Readability of the ACR-Endorsed Patient Education Platform Radiologyinfo.org
@yashaparikhmd Yasha Parikh, MD1 Amar Gupta, MD2; George Cushing, MD1
1:Mount Auburn Hospital & Harvard Medical School 2: New York University Dept. of Otolaryngology
No disclosures.
@yashaparikhmd PURPOSE
Health care literacy directly impacts patient The average American reads at a 7th or 8th grade outcomes and gives patients autonomy over their reading level. However, the average healthcare care. Without proper information, patients cannot literature is written at a 10th grade level make educated decisions about their health. (or higher).
Per the ACR website in 2017, For these reasons and more, we decided to review radiologyinfo.org served over the readability of our ACR and RSNA sponsored ONE MILLION visitors per month. patient information website.
@yashaparikhmd METHODS
Every discrete page on Radiologyinfo.org was analyzed Duplicate pages were excluded Total: 217 Extracted data included Number of characters per discrete page Number of words per discrete page Number of sentences per discrete page Average number of syllables per word Average number of words per sentence Date of last update @yashaparikhmd METHODS
Gunning Fox Index
Coleman-Liau Index Analysis with SIX Flesch Kincaid Grade Level measures of readability Flesch Reading Ease Score
Automated Readability Index
Simple Measure of Gobbledygook @yashaparikhmd MEASURES OF READABILITY
ReadabilityTo o l Formula
����� ������� ����� 0.4 + 100 Gunning Fog Index ��������� �����
Coleman-Liau Index 0.0588 ∗ � − 0.296 ∗ � − 15.8 L is average number of letters per 100 words. S is average number of sentences per 100 words. ����� ����� ����� ��������� Flesch Kincaid Grade Level 0.38 + 11.8 − 15.59 ����� ��������� ����� �����
Flesch Reading Ease Score 206.835 − 1.1015 ∗ ������� �������� �����ℎ − (84.6 ∗ ������� ������ �� ��������� ��� ����))
4.71 + 0.5 − 21.43 Automated Readability Index
Simple Measure of 30 1.0430 # ������������� ∗ + 3.1291 Gobbledygook ������ �� ��������� WHAT DO THOSE MEAN?
Coleman-Liau Index Gunning Fog Index Flesch Kincaid Grade Level Flesch Reading Ease Automated Readability Index Simple Measure of Gobbledygook
Overall Complexity of the material, where higher mean decreasing complexity. # of Years of Formal US Average US Grade Level For example, Education Required to achieved to understand 0-30 indicates a college level. understand the Reading the reading material 90-100 is fifth grade level. Material RESULTS
Variable Lower Limit Upper Limit Average Number of characters 3,109 25,328 12,098 (without spaces): Number of words: 559 5,095 2.384
Number of sentences: 41 258 133.6 Average number of 4.8 5.9 5.1 characters per word: Average number of syllables 1.7 2.1 1.8 per word: Average number of words 13.6 23.7 17.8 per sentence: RESULTS
ReadabilityTo o l Lower Limit Upper Limit Average Gunning Fog Index 11.9 19.3 14.4 Coleman-Liau Index 10.7 17.6 12.6 Flesch Kincaid Grade 9.8 17.1 Level 12.6 Automated Readability 8.8 16.7 Index 11.5 Simple Measure of 12.2 17.5 Gobbledygook 14.1 Flesch Reading Ease 9.2 51.3 36.5 @yashaparikhmd Year of Last Update
2018 2017 2016 or earlier
@yashaparikhmd CONCLUSIONS
Radiologyinfo.org is at a reading level that is too high per the recommended guidelines, even though most (97%) pages were updated in the last 2 years.
By improving readability, we can improve patient understanding, which can translate into improved patient satisfaction.
Further, patients can understand our role as radiologists in their overall clinical care. @yashaparikhmd WAYS TO IMPROVE READABILITY
Decrease syllable count per word, Emphasize only one major point or topic at a which may mean substituting complex time. words with more simple terminology.
Be consistent with your terminology. For example, “contrast”, “dye”, “iodinated contrast”, Decrease total words per sentence. “contrast material” all have a similar meaning. Remain consistent throughout your work.
In radiology, using long words can be inevitable. Explaining them and providing a pronunciation Use the word “you” instead of “the guide can help with comprehension of the patient”. I.E., speak in the first person. @yashaparikhmd material. REFERENCES
1. ACR.org. (2019). Accomplishments. [online] Available at: https://www.acr.org/About-ACR/Annual- Reports/2017-Annual-Report/Accomplishments [Accessed 1 May 2019]. 2. “Clear & Simple.” National Institutes of Health, U.S. Department of Health and Human Services, 18 Dec. 2018, www.nih.gov/institutes-nih/nih-office-director/office-communications-public-liaison/clear- communication/clear-simple. 3. Eltorai, Adam E M et al. “Readability of patient education materials on the american association for surgery of trauma website.” Archives of trauma research vol. 3,2 e18161. 30 Apr. 2014, doi:10.5812/atr.18161 4. Grabeel, Kelsey Leonard, et al. “Computerized versus Hand-Scored Health Literacy Tools: a Comparison of Simple Measure of Gobbledygook (SMOG) and Flesch-Kincaid in Printed Patient Education Materials.” Journal of the Medical Library Association, vol. 106, no. 1, 2018, doi:10.5195/jmla.2018.262 5. Hansberry, D., John, A., John, E., Agarwal, N., Gonzales, S. and Baker, S. (2014). A Critical Review of the Readability of Online Patient Education Resources From RadiologyInfo.Org. American Journal of Roentgenology, 202(3), pp.566-575. 6. Rayess, Hani, et al. “Critical Analysis of the Quality, Readability, and Technical Aspects of Online Information Provided for Neck-Lifts.” JAMA Facial Plastic Surgery, vol. 19, no. 2, 2017, p. 115., doi:10.1001/jamafacial.2016.1219 7. “Simply Put; a Guide for Creating Easy-to-Understand Materials - 11938 | Stephen B. Thacker CDC Library Collection.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, stacks.cdc.gov/view/cdc/11938. @yashaparikhmd