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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]

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]

Objective Internet-based patient education materials (PEMs) are often above the recommended sixth grade reading level recommended by the U.S. Department of Health and Human Services. In 2016 the U.S. Food and Drug Administration (FDA) released a warning statement against use of general anesthetic drugs in children and pregnant women due to concerns about neurotoxicity. The aim of this study is to evaluate readability, content, and quality of Internet-based PEMs on anesthesia in the pediatric population and neurotoxicity. Study Design The websites of U.S. medical centers with pediatric anesthesiology fellowship programs were searched for PEMs pertaining to pediatric anesthesia and neurotoxicity. Readability was assessed. PEM content was evaluated using matrices specific to pediatric anesthesia and neurotoxicity. PEM quality was assessed with the Patient Education Material Assessment Tool for Print. A one-sample t -test was used to compare the readability of the PEMs to the recommended sixth grade reading level. Results We identified 27 PEMs pertaining to pediatric anesthesia and eight to neurotoxicity. Mean readability of all PEMs was greater than a sixth grade reading (p <0.001). While only 13% of PEMs on anesthesia for pediatric patient mentioned the FDA warning, 100% of the neurotoxicity materials did. PEMs had good understandability (83%) and poor actionability (60%). Conclusion The readability, content, and quality of PEMs are poor and should be improved to help parents and guardians make informed decisions about their children's health care. Key Points The FDA issued a warning statement against the use of general anesthetic drugs in children and pregnant women. Readability, content, and quality of Internet-based patient education materials on the topic of neurotoxicity are poor. Improving the readability, content, and quality of PEMs could aid parents in making important health care decisions. [ABSTRACT FROM AUTHOR]

Background: The readability of online bariatric surgery patient education materials (PEMs) often surpasses the recommended 6th grade level. Large language models (LLMs), like ChatGPT and Bard, have the potential to revolutionize PEM delivery. We aimed to evaluate the readability of PEMs produced by U.S. medical institutions compared to LLMs, as well as the ability of LLMs to simplify their responses. Methods: Responses to frequently asked questions (FAQs) related to bariatric surgery were gathered from top-ranked health institutions. FAQ responses were also generated from GPT-3.5, GPT-4, and Bard. LLMs were then prompted to improve the readability of their initial responses. The readability of institutional responses, initial LLM responses, and simplified LLM responses were graded using validated readability formulas. Accuracy and comprehensiveness of initial and simplified LLM responses were also compared. Results: Responses to 66 FAQs were included. All institutional and initial LLM responses had poor readability, with average reading levels ranging from 9th grade to college graduate. Simplified responses from LLMs had significantly improved readability, with reading levels ranging from 6th grade to college freshman. When comparing simplified LLM responses, GPT-4 responses demonstrated the highest readability, with reading levels ranging from 6th to 9th grade. Accuracy was similar between initial and simplified responses from all LLMs. Comprehensiveness was similar between initial and simplified responses from GPT-3.5 and GPT-4. However, 34.8% of Bard's simplified responses were graded as less comprehensive compared to initial. Conclusion: Our study highlights the efficacy of LLMs in enhancing the readability of bariatric surgery PEMs. GPT-4 outperformed other models, generating simplified PEMs from 6th to 9th grade reading levels. Unlike GPT-3.5 and GPT-4, Bard's simplified responses were graded as less comprehensive. We advocate for future studies examining the potential role of LLMs as dynamic and personalized sources of PEMs for diverse patient populations of all literacy levels. [ABSTRACT FROM AUTHOR]

Objective: To assess the readability and the comprehensiveness of patient‐reported outcome measures (PROMs) utilized in primary headache disorders literature. Background: As the health‐care landscape has evolved toward a patient‐centric model, numerous PROMs have been developed to capture treatment outcomes in patients with headache disorders. For these PROMs to advance our understanding of headache disorders and their treatment impact, they must be easy to understand (i.e., reading grade level 6 or less) and comprehensively capture what matters to patients with headache. The aim of this study was to (a) assess the readability of PROMs utilized in headache disorders literature, and (b) assess the comprehensiveness of PROMs by mapping their content to a health‐related quality of life framework. Methods: In this scoping review, recently published systematic reviews were used to identify PROMs used in primary headache disorders literature. Readability analysis was performed at the level of individual items and full PROM using established readability metrics. The content of the PROMs was mapped against a health‐related quality‐of‐life framework by two independent reviewers. Results: In total, 22 PROMs (15 headache disorders related, 7 generic) were included. The median reading grade level varied between 7.1 (interquartile range [IQR] 6.3–7.8) and 12.7 (IQR 11.8–13.2). None of the PROMs were below the recommended reading grade level for patient‐facing material (grade 6). Three PROMs, the Migraine‐Treatment Assessment Questionnaire, the Eurolight, and the European Quality of Life 5 Dimensions 3 Level Version, were between reading grade levels 7 and 8; the remaining 19 PROMs were above reading grade level 8. In total, the PROMs included 425 items. Most items (n = 134, 32%) assessed physical function (e.g., work, activities of daily living). The remaining items assessed physical symptoms (n = 127, 30%; e.g., pain, nausea), treatment effects on symptoms (n = 65, 15%; e.g., accompanying symptoms relief, headache relief), treatment impact (n = 56, 13%; e.g., function, side effects), psychological well‐being (n = 41, 10%; e.g., anger, frustration), social well‐being (n = 29, 7%; e.g., missing out on social activities, relationships), psychological impact (n = 14, 3%; e.g., feeling [not] in control, feeling like a burden), and sexual well‐being (n = 3, 1%; e.g., sexual activity, sexual interest). Some of the items pertained to treatment (n = 27, 6%), of which most were about treatment type and use (n = 12, 3%; e.g., medication, botulinum toxin), treatment access (n = 10, 2%; e.g., health‐care utilization, cost of medication), and treatment experience (n = 9, 2%; e.g., treatment satisfaction, confidence in treatment). Conclusion: The PROMs used in studies of headache disorders may be challenging for some patients to understand, leading to inaccurate or missing data. Furthermore, no available PROM comprehensively measures the health‐related quality‐of‐life impact of headache disorders or their treatment, resulting in a limited understanding of patient‐reported outcomes. The development of an easy‐to‐understand, comprehensive, and validated headache disorders–specific PROM is warranted. Plain Language Summary: Patient‐reported outcome measures (PROMs) are used so we can better understand headache disorders (HDs) and how well treatments work; to be most effective, they should be specific to HDs and easy for patients to understand. This study looked at the reading grade level of 22 PROMs used in HD studies and what quality of life topics they covered; the reading grade level ranged from 7.1 to 12.7, higher than the recommended grade level of 6. Most items in the PROMs focused on physical function, symptoms, and treatment effects, but none did a good job of learning about HDs' impacts on quality of life, revealing a need for the development of an improved, easy‐to‐understand HD‐specific PROM. [ABSTRACT FROM AUTHOR]

To evaluate the readability of surgical clinical trial consent forms and compare readability across surgical specialties. We conducted a cross-sectional analysis of surgical clinical trial consent forms available on ClinicalTrials.gov to quantitatively evaluate readability, word count, and length variations among different specialties. The analysis was performed between November 2022 and January 2023. A total of 386 surgical clinical trial consent forms across 14 surgical specialties were included. The main outcomes were language complexity (measured using Flesch–Kincaid Grade Level), number of words (measured as word count), time to read (measured at reading speeds of 240 per min), and readability (measured by Flesch Reading Ease Score, Gunning Frog Index, Simple Measures of Gobbledygook Index, FORCAST, and Automated Readability Index). The surgical consent forms were a mean (standard deviation) of 2626 (1668) words long, with a mean of 12:53 min to read at 240 words per min. None of the surgical specialties had an average readability level of sixth grade or lower across all six indices, and only 16 out of 386 (4%) clinical trials met the recommended reading level. Furthermore, there was no significant difference in reading grade level between surgical specialties based on the Flesch–Kincaid Grade Level and Flesch Reading Ease indices. Our findings suggest that current surgical clinical trial consent documents are too long and complex, exceeding the recommended sixth-grade reading level. Ensuring readable clinical trial consent forms is not only ethically responsible but also crucial for protecting patients' rights and well-being by facilitating informed decision-making. • Largest meta-analysis study of more than 79,000 surgical patients. • Mortality is increased almost 10-fold in surgical patients with COVID-19. • COVID-induced mortality risk is double in low-income and middle-income countries. • Type of surgery is not associated with mortality risk. [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]

Background: Telerehabilitation is an easy and creative approach to rehabilitation treatments for osteoarthritis. In telerehabilitation, there are various modes through which exercises can be explained to the patients. Videos and brochures are commonly used to send patients exercise plans. Videos are easy to understand and can mimic live demonstrations and brochures are easy to create and customise for every patient's need. The present study aimed to evaluate the effectiveness of brochure and video methods of exercise prescription through telerehabilitation in terms of exercise acquisition and retention. Methods: The study design was a randomised clinical trial. A total of 110 knee osteoarthritis patients who agreed to participate in the telerehabilitation programme were recruited for the study. The patients were randomly assigned to a video and brochure group. After the initial consultation through videoconferencing, the prescribed exercises were sent on their phone in the form of video or electronic brochure. The participants were again contacted through video conferencing after 2 days and retention and acquisition tests were recorded. Results: The comparison of both groups through 't' test showed no significant difference in exercise retention and acquisition. The mean and SD of exercise acquisition in the brochure group was 26.3455, ±5.7998 and in the video group was 27.2, ±5.47181 and mean and SD of exercise retention in the brochure group was 7.8727, ±2.31784 and in the video group was 7.6, ±1.256. Further analysis revealed that the hamstring stretching exercise was retained better in the video group than in the brochure group (p = 0.031*). Conclusion: The study found no significant difference in exercise acquisition and retention between the video and brochure groups. Hence, an exercise brochure can be equally effective as a video for exercise prescription if the brochure is developed by keeping in mind the principles of readability and the use of proper instructions. [ABSTRACT FROM AUTHOR]

The objective of this paper is to present and make publicly available the NILC-Metrix, a computational system comprising 200 metrics proposed in studies on discourse, psycholinguistics, cognitive and computational linguistics, to assess textual complexity in Brazilian Portuguese (BP). The metrics are relevant for descriptive analysis and the creation of computational models and can be used to extract information from various linguistic levels of written and spoken language. The metrics were developed during the last 13 years, starting in the end of 2007, within the scope of the PorSimples project. Once the PorSimples finished, new metrics were added to the initial 48 metrics of the Coh-Metrix-Port tool. Coh-Metrix-Port adapted some metrics to BP from the Coh-Metrix tool that computes metrics related to cohesion and coherence of texts in English. Given the large number of metrics, we present them following an organisation similar to the metrics of Coh-Metrix v3.0 to facilitate comparisons made with metrics in Portuguese and English, in future studies using both tools. In this paper, we illustrate the potential of the NILC-Metrix by presenting three applications: (i) a descriptive analysis of the differences between children's film subtitles and texts written for Elementary School I (comprises classes from 1st to 5th grade) and II (Final Years) (comprises classes from 6th to 9th grade, in an age group that corresponds to the transition between childhood and adolescence); (ii) a new predictor of textual complexity for the corpus of original and simplified texts of the PorSimples project; (iii) a complexity prediction model for school grades, using transcripts of children's story narratives told by teenagers. For each application, we evaluate which groups of metrics are more discriminative, showing their contribution for each task. [ABSTRACT FROM AUTHOR]

Background: The internet has become a primary source of health information, particularly for cancer patients. This study evaluated the quality of online health information related to colon cancer in Arabic. Objective: To assess the reliability, accountability, legitimacy, and readability of Arabic websites providing information on colon cancer. Methods: A search was conducted on major search engines using Arabic keywords related to colon cancer. After initial screening, 13 websites were selected for evaluation. The Journal of the American Medical Association (JAMA) benchmarks, DISCERN instrument and website certification (Health on the Net - HON code) were used for assessment. Readability was analyzed using the Flesch Reading Ease Score and Flesch-Kincaid Grade Level. Results: Non-government websites, particularly Wikipedia, msdmanuals.com, and primomedico.com, demonstrated higher compliance with JAMA benchmarks. Six websites scored high on the DISCERN instrument, indicating reliable treatment information. Only one website was HON-code certified. Readability analysis revealed that text comprehension is challenging for most websites. Conclusion: Private agencies and hospitals managed non-government websites generally outperformed government websites' reliability, quality, and readability. However, overall improvement in Arabic's online health information landscape is essential to enhance accessibility and credibility for colon cancer patients. [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]

OBJECTIVES: This study aimed to evaluate the readability of patient education materials (PEMs) on websites of intensive and critical care societies. DATA SOURCES: Websites of intensive and critical care societies, which are members of The World Federation of Intensive and Critical Care and The European Society of Intensive Care Medicine. SETTING: Cross-sectional observational, internet-based, website, PEMs, readability study. STUDY SELECTION: The readability of the PEMs available on societies' sites was evaluated. DATA EXTRACTION: The readability formulas used were the Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG), and Gunning Fog (GFOG). DATA SYNTHESIS: One hundred twenty-seven PEM from 11 different societies were included in our study. In the readability analysis of PEM, the FRES was 58.10 (48.85-63.77) (difficult), the mean FKGL and SMOG were 10.19 (8.93-11.72) and 11.10 (10.11-11.87) years, respectively, and the mean GFOG score was 12.73 (11.37-14.15) (very difficult). All readability formula results were significantly higher than the recommended sixth-grade level (p < 0.001). All PEMs were above the sixth-grade level when the societies were evaluated individually according to all readability results (p < 0.05). CONCLUSIONS: Compared with the sixth-grade level recommended by the American Medical Association and the National Institutes of Health, the readability of PEMs in intensive and critical care societies is relatively high. PEMs in intensive and critical care societies should be prepared with attention to recommendations on readability. [ABSTRACT FROM AUTHOR]

Background: Aortic aneurysms represent a chronic degenerative disease with life-threatening implications. In order for patients to comprehend health related information, it must be written at a level that can be readily understood. Study Design: In January 2023, we searched "aneurisma aorta" and "endoprótesis aorta" terms on Google, Yahoo and Microsoft/Bing. The 31th websites provided by each search engine were analyzed. Four readability measures were used to evaluate websites regarding aortic aneurysm and their endovascular treatment in Spanish language: Flesch Index, Flesch-Szigriszt Index, Fernández-Huerta Index and grading Inflesz scale. The quality on information was evaluated by the HONcode seal, the DISCERN instrument and the JAMA benchmark criteria. Results: 180 websites containing the terms "aneurisma aorta" and "endoprótesis aorta" were analyzed. Among the websites retrieved, the mean Flesh index score (53.12 ± 6.09 and 47.48 ± 7.12, respectively; P =.019), the Flesch-Szigriszt index (56.39 ± 5.72 and 48.10 ± 8.33; P =.000), and the Fernández Huerta index (61.30 ± 5.59 and 53.19 ± 8.21; P =.000), corresponding to a "somewhat difficult" readability level. In addition, the Inflesz scale (2.62 ±.59 and 2.07 ±.61; P =.000) reported a "somewhat difficult" readability, higher for the websites regarding aortic aneurysm. The HONcode seal was only presented in websites regarding aortic aneurysm (16.7%), whereas none of the websites relating to aortic endoprostheses presented it (0%) (P =.000). Websites that presented the HONcode seal obtained higher DISCERN score (P =.000, 95% CI = 6.42-16.84) and JAMA score (P =.000, 95% CI = 3.44-11.32). Conclusion: Internet information on aortic aneurysms and aortic endoprostheses is too difficult to read for the general Spanish-speaking population and is lacking in quality. [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]

People commonly and increasingly rely on the internet to search for health information, including those related to endometriosis-associated dyspareunia. Yet the content of such websites may be of variable accuracy and quality. This review aims to evaluate the quality, readability, and suitability of web-based resources on endometriosis-associated dyspareunia for patients. We searched 3 databases – Google, Bing, and Yahoo – to identify websites related to endometriosis-associated dyspareunia. Two independent reviewers screened the search results against inclusion and exclusion criteria. Another set of two reviewers evaluated the selected websites using validated measurement instruments. Out of 450 websites, 21 met the inclusion criteria and were evaluated. More than half of the websites had information on content updates, reported on authorship, or disclosed sponsorship information. The mean quality and suitability scores were 47.5 (SD = 13.3) and 65.2 (SD = 13.6) respectively, thus suggesting generally adequate quality and suitability levels. However, the mean readability scores exceeded the recommended level for health-related websites. The poor readability of the websites might limit accessibility for a significant proportion of patients with low educational levels. The findings of this review have implications for designing high-quality, readable and up-to-date web interventions for people who rely on web platforms as an alternative or complementary source of health information on dyspareunia. [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]

Objective: The aim of the study is to assess the quality, readability, content, accessibility, and structure of online resources for patients with upper limb spasticity. Design: This was a cross sectional study examined Internet searches across three search engines related to patient resources for upper limb spasticity. Search phrases for either hand or upper limb spasticity were used. The top 20 Websites from each search were evaluated using the four readability metrics and the DISCERN scale for quality assessment. YouTube videos with exact search phrases were evaluated using DISCERN. Descriptive statistical analyses were performed using SPSS software. Results: Thirty-six Websites and 33 videos met the inclusion criteria for this study. The average Flesh-Kincaid Grade Level of the Websites was 11.7 ± 3.1, showing low Website readability. According to this index, only two Websites were written at the suggested sixth-grade level (5.4%). With a maximum score of 75, the mean DISCERN score for both Websites and videos scored in the “good” range (53.5 ± 8 and 50.5 ± 6.6), respectively. Conclusions: Current online resources for upper limb spasticity are good in quality but are written above the health literacy level of American citizens. Organizations should consider reviewing their present materials and developing high-quality patient education materials that are easier to understand. [ABSTRACT FROM AUTHOR]

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]

Background/Objectives: Sinonasal inverted papilloma (IP) is a rare but serious diagnosis, with a paucity of patient‐centred information regarding this condition. As more patients are seeking healthcare information online, the quality and comprehensibility of this information becomes ever more important. The aim of the study was to investigate the readability and quality of websites on inverted papilloma. Methods: The term IP and seven of its synonyms were inputted into the three of the most commonly used search engines in the English‐speaking world (Google, Yahoo and Bing). The first 20 results returned for each search term were then screened with our exclusion criteria. The remaining websites were assessed for their readability using the using the Flesch Reading Ease Score (FRES) and average grade level (AGL). Quality was assessed using the DISCERN questionnaire. Results: Of the 480 websites returned using our search strategy, 410 were excluded using our screening criteria. Removal of duplicates from the remaining 70 websites left 14 for inclusion in the final analysis. The mean FRES score of the remaining websites was 30.5 ± 10 and the mean AGL was 15.2 ± 1.1, corresponding to a reading age of a 21‐year‐old. The median DISCERN score was 33.5 (30.5–36.5), a score which falls within the 'poor quality' range. Conclusion: The readability and quality of online patient information on IP is far below the expected standard. Healthcare providers have a responsibility to direct patients to appropriate sources of information or consider producing new material should a lack of appropriate sources exist. [ABSTRACT FROM AUTHOR]

Appropriate education and information are the keystones of patient autonomy. Surgical societies support this goal through online informational publications. Despite these recommendations, many of these sources do not provide the appropriate level of reading for the average patient. Multiple national organizations, including the AMA and NIH, have recommended that such materials be written at or below a 6th-grade level. We therefore aimed to evaluate the readability of patient information publications provided by the American Society of Metabolic and Bariatric Surgery (ASMBS). Patient information publications were collected from the ASMBS webpage (https://asmbs.org/patients) and evaluated for readability. Microsoft Office was utilized to calculate Flesch Reading Ease (FRE) and Flesch-Kincaid Grade Level (FKGL) scores. Flesch Reading Ease (FRE) is a 0-100 score, with higher scores equating to easier reading (≥80 = 6th-grade reading level). Flesch-Kincaid Grade Level (FKGL) rates text on a US grade school level. Qualitative and univariate analyses were performed. Eleven patient information publications were evaluated. None of the publications achieved an FRE score of 80 or an FKGL of a 6th-grade reading level. The average FRE score was 35.8 (range 14.9-53.6). The average FKGL score was 13.1 (range 10.1-17.5). The publication with the highest FRE and lowest FKGL (best readability) was that for benefits of weight loss. The brochure with the lowest FRE and highest FKGL (worst readability) was that for Medical Tourism. Although the ASMBS patient information publications are a trusted source of patient literature, none of the 11 publications met the recommended criteria for patient readability. Further refinement of these will be needed to provide the appropriate reading level for the average patient. • Readability is critical to improving patient education materials. • Multiple health societies recommend a readability at or below the 6th grade. • The ASMBS provides online materials for prospective and current patients. • All of the patient information brochures on the ASMBS read at an inappropriately high level. [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]

Open data portals have been implemented in numerous countries to provide accessible, usable, and reproducible data. This study aims to assess the readability of datasets from Open Data Pakistan. Using the URL (https://opendata.com.pk/) in an online readability checking tool, six well-known readability formulas were employed, including Flesch Kincaid Reading Ease, Flesch Kincaid Grade Level, Gunning Fog Score, Smog Index, Coleman Liau Index, and Automated Readability Index. The average score of each formula was calculated to analyze the standard readability of the open data portal. Additionally, the website was explored to evaluate the overall status of open datasets, showcases, and features like "Connect" on Open Data Pakistan. The findings indicated that the Open Data Pakistan website has a reading difficulty, scoring an average of 47.4 out of 100, making it challenging for the general public to read. However, the overall analysis suggested that the readability status of open data in Pakistan is satisfactory. These results offer insights into improving the readability of open data for enhanced citizen participation and informed decision-making. Moreover, the study has implications for policymakers and stakeholders regarding the readability of Open Data Pakistan, emphasizing the importance of considering readability in open data publication policies and guidelines, with a recommendation to decrease the percentage of open data portals categorized as hard to read. [ABSTRACT FROM AUTHOR]

The Prison Rape Elimination Act (PREA) was implemented to prevent sexual assault within correctional facilities. To communicate PREA principles to inmates, written materials including handbooks, policies, and brochures are utilized. This research evaluates the readability of PREA messaging, employing three established metrics: Flesh Reading Ease Score, Flesch–Kincaid Grade Level, and Simple Measure of Gobbledygook. Findings reveal significant deviation from recommended reading targets for both the general (7th–8th grade) and inmate (5th–6th grade) populations. Prison Rape Elimination Act policies averaged a 16th-grade level, raising concerns regarding the efficacy of PREA implementation and compliance in light of potential comprehension challenges. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the research was to find out if there are any differences in the readability score between abstracts published in scientific journals from library and information science with and without an impact factor. Therefore, the author made a comparison between the readability of abstracts from one journal with (Journal of Documentation) and one journal without (Knjižnica or Library) an impact factor. Design/methodology/approach: As a measure of readability, the Flesch Reading Ease Readability Formula was used. Then, with the help of statistical experts, a comparison of the readability scores between the abstracts of two selected journals was performed. Findings: The results showed that some statistically important differences exist between the abstracts published in the Journal of Documentation and Knjižnica. The statistically important differences were found in the number of words and sentences in abstracts and in the readability of abstracts included in the research. Therefore, it can be said that there exists a statistically important difference between abstracts with and without an impact factor. Originality/value: The primary purpose was to find out whether there is a statistically important difference in the readability score of abstracts with and without an impact factor in the field of library and information science. Some similar research studies have been conducted in other scientific fields. [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]

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]

Lay abstracts are brief descriptions or summaries of research that are targeted at a general audience. They are held as an important means for the research community to provide greater transparency to the general public and to increase visibility of the pertinent research. This study aims to examine the extent to which lay abstracts published in the journal Autism are comprehensible to a lay audience in terms of readability measures. Results showed that lay abstracts published in Autism were more readable than their corresponding abstracts but were less readable than plain English texts (e.g. news reports). To our knowledge, this is probably the first comparative study on the readability of lay abstracts. Possible explanations for and implications of these findings were offered. Research papers are sometimes hard to follow. Lay abstracts give a short account of research papers. However, it is unclear whether lay abstracts are readable to the lay people. This study examined the readability of 570 abstracts and lay abstracts published between 2020 and 2022 in the journal Autism. We found that that lay abstracts are easier to read than abstracts but are harder to read than news reports. The findings suggest that lay abstracts, on average, are hard to read for the lay people. We propose that the journal and its authors may invite reviewers from outside the research community to test whether a lay abstract is readable. [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]

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]

iPledge is a program meant to reduce the incidence of pregnancy in patients using isotretinoin, a teratogenic acne medication. Adherence to the iPledge program is essential in preventing pregnancy complications among isotretinoin users. We present an analysis of the readability of both English and Spanish patient education materials published by iPledge. Readability grade levels for twelve iPledge documents were compared using both Lexile and graph-based methods (English: Fry; Spanish: Gilliam-Peña-Mountain). In both English and Spanish, aggregate Lexile grade levels are written below the 6th grade level; however, approximately one-third of pages are written above the 6th grade level. Aggregate graph-based grade levels are written above the 6th grade level as well. This suggests that iPledge materials should be rewritten at a lower grade level. Doing so may allow more patients to understand and utilize the important information presented in iPledge. [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]

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]

Objective: To investigate the information content, readability, reliability, and quality level of websites that provide online information in Turkish about osteoporosis (OP). Materials and Methods: In September 2022, the words "osteoporosis, bone melt" were scanned on Google search and the first 20 websites were investigated. The websites were divided into three groups according to the creator: Group 1= hospitals, associations, and official institutions; group 2= health professionals; and group 3= others. The readability level was evaluated according to the Ateşman and Bezirci-Yılmaz formula; the reliability and quality were evaluated according to the Journal of the American Medical Association (JAMA) score, the Quality Criteria for Consumer Health Information (DISCERN) scale, the Global Quality scale (GQS), and the Physician Global Quality assessment (PGQA). The information content was analyzed with reference to the subject headings in the patient information texts on the official website of the Turkish Osteoporosis Association. Results: One hundred sixty websites were included in the study; 62 were in group 1, 58 were in group 2, and 40 were in group 3. The median of the Ateşman value is 48,2, which is difficult to read; the Bezirci-Yılmaz value was a median of 12,6. The JAMA score was 1,0 and almost all (98,7%) websites were found to be low reliable. Only 10 of the websites had complete information content. The DISCERN score was of poor quality, with a median of 29. It was also found to be of insufficient quality for PGQA and GQS. There was no significant difference between the groups in terms of readability, reliability, and quality criteria. Conclusion: Current findings show that Turkish websites are far from providing sufficient and quality information on osteoporosis. Considering the importance of patient education in the management of OP treatment, the results obtained are quite inadequate. Physicians and patients should be aware of this situation; relevant institutions should develop the necessary health policies to solve the problem. [ABSTRACT FROM AUTHOR]

Patients increasingly access online materials for health-related information. Using validated assessment tools, we aim to assess the quality and readability of online information for patients considering incisional hernia (IH) repair. The top three online search engines (Google, Bing, Yahoo) were searched in July 2022 for "Incisional hernia repair" and "Surgical hernia repair". Included websites were classified as academic, hospital-affiliated, commercial, and unspecified. The quality of information was assessed using the Journal of the American Medical Association (JAMA) benchmark criteria (0–4), DISCERN instrument (16–80), and the presence of Health On the Net code (HONcode) certification. Readability was assessed using the Flesch Reading Ease (FRE) and Flesch-Kincaid Grade Level (FKGL) tests. 25 unique websites were included. The average JAMA and DISCERN scores of all websites were 0.68 ± 1.02 and 36.50 ± 10.91, respectively. Commercial sites showed a significantly higher DISCERN mean score than academic sites (p = 0.034), while no significant difference was demonstrated between other website categories. 3 (12%) websites reported HONcode certification and had significantly higher JAMA (p = 0.016) and DISCERN (p = 0.045) mean scores than sites without certification. Average FRE and FKGL scores were 39.84 ± 13.11 and 10.62 ± 1.76, respectively, corresponding to college- and high school-level comprehensibility. Our findings suggest online patient resources on IH repair are of poor overall quality and may not be comprehensible to the public. Patients accessing internet resources for additional information on IH repair should be made aware of these inadequacies and directed to sites bearing HONcode certification. • Online information on incisional hernia repair assessed using five validated tools • Websites demonstrated poor overall quality and questionable reliability • All sites analyzed were written above the recommended 6th grade reading level [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]

Researchers have taken great interest in the assessment of text readability. This study expands on this research by developing readability models that predict the processing effort involved during first language (L1) and second language (L2) text reading. Employing natural language processing tools, the study focused on assessing complex linguistic features of texts, and these features were used to explain the variance in processing effort, as evidenced by eye movement data for L1 or L2 readers of English that were extracted from an open eye-tracking corpus. Results indicated that regression models using the indices of complex linguistic features provided better performance in predicting processing effort for both L1 and L2 reading than the models using simple linguistic features (word and sentence length). Furthermore, many of the predictive variables were lexical features for both L1 and L2 reading, emphasizing the importance of decoding for fluent reading regardless of the language used. [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]

Readability is a systematic measure of ease, with which written information can be read and understood. It can affect the reader's ability to access, comprehend, and utilize health information. This study assessed the readability of online COVID-19 information readily available to the public to engage with. At a time when organisations and institutions were rapidly providing advice and reacting to a developing pandemic, it was hypothesised that some of that haste would be associated with a lack of clarity, as measured by readability indices. N = 65 website sources containing information relating to COVID-19 were accessed and assessed for inclusion in the study. Eight readability indices, including Flesch Reading Ease and Flesch-Kincaid Grade Level, were calculated to determine readability scores for each source of information. Readability scores varied greatly between individual sources of COVID-19 information. Despite the recommendation that information be presented to the general public at a sixth-grade reading level, most websites we assessed addressing COVID-19 information and advice presented content at greater than the recommended reading level. Based on these results, a significant amount of information available on the Internet about COVID-19 will not be easily readable for many individuals attempting to use the Internet to help inform their decisions about their health and behavior. [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]

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]

Background: The Internet has become a popular source of health information for patients and their families. Healthcare experts recommend that the readability of online education materials be at or below a sixth grade reading level. This translates to a standardized Flesch Reading Ease Score between 81 and 90, which is equivalent to conversational English. However, previous studies have demonstrated that the readability of online education materials of various orthopedic topics is too advanced for the average patient. To date, the readability of online education materials for pediatric spinal conditions has not been analyzed. The objective of this study was to assess the readability of online educational materials of top pediatric orthopedic hospital websites for pediatric spinal conditions. Methods: Online patient education materials from the top 25 pediatric orthopedic institutions, as ranked by the U.S. News and World Report hospitals for pediatric orthopedics, were assessed utilizing multiple readability assessment metrics including Flesch–Kincaid, Flesch Reading Ease, Gunning Fog Index, and others. Correlations between academic institutional ranking, geographic location, and the use of concomitant multimedia modalities with Flesch–Kincaid scores were evaluated using a Spearman regression. Results: Only 32% (8 of 25) of top pediatric orthopedic hospitals provided online health information at or below a sixth grade reading level. The mean Flesch–Kincaid score was 9.3 ± 2.5, Flesch Reading Ease 48.3 ± 16.2, Gunning Fog Score 10.7 ± 3.0, Coleman–Liau Index 12.1 ± 2.8, Simple Measure of the Gobbledygook Index 11.7 ± 2.1, Automated Readability Index 9.0 ± 2.7, FORCAST 11.3 ± 1.2, and Dale–Chall Readability Index 6.7 ± 1.4. There was no significant correlation between institutional ranking, geographic location, or use of video material with Flesch–Kincaid scores (p = 0.1042, p = 0.7776, p = 0.3275, respectively). Conclusion: Online educational material for pediatric spinal conditions from top pediatric orthopedic institutional websites is associated with excessively complex language which may limit comprehension for the majority of the US population. Type of study/Level of evidence: Economic and Decision Analysis/level III. [ABSTRACT FROM AUTHOR]

To assess the suitability of newborn hearing screening brochures by evaluating current state-level brochures and pregnant people's understanding of screening result terminology. In Study 1, state-level brochures were evaluated based on readability, design, picture appropriateness, and use of the word "refer." In Study 2, pregnant people completed a questionnaire that queried their understanding of and expected anxiety about three newborn hearing screening outcomes ("refer," "did not pass," and "pass"). In Study 1, 59 newborn hearing screening brochures were analysed. In Study 2, 43 pregnant people completed surveys during a prenatal appointment. Most of the brochures were found deficient on at least one element. Thirty percent of brochures used the word "refer" to indicate a hearing screening failure; yet, fewer than half of participants understood its meaning. Ratings of expected anxiety were highest in response to the term "did not pass." Based on four study criteria of brochure suitability, 88% of available state-level newborn hearing screening brochures should be modified to make them readily understandable by a broad educational demographic. Discretion in use of the term "refer" should be made when indicating screening results, because the term is not readily understood. [ABSTRACT FROM AUTHOR]

Background: Readability metrics provide us with an objective and efficient way to assess the quality of educational texts. We can use the readability measures for finding assessment items that are difficult to read for a given grade level. Hard‐to‐read math word problems can put some students at a disadvantage if they are behind in their literacy learning. Despite their math abilities, these students can perform poorly on difficult‐to‐read word problems because of their poor reading skills. Less readable math tests can create equity issues for students who are relatively new to the language of assessment. Less readable test items can also affect the assessment's construct validity by partially measuring reading comprehension. Objectives: This study shows how large language models help us improve the readability of math assessment items. Methods: We analysed 250 test items from grades 3 to 5 of EngageNY, an open‐source curriculum. We used the GPT‐3 AI system to simplify the text of these math word problems. We used text prompts and the few‐shot learning method for the simplification task. Results and Conclusions: On average, GPT‐3 AI produced output passages that showed improvements in readability metrics, but the outputs had a large amount of noise and were often unrelated to the input. We used thresholds over text similarity metrics and changes in readability measures to filter out the noise. We found meaningful simplifications that can be given to item authors as suggestions for improvement. Takeaways: GPT‐3 AI is capable of simplifying hard‐to‐read math word problems. The model generates noisy simplifications using text prompts or few‐shot learning methods. The noise can be filtered using text similarity and readability measures. The meaningful simplifications AI produces are sound but not ready to be used as a direct replacement for the original items. To improve test quality, simplifications can be suggested to item authors at the time of digital question authoring. Lay Description: What is Known About the Subject: Difficult to read math assessment items cause measurement and equity issuesReadability of math word problems negatively correlated with outcomes What Our Paper Adds: GPT‐3 AI system is capable to simplify math word problemsPrompt‐based and few‐shot learning‐based approaches are able to create meaningful simplifications, but with a very low accuracy rateText similarity and readability measures can be used to filter out noisy outputs and discover interesting simplifications What are the Implications for Practitioners: GPT‐3 AI is capable of generating relevant math world problem simplificationsSimplified text can be used as suggestions to question authors during the digital item authoring process [ABSTRACT FROM AUTHOR]

We analyzed the readability of PEMs for sunscreen to identify opportunities to optimize PEMs. Keywords: Sunscreen; Sun protection; Patient education; Readability; Online education EN Sunscreen Sun protection Patient education Readability Online education 677 681 5 03/21/23 20230401 NES 230401 The internet is a popular source for patients to obtain health information, as 70% of users obtain health information online [[1]]. It is crucial that patient-education materials (PEMs) are written at an appropriate reading level as they can impact patients' behavior. [Extracted from the article]

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]

Issue addressed: This study evaluated the readability of web pages from two public‐facing Victorian government websites that were responsible for communicating key health messages relating to the COVID‐19 pandemic in 2020. Methods: Webpages were downloaded and filtered to identify relevant materials (English language materials containing HTML files that referred to COVID‐19). The files were converted to text files and two Python packages, SpaCy and TextStat were used to obtain the data presented here. In addition to running two well‐established readability tests, SMOG Index (Simple Measure of Gobbledygook) and Flesch Reading Ease formula, we also calculated the figures for sentence length and word length, which drive the readability measures and allow a disaggregated view of the data. Type token ratio measures were conducted as a reflection of the breadth of vocabulary used in the web pages. Results: Derived measures of text complexity were higher than recommended levels of text complexity for health promotion materials, which are generally set at senior primary school levels. This did not vary depending on the intended audience (public or professional). A senior secondary reading level was required for effective engagement with the text published on both sites. Conclusions: Improving the readability of materials on key government websites where information about COVID‐19 is being communicated to the public, represents a low cost and potentially effective means of improving public understanding of the pandemic and the steps individuals need to take to protect themselves and the community. So what?: Given the challenges widely identified in ensuring compliance with protective behaviours, confidence in seeking vaccination and increasing distrust of government, it would be strategic to improve public communication to ensure health messages are simple and readily understood. Summary: The complexity and readability of text contained in web pages during 2020 from two Victorian government departments were evaluated. Communication regarding the restrictions and the management of risks associated with COVID‐19 was the main focus of these 367 individual web pages from the Department of Health and Human Services (DHHS) and the Department of Education and Training (DET). Results indicated that across both sites and on both readability measures used, an education level equivalent to senior secondary school would be required to readily understand the contents. [ABSTRACT FROM AUTHOR]

An estimated 46% of the worldwide adult population live with an active headache disorder, and it is thought that there is a proportion of headache and migraine sufferers who do not attend for medical care, instead choosing to manage their symptoms at home. The internet continues to act as a source of online health information for self-management, however, it is important that this information can be understood by the user. Research indicates that most health information online is written at a level too difficult for much of the UK population to understand. The aim of this study was to investigate the readability of online health information pertaining to headache and migraine for a UK-based internet user accessing the top four search engines. Searches for 'headache' and 'migraine' were performed on each search engine and results from the first page were selected for analysis. Five validated readability tests were used to analyse readability; Flesch-Kincaid Grade Level, Flesch Reading Ease, Gunning Fog Index, Coleman-Liau Index and Simple Measure of Gobbledygook Index. We found that the majority of online health information about migraine and headache is too difficult for the UK adult population to read. Findings highlight work is required to ensure that information from a wider variety of sources is easier to comprehend for much of the population in order for individuals to make informed decisions about health seeking and self-management of headache and migraine. Health information providers should weave readability analysis into their content design process, incorporating shorter sentences and simpler words in their description of conditions and treatment. [ABSTRACT FROM AUTHOR]

Purpose: To assess the readability and accountability of online patient education materials related to glaucoma diagnosis and treatment. Methods: We conducted a Google search for 10 search terms related to glaucoma diagnosis and 10 search terms related to glaucoma treatment. For each search term, the first 10 patient education websites populated after Google search were assessed for readability and accountability. Readability was assessed using five validated measures: Flesch Reading Ease (FRE), Gunning Fog Index (GFI), Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG), and New Dale-Chall (NDC). Accountability was assessed using the Journal of the American Medical Association (JAMA) benchmarks. The source of information for each article analyzed was recorded. Results: Of the 200 total websites analyzed, only 11% were written at or below the recommended 6th grade reading level. The average FRE and grade level for 100 glaucoma diagnosis-related articles were 42.02 ± 1.08 and 10.53 ± 1.30, respectively. The average FRE and grade level for 100 glaucoma treatment-related articles were 43.86 ± 1.01 and 11.29 ± 1.54, respectively. Crowdsourced articles were written at the highest average grade level (12.32 ± 0.78), followed by articles written by private practice/independent users (11.22 ± 1.74), national organizations (10.92 ± 1.24), and educational institutions (10.33 ± 1.35). Websites averaged 1.12 ± 1.15 of 4 JAMA accountability metrics. Conclusion: Despite wide variation in the readability and accountability of online patient education materials related to glaucoma diagnosis and treatment, patient education materials are consistently written at levels above the recommended reading level and often lack accountability. Articles from educational institutions and national organizations were often written at lower reading levels but are less frequently encountered after Google search. There is a need for accurate and understandable online information that glaucoma patients can use to inform decisions about their eye health. [ABSTRACT FROM AUTHOR]