American Journal of Medicine, internal medicine, medicine, health, healthy lifestyles, cancer, heart disease, drugs

Reading Level of Internet Medical Information for Common Diagnoses

doctor-on-phone-and-laptop-stock The National Institutes of Health (NIH) recommend that health materials be written at a grade 6-7 reading level, which has generally not been achieved in online reading materials. Up to the present time, there have not been any assessments focused on the reading level of online educational materials across the most popular consumer Web sites for common internal medicine diagnoses. In this study, we examined the readability of open-access online health information for 9 common internal medicine diagnoses.

Methods

Nine of the most frequently encountered inpatient and ambulatory internal medicine diagnoses were selected for analysis. In November and December 2014, these diagnoses were used as search terms in Google, and the top 5 Web sites across all diagnoses and a diagnosis-specific site were analyzed across 5 validated reading indices.

Results

On average, the lowest reading grade-level content was provided by the NIH (10.7), followed by WebMD (10.9), Mayo Clinic (11.3), and diagnosis-specific Web sites (11.5). Conversely, Wikipedia provided content that required the highest grade-level readability (14.6). The diagnoses with the lowest reading grade levels were chronic obstructive pulmonary disease (10.8), followed by diabetes (10.9), congestive heart failure (11.7), osteoporosis (11.7) and hypertension (11.7). Depression had the highest grade-level readability (13.8).

Discussion

Despite recommendations for patient health information to be written at a grade 6-7 reading level, our examination of online educational materials pertaining to 9 common internal medicine diagnoses revealed reading levels significantly above the NIH recommendation. This was seen across both diagnosis-specific and general Web sites. There is a need to improve the readability of online educational materials made available to patients. These improvements have the potential to greatly enhance patient awareness, engagement, and physician–patient communication. The Internet has a ubiquitous presence in the physician–patient encounter. Oftentimes a patient arrives at a clinical visit having read a number of online education materials about their diagnosis. Information presented by the patient can invite shared decision-making and be a starting point for communication in the medical setting. Up to the present time, there have not been any assessments focused on the reading level of online educational materials across the most popular consumer Web sites for common internal medicine diagnoses. According to the 2006 National Assessment of Literacy Report, 22% of Americans have Basic health literacy and a further 14% have Below Basic health literacy.1 The National Institutes of Health (NIH) recommends that health materials be written at a grade 6-7 reading level. However, a recent study demonstrated that none of the online patient educational resources provided by 16 professional medical organizations met a sixth-grade reading level.

Objective

In this study, we examined the readability of open-access online health information for 9 common internal medicine diagnoses.

Methods

Nine of the most frequently encountered inpatient and ambulatory internal medicine diagnoses were analyzed: pneumonia, osteoarthritis, congestive heart failure, sepsis, atrial fibrillation, chronic obstructive pulmonary disease, depression, hypertension, and diabetes. In November and December 2014, these diagnoses were used as search terms in the largest Internet search engine, Google, simulating the method by which the majority of online users access health information. The top 5 Web sites across all diagnoses: Wikipedia.org, Mayoclinic.org,Webmd.com, Medicinenet.com, and NIH.gov, were selected. A diagnosis-specific site was also chosen for each search term, based on the top disease-specific or organ-specific site for each diagnosis. Health information pertaining to each diagnosis was extracted from every Web site and standardized to remove citations, images, tables, videos, advertisements, and acknowledgments. Texts were analyzed using the following validated readability indices to determine reading grade level: Flesch Kincaid Grade Level, Gunning Fog Score, SMOG index, Coleman Liau Index, and Automated Readability Index. All statistical analyses were conducted using SAS Software 9.4 for Windows (SAS Institute, Inc, Cary, NC), using PROC GLIMMIX. Grade-level readability of online patient education materials by diagnosis was analyzed using a general estimating equation with sandwich estimation, nesting by readability algorithm scores. Plots of point estimates along with 95% confidence intervals were included.

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-Nora Hutchinson, MD, CM, MPhil, Grayson L. Baird, MS, Megha Garg, MD, MPH

This article originally appeared in the June 2016 issue of The American Journal of Medicine.

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