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Introduction: Health literacy is the ability of individuals to use basic health information and services to make well-informed decisions. Low health literacy among surgical patients has been associated with nonadherence to preoperative and/or discharge instructions as well as poor comprehension of surgery. It likely poses as a barrier to patients considering foregut surgery which requires an understanding of different treatment options and specific diet instructions. The objective of this study was to assess and compare the readability of online patient education materials (PEM) for foregut surgery. Methods: Using Google, the terms "anti-reflux surgery, "GERD surgery," and "foregut surgery" were searched and a total of 30 webpages from universities and national organizations were selected. The readability of the text was assessed with seven instruments: Flesch Reading Ease formula (FRE), Gunning Fog (GF), Flesch-Kincaid Grade Level (FKGL), Coleman Liau Index (CL), Simple Measure of Gobbledygook (SMOG), Automated Readability Index (ARI), and Linsear Write Formula (LWF). Mean readability scores were calculated with standard deviations. We performed a qualitative analysis gathering characteristics such as, type of information (preoperative or postoperative), organization, use of multimedia, inclusion of a version in another language. Results: The overall average readability of the top PEM for foregut surgery was 12th grade. There was only one resource at the recommended sixth grade reading level. Nearly half of PEM included some form of multimedia. Conclusions: The American Medical Association and National Institute of Health have recommended that PEMs to be written at the 5th–6th grade level. The majority of online PEM for foregut surgery is above the recommended reading level. This may be a barrier for patients seeking foregut surgery. Surgeons should be aware of the potential gaps in understanding of their patients to help them make informed decisions and improve overall health outcomes. [ABSTRACT FROM AUTHOR]

Background: Inferior Vena Cava (IVC) filters have become an advantageous treatment modality for patients with venous thromboembolism. As the use of these filters continues to grow, it is imperative for providers to appropriately educate patients in a comprehensive yet understandable manner. Likewise, generative artificial intelligence models are a growing tool in patient education, but there is little understanding of the readability of these tools on IVC filters. Methods: This study aimed to determine the Flesch Reading Ease (FRE), Flesch–Kincaid, and Gunning Fog readability of IVC Filter patient educational materials generated by these artificial intelligence models. Results: The ChatGPT cohort had the highest mean Gunning Fog score at 17.76 ± 1.62 and the lowest at 11.58 ± 1.55 among the Copilot cohort. The difference between groups for Flesch Reading Ease scores (p = 8.70408 × 10−8) was found to be statistically significant albeit with priori power found to be low at 0.392. Conclusions: The results of this study indicate that the answers generated by the Microsoft Copilot cohort offers a greater degree of readability compared to ChatGPT cohort regarding IVC filters. Nevertheless, the mean Flesch–Kincaid readability for both cohorts does not meet the recommended U.S. grade reading levels. [ABSTRACT FROM AUTHOR]

The medical information about anemia prevention produced by health-care professionals is difficult to understand because of its complicated terminology. To evaluate quantitatively for the first time the clarity of existing online information about anemia prevention in Japanese. On January 20, 2023, we used the keyword "anemia" to evaluate 200 websites, followed by use of the Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P) and the Clear Communication Index (CCI) to evaluate understandability and actionability. The PEMAT-P and CCI were both evaluated as excellent in terms of understandability and actionability, with cutoff values of 70% or higher and 90% or higher, respectively. We also evaluated readability using jReadability and quality using the Journal of the American Medical Association (JAMA) Benchmark Criteria and The Global Quality Scale (GQS). The PEMAT-P scores for understandability and actionability exceeded the cutoff value in 59 (29.5%) and 36 cases (18.0%), respectively, while the CCI exceeded the cutoff value in two cases (1.0%). With respect to web pages, nine (4.5%) were considered "readable" and 96 (48.0%) "neutral." These findings suggest that websites on anemia in Japanese have poor "understandability," "actionability," and "readability," and are therefore inaccessible to the general public. Improving existing anemia websites using indicators such as the PEMAT-P could improve behaviors related to anemia prevention. [ABSTRACT FROM AUTHOR]

Objective: This study aims to analyze the readability of online craniosynostosis materials from the perspective of a caregiver, and to assess if readability levels conform to recommendations by the American Medical Association (AMA) and National Institutes of Health (NIH). Design: This is a cross-sectional investigation in which an internet search was conducted simulating the search terms of a caregiver of a patient with craniosynostosis. The first three pages of resulting records were calculated for comprehension ease using validated readability indices. Records were also classified by author type, including hospital system, national health organization, academic journal, and other. Main Outcome Measures: Flesch-Kincaid Reading Grade Level, Gunning fog Index, SMOG Index, and Coleman Liau Index. Results: Thirty records were identified for which the mean readability level was 12.8 ± 2.6 grade levels (range, 7.6–15.9). There were no significant differences in mean readability across readability indices or author type. None of the thirty records met levels recommended by the AMA or NIH and were 6.8 grade levels above these guidelines on average. Conclusions: Online material pertaining to craniosynostosis is written, on average, at the reading level of a first-year undergraduate student. The AMA and NIH recommend that articles be written at approximately a sixth-grade reading level to promote comprehension. Therefore, there is significant room for improvement of current online materials. Authors should consider consulting publicly available guides in preparing future resources. [ABSTRACT FROM AUTHOR]

This study aimed to assess the potential of using an artificial intelligence (AI) large language model to improve the readability of burns first aid information. An AI language model (ChatGPT-3) was used to rewrite content from the top 50 English-language webpages containing burns first aid information to be understandable by an individual with the literacy level of an 11-year-old, as recommended by the American Medical Association and Health Education England. The assessment of readability was conducted using five validated tools. In their original form, only 4% of the patient education materials (PEMs) met the target readability level across all tools. The median grade was 6.9 (SD=1.1). One-sample one-tailed t -test revealed that this was not significantly below the target (p =.31). After AI-modification, 18% of PEMs reached the target level using all tools, with a median grade of 6 (SD=0.9), which was significantly below the target level (p <.001). Once rewritten using AI, paired t-test demonstrated that all readability scores improved significantly (p <.001). Utilising an AI language model proved an effective and viable method for enhancing readability of burns first aid information. • Online burns first aid information is often written above the recommended level. • An AI language model can improve readability of burns first aid information. • This is likely to require an iterative process of prompts. [ABSTRACT FROM AUTHOR]

This study examined the response of two students in the Southwestern United States with autism spectrum disorder and IQ in the intellectual disability range to a comprehensive, text-based reading intervention. The intervention, Friends on the Block, includes multiple strands of literacy providing explicit instruction in phonics, phonemic awareness, high-frequency irregular or temporarily irregular words, decoding, vocabulary, oral language, and comprehension. Multiple supports for students with intensive needs are embedded within the intervention, such as specially designed multi-criteria books, extensive scaffolding, and intensive cumulative review. Teachers customize the program to address the varying needs of students. We used single-case multiple baselines across levels of instruction design to assess growth on a measure of reading (words read correctly). Results indicated a positive, functional relation between reading intervention and word reading. Both students also demonstrated modest growth on measures of phonemic awareness, letter–sound knowledge, and word identification from pre- to post-intervention. [ABSTRACT FROM AUTHOR]

Study Design: Observational study. Objective: To evaluate the readability of commonly utilized patient-reported outcome measures (PROMs) in spine surgery. Summary of Background Data: Although studies have evaluated patient education materials, discharge instructions, and informed consent forms in spine surgery, there is a dearth of literature on the readability of PROMs despite widespread health illiteracy. Without knowledge of PROM readability, it is unclear whether these measures are able to be understood by the average spine patient. Materials and Methods: We analyzed all commonly utilized nonvisual PROMs within the spinal literature and uploaded PROMs into an online readability calculator. The Flesch Reading Ease Score (FRES) and Simple Measure of Gobbledygook (SMOG) Index were collected. A FRES> 79 or SMOG<7 was considered readable by the general population per American Medical Association and Centers for Disease Control guidelines. A stricter threshold recommended in health care (SMOG <6 or FRES>89) was then used to further review readability. Results: Seventy-seven PROMs were included. Based on FRES, the mean readability of all PROMs was 69.2 ± 17.2 (range, 10--96.4), indicating an average eighth to ninth-grade reading level. The mean readability score categorized by the SMOG Index was 8.12 ± 2.65 (range, 3.1--25.6), representing an eighth-grade reading level. Compared with the reading level of the general population, 49 (63.6%) PROMs are written above the United States literacy level, according to FRES. Using stricter definitions of readability, 8 PROMs were considered readable, including PROM Information System pain behavior (FRES: 96.4 and SMOG: 5.2), PROM Information System sleep disturbance (SMOG: 5.6), Neck Pain and Disability Scale (SMOG: 4.3), and Zung Depression Scale (SMOG: 3.1). Conclusions: Most PROMs utilized in spine surgery require an average reading competency far above the average patient's comprehension. This may have a meaningful impact on understanding PROM instruments and may affect the accuracy of complete surveys and the rates of incompletion. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the effects of a mobile app designed to improve chronic disease self-management in patients aged 40 years and older with low health literacy and who had at least one chronic health condition, and to assess the impact of delivering information at different levels of reading difficulty. A randomized controlled trial was completed at two sites. Individuals aged 40 years and older screened for low health literacy who had at least one chronic health condition were randomly assigned to a tailored information multimedia app with text at one of three grade levels. Four primary outcomes were assessed: patient activation, chronic disease self-efficacy, health-related quality of life, and medication adherence. All groups showed overall increases in activation, self-efficacy, and health-related quality of life, but no change in medication adherence. No between-group differences were observed. The mobile app may have been effective in increasing participants' levels of several psychosocial variables, but this interpretation can only be advanced tentatively in light of the lack of control-experimental group differences. Reading difficulty level was not significantly related to outcomes. [ABSTRACT FROM AUTHOR]

Background: Gynaecological cancer symptoms are often vague and non‐specific. Quality health information is central to timely cancer diagnosis and treatment. The aim of this study was to identify and evaluate the quality of online text‐based patient information resources regarding gynaecological cancer symptoms. Methods: A targeted website search and Google search were conducted to identify health information resources published by the Australian government and non‐government health organisations. Resources were classified by topic (gynaecological health, gynaecological cancers, cancer, general health); assessed for reading level (Simple Measure of Gobbledygook, SMOG) and difficulty (Flesch Reading Ease, FRE); understandability and actionability (Patient Education Materials Assessment Tool, PEMAT, 0–100), whereby higher scores indicate better understandability/actionability. Seven criteria were used to assess cultural inclusivity specific for Aboriginal and Torres Strait Islander people; resources which met 3–5 items were deemed to be moderately inclusive and 6+ items as inclusive. Results: A total of 109 resources were identified and 76% provided information on symptoms in the context of gynaecological cancers. The average readability was equivalent to a grade 10 reading level on the SMOG and classified as 'difficult to read' on the FRE. The mean PEMAT scores were 95% (range 58–100) for understandability and 13% (range 0–80) for actionability. Five resources were evaluated as being moderately culturally inclusive. No resource met all the benchmarks. Conclusions: This study highlights the inadequate quality of online resources available on pre‐diagnosis gynaecological cancer symptom information. Resources should be revised in line with the recommended standards for readability, understandability and actionability and to meet the needs of a culturally diverse population. [ABSTRACT FROM AUTHOR]

Stroke education materials are crucial for the recovery of stroke patients, but their effectiveness depends on their readability. The American Medical Association (AMA) recommends patient education materials be written at a sixth-grade level. Studies show existing paper and online materials exceed patients' reading levels and undermine their health literacy. Low health literacy among stroke patients is associated with worse health outcomes and decreased efficacy of stroke rehabilitation. We reviewed the readability of paper (i.e brochures, factsheets, posters) and online (i.e American Stroke Association, Google, Yahoo!) stroke patient education materials, reading level of stroke patients, accessibility of online health information, patients' perceptions on gaps in stroke information, and provided recommendations for improving readability. A PRISMA-guided systematic literature review was conducted using PUBMED, Google Scholar, and EbscoHost databases and "stroke", "readability of stroke patient education", and "stroke readability" search terms to discover English-language articles. A total of 12 articles were reviewed. SMOG scores for paper and online material ranged from 11.0 - 12.0 grade level and 7.8 - 13.95 grade level respectively. Reading level of stroke patients ranged from 3rd grade to 9th grade level or above. Accessibility of online stroke information was high. Structured patient interviews illustrated gaps in patient education materials and difficulty with comprehension. Paper and online patient education materials exceed the reading level of stroke patients and the AMA recommended 6th grade level. Due to limitations in readability, stroke patients are not being adequately educated about their condition. [ABSTRACT FROM AUTHOR]

The National Heart, Lung, and Blood Institute (NHLBI) Learn About Chronic Obstructive Pulmonary Disease (COPD) YouTube playlist educates the public on diagnosing, treating, and managing COPD. Despite its potential benefits, it is unknown if users with inadequate health literacy will likely understand and apply the information described in these videos. Assess the Learn About COPD playlist's readability, actionability, and understandability. Central tendency statistics were computed to describe the meta-data of 28 videos available as of April 2023. Assessments included the Patient Education Materials Assessment Tool for Audiovisual Materials (PEMAT-AV), Accessible Health IT for Limited-Literacy Populations Checklist (LLPC), and the Modified Centers for Disease Control and Prevention (CDC)-Clear Communication Index (CCI) for audiovisual materials. Playlist videos received an average of over 2,000 views (Mdn = 2,220, IQR = 496–8336), with very few "likes" (Mdn = 13, IQR = 1–48 "likes"). PEMAT-understandability (Mdn = 81.81%, IQR = 80–97.72%) and LLPC (Mdn = 87.50%, IQR = 75–93.75%) scores were high (above 80%). However, the modified CDC-CCI median score was 57.14% (IQR = 42.86–75%), and the median PEMAT-actionability score was 50% (IQR = 0–66.67%). The playlist earned passing understandability, acceptability, and usability scores but scored poorly on actionability and communication clarity. Findings could inform enhancements to NHLBI's Learn About COPD YouTube playlist. [ABSTRACT FROM AUTHOR]

Background: Addressing disparities in living kidney donation requires making information accessible across literacy levels, especially important given that the average American adult reads at an 8th-grade level. This study evaluated the effectiveness of ChatGPT, an advanced AI language model, in simplifying living kidney donation information to an 8th-grade reading level or below. Methods: We usedChatGPTversions 3.5 and4.0 tomodify 27 questions and answers fromDonate Life America, a key resource on living kidney donation. We measured the readability of both original and modified texts using the Flesch-Kincaid formula. A paired t-test was conducted to assess changes in readability levels, and a statistical comparison between the two ChatGPT versions was performed. Results: Originally, the FAQs had an average reading level of 9.6 ± 1.9. Postmodification, ChatGPT 3.5 achieved an average readability level of 7.72 ± 1.85, while ChatGPT 4.0 reached 4.30±1.71, both with a p-value <0.001 indicating significant reduction. ChatGPT 3.5 made 59.26% of answers readable below 8th-grade level, whereas ChatGPT 4.0 did so for 96.30% of the texts. The grade level range for modified answers was 3.4-11.3 for ChatGPT 3.5 and 1-8.1 for ChatGPT 4.0. Conclusion: Both ChatGPT 3.5 and 4.0 effectively lowered the readability grade levels of complex medical information, with ChatGPT 4.0 being more effective. This suggests ChatGPT's potential role in promoting diversity and equity in living kidney donation, indicating scope for further refinement in making medical information more accessible. [ABSTRACT FROM AUTHOR]

People from culturally and linguistically diverse (CaLD) backgrounds in Australia generally experience poorer health outcomes, explained in part by low levels of health literacy. We conducted a systematic review to examine the development and evaluation of health education resources designed for CaLD populations. Five electronic databases were searched for English language, peer-reviewed studies published between 1980 and 2020. Thirty-four studies met the inclusion criteria. Twenty-four different health education resources were described and broadly categorized into four types: media campaigns (n  = 10), text-based materials (n  = 5), films (n  = 8) and radio (n  = 1). Studies were assessed against domains adapted from a health literacy guideline incorporating: need, collaboration, audience, health literacy, theory, test and process and impact evaluation. All but one study met the majority of the domains. All studies reported positive evaluation outcomes; this may be due to studies involving community early in resource design and including health literacy considerations in their design. Reporting resource design and evaluation against standard practice controls is recommended to build a more robust evidence base for developing effective health education resources for use by audiences from CaLD backgrounds. [ABSTRACT FROM AUTHOR]

Background: Given the increasing accessibility of Internet access, it is critical to ensure that the informational material available online for patient education is both accurate and readable to promote a greater degree of health literacy. This study sought to investigate the quality and readability of the most popular online resources for ankle fractures. Methods: After conducting a Google search using 6 terms related to ankle fractures, we collected the first 20 nonsponsored results for each term. Readability was evaluated using the Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (FKGL), and Gunning Fog Index (GFI) instruments. Quality was evaluated using custom created Ankle Fracture Index (AFI). Results: A total of 46 of 120 articles met the inclusion criteria. The mean FKGL, FRE, and GFI scores were 8.4 ± 0.5, 57.5 ± 3.2, and 10.5 ± 0.5, respectively. The average AFI score was 15.4 ± 1.4, corresponding to an "acceptable" quality rating. Almost 70% of articles (n = 32) were written at or below the recommended eighth-grade reading level. Most articles discussed the need for imaging in diagnosis and treatment planning while neglecting to discuss the risks of surgery or potential future operations. Conclusion: We found that online patient-facing materials on ankle fractures demonstrated an eighth-grade average reading grade level and an acceptable quality on content analysis. Further work should surround increasing information regarding risk factors, complications for surgery, and long-term recovery while ensuring that readability levels remain below at least the eighth-grade level. [ABSTRACT FROM AUTHOR]

Purpose: While the National Institutes of Health and American Medical Association recommend patient education materials (PEMs) should be written at the sixth‐grade reading level or below, many patient education materials related to traumatic orthopaedic injuries do not meet these recommendations. The purpose of this study is to create a standardised method for enhancing the readability of trauma‐related orthopaedic PEMs by reducing the use of ≥ three syllable words and reducing the use of sentences >15 words in length. We hypothesise that applying this standardized method will significantly improve the objective readability of orthopaedic trauma PEMs. Methods: A patient education website was queried for PEMs relevant to traumatic orthopaedic injuries. Orthopaedic trauma PEMs included (N = 40) were unique, written in a prose format, and <3500 words. PEM statistics, including scores for seven independent readability formulae, were determined for each PEM before and after applying this standard method. Results: All PEMs had significantly different readability scores when comparing original and edited PEMs (p < 0.01). The mean Flesch Kincaid Grade Level of the original PEMs (10.0 ± 1.0) was significantly higher than that of edited PEMs (5.8 ± 1.1) (p < 0.01). None of the original PEMs met recommendations of a sixth‐grade reading level compared with 31 (77.5%) of edited PEMs. Conclusions: This standard method that reduces the use of ≥ three syllable words and <15 word sentences has been shown to significantly reduce the reading‐grade level of PEMs for traumatic orthopaedic injuries. Improving the readability of PEMs may lead to enhanced health literacy and improved health outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Orthopaedic Patient Education Materials (PEMs) related to total hip and total knee arthroplasty (TKA) have repeatedly been shown to not meet American Medical Association and National Institutes of Health recommendations for readability. PEMs that are written with too much complexity limit the ability of some readers to comprehend the material. These complex PEMs also limit the health literacy of patients, a key determinant of health status and outcomes. The purpose of this study was to improve the readability of total hip and TKA‐related PEMs by limiting the use of sentences with ≥15 words and limiting the use of words with ≥ three syllables. Methods: The readability of all 26 PEMs in this study was assessed before and after editing. Editing of articles included limiting the use of sentences with ≥15 words and limiting the use of words with ≥three syllables while preserving PEM content. Results: A total of 26 PEMs were available for use in this study after the application of inclusion and exclusion criteria. The percentage of original PEMs at or below the recommended sixth‐grade reading level was 0% (0 out of 26), while the percentage of edited PEMs at or below the sixth‐grade reading level was 50% (13 out of 26). Conclusions: Using this standardised method for reducing sentence length to <15 words and limiting the use of words with >2 syllables, while preserving key content, significantly improved the readability of PEMs related to total hip and TKA. [ABSTRACT FROM AUTHOR]

Medication guides (MGs) provide patients with important information about certain prescription drugs to help them take these drugs safely. We surveyed US residents about their perceptions of MG readability and understandability. We randomly sampled 5204 US residents (age 18+) from Ipsos's KnowledgePanel to complete a two-part survey. Only respondents who reported receiving an MG with their prescription drugs (n  = 3852) completed part 2, which included two key items: How easy to [(1) read/ (2) understand ] are the MGs that you have received from a pharmacy along with your prescription medicines? (1 =  Very easy, 5 =  Very difficult ; reverse-coded). Health literacy (HL) and demographic data were also collected. After weighting our data, we found that 85% of respondents who reported receiving an MG perceived this information as 'very easy' (27.3%), 'somewhat easy' (28.3%) or 'about average' (29.3%) to read. Eighty-seven percent of respondents who reported receiving an MG perceived it as 'very easy' (27.6%), 'somewhat easy' (30.2%) or 'about average' (29.5%) to understand. ANOVAs revealed higher average perceived MG reading and comprehension ease scores among respondents presumed to have adequate versus inadequate HL (ps  ≤ 0.0006). Younger or less-educated respondents and non-Hispanic Blacks perceived MGs as easier to read and understand, on average, than their counterparts (p s ≤ 0.0001). Many of these relationships remained intact in models predicting perceived MG reading and comprehension ease (p s ≤ 0.001). Adjusted R 2 values across models were small, however (≤0.06). Our findings suggest most US residents (18+) who received MGs perceived them to be 'about average' to 'very easy' to read and understand. [ABSTRACT FROM AUTHOR]

Background: Systems of across the world have developed and implemented patient rights policies to protect and improve the provider-patient relationship. The Patient Charter of Ghana was developed in 2002 to improve service quality and protect patients' rights. However, it is not yet known whether those at the frontline of healthcare delivery can read and understand the contents of the charter. While studies have explored the socioeconomic and institutional level factors related to awareness and knowledge of the Patient Rights Charter, there is a lack of literature on its readability and comprehensibility among nurses. This study assesses nurses' knowledge of the Patient Rights Charter and associated literacy-related factors. Method: An exploratory cross-sectional design and quantitative methods were used to collect data on knowledge, comprehension, and readability of the Patient Rights Charter. 205 nurses from four district hospitals in the Central Region were recruited using proportional and total enumeration sampling. Data were collected using structured questionnaires and were processed using SPSS (version 26) and an online text readability consensus calculator (version 2.0). Descriptive and inferential statistical analyses were performed, and data were presented using simple frequencies, readability statistics, and regression output. Results: The results show the charter is written at a higher reading grade level; Flesch-Kincaid Grade Level (13.36), Simple Measure of Gobbledygook (11.57), and Coleman-Liau Readability Index (14.2). The average reading grade level score was 14. The Gunning Fox Index (15.40) and the Flesch Reading Ease Score (34%) show the patient charter is difficult to read and will require at least 14 years of education to be able to read. 87.3% of nurses were able to read and comprehend the charter. Very few (8.3%) read at frustration level. Nurses' actual comprehension of the charter was the only significant predictor of knowledge of the charter. Conclusion: Comprehension of the patient charter is an important predictor of its knowledge. The results emphasize the need to enhance the readability and comprehensibility of the charter for providers. Hospitals can stimulate nurses' knowledge of the charter by simplifying the charter's language and deliberately educating nurses on its content. [ABSTRACT FROM AUTHOR]

The aim of our study was to evaluate the potential role of Artificial Intelligence tools like ChatGPT in patient education. To do this, we assessed both the quality and readability of information provided by ChatGPT 3.5 and 4 in relation to Anterior Cruciate Ligament (ACL) injury and treatment. ChatGPT 3.5 and 4 were used to answer common patient queries relating to ACL injuries and treatment. The quality of the information was assessed using the DISCERN criteria. Readability was assessed with the use of seven readability formulae: the Flesch–Kincaid Reading Grade Level, the Flesch Reading Ease Score, the Raygor Estimate, the SMOG, the Fry, the FORCAST, and the Gunning Fog. The mean reading grade level (RGL) was compared with the recommended 8th-grade reading level, the mean RGL among adults in America. The perceived quality and mean RGL of answers given by both ChatGPT 3.5 and 4 was also compared. Both ChatGPT 3.5 and 4 yielded DISCERN scores suggesting "good" quality of information, with ChatGPT 4 slightly outperforming 3.5. However, readability levels for both versions significantly exceeded the average 8th-grade reading level for American patients. ChatGPT 3.5 had a mean RGL of 18.08, while the mean RGL of ChatGPT 4 was 17.9, exceeding the average American reading grade level by 10.08 grade levels and 9.09 grade levels, respectively. While ChatGPT can provide both reliable and good quality information on ACL injuries and treatment options, the readability of the content may limit its utility. Additionally, the consistent lack of source citation represents a significant area of concern for patients and clinicians alike. If AI is to play a role in patient education, it must reliably produce information which is accurate, easily comprehensible, and clearly sourced. [ABSTRACT FROM AUTHOR]

This article discusses the readability of COVID-19 information provided by commercial cruise lines on their websites. The study found that the readability of the information did not meet reference target values, indicating a need for improvement. Only 6% of cruise line websites met the readability targets, compared to one-fourth of airline websites. The article suggests that authors should utilize resources and tools to improve the readability of health-related information for passengers, in order to enhance health literacy and compliance with public health directives. The findings of this study are relevant even four years after the COVID-19 outbreak, and the methodology can be applied to other infectious diseases in the future. [Extracted from the article]

The purpose of this study is to evaluate the readability and quality of Internet information related to vocal health, voice disorders and voice therapy. This is a cross-sectional study. Eighty-two websites were included. Websites were then analyzed; their origin (clinic/hospital, non-profit, government), quality (Health On the Net [HON] certification and DISCERN scores) and readability (Ateşman readability formula and Bezirci-Yılmaz new readability formula) were assessed. Statistical analysis was used to examine differences between website origin and quality and readability scores and correlations between readability instruments. Of the 82 websites, 93% were of private clinic/hospital, 6% were of non-profit organisation and 1% were of government. None of the 82 websites were HON certification, and the mean score of the item determining the general quality measure in DISCERN was 1.83 in a five-point scale. The mean of Ateşman readability formula value was calculated as 50.46 (±8.16). This value is defined as 'moderately hard' according to the readability scale. The average of Bezirci-Yılmaz new readability formula value is 13.85 (±3.48). This value is defined as 13th and 14th grade. The quality of Internet-based health information about the voice is generally inadequate, and the sites examined in this study may be limited due to high readability levels. This may be a problem in people with poor literacy skills. For this reason, it is very important for speech and language therapists and other health professionals to evaluate and monitor the quality and readability of Internet-based information. [ABSTRACT FROM AUTHOR]

Purpose: Several therapeutic options are usually discussed for otosclerosis management. Patients seek medical advice from an ENT specialist but are also increasingly using the internet for medical issues. This study intends to assess readability and quality of websites with information on otosclerosis. Materials and methods: This is a cross-sectional study performed in a tertiary care centre. The results of the first two pages of a Google search with the keyword "otosclerosis" were reviewed by two independent investigators. Readability was assessed with the Flesch–Kincaid Grade Level (FKGL), Flesch Reading Ease Score (FRES) and Gunning Fog Index. For quality and reliability assessment, the 16-item DISCERN instrument was used. Spearman's coefficient was used for correlations, and multivariate analyses of variance were used to assess differences. Inter-rater agreement was evaluated with concordance correlation coefficient. Results: 18 websites were included. Two websites (11.0%) were authored by academic institutions, 5/18 (28%) by government agencies, 6/18 (33%) by professional organisations and 5/18 (28%) were medical information websites. The mean DISCERN score of the 18 websites was 40.8 ± 6.7/80 (range 28.7–51.7), corresponding to "fair" quality. The mean FRES score was 43.27 ± 10.6, and the mean FKGL was 11.43 ± 2.30, corresponding to "difficult to read". The mean Gunning Fog index was 12.90 ± 2.19 (range 9.81–18.20), corresponding to a "college freshman" level. Conclusions: This study shows that internet information on otosclerosis has an overall low readability, while the quality is heterogeneous and varies from "poor" to "good". Efforts should be made to improve the readability of otosclerosis websites. [ABSTRACT FROM AUTHOR]

Losing your head? An evaluation of the readability and reliability of patient information available online for Avascular Necrosis of the Head of Femur. Avascular necrosis of the head of femur commonly affects patients with an average age of 58.3 years, and is generally managed in the elective setting, allowing patients a timeframe to research their diagnosis and management options. The aim of this study is to evaluate the readability and reliability of the information available online to patients about this condition. Google, Bing and Yahoo internet search engines were utilised, using the search terms "Avascular necrosis head of femur" and "hip avascular necrosis", with the first 30 URLs selected for analysis. Readability was assessed using an online readability calculator to produce 3 scores (Gunning FOG, Flesch Kincaid Grade and Flesch Reading Ease). Information quality was assessed using a HONcode detection web-extension and the JAMA benchmark criteria. 86 webpages were identified for inclusion for assessment. The majority of the information available online about avascular necrosis of the head of the femur is not at an appropriate reading level for the general population, and less than 20% of the most accessible information available online is accredited to be of sufficient quality to be providing advice to patients. Medical professionals must work together to improve health literacy among the patients encountered, and ensure recommendation of only reliable and accessible sources of information should patients ask for guidance on finding these resources. • The internet is an increasingly used resource for patients attending medical care • Avascular necrosis of the head of the femur treatment is often elective • This allows patients to research the condition prior to outpatient clinics • Most of the information online is not at an appropriate reading level • Less than 20% of the information online is of sufficient quality to provide advice [ABSTRACT FROM AUTHOR]

Disinfectants purchased from retail outlets form the cornerstone of infection control and prevention within the domestic household. The growing utilisation of the concept of "hospital-at-home" places greater emphasis on domestic disinfection by the householder in helping to prevent the acquisition of infections within the home. No reports or data exist that indicate how readable the information provided on disinfectants is, which would help householders use disinfectants optimally. The aim of this study was therefore to quantitatively examine the readability (Flesch Reading Ease; Flesch–Kinkaid Grade Level; text metrics) of consumer (public)-facing information (n = 108) of domestic household disinfectants sourced from (i) UK high street supermarket chains (n = 4) and (ii) disinfectant manufacturers (n = 6). The readability of all supermarket and manufacturer information (n = 108) gave a mean Flesch Reading Ease score of 51.7 (target ≥ 60) and a Flesch–Kinkaid Grade Level score of 8.1 (target ≤ 8), thereby failing to achieve readability reference target values. Authors preparing information on the domestic use of disinfectants should be aware of the value of quantitative readability metrics and online tools to help support their writing of such information in order to produce materials which are within target readability values, thereby further supporting health literacy in this population and disinfectant efficacy. [ABSTRACT FROM AUTHOR]

Objective: Complications of parotidectomy can have a massive impact on patients' quality of life. This study aimed to evaluate the readability and quality of online health information on parotidectomy. Method: The search terms 'parotidectomy', 'parotid surgery', 'parotidectomy patient information' and 'parotid surgery patient information' were parsed through three popular search engines. Results: The websites were analysed using readability scores of the Flesch Reading Ease test and the Gunning Fog Index. The DISCERN instrument was used to assess quality and reliability. The average Flesch Reading Ease score was 50.2 ± 9.0, indicating that the materials were fairly difficult to read, the Gunning Fog Index score showed that the patient health information was suitable for an individual above 12th grade level, and the DISCERN score indicated that the online patient health information had fair quality. The Kruskal–Wallis test showed a significant difference in Flesch Reading Ease and DISCERN tool scores according to website category (p < 0.05). Conclusion: Current online patient health information on parotidectomy is too difficult for the public to understand, and it exceeds the reading levels recommended by Health Education England and the American Medical Association. [ABSTRACT FROM AUTHOR]

Objective: Epilepsy surgery is an effective albeit underused treatment for refractory epilepsy, and online materials are vital to patient understanding of the complex process. Our goal is to analyze the readability and content inclusion of online patient health education materials designed for epilepsy surgery. Methods: A private browser setting was used on Google and Bing to identify the top 100 search results for the terms "epilepsy+surgery". Scientific papers, insurance pages, pay‐wall access sites, and non‐text content were excluded. The website text was reformatted to exclude graphics, contact information, links, and headers. Readability metrics were calculated using an online tool. Text content was analyzed for inclusion of important concepts (pre‐surgical evaluation, complications, risks of continued seizures, types of surgery, complimentary diagrams/audiovisual material). Comparison of readability and content inclusion was performed as a function of organization types (epilepsy center, community health organization, pediatric‐specific) and location (region, country). Results: Browser search yielded 82 distinct websites with information regarding epilepsy surgery, with 98.7% of websites exceeding the recommended 6th‐grade reading level for health information. Epilepsy centers had significantly worse readability (Flesch–Kincaid Grade Level (FKGL) P < 0.01 and Flesch Reading Ease (FRE) P < 0.05). Content analysis showed that only 37% of websites discuss surgical side effects and only 23% mention the risks of continued seizures. Epilepsy centers were less likely to report information on surgical side effects (P < 0.001). UK‐based websites had better readability (FKGL P < 0.01 and FRE P < 0.01) and were more likely to discuss side effects (P = 0.01) compared to US‐based websites. Significance: The majority of online health content is overly complex and relatively incomplete in multiple key areas important to health literacy and understanding of surgical candidacy. Our findings suggest academic organizations, including level 4 epilepsy centers, need to simplify and broaden online education resources. More comprehensive, publicly accessible, and readable information may lead to better‐shared decision‐making. [ABSTRACT FROM AUTHOR]

Background: Patients with severe mental illnesses like schizophrenia may benefit from a variety of patient education materials. Despite the availability of various resources, it is essential to assess the extent to which patients can comprehend the materials provided. Objective: This study aims to evaluate the reliability and readability of the patient information leaflet (PIL) for schizophrenia. Method: A quasi-experimental study was conducted for a period of 6 months in the departments of psychiatry. Patients with a diagnosis of schizophrenia were recruited for the study. A user-testing questionnaire was developed and validated with the help of an expert committee to assess reliability. Later, translated versions of the questionnaire were then administered to the patients based on their language preference and evaluated by test-retest analysis. The readability was assessed using pre-validated and translated versions of the PIL. Initially, baseline scores of patient knowledge were assessed using a reliable user-testing questionnaire. Later, their responses were reassessed again using the same questionnaire after reading the PIL. Results: A total of 45 patients participated in the study. From the total sample, 20 participants were randomly selected for reliability assessment. Intraclass-correlation coefficient (ICC), a statistical tool of reliability, give.6 for Kannada,.7 for Malayalam and 1 for the English version of the questionnaire. The overall patient's knowledge was found to be improved from 50.4 to 76.4 after reading the PIL. Conclusion: Patients with schizophrenia were able to comprehend the information available on the PIL. Therefore, further research is needed to determine its efficacy in a larger population. [ABSTRACT FROM AUTHOR]

Online patient education materials (PEMs) often exceed the recommended 6th grade reading level. This can negatively affect transmasculine patients' understanding of treatment plans, increasing barriers to care and worsening health outcomes and patient satisfaction. This study assessed the readability of online English and Spanish PEMs regarding phalloplasty and urethroplasty. The English and Spanish terms for phalloplasty and urethroplasty were queried on Google. The first fifty results were grouped into institutional (government, medical school, teaching hospital), noninstitutional (private practice, news channel, blog, etc.), and academic (journal articles, book chapters) categories. Readability scores were generated using the Simple Measure of Gobbledygook and Spanish Simple Measure of Gobbledygook scales. All PEMs exceeded recommended reading levels. For both procedures, English PEMs had an average reading level approximately of a university sophomore and Spanish PEMs had an average reading level approximately of a high school junior. For both procedures, English PEMs were harder to read than Spanish PEMs overall (P < 0.001) and when compared across the three categories between the two languages (P < 0.001). For Spanish urethroplasty PEMs, noninstitutional PEMs were more difficult to read than institutional PEMs (P < 0.05). Online information for phalloplasty and urethroplasty should be revised and/or standardized materials should be created by trans-affirming health-care providers and national organizations in order to more fully educate the public and prospective patients prior to intervention. A well-informed patient population will improve patient decision-making and surgeon-patient communication, ultimately leading to better health outcomes. [ABSTRACT FROM AUTHOR]

Background: Bruxism patients often access the web to search for information. Unfortunately, the low text readability of online material and the limited medical literacy in the general population may prevent patients' understanding of health information. Objective(s): We aimed to assess the home page's readability of the top 10 patients‐oriented bruxism‐related websites and the educational level required to approach them. Methods: Using the word bruxism in the "no country redirect" extension of Google Chrome browser (www.google.com/ncr), we identified the first 10 patient‐oriented English language websites. The readability of the material was determined using six commonly recommended readability tests (1): Gunning Fog Index (GFI), Coleman Liau Index (CLI), Automated Readability Index (ARI) Simple Measure of Gobbledygook (SMOG), Flesch Kincald Grade Level (FKGL), Flesh Reasing Ease (FRE). Results: The USA National Institutes of Health requirements, which call for websites to be readable at a 6th to 7th‐grade level, were not followed by any of the most popular websites. Conclusion: The average consumer frequently finds the health information on the Internet to be too complex to understand, which can lead to misinterpretation, a delay in diagnosis, and poorer health consequences. [ABSTRACT FROM AUTHOR]

Background: Web-based information on dental caries in Arabic remains poorly understood. This study aimed to assess the quality and readability of web-based information about dental caries in Arabic. Methods: The first 100 websites in Arabic about dental caries were retrieved from Google and Bing using common terms. The websites were classified and evaluated for quality based on the Journal of the American Medical Association (JAMA) benchmark criteria, the DISCERN tool, and the presence of the Health on the Net Foundation Code of Conduct (HONcode). Readability was assessed using online readability indexes. Results: A total of 102 Arabic websites were included. The JAMA benchmark score was low (m = 0.36, SD = 0.56), with 67.7% failing to meet any of the JAMA criteria. The DISCERN total score mean was 37.68 (SD = 7.99), with a majority (67.65%) of moderate quality. None of the websites had the HONcode. Readability was generally good, with 52.94% of websites having a Flesch–Kincaid Grade Level (FKGL) < 7, 91.18% having a Simple Measure of Gobbledygook (SMOG) < 7, and 85.29% having a Flesch reading ease (FRE) score ≥ 80. There was a positive correlation between JAMA and DISCERN scores (p < 0.001). DISCERN scores were positively correlated with the number of words (p < 0.001) and sentences (p = 0.004) on the websites. However, JAMA or DISCERN scores were not correlated with FKGL, SMOG, or FRE scores (p > 0.05). Conclusions: The quality of Arabic dental caries websites was found to be low, despite their readability. Efforts are needed to introduce more reliable sources for discussing dental caries and treatment options on sites aimed at Arabic populations. [ABSTRACT FROM AUTHOR]

Patient education has been transformed using digital media and online repositories which disseminate information with greater efficiency. In dermatology, this transformation has allowed for patients to gain education on common cutaneous conditions and improve health literacy. Xanthelasma palpebrarum is one of the most common cutaneous conditions, yet there is a poor understanding of how digital materials affect health literacy on this condition. Our study aimed to address this paucity of literature utilizing Brief DISCERN, Rothwell's Classification of Questions, and six readability calculations. The findings of this study indicate a poor-quality profile (Brief DISCERN < 16) regarding digital materials and readability scores which do not meet grade-level recommendations in the United States. This indicates a need to improve the current body of educational materials used by clinicians for diagnosing and managing xanthelasma palpebrarum. [ABSTRACT FROM AUTHOR]

Objective: This systematic review was conducted to examine methods and tools used to translate written health-related information from English to Spanish. Methods: The design of this study was a systematic review. This review search was of all published articles up to July 2022. Three databases were used: CINAHL Plus, MEDLINE, and PubMed. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis flowchart was used in the systematic review. Results: A total of 17 articles were used in the analysis. Six (35.3%) of the articles used a machine and human translation method, and eight (47%) used Google Translate as the machine translation tool. The screening, full-text review, and data extraction were done using the Covidence software. Discussions: As translating health-related information accurately is crucial, using metrics or standardizing one is urgently needed. Nursing implications: This review highlights that in addition to a lack of standardized metrics, there currently is no criterion on the qualifications or credentials required by individuals who translate written information from English to Spanish, allowing anyone to do so. This is concerning because it is critical that Spanish speakers and those with limited English proficiency receive linguistically accurate and appropriate resources that allow them to improve their health literacy and promote health. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to assess the content, readability, and quality of online resources on septic arthritis, a crucial orthopedic condition necessitating immediate diagnosis and treatment to avert serious complications, with a particular focus on the relevance to individuals from the general public. Methods: Two search terms ("septic arthritis" and "joint infection") were input into three different search engines on the Internet (Google, Yahoo, and Bing) and 60 websites were evaluated, with the top 20 results in each search engine. The websites underwent categorization based on their type, and their content and quality were assessed utilizing the DISCERN score, the Journal of the American Medical Association (JAMA) benchmark, the Global Quality Score (GQS), and the Information Value Score (IVS). The readability of the text was assessed through the utilization of the Flesch Kincaid Grade Level (FKGL) and the Flesch Reading Ease Score (FKRS). The presence or absence of the Health on Net (HON) code was evaluated on each website. Results: The DISCERN, JAMA, GQS, FKGL, and IVS scores of the academic category were found to be substantially greater when compared with the physician, medical, and commercial categories. But at the same time, academic sites had high readability scores. Websites with HON code had significantly higher average FKGL, FCRS, DISCERN, JAMA, GQS, and IVS scores than those without. Conclusion: The quality of websites giving information on septic arthritis was variable and not optimal. Although the content of the academic group was of higher quality, it could be difficult to understand. One of the key responsibilities of healthcare professionals should be to provide high quality and comprehensible information concerning joint infections on reputable academic platforms, thereby facilitating patients in attaining a fundamental level of health literacy. [ABSTRACT FROM AUTHOR]

Purpose: Orthopaedic patient education materials (PEMs) have repeatedly been shown to be well above the recommended reading level by the National Institute of Health and American Medical Association. The purpose of this study is to create a standardized method to improve the readability of PEMs describing spine-related conditions and injuries. It is hypothesized that reducing the usage of complex words (≥ 3 syllables) and reducing sentence length to < 15 words per sentence improves readability of PEMs as measured by all seven readability formulas used. Methods: OrthoInfo.org was queried for spine-related PEMs. The objective readability of PEMs was evaluated using seven unique readability formulas before and after applying a standardized method to improve readability while preserving critical content. This method involved reducing the use of > 3 syllable words and ensuring sentence length is < 15 words. Paired samples t-tests were conducted to assess relationships with the cut-off for statistical significance set at p < 0.05. Results: A total of 20 spine-related PEM articles were used in this study. When comparing original PEMs to edited PEMs, significant differences were seen among all seven readability scores and all six numerical descriptive statistics used. Per the Flesch Kincaid Grade level readability formula, one original PEM (5%) versus 15 edited PEMs (75%) met recommendations of a sixth-grade reading level. Conclusion: The current study shows that using this standardized method significantly improves the readability of spine-related PEMs and significantly increased the likelihood that PEMs will meet recommendations for being at or below the sixth-grade reading level. [ABSTRACT FROM AUTHOR]

Background: Professional vascular societies and forums have disseminated patient information on education materials about chronic venous disease (CVD) via their official websites. While online patient education material is readily available with an Internet connection, its practical utility may be limited for patients with low health literacy. Methods: Six readability measures were used to evaluate the patient education materials regarding CVD published by 12 professional medical societies. Results: Patient education materials on CVD vary considerably in length among medical societies, and their comprehensibility points toward a difficult level. The mean readability score was 11.20, prominently above the National Institutes of Health (NIH) and American Medical Association (AMA) recommendations. Conclusion: Our analysis of patient education materials produced by 12 professional vascular societies and forums found that all materials exceeded the recommended readability levels. The innovative section "Information for patients'' in the ESVS CVD guidelines also exceeded these levels. Improving the readability of patient education materials is essential to meet patient health literacy standards and might improve patient outcomes in managing CVD. [ABSTRACT FROM AUTHOR]

Introduction: Bariatric surgery is a successful treatment for obesity, but barriers to surgery exist, including low health literacy. National organizations recommend patient education materials (PEM) not exceed a sixth-grade reading level. Difficult to comprehend PEM can exacerbate barriers to bariatric surgery, especially in the Deep South where high obesity and low literacy rates exist. This study aimed to assess and compare the readability of webpages and electronic medical record (EMR) bariatric surgery PEM from one institution. Methods: Readability of online bariatric surgery and standardized perioperative EMR PEM were analyzed and compared. Text readability was assessed by validated instruments: Flesch Reading Ease Formula (FRE), Flesch Kincaid Grade Level (FKGL), Gunning Fog (GF), Coleman–Liau Index (CL), Simple Measure of Gobbledygook (SMOG), Automated Readability Index (ARI), and Linsear Write Formula (LWF). Mean readability scores were calculated with standard deviations and compared using unpaired t-tests. Results: 32 webpages and seven EMR education documents were analyzed. Webpages were overall "difficult to read" compared to "standard/average" readability EMR materials (mean FRE 50.5 ± 18.3 vs. 67.4 ± 4.2, p = 0.023). All webpages were at or above high school reading level: mean FKGL 11.8 ± 4.4, GF 14.0 ± 3.9, CL 9.5 ± 3.2, SMOG 11.0 ± 3.2, ARI 11.7 ± 5.1, and LWF 14.9 ± 6.6. Webpages with highest reading levels were nutrition information and lowest were patient testimonials. EMR materials were sixth to ninth grade reading level: FKGL 6.2 ± 0.8, GF 9.3 ± 1.4, CL 9.7 ± 0.9, SMOG 7.1 ± 0.8, ARI 6.1 ± 1.0, and LWF 5.9 ± 0.8. Conclusion: Surgeon curated bariatric surgery webpages have advanced reading levels above recommended thresholds compared to standardized PEM from an EMR. This readability gap may unintentionally contribute to barriers to surgery and affect postoperative outcomes. Streamlined efforts are needed to create materials that are easier to read and comply with recommendations. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the readability and reliability of online content related to cerebral palsy (CP) and to classify sites that contain quality and readable information. On April 30, 2022, the term "cerebral palsy" was searched on the Google search engine. The categories, quality, content, readability, Alexa rank values, and backlink numbers of the sites were analyzed. The Journal of American Medical Association score and HONcode seal were used for quality assessment, and the Flesch–Kincaid grade (FKG) and the Simple Measure of Gobbledygook (SMOG) were used for readability assessment. Of the 155 sites, 46 had high-quality content. The quality of health portal and scientific publishing sites appeared to be high. The top 10 sites were determined to be of significantly higher quality (p =.017) than the remaining sites. The average readability values of the sites were not at the recommended level. Despite the abundance of information available on CP-related websites, most of them were not of high quality. Additionally, many websites did not reach the recommended readability levels. Revision of existing online content related to CP and production of new high-quality content in line with readability recommendations is urgently required. [ABSTRACT FROM AUTHOR]

The purpose of this study was to quantify the readability and quality of patient materials on the websites of the Japanese Orthopaedic Association and related orthopaedic societies. We analyzed 143 online patient materials of seven societies, including the Japanese Orthopaedic Association and related six societies. The readability of the text in the material was quantified using two web-based programs ("Obi-3" and "Readability Research Lab") and lexical density. The materials with a difficulty level ≤ second grade of junior high school were classified as "average difficulty," and those ≤ sixth grade of elementary school were classified as "easy to read." The quality of the materials was quantified using the validated Clear Communication Index, DISCERN, and Journal of American Medical Association benchmark criteria scores. The proportion of materials classified as sufficient quality was determined. The measurement values were compared among societies using Kruskal–Wallis tests. The median difficulty level of the overall materials was the third grade of junior high school using the Obi-3 program. Only 44 (31%) were classified as average difficulty, and none were classified as easy to read. Based on lexical density, 31 (22%) materials were classified as average difficulty. The median Clear Communication Index score was 18 points out of 100. The median DISCERN and Journal of American Medical Association benchmark criteria scores were 27 (out of 75) and 0 (out of 4), respectively. Only one material met the criteria as having sufficient quality. There were significant differences among societies in the lexical density, Clear Communication Index, and DISCERN scores. The patient materials on the Japanese Orthopaedic Association and related society websites were too difficult to understand. Furthermore, the quality of the materials was not sufficient. Improvement in readability and quality may be necessary to enhance patient-physician communication. [ABSTRACT FROM AUTHOR]

Hispanic adults with skin cancer are known to exhibit worsened outcomes compared to their counterparts. To critically evaluate the literature on methods to educate Spanish-speaking patients on sun safety and skin cancer, we conducted a systematic review of PubMed, SCOPUS, Embase, Web of Science, and Cochrane Central Register databases from inception through December 18, 2021. Evidence quality was assessed using criteria from the Oxford Centre for Evidence-Based Medicine. A total of 1014 articles were identified and 10 articles using Spanish language materials for community dermatology education were included for review. Seven studies were interventional: four studies were community-based healthcare worker interventions, and three were video-based interventions. Two studies were patient survey studies on skin-related health literacy and the readability of patient resources. One was an online readability study. Our findings show that there is a need for an increased number of materials to educate Spanish-speaking patients about sun safety and skin cancer. [ABSTRACT FROM AUTHOR]

Patient education materials (PEMs) are often used in health education programs to empower patients to self-manage their disease for better health outcomes. Heart failure (HF) patients wanted more information about self-management and educational materials that were easy to understand. Programs with self-efficacy as the core component have proven to be effective in improving patients' self-management. To develop practical, efficacy-enhanced, tailored HF rehabilitation PEMs that satisfy our clients to drive long-lasting behavior change and evaluate the materials' quality (readability, understandability, actionability, and acceptability). Exploratory mixed methods study involving: i) semi-structured interviews; ii) evaluation of the PEMs; iii) revision and reevaluation of the PEMs; iv) publication. An appointed panel of experts evaluates content accuracy, understandability, and actionability. The Patient Education Material Assessment Tool assesses content understandability and actionability. The content readability was assessed using Flesch Kincaid Calculator. Clients' acceptability was assessed using Educational Material Acceptability tool. The newly developed PEMs have good understandability, actionability, readability, and acceptance. Patient-centered PEMs have good acceptance and satisfaction among clients. However, the effectiveness of tailored efficacy-enhanced PEMs for behavior changes needs further evaluation. All stakeholders should be included in developing PEMs. A AJHE Self-Study quiz is online for this article via the SHAPE America Online Institute (SAOI) [ABSTRACT FROM AUTHOR]

Community outreach and engagement has been a regular activity of the National Cancer Institute at its designated Cancer Centers. However, in 2016, community outreach and engagement became a required activity for all cancer centers. Yet there is a gap in the literature that provides guidelines for developing materials that resonate with communities. We developed the PEARL rubric to fulfill that gap from our work developing culturally sensitive breast cancer education materials for African American and Immigrant African women. We conducted a targeted literature review to understand the approaches that have been used for developing education materials for communities. We reviewed the literature and distilled key elements into our PEARL guide for creating culturally appropriate education materials. PEARL consists of five elements: Plain language and understandability, Explicit data, statistics, and graphs, Affirmative framing, Representative content, and Local connection. PEARL is a modern comprehensive guide that researchers can use for creating culturally sensitive materials. It is designed to guide researchers develop educational materials who have little to no experience in community engagement. [ABSTRACT FROM AUTHOR]

Background: As patients seek online health information to supplement their medical decision‐making, the aim of this study is to assess the quality and readability of internet information on the left ventricular assist device (LVAD). Methods: Three online search engines (Google, Bing, and Yahoo) were searched for "LVAD" and "Left ventricular assist device." Included websites were classified as academic, foundation/advocacy, hospital‐affiliated, commercial, or unspecified. The quality of information was assessed using the JAMA benchmark criteria (0–4), DISCERN tool (16–80), and the presence of Health On the Net code (HONcode) accreditation. Readability was assessed using the Flesch Reading Ease score. Results: A total of 38 unique websites were included. The average JAMA and DISCERN scores of all websites were 0.82 ± 1.11 and 52.45 ± 13.51, respectively. Academic sites had a significantly lower JAMA mean score than commercial (p < 0.001) and unspecified (p < 0.001) websites, as well as a significantly lower DISCERN, mean score than commercial sites (p = 0.002). HONcode certification was present in 6 (15%) websites analyzed, which had significantly higher JAMA (p < 0.001) and DISCERN (p < 0.016) mean scores than sites without HONcode certification. Readability was fairly difficult and at the level of high school students. Conclusions: The quality of online information on the LVAD is variable, and overall readability exceeds the recommended level for the public. Patients accessing online information on the LVAD should be referred to sites with HONcode accreditation. Academic institutions must provide higher quality online patient literature on LVADs. [ABSTRACT FROM AUTHOR]

This study aims to determine the readability and trustworthiness of English and Spanish hypo- and hyperthyroid-related online information. Google searches were conducted for four search terms: hypothyroidism, Hashimoto's Disease, hyperthyroidism, and Graves' Disease. For each search term, the first 10 websites were analyzed with a total of 40 websites analyzed. Readability formulas were used to determine English and Spanish readability. Trustworthiness was determined using HONcode status, JAMA Benchmark Criteria, and NLM Trustworthy Score. Overall readability largely exceeded recommended grade levels. Only 1 website (2.5%) presented information below the eighth-grade reading level based on overall Readability Consensus score, while 31 websites (77.5%) exceeded this threshold for all measures. The mean (SD) English readability grade level was 9.6 (3.44); the mean (SD) Spanish grade was 8.5 (4.58). No significant relationships were found between the JAMA Benchmark Criteria, NLM Trustworthy Score, HONcode status, and readability. 67.5% of websites analyzed (n = 27) were certified with the Health on the Net Foundation's code of conduct. Websites about common thyroid-related conditions have overall poor readability. The availability of resources for Spanish-speaking patients is also poor. Steps should be taken to ensure that online health-related materials are comprehensible. Physicians should recognize that patients may have few trustworthy and easy-to-understand sources to access information. The readability and trustworthiness of sources should be considered when providing patients suggested sources for further reading. It may be particularly helpful for physicians to utilize websites with favorable readability scores such as the American Thyroid Association website. [ABSTRACT FROM AUTHOR]

Background: Health information concerns both individuals' engagement and the way services and professionals provide information to facilitate consumers' health decision making. Citizens' and patients' participation in the management of their own health is related to the availability of tools making health information accessible, thus promoting empowerment and making care more inclusive and fairer. A novel instrument was developed (Evaluation Tool of Health Information for Consumers—ETHIC) for assessing the formal quality of health information materials written in Italian language. This study reports ETHIC's content and face validity. Methods: A convenience sample of 11 experts and 5 potential users was involved. The former were requested to evaluate relevance and exhaustiveness, the latter both readability and understandability of ETHIC. The Content Validity Index (CVI) was calculated for ETHIC's sections and items; experts and potential users' feedback were analyzed by the authors. Results: All sections and most items were evaluated as relevant. A new item was introduced. Potential users provided the researchers with comments that partly confirmed ETHIC's clarity and understandability. Conclusions: Our findings strongly support the relevance of ETHIC's sections and items. An updated version of the instrument matching exhaustivity, readability, and understandability criteria was obtained, which will be assessed for further steps of the validation process. [ABSTRACT FROM AUTHOR]

The Internet is a significant source of information for patients. According to the National Institutes of Health, patient education materials (PEMs) should be at or below an eighth-grade reading level. Merkel cell carcinoma (MCC) is a rare and aggressive skin cancer that affects patients over 50 with rising incidence. Unfortunately, US adults aged 65 + have the least proficiency in health literacy. This study assessed the readability of online PEMs and factors that contribute to readability. We retrieved 50 PEM websites and extracted primary content. A readability software package calculated six readability statistics and generated a consensus standard readability. Overall, only eight articles had a standard reading level of eighth-grade level or below (16%). The median standard reading level was at the 11th-grade level. We also examined MCC PEMs from cancer treatment institution websites (N = 20). We determined whether they contained institution-specific information, meaning they contained text information about the institution-specific expertise and specialist team. Websites containing this information (N = 13) had a significantly higher reading level than websites that did not (N = 7) in five of six readability metrics (p < 0.05). We concluded that MCC PEMs with institution-specific information led to significantly higher reading level scores. We propose that such information may increase cognitive load, as patients are learning about their disease and treatment and contending with the institution-specific information. The Cognitive Load Theory principles of intrinsic load (learning the material relevant to the disease and treatment) and extraneous load (institution-specific information and increased reading level) are constrained by limited working memory. Working memory decreases with age; hence, the patient demographic most sensitive to increased extraneous load tends to overlap with that of MCC. As patients typically read pages linked from their search engine, we suggest moving institution-specific information to another page, separate from the PEMs. [ABSTRACT FROM AUTHOR]

Background: Patient education information material (PEIM) is an essential component of patient education programs in increasing patients' ability to cope with their diseases. Therefore, it is essential to consider the criteria that will be used to prepare and evaluate these resources. Objective: This paper aims to identify these criteria and recognize the tools or methods used to evaluate them. Methods: National and international databases and indexing banks, including PubMed, Scopus, Web of Science, ProQuest, the Cochrane Library, Magiran, SID and ISC, were searched for this review. Original or review articles, theses, short surveys, and conference papers published between January 1990 and June 2022 were included. Results: Overall, 4688 documents were retrieved, of which 298 documents met the inclusion criteria. The criteria were grouped into 24 overarching criteria. The most frequently used criteria were readability, quality, suitability, comprehensibility and understandability. Conclusion: This review has provided empirical evidence to identify criteria, tools, techniques or methods for developing or evaluating a PEIM. The authors suggest that developing a comprehensive tool based on these findings is critical for evaluating the overall efficiency of PEIM using effective criteria. [ABSTRACT FROM AUTHOR]

Background: The internet has become an increasingly important resource for health information, especially for lay people. However, the information found does not necessarily comply with the user's health literacy level. Therefore, it is vital to (1) identify prominent information providers, (2) quantify the readability of written health information, and (3) to analyze how different types of information sources are suited for people with differing health literacy levels. Objective: In previous work, we showed the use of a focused crawler to "capture" and describe a large sample of the "German Health Web", which we call the "Sampled German Health Web" (sGHW). It includes health-related web content of the three mostly German speaking countries Germany, Austria, and Switzerland, i.e. country-code top-level domains (ccTLDs) ".de", ".at" and ".ch". Based on the crawled data, we now provide a fully automated readability and vocabulary analysis of a subsample of the sGHW, an analysis of the sGHW's graph structure covering its size, its content providers and a ratio of public to private stakeholders. In addition, we apply Latent Dirichlet Allocation (LDA) to identify topics and themes within the sGHW. Methods: Important web sites were identified by applying PageRank on the sGHW's graph representation. LDA was used to discover topics within the top-ranked web sites. Next, a computer-based readability and vocabulary analysis was performed on each health-related web page. Flesch Reading Ease (FRE) and the 4th Vienna formula (WSTF) were used to assess the readability. Vocabulary was assessed by a specifically trained Support Vector Machine classifier. Results: In total, n = 14,193,743 health-related web pages were collected during the study period of 370 days. The resulting host-aggregated web graph comprises 231,733 nodes connected via 429,530 edges (network diameter = 25; average path length = 6.804; average degree = 1.854; modularity = 0.723). Among 3000 top-ranked pages (1000 per ccTLD according to PageRank), 18.50%(555/3000) belong to web sites from governmental or public institutions, 18.03% (541/3000) from nonprofit organizations, 54.03% (1621/3000) from private organizations, 4.07% (122/3000) from news agencies, 3.87% (116/3000) from pharmaceutical companies, 0.90% (27/3000) from private bloggers, and 0.60% (18/3000) are from others. LDA identified 50 topics, which we grouped into 11 themes: "Research & Science", "Illness & Injury", "The State", "Healthcare structures", "Diet & Food", "Medical Specialities", "Economy", "Food production", "Health communication", "Family" and "Other". The most prevalent themes were "Research & Science" and "Illness & Injury" accounting for 21.04% and 17.92% of all topics across all ccTLDs and provider types, respectively. Our readability analysis reveals that the majority of the collected web sites is structurally difficult or very difficult to read: 84.63% (2539/3000) scored a WSTF ≥ 12, 89.70% (2691/3000) scored a FRE ≤ 49. Moreover, our vocabulary analysis shows that 44.00% (1320/3000) web sites use vocabulary that is well suited for a lay audience. Conclusions: We were able to identify major information hubs as well as topics and themes within the sGHW. Results indicate that the readability within the sGHW is low. As a consequence, patients may face barriers, even though the vocabulary used seems appropriate from a medical perspective. In future work, the authors intend to extend their analyses to identify trustworthy health information web sites. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to analyze the readability of the Individuals with Disabilities Education Act (IDEA) Part B procedural safeguard notices written in Spanish, as distributed by each of the 50 states in the United States and the District of Columbia. Results were compared with the 6th–8th grade document readability guideline recommended by experts in health communication. Method: A commercially available readability software program was used to assess document readability using three readability indices: the Gilliam–Peña– Mountain Graph, SOL, and the Fry Readability Adaptation for Spanish Evaluation. Results: All procedural safeguard notices were written at a reading grade level greater than established guidelines. This finding agrees with research that has examined the readability of English-language versions of IDEA Part B procedural safeguard notices. Conclusions: Literacy-related skills and demands may influence the ability of the parent to advocate on behalf of his or her child with a disability within the school setting. Educators and specialists should be sensitive to parent reading preferences and proficiency when reviewing IDEA procedural safeguards notices. Authors of procedural safeguard notices should account for the native language and culture of the intended reader as revisions to, and translations are made of, IDEA procedural safeguards notices. [ABSTRACT FROM AUTHOR]