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This study aims to assess the quality and readability of online resources regarding postoperative pain control for patients having undergone total shoulder arthroplasty (TSA), along with identifying gaps among the types of information. Three search engines were used to conduct internet searches utilizing a combination of TSA and pain management search phrases. The top 20 web pages from each search engine were gathered, reviewed, and scored by five different evaluators. Scoring was performed using 30-point criteria, integrated into an overall quality of resource (QR) score considered significant for patient education about TSA and pain management according to American Pain Society and American Academy of Orthopaedic Surgeons' published recommendations (Table I). Domain scores (route of administration, type of analgesia, opioid-specific, and general guidance) were calculated by summing the total points and dividing by the total possible score for each domain. The reading level of the Flesch-Kinkaid grade level, the Flesch reading ease, and the simple measure of gobbledygook index was also assessed. The overall readability was low, with a mean Flesch-Kincaid grade level score of 10.3 ± 2.0 and Simple Measure of Gobbledygook score of 9.9 ± 1.5. According to this index, only one website (2.3%) was written below the suggested 6th grade reading level. There was a mean QR score of 9.6/30 points, ranging from 2 to 22 (Table II). Most resources (90.9%) did not achieve greater than 50% of the total available points (greater than 15 out of 30). Of the domains, the mean score for route of administration was 31.8%, types of analgesia was 43.6%, opioid-specific was 11.4%, and general guidance was 43.2%. Opioid-specific scores were lower than all three other domain scores (all P <.001). According to our findings, current online resources for pain management following TSA are written above the average literacy level for adults in the United States and lack educational content, especially regarding opioid-specific discussion and recommendations. Resources must target gaps in online patient education to better inform patients of postoperative pain control, convey expectations, and encourage patient-physician conversations and decision-making. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine the readability level of information on 100 unique websites with information on preeclampsia. Five different readability measures were used to measure each website's readability via an online readability calculator. All five readability measures determined that a vast majority of the sites sampled were written at unacceptable levels (89%+). Independent one-tailed t-tests (α = 0.05) determined that there was no statistical difference in the readability scores of.com vs the other websites on any of the 5 readability assessments. We recommend that efforts be made to simplify language in accordance with plain language recommendations for health information in the United States. [ABSTRACT FROM AUTHOR]

Background: Patients are increasingly using the Internet to access health information. Patient awareness and education are crucial to advancing the field of PM&R, but many U.S. adults have insufficient health literacy skills to read and understand patient education materials (PEM), frequently written at the 10th-15th-grade level. Reading ability is key for health literacy, but no previous research has assessed the readability of PEM provided by professional PM&R societies.Objectives: Evaluate whether the readability of PM&R PEM meets the NIH-recommended eighth-grade reading level; compare readability of PM&R PEM to two commonly accessed patient resources for sports and rehabilitation medicine topics, handouts from the American Academy of Orthopaedic Surgeons (AAOS) and American Academy of Family Physicians (AAFP), whose readability has been previously analyzed.Design: Cross-sectional study.Methods: Publicly accessible entries within the patient education section of websites sanctioned by professional PM&R societies, as well as the AAOS and AAFP, were analyzed for readability using two validated and widely used tools, the Flesch-Kincaid Grade Level (FKGL) and Simplified Measure of Gobbledygook (SMOG) formulas. Comparative statistics were performed between the three surveyed specialties.Main Outcome Measures: FKGL and SMOG readability scores, which estimate U.S. grade level, or years of education, needed to comprehend text.Results: A total of 167 online PM&R resources were identified and compared to 94 articles from AAOS and 65 from AAFP. Mean SMOG and FKGL levels exceeded the eighth-grade level for both PM&R (SMOG-9.71, 95% CI 9.42-10.0; FKGL-10.35, 95% CI 9.99-10.7) and AAOS (SMOG-9.15, 95% CI 8.96-9.35; FKGL-9.51, 95% CI 9.29-9.74), whereas AAFP met readability guidelines for both measures (SMOG-7.00, 95% CI 6.74-7.27; FKGL-6.76, 95% CI 6.45-7.07). SMOG and FKGL scores suggested significantly higher reading difficulty for PM&R compared to AAOS (SMOG P = .017; FKGL P = .0001) and AAFP (SMOG P < .0001; FKGL P < .0001). Results indicated that 17% of PM&R resources complied with NIH guidelines, vs 8% for AAOS and 83% for AAFP.Conclusions: The average readability of PM&R PEM exceeds the NIH-recommended and average U.S. adult eighth-grade reading level. The physiatry community can make its patient materials more comprehensible and accessible for patients by providing resources at a more appropriate reading level. [ABSTRACT FROM AUTHOR]

The idea that education in America is deteriorating is emotionally charged and controversial. While there is no disputing that education levels in the United States continue to rise, there is also a pervasive notion that this was accomplished by gradually reducing the readability level and general difficulty of textbooks. One tool often employed in the defense of education is the employment of readability indices in the evaluation of textbooks. There are a variety of these readability indices that serve the purpose of indicating a grade level for a particular piece of writing (Kinkaid, et. al., 1975). It’s relatively easy to find dozens of sites where a teacher or interested person can submit text or a URL with the purpose of finding out the reading level expressed as a grade level for a particular piece of text. Most sites report on five different indices: Automated Readability Index, Flesch Reading Ease, Flesch-Kinkaid Score, Gunning-Fogg Index, and SMOG Index (Simplified Measure of Gobbledygook). This paper addresses these indices, their applications, and the drawbacks of their use.. [ABSTRACT FROM AUTHOR]

Objectives: This study determined the completeness, accuracy, and reading level of Wikipedia patient drug information compared with the corresponding United States product insert medication guides.Methods: From the Top 200 Drugs of 2012, the top 33 medications with medication guides were analyzed. Medication guides and Wikipedia pages were downloaded on a single date to ensure continuity of Wikipedia content. To quantify the completeness and accuracy of the Wikipedia medication information, a scoring system was adapted from previously published work and compared with the 7 core domains of medication guides.Results: Wikipedia did not provide patient information that was as complete or accurate as the information within the medication guides: 14.73 out of 42 (SD 5.75). Wikipedia medication pages were written at a significantly higher reading level compared with medication guides (Flesch reading ease score 52.93 vs. 33.24 [P <0.001]; Flesch-Kincaid grade level 10.26 vs. 6.86 [P <0.001]).Conclusion: Wikipedia medication pages include incomplete and inaccurate patient information compared with the corresponding product medication guides. Wikipedia patient drug information was also written at reading levels above that of medication guides and substantially above the average United States consumer health literacy level. As the public use of Wikipedia increases, the need for educating patients about the quality of information on Wikipedia and the availability of adequate patient education resources is ever more important to minimize inaccuracies and incomplete information sharing. [ABSTRACT FROM AUTHOR]

Background: Lipoprotein(a) (Lp(a)) is a highly proatherogenic lipid fraction that is a clinically significant risk modifier. Patients wanting to learn more about Lp(a) are likely to use online patient educational materials (OPEMs). However, the readability of OPEMs may exceed the health literacy of the public.Objective: This study aims to assess the readability of OPEMs related to Lp(a). We hypothesized that the readability of these online materials would exceed the sixth grade level recommended by the American Medical Association.Methods: Using an online search engine, we queried the top 20 search results from 10 commonly used Lp(a)-related search terms to identify a total of 200 websites. We excluded duplicate websites, advertised results, research journal articles, or non-patient-directed materials, such as those intended only for health professionals or researchers. Grade level readability was calculated using 5 standard readability metrics (automated readability index, SMOG index, Coleman-Liau index, Gunning Fog score, Flesch-Kincaid score) to produce robust point (mean) and interval (CI) estimates of readability. Generalized estimating equations were used to model grade level readability by each search term, with the 5 readability scores nested within each OPEM.Results: A total of 27 unique websites were identified for analysis. The average readability score for the aggregated results was a 12.2 (95% CI 10.9798-13.3978) grade level. OPEMs were grouped into 6 categories by primary source: industry, lay press, research foundation and nonprofit organizations, university or government, clinic, and other. The most readable category was OPEMs published by universities or government agencies (9.0, 95% CI 6.8-11.3). The least readable OPEMs on average were the ones published by the lay press (13.0, 95% CI 11.2-14.8). All categories exceeded the sixth grade reading level recommended by the American Medical Association.Conclusions: Lack of access to readable OPEMs may disproportionately affect patients with low health literacy. Ensuring that online content is understandable by broad audiences is a necessary component of increasing the impact of novel therapeutics and recommendations regarding Lp(a). [ABSTRACT FROM AUTHOR]

Much of health literacy is predicated on being able to read and understand health information and instructions given during the patient-provider encounter. Older adults with low vision face barriers to attaining health literacy because they have difficulty reading and interacting with health providers. Health care professionals can facilitate health literacy by understanding how vision impairment potentially limits health literacy in older adults. The article describes simple strategies both to increase the visibility and readability of printed health information and to improve the quality of the encounter between the health care provider and the patient, using suggestions from persons with vision impairment. [ABSTRACT FROM AUTHOR]

For groups like the elderly who are at risk for low levels of health literacy, documents must be easily comprehensible, particularly as the information becomes increasingly complex. The current research focused on a multilevel examination of a procedural excerpt of a handbook on Medicare, the US government program providing financial assistance to senior citizens for healthcare. Complementing assessments of readability, syntax, and verb mood were content analysis and the validated SAM (suitability of materials) instrument. The research focused on techniques used within this document excerpt (excluding hyperlinks), along with suggested actions for improvement. The excerpt targeted an audience with average to low levels of literacy in terms of shorter words and paragraphs; proportions of complex sentences, conditional mood, and the subordinating conjunction 'if' signal potential difficulty in comprehension. Results from the SAM analysis identified specific improvements within the broad categories of organization, visualization, and simplification. Tools like the SAM instrument, in conjunction with related techniques, can assist in the design and revision of healthcare documents suitable to the target audience intended to benefit. [ABSTRACT FROM AUTHOR]

Patients in the United States receive multiple forms of written information about their prescription medications. This pilot study was conducted to evaluate alternative formats of patient-directed written prescription information for four medications: cefaclor suspension, simvastatin tablets, albuterol inhaler, and capecitabine tablets. Fifty-four consumers evaluated this information using a S-point satisfaction scale, responding to 10-12 questions, and participating in group discussion. Overall, consumers valued short, simple text, a question-answer format, a table layout, large font, adequate text spacing, bold type for emphasis, and easy-to-understand, actionable information that included impact statements on activities and lifestyle. This pilot study reveals that simplified prescription information with improved readability and reduced ambiguity may enhance consumer information retrieval and reinforce appropriate use of prescription medicines. [ABSTRACT FROM AUTHOR]

Background: Health care organizations are tasked with providing web-based health resources and information. Usability refers to the ease of user experience on a website. In this study, we conducted a usability analysis of academic medical centers in the United States, which, to the best of our knowledge, has not been previously carried out.Objective: The primary aims of the study were to the following: (1) adapt a preexisting usability scoring methodology to academic medical centers; (2) apply and test this methodology on a sample set of academic medical center websites; and (3) make recommendations from these results on potential areas of improvements for our sample of academic medical center websites.Methods: All website usability testing took place from June 1, 2020, to December 15, 2020. We replicated a methodology developed in previous literature and applied it to academic medical centers. Our sample included 73 US academic medical centers. Usability was split into four broad categories: accessibility (the ability of those with low levels of computer literacy to access and navigate the hospital's website); marketing (the ability of websites to be found through search engines and the relevance of descriptions to the links provided); content quality (grammar, frequency of information updates, material relevancy, and readability); and technology (download speed, quality of the programming code, and website infrastructure). Using these tools, we scored each website in each category. The composite of key factors in each category contributed to an overall "general usability" score for each website. An overall score was then calculated by applying a weighted percentage across all factors and was used for the final "overall usability" ranking.Results: The category with the highest average score was technology, with a 0.82 (SD 0.068, SE 0.008). The lowest-performing category was content quality, with an average of 0.22 (SD 0.069, SE 0.008). As these numbers reflect weighted percentages as an integer, the higher the score, the greater the overall usability in that category.Conclusions: Our data suggest that technology, on average, was the highest-scored variable among academic medical center websites. Because website functionality is essential to a user's experience, it is justified that academic medical centers invest in optimal website performance. The overall lowest-scored variable was content quality. A potential reason for this may be that academic medical center websites are usually larger in size, making it difficult to monitor the increased quantity of content. An easy way to improve this variable is to conduct more frequent website audits to assess readability, grammar, and relevance. Marketing is another area in which these organizations have potential for improvement. Our recommendation is that organizations utilize search engine optimization techniques to improve their online visibility and discoverability. [ABSTRACT FROM AUTHOR]

The Health Insurance Portability and Accountability Act of 1996 requires Notices of Privacy Practices (NPP) in plain (clear. concise, and easily understood) language. The objectives of this study were to test the readability of U.S. dental school NPPs; examine factors relating to readability: and develop a plain language NPP supplement. Readability statistics were Flesch Reading Ease (FRE) and Flesch-Kincaid Grade Level (FKGL). Social capital measures of potential resources available to people in a civil society (e.g., perceived trust, perceived reciprocity, and per capita voluntary organization membership) along with lawyers per capita for each state were examined for potential relationships with readability levels. One-sample t-tests assessed plain language (FRE=60, FKGL=8), and analyses of variance compared groups. Spearman rank correlations (rs) compared social capital to readability. A plain language NPP supplement was developed. All fifty-six U.S. dental school NPPs were obtained (100 percent response). Forty-eight of fifty-six schools (86 percent) bad website NPPs. FRE and FKGL were significantly more complex than plain language overall (both p<0.001, 95% CIs: FRE 37.6, 40.5; FKGL = 11.2, 11.8) and by region (all p<0.014). Readability did not differ by region. Social capital measures moderately related to readability (0.18 ≤ |r[sub s]| ≤0.39) with reciprocity being most related (FRE rs 0.36, FKGL rs -0.39) U.S. dental school NPPs are more complex than "plain language." [ABSTRACT FROM AUTHOR]

The article offers suggestions to pharmacists regarding selecting, applying, and interpreting readability formulas. It states that medication information can be routinely communicated on the Internet regardless of veracity and readability, which underscore the importance of the pharmacist's role, and mentions that pharmacists should disclose the text sample size, text location within the document. It notes availability of guidelines Centers for Medicare and Medicaid Services.

Background: Access to information is critical to a patient's valid exercise of autonomy. One increasingly important source of medical information is the Internet. Individuals often turn to drug company ("pharma") websites to look for drug information.Objective: The objective of this study was to determine whether there is information on pharma websites that is embargoed: Is there information that is hidden from the patient unless she attests to being a health care provider? We discuss the implications of our findings for health care ethics.Methods: We reviewed a convenience sample of 40 pharma websites for "professionals-only" areas and determined whether access to those areas was restricted, requiring attestation that the user is a health care professional in the United States.Results: Of the 40 websites reviewed, 38 had information that was labeled for health care professionals-only. Of these, 24 required the user to certify their status as a health care provider before they were able to access this "hidden" information.Conclusions: Many pharma websites include information in a "professionals-only" section. Of these, the majority require attestation that the user is a health care professional before they can access the information. This leaves patients with two bad choices: (1) not accessing the information or (2) lying about being a health care professional. Both of these outcomes are unacceptable. In the first instance, the patient's access to information is limited, potentially impairing their health and their ability to make reasonable and well-informed decisions. In the second instance, they may be induced to lie in a medical setting. "Teaching" patients to lie may have adverse consequences for the provider-patient relationship. [ABSTRACT FROM AUTHOR]