and results are reported in grade-level equivalents. Original materials were also reanalyzed with the same method. RESULTS American Cancer Society materials had the lowest average baseline levels (9.4-11.3 grade level) and showed improved readability in the more recent materials (8.0-10.5 grade level). By contrast, the American Society for Radiation Oncology materials had high average baseline readability levels (11.1-13.9 grade level) that actually worsened in the more recent materials (11.7-16.2 grade level). The number of documents meeting national recommendations did not improve in the updated cohort. CONCLUSION Despite evidence that readability levels of patient education materials in radiation oncology are unacceptably high, the readability of newly created materials is not consistently improving across professional societies. Although certain groups may incorporate readability in the design of educational documents, more consistent consideration across all organizations is needed.
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Affiliation(s)
- Michael K Rooney
- College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Sean Sachdev
- Department of Radiation Oncology, Northwestern University, Chicago, Illinois
| | - John Byun
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Reshma Jagsi
- Department of Radiation Oncology and Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan
| | - Daniel W Golden
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois.
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Abu-Heija AA, Shatta M, Ajam M, Abu-Heija U, Imran N, Levine D. Quantitative Readability Assessment of the Internal Medicine Online Patient Information on Annals.org. Cureus 2019; 11:e4184. [PMID: 31106084 PMCID: PMC6504028 DOI: 10.7759/cureus.4184] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Approximately 90% of Americans have access to the internet with the majority of people searching online for medical information pertaining to their health, or the health of loved ones. The public relies immensely on online health information to make decisions related to their healthcare. The American Medical Association (AMA) and the National Institute of Health (NIH) recommend that publicly available health-related information be written at the level of the sixth-seventh grade. Materials and methods Patient education materials available to the public on the Annals.org, a website sponsored by the American College of Physicians, were collected. All 89 patient education articles were downloaded from the website and analyzed for their ease of readability. The articles were analyzed utilizing a readability software generating five quantitative readability scores: Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (FKGL), Gunning Fog Index (GFI), Coleman-Liau Index (CLI), Simple Measure of Gobbledygook (SMOG). All scores, with the exception of FRE, generate a grade level that correlates with the required school-grade level to ensure adequate readability of the information. Results Eighty-nine articles were analyzed generating an average score as follows: FRE 62.8, FKGL 7.0, GFI 8.6, CLI 9.6 and SMOG 9.8. Overall, 87.6% of the articles were written at a level higher than the 7th-grade level, which is recommended by the AMA and NIH. Conclusion In an era of increased reliance on the internet for medical information pertaining to patients’ health, materials written at a higher grade than recommended has the potential to negatively impact patients’ well-being, in addition to tremendous ramifications on the healthcare system. Potentially redrafting, these articles can prove beneficial to patients who rely on these resources for making healthcare-related decisions.
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Affiliation(s)
- Ahmad A Abu-Heija
- Internal Medicine, Wayne State University, Detroit Medical Center, Detroit, USA
| | - Maya Shatta
- Internal Medicine, Wayne State University, Detroit Medical Center, Detroit, USA
| | - Mustafa Ajam
- Internal Medicine, Wayne State University, Detroit Medical Center, Detroit, USA
| | - Usama Abu-Heija
- Miscellaneous, Jordan University of Science and Technology, Amman, JOR
| | - Nashat Imran
- Nephrology, Wayne State University, Detroit Medical Center, Detroit, USA
| | - Diane Levine
- Internal Medicine, Wayne State University, Detroit Medical Center, Detroit, USA
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Affiliation(s)
- Tamara Miner Haygood
- From the Department of Diagnostic Radiology, MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1475, Houston, TX 77030
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Ginat DT, Christoforidis G. A printed information leaflet about MRI and radiologists improves neuroradiology patient health literacy. Neuroradiol J 2018; 31:609-613. [PMID: 29999453 PMCID: PMC6243463 DOI: 10.1177/1971400918788361] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023] Open
Abstract
PURPOSE To determine the health literacy benefit of a printed informational leaflet for patients scheduled to undergo brain magnetic resonance imaging (MRI) scans. METHODS AND MATERIALS A two-page leaflet that provided an overview of MRI and the role of radiologists was prepared and given to outpatients scheduled to undergo brain MRI examinations while in the waiting room. A survey composed mainly of yes/no and Likert scale questions pertaining to the leaflet, as well as patient demographics, was administered to the patients. RESULTS A total of 147 patients completed the survey, of which 110 (75%) had undergone a prior MRI scan, 120 (82%) stated that their ordering provider explained the reason for the MRI scan, and less than 1% reported having referenced online resources related to MRI. The average score for how well patients understood the MRI scan procedure and how it is reviewed was 4.16/5 (standard deviation 1.18) before versus 4.39/5 (standard deviation 1.08) after reading the leaflet, which was a statistically significant improvement based on the Wilcoxon signed-rank test ( P < 0.01). The score for how helpful the reading material was for explaining what is MRI was 4.06/5 (standard deviation 1.02) and the score for how helpful the reading material was for explaining what is a radiologist was 4.18/5 (standard deviation 0.98). CONCLUSION A printed leaflet about MRI and radiologists can serve as an opportunity to educate patients about certain aspects of their scans during their stay in the waiting room.
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Improving Health Literacy. The New American Thoracic Society Guidelines for Patient Education Materials. Ann Am Thorac Soc 2018; 13:1208-11. [PMID: 27509148 DOI: 10.1513/annalsats.201605-337ot] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Park A, Conway M. Harnessing Reddit to Understand the Written-Communication Challenges Experienced by Individuals With Mental Health Disorders: Analysis of Texts From Mental Health Communities. J Med Internet Res 2018; 20:e121. [PMID: 29636316 PMCID: PMC5915669 DOI: 10.2196/jmir.8219] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 12/09/2017] [Accepted: 01/03/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Mental disorders such as depression, bipolar disorder, and schizophrenia are common, incapacitating, and have the potential to be fatal. Despite the prevalence and gravity of mental disorders, our knowledge concerning everyday challenges associated with them is relatively limited. One of the most studied deficits related to everyday challenges is language impairment, yet we do not know how mental disorders can impact common forms of written communication, for example, social media. OBJECTIVE The aims of this study were to investigate written communication challenges manifest in online mental health communities focusing on depression, bipolar disorder, and schizophrenia, as well as the impact of participating in these online mental health communities on written communication. As the control, we selected three online health communities focusing on positive emotion, exercising, and weight management. METHODS We examined lexical diversity and readability, both important features for measuring the quality of writing. We used four well-established readability metrics that consider word frequencies and syntactic complexity to measure writers' written communication ability. We then measured the lexical diversity by calculating the percentage of unique words in posts. To compare lexical diversity and readability among communities, we first applied pairwise independent sample t tests, followed by P value adjustments using the prespecified Hommel procedure to adjust for multiple comparison. To measure the changes, we applied linear least squares regression to the readability and lexical diversity scores against the interaction sequence for each member, followed by pairwise independent sample t tests and P value adjustments. Given the large sample of members, we also report effect sizes and 95% CIs for the pairwise comparisons. RESULTS On average, members of depression, bipolar disorder, and schizophrenia communities showed indications of difficulty expressing their ideas compared with three other online health communities. Our results also suggest that participating in these platforms has the potential to improve members' written communication. For example, members of all three mental health communities showed statistically significant improvement in both lexical diversity and readability compared with members of the OHC focusing on positive emotion. CONCLUSIONS We provide new insights into the written communication challenges faced by individuals suffering from depression, bipolar disorder, and schizophrenia. A comparison with three other online health communities suggests that written communication in mental health communities is significantly more difficult to read, while also consisting of a significantly less diverse lexicon. We contribute practical suggestions for utilizing our findings in Web-based communication settings to enhance members' communicative experience. We consider these findings to be an important step toward understanding and addressing everyday written communication challenges among individuals suffering from mental disorders.
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Affiliation(s)
- Albert Park
- Department of Biomedical Informatics, School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Mike Conway
- Department of Biomedical Informatics, School of Medicine, University of Utah, Salt Lake City, UT, United States
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Zheng J, Yu H. Assessing the Readability of Medical Documents: A Ranking Approach. JMIR Med Inform 2018; 6:e17. [PMID: 29572199 PMCID: PMC5889493 DOI: 10.2196/medinform.8611] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 01/12/2018] [Accepted: 01/31/2018] [Indexed: 02/02/2023] Open
Abstract
Background The use of electronic health record (EHR) systems with patient engagement capabilities, including viewing, downloading, and transmitting health information, has recently grown tremendously. However, using these resources to engage patients in managing their own health remains challenging due to the complex and technical nature of the EHR narratives. Objective Our objective was to develop a machine learning–based system to assess readability levels of complex documents such as EHR notes. Methods We collected difficulty ratings of EHR notes and Wikipedia articles using crowdsourcing from 90 readers. We built a supervised model to assess readability based on relative orders of text difficulty using both surface text features and word embeddings. We evaluated system performance using the Kendall coefficient of concordance against human ratings. Results Our system achieved significantly higher concordance (.734) with human annotators than did a baseline using the Flesch-Kincaid Grade Level, a widely adopted readability formula (.531). The improvement was also consistent across different disease topics. This method’s concordance with an individual human user’s ratings was also higher than the concordance between different human annotators (.658). Conclusions We explored methods to automatically assess the readability levels of clinical narratives. Our ranking-based system using simple textual features and easy-to-learn word embeddings outperformed a widely used readability formula. Our ranking-based method can predict relative difficulties of medical documents. It is not constrained to a predefined set of readability levels, a common design in many machine learning–based systems. Furthermore, the feature set does not rely on complex processing of the documents. One potential application of our readability ranking is personalization, allowing patients to better accommodate their own background knowledge.
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Affiliation(s)
- Jiaping Zheng
- College of Information and Computer Sciences, University of Massachusetts, Amherst, MA, United States
| | - Hong Yu
- College of Information and Computer Sciences, University of Massachusetts, Amherst, MA, United States.,Center for Healthcare Organization and Implementation Research, Bedford Veterans Affairs Medical Center, Bedford, MA, United States.,Department of Computer Science, University of Massachusetts, Lowell, MA, United States.,Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
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Evaluation of the Informational Content, Readability and Comprehensibility of Online Health Information on Monogenic Diabetes. J Genet Couns 2017; 27:608-615. [PMID: 28951986 DOI: 10.1007/s10897-017-0155-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 09/10/2017] [Indexed: 10/18/2022]
Abstract
The purpose of this study was to assess the informational content, readability, suitability and comprehensibility of websites offering educational information about monogenic diabetes available to patients. The top 20 results from 15 queries in four search engines were screened. Content analysis was performed by two independent coders. Readability was determined using Flesch-Kincaid grade level (FKGL) and Simplified Measure of Goobledygook (SMOG). The Comprehensibility Assessment of Materials (SAM + CAM) scale was utilized to evaluate website suitability and comprehensibility. Only 2% (N = 29) of 1200 screened websites met inclusion criteria. Content analysis showed that 16 websites presented information on at least the most common forms of MODY (1, 2 and 3), four addressed the utility of genetic counseling, and none included support resources for patients. All websites exceeded the consensus readability level (6th grade) as assessed by FKGL (10.1 grade) and SMOG (12.8 ± 1.5 grades). Although the majority (N = 20) of websites had an overall "adequate" to "superior" quality score (SAM + CAM score > = 40%), more than one-third scored "not suitable" in categories of content, literacy demand, graphics, and learning motivation. The online educational resources for monogenic diabetes have a high readability level and require improvement in ease of use and comprehensibility for patients with diabetes.
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Seitz CM, Shiplo S, Filippini T, Kabir Z, Lennon JL, Fowler D. The Reading Level of Government and Voluntary Health Organization Smoking Cessation Websites: A Descriptive Analysis. AMERICAN JOURNAL OF HEALTH EDUCATION 2017. [DOI: 10.1080/19325037.2017.1358122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Gupta R, Adeeb N, Griessenauer CJ, Moore JM, Patel AS, Kim C, Thomas AJ, Ogilvy CS. Evaluating the complexity of online patient education materials about brain aneurysms published by major academic institutions. J Neurosurg 2017; 127:278-283. [DOI: 10.3171/2016.5.jns16793] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEHealth care education resources are increasingly available on the Internet. A majority of people reference these resources at one point or another. A threshold literacy level is needed to comprehend the information presented within these materials. A key component of health literacy is the readability of educational resources. The National Institutes of Health (NIH) and the American Medical Association have recommended that patient education materials be written between a 4th- and a 6th-grade education level. The authors assessed the readability of online patient education materials about brain aneurysms that have been published by several academic institutions across the US.METHODSOnline patient education materials about brain aneurysms were downloaded from the websites of 20 academic institutions. The materials were assessed via 8 readability scales using Readability Studio software (Oleander Software Solutions), and then were statistically analyzed.RESULTSNone of the patient education materials were written at or below the NIH's recommended 6th-grade reading level. The average educational level required to comprehend the texts across all institutions, as assessed by 7 of the readability scales, was 12.4 ± 2.5 (mean ± SD). The Flesch Reading Ease Scale classified the materials as “difficult” to understand, correlating with a college-level education or higher. An ANOVA test found that there were no significant differences in readability among the materials from the institutions (p = 0.215).CONCLUSIONSBrain aneurysms affect 3.2% of adults 50 years or older across the world and can cause significant patient anxiety and uncertainty. Current patient education materials are not written at or below the NIH's recommended 4th- to 6th-grade education level.
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Affiliation(s)
- Raghav Gupta
- 1Department of Surgery, Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and
| | - Nimer Adeeb
- 1Department of Surgery, Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and
| | - Christoph J. Griessenauer
- 1Department of Surgery, Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and
| | - Justin M. Moore
- 1Department of Surgery, Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and
| | - Apar S. Patel
- 1Department of Surgery, Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and
| | | | - Ajith J. Thomas
- 1Department of Surgery, Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and
| | - Christopher S. Ogilvy
- 1Department of Surgery, Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and
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Hansberry DR, Agarwal N, John ES, John AM, Agarwal P, Reynolds JC, Baker SR. Evaluation of internet-based patient education materials from internal medicine subspecialty organizations: will patients understand them? Intern Emerg Med 2017; 12:535-543. [PMID: 28138915 DOI: 10.1007/s11739-017-1611-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 01/18/2017] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- David R Hansberry
- Department of Radiology, Thomas Jefferson University Hospitals, 132 South 10th Street, Philadelphia, PA, 19107, USA.
| | - Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Elizabeth S John
- Department of Medicine, University of Central Florida College of Medicine, Orlando, FL, USA
| | - Ann M John
- Department of Medicine, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Prateek Agarwal
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - James C Reynolds
- Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Stephen R Baker
- Department of Radiology, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ, USA
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Kher A, Johnson S, Griffith R. Readability Assessment of Online Patient Education Material on Congestive Heart Failure. Adv Prev Med 2017; 2017:9780317. [PMID: 28656111 PMCID: PMC5471568 DOI: 10.1155/2017/9780317] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 04/16/2017] [Accepted: 05/07/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Online health information is being used more ubiquitously by the general population. However, this information typically favors only a small percentage of readers, which can result in suboptimal medical outcomes for patients. OBJECTIVE The readability of online patient education materials regarding the topic of congestive heart failure was assessed through six readability assessment tools. METHODS The search phrase "congestive heart failure" was employed into the search engine Google. Out of the first 100 websites, only 70 were included attending to compliance with selection and exclusion criteria. These were then assessed through six readability assessment tools. RESULTS Only 5 out of 70 websites were within the limits of the recommended sixth-grade readability level. The mean readability scores were as follows: the Flesch-Kincaid Grade Level (9.79), Gunning-Fog Score (11.95), Coleman-Liau Index (15.17), Simple Measure of Gobbledygook (SMOG) index (11.39), and the Flesch Reading Ease (48.87). CONCLUSION Most of the analyzed websites were found to be above the sixth-grade readability level recommendations. Efforts need to be made to better tailor online patient education materials to the general population.
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Affiliation(s)
- Akhil Kher
- Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | - Sandra Johnson
- Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | - Robert Griffith
- Geisinger Commonwealth School of Medicine, Scranton, PA, USA
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Hansberry DR, Donovan AL, Prabhu AV, Agarwal N, Cox M, Flanders AE. Enhancing the Radiologist-Patient Relationship through Improved Communication: A Quantitative Readability Analysis in Spine Radiology. AJNR Am J Neuroradiol 2017; 38:1252-1256. [PMID: 28385883 PMCID: PMC7960072 DOI: 10.3174/ajnr.a5151] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 01/25/2017] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND PURPOSE More than 75 million Americans have less than adequate health literacy skills according to the National Center for Education Statistics. Readability scores are used as a measure of how well populations read and understand patient education materials. The purpose of this study was to assess the readability of Web sites dedicated to patient education for radiologic spine imaging and interventions. MATERIALS AND METHODS Eleven search terms relevant to radiologic spine imaging were searched on the public Internet, and the top 10 links for each term were collected and analyzed to determine readability scores by using 10 well-validated quantitative readability assessments from patient-centered education Web sites. The search terms included the following: x-ray spine, CT spine, MR imaging spine, lumbar puncture, kyphoplasty, vertebroplasty, discogram, myelogram, cervical spine, thoracic spine, and lumbar spine. RESULTS Collectively, the 110 articles were written at an 11.3 grade level (grade range, 7.1-16.9). None of the articles were written at the American Medical Association and National Institutes of Health recommended 3rd-to-7th grade reading levels. The vertebroplasty articles were written at a statistically significant (P < .05) more advanced level than the articles for x-ray spine, CT spine, and MR imaging spine. CONCLUSIONS Increasing use of the Internet to obtain health information has made it imperative that on-line patient education be written for easy comprehension by the average American. However, given the discordance between readability scores of the articles and the American Medical Association and National Institutes of Health recommended guidelines, it is likely that many patients do not fully benefit from these resources.
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Affiliation(s)
- D R Hansberry
- From the Department of Radiology (D.R.H., M.C., A.E.F.), Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - A L Donovan
- Department of Radiation Oncology (A.L.D., A.V.P.), University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - A V Prabhu
- Department of Radiation Oncology (A.L.D., A.V.P.), University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - N Agarwal
- Department of Neurological Surgery (N.A.), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - M Cox
- From the Department of Radiology (D.R.H., M.C., A.E.F.), Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - A E Flanders
- From the Department of Radiology (D.R.H., M.C., A.E.F.), Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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Hansberry DR, Patel SR, Agarwal P, Agarwal N, John ES, John AM, Reynolds JC. A quantitative readability analysis of patient education resources from gastroenterology society websites. Int J Colorectal Dis 2017; 32:917-920. [PMID: 27924368 DOI: 10.1007/s00384-016-2730-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/24/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS The lay public frequently access and rely on online information as a source of their medical knowledge. Many medical societies are unaware of national patient education material guidelines and subsequently fail to meet them. The goal of the present study was to evaluate the readability of patient education materials within the medical field of gastroenterology. METHODS Two hundred fourteen articles pertaining to patient education materials were evaluated with ten well-established readability scales. The articles were available on the websites for the American College of Gastroenterology (ACG), the American Gastroenterological Association (AGA), the American Society of Gastrointestinal Endoscopy (ASGE), the British Society of Gastroenterology (BSG), and the NIH section National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). One-way analysis of variance (ANOVA) and Tukey's honest significant difference (HSD) post hoc analysis were conducted to determine any differences in level of readability between websites. RESULTS The 214 articles were written at an 11.8 ± 2.1 grade level with a range of 8.0 to 16.0 grade level. A one-way ANOVA and Tukey's HSD post hoc analysis determined the ACG was written at a significantly (p < 0.05) more difficult level when compared to the AGA, the BSG, and the NIDDK websites. No differences were noted when comparing the ASGE website. CONCLUSIONS None of the patient education materials were written at a level that met national guidelines. If the materials are redrafted, the general American public will likely have a greater understanding of the gastroenterology content.
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Affiliation(s)
- David R Hansberry
- Department of Radiology, Thomas Jefferson University Hospitals, 132 South 10th Street, Philadelphia, PA, 19107, USA.
| | - Sahil R Patel
- Department of Medicine, Division of Gastroenterology, Hahnemann University Hospital, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Prateek Agarwal
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Elizabeth S John
- Department of Medicine, Rutgers University, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Ann M John
- Department of Medicine, Rutgers University, New Jersey Medical School, Newark, NJ, USA
| | - James C Reynolds
- Department of Medicine, Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Hansberry DR, Ayyaswami V, Sood A, Prabhu AV, Agarwal N, Deshmukh SP. Abdominal imaging and patient education resources: enhancing the radiologist-patient relationship through improved communication. Abdom Radiol (NY) 2017; 42:1276-1280. [PMID: 27838772 DOI: 10.1007/s00261-016-0977-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The relative ease of Internet access and its seemingly endless amount of information creates opportunities for Americans to research medical diseases, diagnoses, and treatment plans. Our objective is quantitative evaluation of the readability level of patient education websites, written for the lay public, pertaining to common radiologic diagnostic test, and radiologic diagnoses specific to abdominal imaging. METHODS In October 2015, 10 search terms were entered in the Google search engine, and the top 10 links for each term were collected and independently examined for their readability level using 10 well-validated quantitative readability scales. Search terms included CT abdomen, MRI abdomen, MRI enterography, ultrasound abdomen, X-ray abdomen, cholecystitis, diverticulitis, hepatitis, inflammatory bowel disease, and pancreatitis. Websites not written exclusively for patients were excluded from the analysis. RESULTS As a group, the 100 articles were assessed at an 11.7 grade level. Only 2% (2/100) were written at the National Institutes of Health (NIH), and American Medical Association (AMA) suggested 3rd to 7th grade level to meet the 8th grade average reading level in the United States. In fact, 49% were written at a level that required a high school education or higher (greater than 12th grade). CONCLUSIONS With websites like radiologyinfo.org, generating over a million visitors a month, it is that clear there is a public interest in learning about radiology. However, given the discordance between the level of readability of the majority of the Internet articles and the NIH and AMA guidelines noted in this study on abdominal imaging readability, it is likely that many readers do not fully benefit from these resources on abdominal imaging.
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Affiliation(s)
- David R Hansberry
- Department of Radiology, Thomas Jefferson University Hospital, 132 South 10th Street, Philadelphia, PA, 19107, USA.
| | - Varun Ayyaswami
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Anshum Sood
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Arpan V Prabhu
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Sandeep P Deshmukh
- Department of Radiology, Thomas Jefferson University Hospital, 132 South 10th Street, Philadelphia, PA, 19107, USA
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