Patient education for carpal tunnel syndrome: analysis of readability

Changes in Health Education Literacy After Structured Web-Based Education Versus Self-Directed Online Information Seeking in Patients Undergoing Carpal Tunnel Release Surgery: Nonrandomized, Controlled Study

Background

With advancements in anesthesiologic and surgical techniques, many surgeries are now performed as day-surgery procedures, requiring greater responsibilities for self-management from patients during the perioperative process. Online health information often lacks reliability and comprehensibility, posing risks for patients with low health literacy. Carpal tunnel release (CTR) surgery, a common day-surgery procedure, necessitates effective patient education for optimal recovery and self-management.

Objective

This study introduces the CTS Academy, a web-based education program designed for patients undergoing CTR day surgery. The study aimed to evaluate the CTS Academy's impact on patients' health education literacy (HEL) compared with self-directed online information seeking.

Methods

A scoping review on education programs focusing on the perioperative process of CTR was conducted before this study. In a nonrandomized controlled study, 60 patients scheduled for CTR were assigned to 2 groups based on the patients' preferences; the test group used the CTS Academy, while the control group performed self-directed online searches. HEL was assessed using the Health Education Literacy of Patients with chronic musculoskeletal diseases (HELP) questionnaire, focusing on patients's comprehension of medical information (COMPR), patients's ability to apply health-related information in an everyday life (APPLY), and patient's ability to communicate with health care professional (COMM). Secondary outcomes included content comprehensibility, patient preferences, platform usability, and clinical carpal tunnel syndrome (CTS)-related parameters.

Results

In the scoping review, 17 studies could be identified and included for full-text analysis. Eighteen patients each were included in the test group (13 women and 5 men) and in the control group (11 women and 7 men). The average time spent in the study was 167 and 176 days for the test and control groups, respectively. The test group showed significant improvements in APPLY (mean 28, SD 7.99 vs mean 24, SD 5.14; P<.05) and COMM (mean 30, SD 10.52 vs mean 25, SD 6.01; P=.02) after using the CTS Academy in a longitudinal analysis. No significant changes were observed in the control group. In a comparison between groups, the test group had significantly higher APPLY scores at follow-up (mean 24, SD 5.14 vs mean 33, SD 14.78; P=.044) and fewer comprehension issues at baseline (mean 38, SD 16.60 vs mean 50, SD 19.00; P=.03). The CTS-related knowledge assessment yielded 92% (66/72) versus 90% (65/72) correct answers in the test and control groups, respectively. The test group rated the CTS Academy highly in usability (6.22 of 7.00 points) and utility (6.13 of 7.00 points). Preferences leaned toward using CTS Academy alongside doctor consultations (16/18, 89%) and over self-directed searches (15/18, 84%). No significant differences were found in CTS-related symptoms between groups.

Conclusions

The CTS Academy effectively enhanced patients' HEL, especially in applying and communicating medical information. The platform's usability and utility were rated favorably, and patients preferred it over independent online information seeking. This suggests that structured, web-based education enhances patient self-management during the day surgery process.

Evaluation of Patient Education Materials From Large-Language Artificial Intelligence Models on Carpal Tunnel Release

BACKGROUND

ChatGPT, an artificial intelligence technology, has the potential to be a useful patient aid, though the accuracy and appropriateness of its responses and recommendations on common hand surgical pathologies and procedures must be understood. Comparing the sources referenced and characteristics of responses from ChatGPT and an established search engine (Google) on carpal tunnel surgery will allow for an understanding of the utility of ChatGPT for patient education.

METHODS

A Google search of "carpal tunnel release surgery" was performed and "frequently asked questions (FAQs)" were recorded with their answer and source. ChatGPT was then asked to provide answers to the Google FAQs. The FAQs were compared, and answer content was compared using word count, readability analyses, and content source.

RESULTS

There was 40% concordance among questions asked by the programs. Google answered each question with one source per answer, whereas ChatGPT's answers were created from two sources per answer. ChatGPT's answers were significantly longer than Google's and multiple readability analysis algorithms found ChatGPT responses to be statistically significantly more difficult to read and at a higher grade level than Google's. ChatGPT always recommended "contacting your surgeon."

CONCLUSION

A comparison of ChatGPT's responses to Google's FAQ responses revealed that ChatGPT's answers were more in-depth, from multiple sources, and from a higher proportion of academic Web sites. However, ChatGPT answers were found to be more difficult to understand. Further study is needed to understand if the differences in the responses between programs correlate to a difference in patient comprehension.

A Readability Study of Carpal Tunnel Release in 2023

BACKGROUND

The National Institutes of Health (NIH) and the American Medical Association (AMA) recommend a sixth-grade reading level for patient-directed content. This study aims to quantitatively evaluate the readability of online information sources related to carpal tunnel surgery using established readability indices.

METHODS

Web searches for "carpal tunnel release" and "carpal tunnel decompression surgery" queries were performed using Google, and the first 20 websites were identified per query. WebFX online software tools were utilized to determine readability. Indices included Flesch Kincaid Reading Ease, Flesch Kincaid Grade Level, Coleman Liau Index, Automated Readability Index, Gunning Fog Score, and the Simple Measure of Gobbledygook Index. Health-specific clickthrough rate (CTR) data were used in order to select the first 20 search engine results page from each query.

RESULTS

"Carpal tunnel release" had a mean readability of 8.46, and "carpal tunnel decompression surgery" had a mean readability of 8.70. The range of mean readability scores among the indices used for both search queries was 6.17 to 14.0. The total mean readability for carpal tunnel surgery information was found to be 8.58. This corresponds to approximately a ninth-grade reading level in the United States.

CONCLUSION

The average readability of carpal tunnel surgery online content is three grade levels above the recommended sixth-grade level for patient-directed materials. This discrepancy indicates that existing online materials related to carpal tunnel surgery are more difficult to understand than the standards set by NIH and AMA.

Carpal Tunnel Surgery: Can Patients Read, Understand, and Act on Online Educational Resources?

Background

Patients often access online resources to educate themselves prior to undergoing elective surgery such as carpal tunnel release (CTR). The purpose of this study was to evaluate available online resources regarding CTR on objective measures of readability (syntax reading grade-level), understandability (ability to convey key messages in a comprehensible manner), and actionability (providing actions the reader may take).

Methods

The study conducted two independent Google searches for "Carpal Tunnel Surgery" and among the top 50 results, analyzed articles aimed at educating patients about CTR. Readability was assessed using six different indices: Flesch-Kincaid Grade Level Index, Flesch Reading Ease, Gunning Fog Index, Simple Measure of Gobbledygook (SMOG) Index, Coleman Liau Index, Automated Readability Index. The Patient Education Materials Assessment Tool evaluated understandability and actionability on a 0-100% scale. Spearman's correlation assessed relationships between these metrics and Google search ranks, with p<0.05 indicating statistical significance.

Results

Of the 39 websites meeting the inclusion criteria, the mean readability grade level exceeded 9, with the lowest being 9.4 ± 1.5 (SMOG index). Readability did not correlate with Google search ranking (lowest p=0.25). Mean understandability and actionability were 59% ± 15 and 26% ± 24, respectively. Only 28% of the articles used visual aids, and few provided concise summaries or clear, actionable steps. Notably, lower grade reading levels were linked to higher actionability scores (p ≤ 0.02 in several indices), but no readability metrics significantly correlated with understandability. Google search rankings showed no significant association with either understandability or actionability scores.

Conclusion

Online educational materials for CTR score poorly in readability, understandability, and actionability. Quality metrics do not appear to affect Google search rankings. The poor quality metric scores found in our study highlight a need for hand specialists to improve online patient resources, especially in an era emphasizing shared decision-making in healthcare. Level of Evidence: IV.

Readability of Online Hand and Upper Extremity Patient Resources

Background Online patient resources regarding hand and upper extremity topics published by professional societies are written at a level that exceeds that of the average reader. Methodology Online patient resources focused on hand and upper extremity topics published by the American Society for Surgery of the Hand (ASSH), the American Association for Hand Surgery (AAHS), and the American Academy of Orthopaedic Surgeons (AAOS) were reviewed. The reading material from each topic page was analyzed using the Flesch-Kincaid Grade Level (FKGL) and Flesch Reading Ease (FRE) formulas. The reading level (FKGL) of each topic page was compared against an eighth-grade reading level, which corresponds to the average US reading level. Results A total of 170 online patient resources were reviewed, including 84 from the ASSH, 74 from the AAOS, and 12 from the AAHS. Overall, the mean FKGL was 9.1, and the mean FRE was 57.3. Overall, 50% of all hand and upper extremity online resources were written at or below an eighth-grade reading level. Pairwise testing revealed topic pages written by the ASSH had lower FKGL compared to those written by the AAHS (p = 0.046). Conclusions Online patient resources focused on hand and upper extremity topics are, on average, written at a level that exceeds the ability of the average reader. Comparisons between organizations showed a statistical, but not clinical, difference in readability measures. An emphasis on improving readability should be maintained as professional organizations continue to develop their online patient resources.

The Usefulness of Instagram Posts Tagging Hand Surgery Conditions

Introduction  The objective of this study was to assess the usefulness of Instagram posts for users seeking information about common hand conditions. Materials and Methods  An internet-based study was performed of the top 200 trending posts on Instagram for each of the tags #carpaltunnel and #triggerfinger. The trending position (1 through 200), number of likes (for all posts), and number of views (for video posts only) were recorded. Each post was assessed to determine whether it would be useful for a user seeking medical information. Useful and not useful posts were further classified into thematic categories. Results  Useful posts comprised only 21% of #carpaltunnel posts and 12% of #triggerfinger posts. #carpaltunnel had a significantly higher proportion of useful posts than #triggerfinger. For both #carpaltunnel and #trigger finger, useful posts were not associated with trending position or number of likes. Useful posts commonly provided a clinical image or an anatomical diagram. Posts that were not useful were generally irrelevant to the hand condition, but a minority provided information not supported by evidence or were solely advertising material. Conclusion  Hand surgery patients can be educated that, in its current form, Instagram is not a source of useful information about common hand conditions.

Ankle Fractures: The Current State of Online Patient Information

Background. We assessed the quality, accuracy, and readability of websites for ankle fractures. Methods. Ankle Fracture, Broken Ankle, and Fibular Fracture were entered into 3 search engines. The first 25 results from each search were collected. Quality, accuracy, and readability were assessed by a custom rubric, 3 surgeons, and Fleisch-Kincaid grade level (FKGL), respectively. Results. A total of 57 websites were included: 24 were assigned to Ankle Fracture, 26 to Broken Ankle, and 7 to Fibular Fracture. The average quality score out of 36, accuracy score out of 12, and FKGL for all websites were 13.1 ± 6.8, 10.8 ± 1.2, and 9.6 ± 1.7, respectively. Websites assigned to the term Broken Ankle had a significantly lower New Dale-Chall score. Websites of lower FKGL and appearing earlier in results had significantly higher quality scores. Physician specialty societies (PSSs) had a significantly lower FKGL than websites of other types. Conclusion. The readability of patient materials is above the recommended level for ankle fractures. Encouragingly, a trade-off between readability and quality was not found. Patients should use search terms they are familiar with and prioritize websites that appear earlier in search results, are easier to read, and produced by PSSs.Level of Evidence: Level 3.

Assessing Readability of Patient Education Materials on Breast Reconstruction by Major US Academic Hospitals as Compared With Nonacademic Sites

PURPOSE

Women undergoing postmastectomy breast reconstruction face many complex choices. A myriad of online patient education materials exist to assist in decision making. Understanding of these materials, termed health literacy, affects surgical decision making and outcomes. The National Institutes of Health recommends writing patient education materials at a sixth- to seventh-grade reading level. The primary goal of this study was to assess readability of online breast reconstruction materials.

METHODS AND MATERIALS

Resources were collected from every academic hospital with a plastic surgery residency program, 97 in total. These data were compared with the top nonacademic Web sites ranked by search engine results, 14 in total. Materials were analyzed using 3 validated readability assessment scales: Coleman-Liau Index, SMOG (Simplified Measure of Gobbledygook) Readability Formula, and Flesch-Kincaid Grade Level. Average readability was analyzed, and results were compared using a 1-way analysis of variance to assess for significance between the different tools and a 2-sided t test to assess for significance between academic and nonacademic readability results.

RESULTS

The mean readability scores across the academic programs were a Coleman-Liau Index of 13.38 (standard Deviation [SD] 2.81, 13th to 14th grade), Flesch-Kincaid Grade Level of 13.04 (SD = 3.9, 13th grade), and SMOG Readability of 13.64 (SD = 2.99, 13th to 14th grade). For the 14 nonacademic sites, results showed a Coleman-Liau Index of 11.93 (SD = 1.14, 12th grade), Flesch-Kincaid of 11.82 (SD = 2.33, 11th to 12th grade), and SMOG Readability of 10.91 (SD = 1.79, 11th grade). One-way analysis of variance demonstrated no significant differences in mean readability scores across the 3 readability tools used (academic F = 2.7804, P = 0.06; nonacademic F = 1.14, P = 0.33). Two-tailed t test results demonstrated that there was statistical significance between readability of the academic in comparison with nonacademic search engine results (t = 2.04, P = 0.04).

CONCLUSIONS

Average readability across all Web sites were much higher than the recommended reading level, at a 13th to 14th grade reading level for academic institutions, and an 11th to 12th grade for nonacademic Web sites. Plastic surgeons may contribute to improving patient understanding and perioperative outcomes through revising patient education materials.

Comparing Diagnostic and Treatment Recommendations of Carpal Tunnel Syndrome Available on the Internet With AAOS Clinical Practice Guidelines

Background: Carpal tunnel syndrome (CTS) is one of the most common diagnoses in a hand surgeon's office, with estimated cost exceeding US $2 billion annually in the United States. Due to this prevalence and cost, patients often turn to the Internet for their medical care. It has been estimated that 72% of Internet users have looked online for health information in the last year. There is concern that patients may be getting misinformation with their Internet medical searches. Methods: An informal survey of the Internet was conducted to evaluate the content available to the public on the Internet and social media platforms regarding the diagnosis and treatment of CTS. The top 20 listings of 3 major search engines and information within 3 major social media sites were included. Results: Information gleaned from the search showed that while most listings were helpful in providing accurate diagnostic information and appropriate treatment modalities, there was also a great number of treatment modalities mentioned that may not be recommended by the treating physician. The guidelines established by the American Academy of Orthopaedic Surgeons both in 2007 and in 2008 and more recently in 2016 were used as a general reference but not directly compared with the informal Internet search for statistical analysis. Conclusions: This search outlines the importance of the information readily available to patients and how this may potentially alter patients' expectations prior to their arrival in the office.

Kienböck Disease: Quality, Accuracy, and Readability of Online Information

Background: Patients with limited health literacy require online educational materials to be written below a sixth grade level for optimal understanding. We assessed the quality, accuracy, and readability of online materials for Kienböck disease (KD). Methods: "Kienbock's Disease" and "Lunate Avacular Necrosis" were entered into 3 search engines. The first 25 Web sites from each search were collected. Quality was assessed via a custom grading rubric, accuracy by 2 residents and a fellow, and readability by Flesch-Kincaid grade level (FKGL) and New Dale-Chall test. Web sites were stratified according to the search term, FKGL, order of appearance, and authorship type. Results: A total of 38 unique Web sites were included, of which 22 were assigned to "KD" and 16 to "Lunate Avascular Necrosis." The average quality score out of 30, accuracy score out of 12, and FKGL for all Web sites were 13.3 ± 7.3, 10.4 ± 1.9, and 10.5 ± 1.4, respectively. Web sites assigned to the term "Kienbock's Disease" had a significantly higher FKGL. Web sites of higher FKGL had significantly worse accuracy scores. Order of appearance had no influence. Physician specialty societies (PSS) had a significantly lower FKGL than Web sites of other authorship types. Conclusions: Despite concerted efforts by national organizations, the readability of online patient materials is above the recommended level for KD. Patients with limited health literacy will be most affected by this reality. Until readability improves, patients should continue to consult their physicians when uncertain and prioritize Web sites that are easier to read and produced by PSS.

Evaluation of written and video education tools after mallet finger injury

STUDY DESIGN

Prospective cohort.

INTRODUCTION

Successful nonoperative treatment of mallet finger injuries requires compliance to prolonged immobilization and understandable educational materials.

PURPOSE OF THE STUDY

This study evaluated the use of written and online video education tools after mallet finger injury.

METHODS

After ethics board approval and informed consent, adults with an acute mallet finger injury referred to hand therapy were included. Standard nonoperative treatment was instituted with orthotic immobilization and verbal instructions, in addition to an education pamphlet and an online video link. A questionnaire regarding the educational materials was administered at the follow-up appointment.

RESULTS

There were 61 patients (mean age, 42 ± 14 years). The middle (n = 21) and ring (n = 22) fingers were most commonly injured. All patients were fluent in English. Written instructions (n = 57) were used by more patients than the videos (n = 30). Comparing patients who viewed the video with those who did not, there were no differences (P > .05) in demographics (sex, age, education, work status, and second language). Both written and video instructions were reported as helpful; mean helpful score for the video was significantly (P = .03) higher than written instructions. Most patients preferred having written and video instructions, and both were easy to understand and convenient.

DISCUSSION

In our study of patients with acute mallet finger injuries, written and video instructions were utilized and both were reported as helpful.

CONCLUSIONS

This study provides evidence of the usefulness of online videos as an educational aid and the opportunity for future investigations to improve patient access to education materials.

Readability of online materials for Dupuytren's contracture

STUDY DESIGN

Descriptive.

BACKGROUND

Dupuytren's contracture is a common disorder involving fibrosis of the palmar fascia. As patients are increasingly using online materials to gather health care information, it is imperative to assess the readability and appropriateness of this content. The recommended grade level for patient educational materials is seventh to eighth grade according to the National Institutes of Health. This study aims to assess the readability and content of online patient resources for Dupuytren's contracture.

PURPOSE OF THE STUDY

Evaluate readability of online patient education materials for Dupuytren's contracture.

METHODS

The largest public search engine, Google, was queried using the term "Dupuytren's contracture surgery" on February 26, 2016. Location filters were disabled, and sponsored results were excluded to avoid any inadvertent search bias. The 10 most popular Web sites were identified, and all relevant patient-directed information within 1 click from the original site was downloaded and saved as plain text. Readability was analyzed using 6 established analyses (Readable.io, Added Bytes, Ltd, UK).

RESULTS

Analysis of 10 Web sites demonstrates an average grade level of at least 11th grade (Flesch-Kincaid grade level, 10.2; Gunning-Fog grade level, 13.1; Coleman-Liau grade level, 14.4; Simple Measure of Gobbledygook grade level, 10.0; automated readability grade level, 9.7; and average grade level, 11.5). Overall Flesch-Kincaid reading ease index was 46.4, which is difficult. No single article was at the recommended reading level.

CONCLUSIONS

Online materials available for treatment of Dupuytren's contracture are above recommended reading levels and do not include a comprehensive explanation of treatment options, which may negatively impact decision making in patients seeking treatment for this condition. Surgeons and hand therapists alike should be cognizant of available online patient materials and make efforts to develop and provide more appropriate materials.

LEVEL OF EVIDENCE

V.

Readability and Understandability Analysis of Online Materials Related to Abdominal Aortic Aneurysm Repair

Background:

Patients commonly use online materials as a source of health information. Since poor health literacy has been shown to correlate with negative outcomes, it is recommended that patient-directed materials be written at a sixth-grade reading level. This study evaluates the readability and understandability of commonly accessed online materials pertaining to both endovascular and open repair of abdominal aortic aneurysm.

Methods:

Searches for “endovascular repair abdominal aortic aneurysm” and “open repair abdominal aortic aneurysm” were performed on both Google and Bing, and the top 10 websites from each search engine were identified. Relevant websites (total N = 28, endovascular n = 15, open n = 15, and 2 redundant sites) with patient-directed content were analyzed. Readability was assessed using 9 established methods, and understandability was assessed using the Patient Education Materials Assessment Tool scoring system.

Results:

The average reading grade level for all sites was 12.8. Endovascular sites averaged a reading grade level of 13.6 with a range from 11.5 to 15.6. Open-repair websites had a grade-level average of 12.1 with a range from 9.9 to 14.1. Readability was found to be inversely related to understandability, with a Pearson correlation coefficient of −0.551 ( P = .003). No website was written at or below the recommended sixth-grade reading level.

Conclusions:

Patient-directed online health information pertaining to open and endovascular repair of abdominal aortic aneurysm exceeds the recommended sixth-grade reading level. Increasing complexity of health literature correlates with poor understandability. Modifications such as shorter sentences, fewer words with more than 6 letters, and increasing usage of clear visual aids can increase readability and understandability.

A Comparative Multimetric Assessment of English and Spanish Carpal Tunnel Syndrome Materials

BACKGROUND

Spanish-speaking Hispanics living in the United States utilize the internet as a primary means to obtain health information. Accurate, accessible information is important for English speakers; however, it could have even greater utility for Spanish speakers who have lower health literacy levels. The aim of this study was to evaluate and compare online English and Spanish carpal tunnel surgery materials provided by using a multimetric approach.

MATERIALS AND METHODS

A web search using the English term "carpal tunnel surgery" was performed. The first 10 institutional/organizational websites that provided carpal tunnel surgery information in English and Spanish were included. All relevant online materials were evaluated using the Patient Education and Materials Assessment Tool (PEMAT), Cultural Sensitivity Assessment Tool (CSAT), and Simplified Measure of Gobbledygook, Spanish (SOL) to assess understandability and actionability, cultural sensitivity, and readability, respectively.

RESULTS

There were no statistically significant differences in understandability or actionability scores between Spanish and English materials. Average cultural sensitivity scores for Spanish materials were significantly lower than English materials (P = 0.015). The average reading grade level of online English materials was greater than that for Spanish materials (P = 0.011). Both mean values were above the recommended sixth-grade reading level.

CONCLUSIONS

Online patient-directed information regarding carpal tunnel surgery exceeded the recommended reading grade level for both English and Spanish-speaking populations. Most Spanish materials were often direct translations and were not contoured to the elevated literacy needs of this demographic. Institutions must caution their authors to tailor their web material in a way that is sensitive to their target population to optimize understanding.

Factors Associated With Quality of Online Information on Trapeziometacarpal Arthritis

PURPOSE

People increasingly search the Internet for information about common medical problems such as trapeziometacarpal (TMC) joint arthritis. But this information can be biased, inaccurate, and misleading. Medical professionals should be aware of what patients may be reading about their condition because concepts and beliefs can affect symptoms, limitations, and decision making. This study sought factors associated with the quality of design and content of health information Web sites about TMC arthritis.

METHODS

Using 3 search engines we entered "thumb arthritis" and measured the quality of design and content of 67 Web sites using the DISCERN and LIDA tools, dominant tones using the IBM Watson Tone Analyzer, and readability, and we recorded Web site characteristics. All but 1 Web site exceeded the recommended sixth-grade reading level. We created 2 backward stepwise regression models to identify independent factors associated with Web site design and content quality.

RESULTS

In multivariable analysis, the Web site not having a clear preference for treatment was independently associated with greater design and content quality measured by DISCERN. Health On the Net (HON) code certification-a code of conduct for medical Web sites-and nonprofit Web sites had higher LIDA scores.

CONCLUSIONS

Online information on TMC arthrosis is difficult to read, often biased in favor of a particular treatment and influenced by profit and HONcode.

CLINICAL RELEVANCE

Hand surgeons should prepare to gently correct misconceptions established or reinforced, in part, by material found on the Internet.

Readability of Healthcare Literature for Gastroparesis and Evaluation of Medical Terminology in Reading Difficulty

Background

Gastroparesis is a chronic condition that can be further enhanced with patient understanding. Patients’ education resources on the Internet have become increasingly important in improving healthcare literacy. We evaluated the readability of online resources for gastroparesis and the influence by medical terminology.

Methods

Google searches were performed for “gastroparesis”, “gastroparesis patient education material” and “gastroparesis patient information”. Following, all medical terminology was determined if included on Taber’s Medical Dictionary 22nd Edition. The medical terminology was replaced independently with “help” and “helping”. Web resources were analyzed with the Readability Studio Professional Edition (Oleander Solutions, Vandalia, OH) using 10 different readability scales.

Results

The average of the 26 patient education resources was 12.7 ± 1.8 grade levels. The edited “help” group had 6.6 ± 1.0 and “helping” group had 10.4 ± 2.1 reading levels. In comparing the three groups, the “help” and “helping” groups had significantly lower readability levels (P < 0.001). The “help” group was significantly less than the “helping” group (P < 0.001).

Conclusions

The web resources for gastroparesis were higher than the recommended reading level by the American Medical Association. Medical terminology was shown to be the cause for this elevated readability level with all, but four resources within the recommended grade levels following word replacement.

Readability, complexity, and suitability analysis of online lymphedema resources

BACKGROUND

Over 72% of Americans use online health information to assist in health care decision-making. Previous studies of lymphedema literature have focused only on reading level of patient-oriented materials online. Findings indicate they are too advanced for most patients to comprehend. This, more comprehensive study, expands the previous analysis to include critical elements of health materials beyond readability using assessment tools to report on the complexity and density of data as well as text design, vocabulary, and organization.

METHODS

The top 10 highest ranked websites on lymphedema were identified using the most popular search engine (Google). Website content was analyzed for readability, complexity, and suitability using Simple Measure of Gobbledygook, PMOSE/iKIRSCH, and Suitability Assessment of Materials (SAM), respectively. PMOSE/iKIRSCH and SAM were performed by two independent raters. Fleiss' kappa score was calculated to ensure inter-rater reliability.

RESULTS

Online lymphedema literature had a reading grade level of 14.0 (SMOG). Overall complexity score was 6.7 (PMOSE/iKIRSCH) corresponding to "low" complexity and requiring a 8th-12th grade education. Fleiss' kappa score was 80% (P = 0.04, "substantial" agreement). Overall suitability score was 45% (SAM) correlating to the lowest level of "adequate" suitability. Fleiss' kappa score was 76% (P = 0.06, "substantial" agreement).

CONCLUSIONS

Online resources for lymphedema are above the recommended levels for readability and complexity. The suitability level is barely adequate for the intended audience. Overall, these materials are too sophisticated for the average American adult, whose literacy skills are well documented. Further efforts to revise these materials are needed to improve patient comprehension and understanding.

Online Patient Resources for Liposuction: A Comparative Analysis of Readability

BACKGROUND

As patients strive to become informed about health care, inadequate functional health literacy is a significant barrier. Nearly half of American adults have poor or marginal health literacy skills and the National Institutes of Health and American Medical Association have recommended that patient information should be written at a sixth grade level. The aim of this study is to identify the most commonly used online patient information about liposuction and to evaluate its readability relative to average American literacy.

METHODS

An internet search of "liposuction" was performed and the 10 most popular websites identified. User and location data were disabled and sponsored results excluded. All relevant, patient-directed articles were downloaded and formatted into plain text. Articles were then analyzed using 10 established readability tests. A comparison group was constructed to identify the most popular online consumer information about tattooing. Mean readability scores and specific article characteristics were compared.

RESULTS

A total of 80 articles were collected from websites about liposuction. Readability analysis revealed an overall 13.6 grade reading level (range, 10-16 grade); all articles exceeded the target sixth grade level. Consumer websites about tattooing were significantly easier to read, with a mean 7.8 grade level. These sites contained significantly fewer characters per word and words per sentence, as well as a smaller proportion of complex, long, and unfamiliar words.

CONCLUSIONS

Online patient resources about liposuction are potentially too difficult for a large number of Americans to understand. Liposuction websites are significantly harder to read than consumer websites about tattooing. Aesthetic surgeons are advised to discuss with patients resources they use and guide patients to appropriate information for their skill level.

Readability of Patient Education Materials in Hand Surgery and Health Literacy Best Practices for Improvement

PURPOSE

This study aimed to update a portion of a 2008 study of patient education materials from the American Society for Surgery of the Hand Web site with new readability results, to compare the results to health literacy best practices, and to make recommendations to the field for improvement.

METHODS

A sample of 77 patient education documents were downloaded from the American Society for Surgery of the Hand Web site, handcare.org, and assessed for readability using 4 readability tools. Mean readability grade-level scores were derived. Best practices for plain language for written health materials were compiled from 3 government agency sources.

RESULTS

The mean readability of the 77 patient education documents in the study was 9.3 grade level. This reading level is reduced from the previous study in 2008 in which the overall mean was 10.6; however, the current sample grade level still exceeds recommended readability according to best practices.

CONCLUSIONS

Despite a small body of literature on the readability of patient education materials related to hand surgery and other orthopedic issues over the last 7 years, readability was not dramatically improved in our current sample. Using health literacy as a framework, improvements in hand surgery patient education may result in better understanding and better outcomes for patients seeing hand surgeons.

CLINICAL RELEVANCE

Improved understanding of patient education materials related to hand surgery may improve preventable negative outcomes that are clinically significant as well as contribute to improved quality of life for patients.

Readability analysis of online resources related to lung cancer

BACKGROUND

Patients seeking health information commonly use the Internet as the first source for material. Studies show that well-informed patients have increased involvement, satisfaction, and healthcare outcomes. As one-third of Americans have only basic or below basic health literacy, the National Institutes of Health and American Medical Association recommend patient-directed health resources be written at a sixth-grade reading level. This study evaluates the readability of commonly accessed online resources on lung cancer.

METHODS

A search for "lung cancer" was performed using Google and Bing, and the top 10 websites were identified. Location services were disabled, and sponsored sites were excluded. Relevant articles (n = 109) with patient-directed content available directly from the main sites were downloaded. Readability was assessed using 10 established methods and analyzed with articles grouped by parent website.

RESULTS

The average reading grade level across all sites was 11.2, with a range from 8.8 (New Fog Count) to 12.2 (Simple Measure of Gobbledygook). The average Flesch Reading Ease score was 52, corresponding with fairly difficult to read text. The readability varied when compared by individual website, ranging in grade level from 9.2 to 15.2. Only 10 articles (9%) were written below a sixth-grade level and these tended to discuss simpler topics.

CONCLUSIONS

Patient-directed online information about lung cancer exceeds the recommended sixth-grade reading level. Readability varies between individual websites, allowing physicians to direct patients according to level of health literacy. Modifications to existing materials can significantly improve readability while maintaining content for patients with low health literacy.