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Alastair Denniston, Matthew Edmunds; Readability Assessment of Online Thyroid Eye Disease Patient Information. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5908.
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Patients increasingly use the internet to access educational information related to their ophthalmic disease. Health literacy of the adult population is known to be poor, with multiple agencies (e.g. the U.S. Department of Health and Human Services [USDHHS]) recommending that patient-orientated literature be written at a fourth- to sixth-grade (9 to 12 years of age) reading level to assist understanding. Previous studies examining readability of online literature in different diseases have determined that only the minority are appropriate. We aimed to assess the readability of online literature specifically for thyroid eye disease (TED).
The readability of the content of 50 of the highest ranked TED patient-orientated online resources was analysed. Relevant webpages were identified using Google search terms ‘thyroid eye disease’, ‘thyroid-associated ophthalmopathy’ and ‘Graves’ ophthalmopathy’. All extraneous text (e.g. hyperlinks, citations, affiliations, disclaimers, copyright notices) was removed. Relevant body text proceeded to analysis with an online calculator of readability assessment using three validated measures: the Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL) and Simple Measure of Gobbledygook (SMOG). Readability was categorised according to USDHHS standards.
All TED patient literature reviewed was of acceptable accuracy. The majority (58%) were of U.K origin. Most (46%) were from non-commercial health information websites, with 30% from academic or healthcare institutions and 24% from commercial websites. Mean webpage word count was 1191 (SD 733, range 195 - 3867). Mean FRES was 45 (SD 8.9, range 24 - 64). The USDHHS classifies such scores as being of “difficult” readability, with FRES 30 - 49 being equivalent to college level. Mean FKGL was 12 (SD 1.8, range 7.2 - 17) and mean SMOG 13 (SD 1.4, range 9.6 - 17), each being equivalent to a reading level of >12th grade and “difficult” on the USDHHS classification. There was no statistically significant difference in readability according to country of origin or type of website.
Readability scores for online TED patient-orientated educational materials are inferior to those recommended. Although readability is only one aspect of comprehension, screening TED online materials for readability, and subsequent revision, is crucial to increase patient knowledge, satisfaction and treatment compliance.
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