Evaluating the Readibility of Informed Consent Forms Available Before Anaesthesia: A Comparative Study

Evaluation of readability levels of online patient education materials for female pelvic floor disorders

Most women hesitate to seek help from healthcare providers as they find it difficult to share complaints of involuntary leakage or vaginal prolapse. Hence, they often refer to the websites of national and/or international bodies' patient education materials (PEMs), which are considered the most reliable sources. The crucial factor that determines their usefulness is their readability level, which makes them "easy" or "difficult" to read, and is recommended, not to exceed the sixth grade level. In this study, we aimed to assess the readability levels of Turkish translated PEMs from the websites of the International Urogynecological Association and the European Association of Urology and the PEMs originally written in Turkish from the website of the Society of Urological Surgery in Turkey. All the PEMs (n = 52) were analyzed by online calculators using the Atesman formula, Flesch-Kincaid grade level, and Gunning Fog index. The readability parameters, number of sentences, words, letters, syllables, and readability intervals of these methods were compared among the groups using the Kruskal-Wallis test, or ANOVA test, with post hoc comparisons where appropriate. The readability level of all PEMs is at least at an "averagely difficult" interval, according to both assessment methods. No significant differences were found among the PEM groups in terms of readability parameters and assessment methods (P > .05). Whether original or translated, international or national societies' PEMs' readability scores were above the recommended level of sixth grade. Thus, the development of PEMs needs to be revised accordingly by relevant authorities.

In what ways does user experience design improve printed educational materials?

We report on a series of four studies that investigated how user experience design (UXD) can improve printed educational materials (PEMs). We examined the perceived usability of an existing PEM for breast cancer screening and observed the usability problems associated with it (Study 1). We then compared a breast cancer screening PEM created by user experience designers with two other breast cancer screening PEMS, finding that the PEM based on UXD had higher perceived usability, and lower mentions of usability problems, than the other two PEMs (Study 2). We next examined the impact of individual differences in design expertise on perceived usability, this time including a PEM on cervical cancer screening as well as one on breast cancer screening (Study 3). Our concluding study (Study 4) then examined the impacts of UXD on learnability of PEM content as defined by answers to a knowledge questionnaire about screening administered before and after reading the PEM, and by intention to screen for cancer after reading the PEM. The first three studies showed that the involvement of UXD improved the perceived usability of PEMs, and Study 3 showed that designers differ in their ability to create useable PEMs. Study 4 failed to find a corresponding improvement in learnability or intention to screen when UXD was used to improve perceived usability. We conclude that a user experience design approach that incorporates graphic design can improve the perceived usability of PEMs in some situations (e.g., when the PEM material is not too lengthy or complex, and when the graphic designer is sufficiently skilled). However, we found no evidence that lack of perceived usability accounted for the failure of PEMS (found in previous research) to improve knowledge or intention to screen.

Determination of the Readability Level of Consent Forms Used in the Gynecology and Obstetrics Clinic at Suleyman Demirel University

Background This study aimed to evaluate the readability level of consent forms used for interventional procedures in the obstetrics and gynecology clinic and to determine the readability of the texts according to the education level of the patient. Methodology This study determined the readability of patient consent forms used before interventional procedures in the gynecology and obstetrics clinic at the Suleyman Demirel University Hospital, Isparta. The consent forms were divided into two main groups according to their use in obstetrics and gynecology procedures. The readability level of consent forms was assessed using two readability formulas developed by Ateşman and Bezirci-Yılmaz, which determine the readability level of Turkish texts in the literature. Results When the consent forms were analyzed according to Atesman's readability formula, they were found to be readable with more than 15 years of education at the undergraduate level, while according to Bezirci-Yılmaz's readability formula, they were found to be readable with 17 years of education at the postgraduate level. Conclusions Easy-to-read consent forms will ensure that patients are more informed about interventional procedures and participate more effectively in the treatment process. There is a need to develop readable consent forms suitable for the general education level.

An Evaluation of the Comprehensibility Levels of Ophthalmology Surgical Consent Forms

Background/Aim

This study aimed to evaluate the comprehensibility of the consent forms used for interventional procedures in the ophthalmology clinic of a university hospital and to determine which texts could be read according to patient age and education level.

Materials and methods

Forty separate consent forms used as the standard for various interventional procedures in the ophthalmology department of a university hospital were evaluated. The comprehensibility formulas used were developed for the Turkish language by Ateşman and Bezirci-Yilmaz.

Results

As a result of the evaluation of the consent forms in this study, a mean of 55.6±5.73 points was obtained according to the Ateşman comprehensibility index, and this value was found to correspond to being understood by eleventh and twelfth-grade school students. According to the Bezirci-Yilmaz comprehensibility index, the mean points of the consent forms were 10.05±2, which corresponded to a level that could be understood by 10th and 11th-grade students.

Conclusion

The comprehensibility level of the consent forms given to patients was found to be low in this study, which was similar to the findings of previous studies in the literature. When preparing informed consent forms, the education level of the country must be taken into consideration.

Is There a Difference Between the Readabilities of Informed Consent Forms Used for Elective and Emergency Procedures in Turkey?

Background:

Informed consent is an important aspect of ethical medical practice. In legal terms, making an intervention without informed consent may mean negligence or malpractice and may lead to legal action, maltreatment, and even attack against the doctor. This study aims to evaluate the readability of informed consent forms (ICFs) used for elective (urology and general surgery) and emergency procedures (emergency medicine and intensive care) by comparing through readability formulas.

Methods:

Elective and emergency ICFs were accessed through the web sites of national health care associations. A total of 387 consent forms were evaluated and the same forms were included only once. A total of 35 consent forms were evaluated for emergency procedures, while a total of 55 consent forms were evaluated for elective procedures. Ateşman and Bezirci-Yılmaz formulas defined for determining the readability level of Turkish texts and Gunning fog and Flesch Kincaid formulas measuring the general readability level were used for calculating the readability level of consent forms.

Results:

Even though elective ICFs are more readable compared to those of emergency procedures according to Bezirci-Yılmaz formulas, this was statistically insignificant ( P = .54). The readability of elective consent forms was found to be at a significantly more difficult level to read compared to Ateşman, Gunning fog, and Flesch Kincaid formulas ( P = .002, P < .001, P < .001, respectively).

Conclusion:

Even though the procedure is emergency or elective, a difficult readability level may cause problems for the doctor in legal phases. Readable and understandable consent forms should be available to be able to explain morbidity and mortality and improve prognosis. Education level of our country should also be considered while preparing these consent forms.

To understand or not to understand: This is the problem

BACKGROUND/AIMS

The aim of the study was to evaluate the level of readability of the informed consent used before colonoscopy in a university hospital by different methods, and to investigate related sociodemographic variables.

MATERIALS AND METHODS

This descriptive, cross-sectional study included 211 subjects aged over 18. Three different measurement tools were used to evaluate the level of readability of the informed consent: The Cloze Readability Procedure, the Flesch's readability formula adapted to Turkish by Atesman, and the readability formula developed by Cetinkaya and Uzun.

RESULTS

The readability scores of the text, calculated according to Atesman's formula, the Cetinkaya-Uzun, and Cloze Readability Procedure were 50.183 (the average level of difficulty), 31.021 (frustration level), and 26.68 (frustration level), respectively. The informed consent was found to be appropriate for individuals educated at the grade level 10 and above. The following participants were found to have significantly higher scores: educated above high school; reading books, magazines, digital media, and printed media every day or every other day; and previously informed about colonoscopy.

CONCLUSION

Within the framework of a colon cancer screening program conducted by the Public Health Institution of Turkey, individuals who tested positive were subjected to the colonoscopy procedure, if necessary. This increases the importance of the informed consent form used prior to the colonoscopy procedure. The patients and/or patients'relatives who are at the frustration level of reading ability would have problems in reading and comprehending the text. The Cloze Test Procedure might be used in examining problematic consent forms.

Evaluation of the readability of informed consent forms used in urology: Is there a difference between open, endoscopic, and laparoscopic surgery?

OBJECTIVE

The aim of this study is to evaluate the readability levels of informed consent forms used in Turkey before urological surgery and to compare the readability levels of open, endoscopic, and laparoscopic surgical informed consent forms.

MATERIAL AND METHODS

A total of 529 informed consent forms used for urological open, endoscopic, and laparoscopic surgical procedures were collected from different hospitals in Turkey. Evaluating informed consent forms that have exactly the same text only once, a total of 69 consent forms were evaluated. The Gunning Fog Index and Flesch-Kincaid test measuring the general readability level were used to calculate the readability level of informed consent forms in addition to the Ateşman and Bezirci-Yılmaz formulas defined to determine the readability level of Turkish texts. Informed consent forms were evaluated and divided into three groups as open, endoscopic, and laparoscopic surgery forms, depending on their content.

RESULTS

Among 69 informed consent forms evaluated, 35 were open, 19 were endoscopic, and 15 were laparoscopic surgery consent forms. The readability level of all informed consent forms was detected as average according to the Ateşman formula, very difficult according to the Flesch-Kincaid test, difficult according to the Gunning Fog Index, and at the high school education level according to the Bezirci-Yılmaz formula. A statistical evaluation of the three groups did not show a significant difference in the readability level.

CONCLUSION

In this study, it was detected that the informed consent form readability levels used for urological surgical procedures in our country were rather low. We think that the cooperation of the concerned institutions is required for the revision of the consent information texts available and the improvement of the texts according to the strategies recommended.

Readability of internet-sourced patient education material related to "labour analgesia"

We evaluated the readability of Internet-sourced patient education materials (PEMs) related to "labour analgesia." In addition to assessing the readability of websites, we aimed to compare commercial, personal, and academic websites.We used the most popular search engine (http://www.google.com) in our study. The first 100 websites in English that resulted from a search for the key words "labour analgesia" were scanned. Websites that were not in English, graphs, pictures, videos, tables, figures and list formats in the text, all punctuation, the number of words in the text is less than 100 words, feedback forms not related to education, (Uniform Resource Locator) URL websites, author information, references, legal disclaimers, and addresses and telephone numbers were excluded.The texts included in the study were assessed using the Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG), and Gunning Frequency of Gobbledygook (FOG) readability formulae. The number of Latin words within the text was determined.Analysis of 300-word sections of the texts revealed that the mean FRES was 47.54 ± 12.54 (quite difficult), mean FKGL and SMOG were 11.92 ± 2.59 and 10.57 ± 1.88 years of education, respectively, and mean Gunning FOG was 14.71 ± 2.76 (very difficult). Within 300-word sections, the mean number of Latin words was identified as 16.56 ± 6.37.In our study, the readability level of Internet-sourced PEM related to "labour analgesia" was identified to be quite high indicating poor readability.