Readability assessment of vaccine information: A systematic review for addressing vaccine hesitancy

Readability of written information for patients across 30 years: A systematic review of systematic reviews

OBJECTIVE

This study conducted a systematic review of the systematic reviews of readability assessment studies to contribute to future readability research and practice by providing a comprehensive overview of information readability for patients.

METHODS

We searched multiple databases. We included systematic reviews of studies that quantitatively assessed the readability of health information.

RESULTS

This study included 24 systematic reviews, which assessed the readability of 29,424 materials across 438 studies from 1990 to 2022. All systematic reviews reported that the readability of most materials exceeded the recommended sixth to eight-grade reading level. The readability level did not improve between 2001 and 2022, when the included systematic reviews were published.

CONCLUSIONS

We found that the required reading level of information was too high for patients in all clinical areas included in this systematic review. We also identified gaps in readability assessment research in clinical areas and across media types and languages, which should be addressed by future studies.

PRACTICE IMPLICATIONS

Health professionals should use available guidelines to make existing patient information easy to read and to write easy-to-read patient information, thereby improving readability. Such efforts are needed regardless of the organizations these professionals work at.

Improving the health literacy of persons with epilepsy

Improving health literacy can improve health. This essay reviews the resources available to help improve epilepsy health literacy, including websites, drug inserts/labels/information leaflets, patient educators, handouts, plain language, lay summaries, and other efforts to close the gaps between research and epilepsy health literacy.

The Deadly Details: How Clear and Complete Are Publicly Available Sources of Human Rabies Information?

Human rabies is preventable but almost always fatal once symptoms appear, causing 59,000 global deaths each year. Limited awareness and inconsistent access to post-exposure prophylaxis hinder prevention efforts. To identify gaps and opportunities for improvement in online rabies information, we assessed the readability, understandability, actionability, and completeness of online public rabies resources from government and health agencies in Australia and similar countries, with the aim of identifying gaps and opportunities for improvement. We identified materials via Google and public health agency websites, assessing readability using the Simple Measure of Gobbledygook (SMOG) index and understandability and actionability with the Patient Education Materials Tool for Print materials (PEMAT-P). Completeness was assessed using a framework focused on general and vaccine-specific rabies information. An analysis of 22 resources found a median readability of grade 13 (range: 10-15), with a mean understandability of 66% and mean actionability of 60%; both below recommended thresholds. Mean completeness was 79% for general rabies information and 36% for vaccine-specific information. Visual aids were under-utilised, and critical vaccine-specific information was often lacking. These findings highlight significant barriers in rabies information for the public, with most resources requiring a high literacy level and lacking adequate understandability and actionability. Improving readability, adding visual aids, and enhancing vaccine-related content could improve accessibility and support wider prevention efforts.

Readability of online and offline written health information: a protocol of a systematic review of systematic reviews

INTRODUCTION

Healthcare organisations should create and disseminate readable information to citizens and patients to reduce the level of health literacy required for individuals. Several systematic reviews have reported overviews of the readability of written health information for each subject area. This systematic review of systematic reviews will synthesise evidence from existing systematic reviews to provide an overview of studies that assessed readability in diverse areas and identify gaps to be filled in future research and practice to improve the readability of health information.

METHODS AND ANALYSIS

The following databases will be searched: PubMed, MEDLINE, CINAHL, PsycINFO, Web of Science Core Collection, Scopus, Cochrane Database of Systematic Reviews, and Google Scholar. The reference lists of the eligible studies will be searched to identify additional studies. The eligible literature will be systematic reviews of published empirical studies that quantitatively assessed the readability of health information for patients and/or citizens. Two independent reviewers will screen the titles, abstracts and full texts of all identified literature. A lead researcher will extract the data, and a second reviewer will check the results. Discrepancies will be resolved through discussion, and a third reviewer will be involved if necessary. Data, such as the characteristics of the systematic review, characteristics of the reviewed literature in the systematic review, subject area, material characteristics, definition(s) of readability, readability assessment methods, main results and quality assessment, will be extracted. The findings will be synthesised in a numerical summary and a descriptive and narrative review.

ETHICS AND DISSEMINATION

This review does not involve any ethical concerns. The results and implications of this systematic review will be disseminated at conferences and in peer-reviewed journals.

Vaccination Promotion Strategies in the Elderly: Systematic Review and Meta-Analysis

Background: The World Health Organization estimates that currently available vaccines prevent 2 to 3 million deaths worldwide each year. Preventing infectious diseases is an important public health priority to ensure healthy ageing and improve quality of life. This study's aim is to identify the best strategies to increase vaccination coverage in the elderly. Methods: A systematic review and meta-analysis were carried out, including a bibliographic search in the PubMed and Scopus databases. Studies in older people (60 years or older) on any type of intervention aimed at increasing vaccination coverage were included. The effect of the intervention was measured using the odds ratio (OR). Results: After applying the selection criteria, 20 studies were identified: 17 on influenza vaccines and 3 on other vaccines. Educational strategies obtained an OR = 1.63 (95% CI: 1.22-2.19, I2 = 0.59). Medical counselling obtained an OR = 3.13 (95% CI: 0.60-16.37, I2 = 0.95). Writing strategies obtained an OR = 1.14 (95% CI: 0.99-1.32, I2 = 0.93). Few studies reported the effect of free vaccination. Conclusions: The educational strategies proved to be more effective than the others in this study. Free vaccination and age may have important roles. Further studies are needed as research in this area remains limited.

Both English- and Spanish-Language Anterior Cruciate Ligament Reconstruction Online Patient Education Materials Are Written at Higher-Than-Recommended Reading Levels

Purpose

To examine the overall reading levels of anterior cruciate ligament reconstruction online patient education materials (OPEMs) written in English and Spanish.

Methods

We conducted Google searches for OPEMs using "ACL surgery" and "cirugía LCA" as English and Spanish search terms, respectively. Several measures of readability were used to analyze 25 English-language OPEMs (Flesch Reading Ease, Flesch Reading Ease Grade Level, Flesch-Kincaid Grade Level, Coleman-Liau Index, Gunning Fog Index, and Simple Measure of Gobbledygook) and 25 Spanish-language OPEMs (Fernández-Huerta Index, Fernández-Huerta Grade Level, and Índice de Legibilidad de Flesch-Szigriszt). English- and Spanish-language OPEMs were compared based on mean overall grade level and number of OPEMs written below a seventh- or ninth-grade reading level.

Results

English-language OPEMs showed a higher mean overall grade level than Spanish-language OPEMs (10.48 ± 1.86 vs 8.64 ± 1.22, P < .001). No significant differences were noted in the number of OPEMs written below a seventh-grade reading level. However, significantly more Spanish-language OPEMs were written below a ninth-grade reading level compared with English-language OPEMs (56% vs 16%, P = .003).

Conclusions

Although Spanish-language OPEMs were written at a lower reading level, average readability for both English- and Spanish-language OPEMs was significantly higher than the recommended level. Across both languages, only a single English-language webpage met the American Medical Association-recommended sixth-grade reading level. More Spanish-language articles were written at or below the average adult reading level in the United States.

Clinical Relevance

It is imperative that patient educational materials be written at a reading level that is understood by the most patients. This is especially true for OPEMs, when a medical provider is not present to answer questions. Therefore, it is important to evaluate the reading level of OPEMs to determine whether they are written at an appropriate level for the best patient understanding.

Readability Metrics in Patient Education: Where Do We Innovate?

The increasing use of digital applications in healthcare has led to a greater need for patient education materials. These materials, often in the form of pamphlets, booklets, and handouts, are designed to supplement physician-patient communication and aim to improve patient outcomes. However, the effectiveness of these materials can be hindered by variations in patient health literacy. Readability, a measure of text comprehension, is a key factor influencing how well patients understand these educational materials. While there has been growing interest in readability assessment in medicine, many studies have demonstrated that digital texts do not frequently meet the recommended sixth-to-eighth grade reading level. The purpose of this opinion article is to review readability from the perspective of studies in pediatric medicine, internal medicine, preventative medicine, and surgery. This article aims to communicate that while readability is important, it tends to not fully capture the complexity of health literacy or effective patient communication. Moreover, a promising avenue to improve readability may be in generative artificial intelligence, as there are currently limited tools with similar effectiveness.

Do social media epistemological beliefs and health perception impact parents' vaccine hesitancy? A mediation analysis

In recent years, there has been a notable increase in vaccine hesitancy among individuals. It is crucial to identify the factors contributing to vaccine hesitancy to effectively address this issue. This study aims to investigate the impact of social media-specific epistemological beliefs on vaccine hesitancy and the mediating role of health perception in this impact. This study is a cross-sectional study conducted with 444 parents. Data were collected using the Personal Information Form, the Social Media-Specific Epistemological Beliefs Scale, the Perception of Health Scale, and the Vaccine Hesitancy Scale. When there is no mediator variable, the total effect of social media-specific epistemological beliefs on vaccine hesitancy is statistically significant (β = -0.219, p < 0.001). However, it was found that health perception did not mediate the relationship between social media-specific epistemological beliefs and vaccine hesitancy (β = 0.0038, 95% confidence interval (-0.0090, 0.0205)). Furthermore, it was determined that social media-specific epistemological beliefs positively predicted health perception (β = 0.136, p < 0.01). Health perception was found to have no significant effect on vaccine hesitancy (β = 0.028, p > 0.05). It can be concluded that social media-specific epistemological beliefs negatively predict vaccine hesitancy, and this effect is independent of health perception. Primary healthcare professionals should consider incorporating interventions aimed at enhancing individuals' social media-specific epistemological beliefs into their health education programs related to vaccines.

Vaccine Hesitancy Affecting Pneumococcal Vaccine Refusal in Older Adults with Morbidities

INTRODUCTION

Pneumonia is a leading cause of mortality worldwide, with Streptococcus pneumoniae being the most common cause. Older adults are particularly at risk. However, vaccination rates in Thailand remain low.

OBJECTIVE

This study aims to examine the prevalence of vaccine refusal and its association with factors outlined in the 5C model (Confidence, Complacency, Constraints, Calculation, and Collective Responsibility) among older patients with morbidities.

SETTING

Study was conducted at outpatient clinic of the Department of Family Medicine, Chiang Mai University.

METHODS

An observational cross-sectional study. The data was collected via a self-administered questionnaire including demographic data, questionnaire in 5C model, and intention to received pneumococcal vaccine. Comparison of characteristic between vaccine refuser and non-refuser was performed by using Chi-square or a T-test. To explore the association between factors in 5C model and vaccine refusal, multiple logistic regression was performed with an adjustment for confounders.

RESULTS

From a total of 150 participants, the mean age was 69.8 ± 5.6 years old. Most of the patients were female (60.7%). The study found that 18% of the participants refused the pneumococcal vaccine. After adjusted for the confounders, the lower collective responsibility and confidence were significantly associated with vaccine refusal (Odds ratio 0.22 (95% confidence interval [CI] 0.06-0.74, P = .015) and Odds ratio 0.43 (95% CI 0.20-0.89, P = .024), respectively.

CONCLUSION

Strategies to enhance confidence and address complacency about vaccines are essential for improving pneumococcal vaccination coverage. This insight can be used as a guideline and policies can be formulated which are aimed at reducing pneumococcal vaccine refusal in the older adults by enhancing communication about the benefits, efficacy, and risks of vaccines.

Readability of patient and family education materials on pediatric surgical association websites

PURPOSE

Globally, pediatric surgical association websites present patient/family education materials on an extensive list of conditions, including descriptions of the condition, signs and symptoms, diagnostic modalities, and treatment options. The purpose of this project was to assess the readability of pediatric surgical association websites' patient/family education materials.

METHODS

With IRB approval, we accessed all patient/family education materials on pediatric surgical association websites from around the globe and used multiple grade-level assessments and readability assessments to determine the reading level at which the information is presented.

RESULTS

The American Pediatric Surgical Association (APSA) website and the British Association of Paediatric Surgeons (BAPS) present publicly accessible patient/family education materials. Seventy-four (74) conditions on APSA's website were analyzed. Three grade-level assessments and the Flesch Reading Ease assessment indicated that the articles are written at high school reading levels. No articles were available in languages other than English. BAPS presented 6 conditions, most of which were more readable than their APSA counterparts.

CONCLUSIONS

Our analysis indicates that the patient/family education materials available on pediatric surgical association websites may not be written at a level that is comprehensible by the general population. Potential solutions include re-writing the materials with an emphasis on readability and presenting materials in languages other than English.

LEVEL OF EVIDENCE

V.

COVID-19 vaccine literacy and vaccine hesitancy among pregnant women and mothers of young children in Japan

BACKGROUND

Delays in the spread of vaccination have been recognized as an urgent public health issue in the context of the COVID-19 pandemic. Vaccine literacy (VL) is a critical determinant of vaccine uptake; however, little is known about VL among pregnant women and mothers of young children.

METHODS

We analyzed data from a nationwide, cross-sectional internet survey in Japan on VL and vaccine hesitancy, conducted with 1,639 pregnant women and 5,688 mothers of young children who had given birth after July 2019, between July 24 and August 30, 2021.

RESULTS

Vaccine hesitancy was observed in 51.1 % of pregnant women and 31.9 % of mothers of young children. The risk of vaccine hesitancy was significantly higher among pregnant women with lower interactive/critical skills (risk ratio [RR] 2.10, 95 % confidence interval [CI] 1.59, 2.78, p < 0.001), although functional skills did not significantly correlate with vaccine hesitancy. For mothers of young children, we found a significantly higher risk of vaccine hesitancy among those with low VL functional skills (RR 1.38, 95 % CI 1.19, 1.61), p < 0.001) and low interactive/critical skills (RR 1.29, 95 % CI 1.10, 1.50, p = 0.001).

CONCLUSIONS

Our findings suggest that aiding individuals to correctly evaluate vaccine-related information is critical for improving vaccine acceptance rates among both pregnant women and mothers of young children. Meanwhile, improving the comprehensibility of communication toolkits may be important for women with children but have a limited effect among pregnant women.

COVID-19 vaccination hesitancy among people with chronic neurological disorders: a position paper

Background and purpose

Health risks associated with SARS‐CoV‐2 infection are undisputed. Moreover, the capability of vaccination to prevent symptomatic, severe, and fatal COVID‐19 is recognized. There is also early evidence that vaccination can reduce the chance for long COVID‐19. Nonetheless, the willingness to get vaccinated and receive booster shots remains subpar among people with neurologic disorders. Vaccine scepticism not only jeopardizes collective efforts to end the COVID‐19 pandemic but puts individual lives at risk, as some chronic neurologic diseases are associated with a higher risk for an unfavorable COVID‐19 course.

Methods

In this position paper, the NeuroCOVID‐19 Task Force of the European Academy of Neurology (EAN) summarizes the current knowledge on the prognosis of COVID‐19 among patients with neurologic disease, elucidates potential barriers to vaccination coverage, and formulates strategies to overcome vaccination hesitancy. A survey among the Task Force members on the phenomenon of vaccination hesitancy among people with neurologic disease supports the lines of argumentation.

Results

The study revealed that people with multiple sclerosis and other nervous system autoimmune disorders are most skeptical of SARS‐CoV‐2 vaccination. The prevailing concerns included the chance of worsening the pre‐existing neurological condition, vaccination‐related adverse events, and drug interaction.

Conclusions

The EAN NeuroCOVID‐19 Task Force reinforces the key role of neurologists as advocates of COVID‐19 vaccination. Neurologists need to argue in the interest of their patients about the overwhelming individual and global benefits of COVID‐19 vaccination. Moreover, they need to keep on eye on this vulnerable patient group, its concerns, and the emergence of potential safety signals.