Health literacy and the Internet: a study on the readability of Australian online health information

Objective: Almost 80% of Australian Internet users seek out health information online so the readability of this information is important. This study aimed to evaluate the readability of Australian online health information and determine if it matches the average reading level of Australians. Methods: Two hundred and fifty‐one web pages with information on 12 common health conditions were identified across sectors. Readability was assessed by the Flesch‐Kincaid (F‐K), Simple Measure of Gobbledygook (SMOG) and Flesch Reading Ease (FRE) formulas, with grade 8 adopted as the average Australian reading level. Results: The average reading grade measured by F‐K and SMOG was 10.54 and 12.12 respectively. The mean FRE was 47.54, a ‘difficult‐to‐read’ score. Only 0.4% of web pages were written at or below grade 8 according to SMOG. Information on dementia was the most difficult to read overall, while obesity was the most difficult among government websites. Conclusions and implications: The findings suggest that the readability of Australian health websites is above the average Australian levels of reading. A quantifiable guideline is needed to ensure online health information accommodates the reading needs of the general public to effectively use the Internet as an enabler of health literacy.     

The Gobbledygook in Online Parent-Focused Information about Child and Adolescent Mental Health

Online parent-focused informational resources play a vital step in parent decision-making about initiating child and adolescent mental health care, but their usefulness may depend on how easily the resource content can be understood. The purpose of this cross-sectional study was to examine the readability and reliability of parent-focused mental health resources provided on Canadian websites. After meeting inclusion criteria, 50 documents retrieved during the search in September 2016 from websites using online health information searching strategies that would be typically employed by parents underwent analysis. Document readability was assessed using Health Canada recommended instruments: Simple Measure of Gobbledygook (SMOG), Flesch–Kincaid Grade Level, and the Flesch Reading-Ease scale. Reliability was assessed using Health on the Net Foundation Code of Conduct (HONcode). Our analysis revealed that all included documents exceeded the 8th grade reading level. The mean ± SD readability scores were SMOG 11.65 ± 1.10 and FKGL 10.03 ± 1.49. Reading-ease scores showed that 42% (n = 21) of the documents were “Difficult” to read. Factorial ANOVA revealed no significant difference in readability across mental health topic areas or organizational sectors (p = > 0.05). Twenty-four percent of documents came from sites with HONcode certification. Findings suggest that almost all child and adolescent mental health information that would typically be found online by parents in Canada had readability scores that were too high for average parents to read and exceeded Health Canada recommended reading levels. Being able to locate resources online can be significantly precluded if a parent cannot understand and use information to mobilize them to accessing mental health care for their families.     

How do women interpret abortion information they find online?

ObjectiveWe sought to assess how women interpret the information they find online about the overall safety and risk of infertility associated with abortion and cesarean delivery (CD).MethodsWe conducted an exploratory, prospective study tracking the internet searches of 100 reproductive-aged individuals who identify as women. We directed participants to search for information about either (1) whether surgical abortion or CD is safe or (2) the risk of infertility following surgical abortion or CD. Our data collection had 3 phases: baseline survey, directed internet search, and a postsearch survey. We analyzed participants’ pre- and postsurvey responses using bivariate tests and analyzed within-subject changes. We evaluated the sites they visited based on expert ratings of site content based on trustworthiness and slant.ResultsWomen perceived abortion as safer and less likely to cause infertility after their web searches than before (70% perceived abortion in the United States as very/completely safe presearch vs 92% postsearch; p < 0.02). Women's perceptions about CD did not change. Participants sought information from web pages that experts largely deemed trustworthy and lacking in slant.ConclusionsWomen's perceptions about abortion safety and risk can be influenced by information they find online; perceptions about CD safety and risk may be less influenced by online information.ImplicationsDisseminating high quality, user-friendly abortion information on highly ranked and easily findable websites can help women find evidence-based information and influence knowledge about abortion.     

Evaluating the health literacy demand and cultural appropriateness of online immunisation information available to refugee and migrant communities in Australia

BackgroundThe internet is a source of health information for many consumers. However, little is known about the availability of online resources about immunisation (for children and adults) directed at refugee and migrant populations. The aim of this study was to evaluate the health literacy demand (understandability, actionability & readability) and cultural appropriateness of immunisation resources in Australia for these communities.MethodsOur study involved two search approaches. Firstly, Google trends was used to identify the most common search terms used in Australia. Search terms used included ‘immunisation’, ‘vaccine’ and ‘refugee immunisation’ amongst others. These search terms were entered into: Google, Bing, Duck Duck Go and Yahoo and the first 5 pages of results for each search were examined. Searches were conducted from November 2018 to June 2019. Secondly, requests were sent out directly to key stakeholders in local health districts and state/territory health departments. Understandability and actionability were assessed using the Patient Education Materials Assessment Tool (PEMAT). The Simple Measure of Gobbledygook (SMOG) and the Flesch readability ease tools were used to assess readability. Cultural appropriateness was assessed using additional criteria developed by the Centre for Culture, Ethnicity and Health (CEH), Victoria, Australia.Results27/33 resources were included in the analysis. The overall mean understandability score was 70% (range: 50–100%). The overall mean actionability score of the resources was 47% (range: 0–83%). In terms of readability, the mean score was a 10.5, which was indicative of an eleventh grade reading level. The average Flesch-Kincaid readability score was 47.7. The average score for cultural appropriateness was 79% (range: 29–100%).ConclusionsOur findings suggest that there are currently not many refugee-specific resources on immunisation. Future work needs to better improve the health literacy demand of online immunisation information. Engaging with members from migrant communities is also recommended so that appropriately tailored resources are co-developed.     

Quality of the patient-oriented information on thyroid cancer in the internet

ObjectivesThis study was conducted to analyse the readability and quality of patient education websites about thyroid cancer.MethodsYahoo!, Google and Bing were searched with their default settings using the keywords thyroid cancer, thyroid tumour, thyroid tumor, and thyroid malignancy for relevant websites. The first 50 websites obtained for each keyword and search engine were evaluated using validated Flesch Reading Ease Score (FRES), LIDA and DISCERN scores to assess readability, usability and reliability, and quality of information. Statistical analysis were done using non-parametric tests.ResultsThe analysis included 49 eligible websites selected out of 600 websites obtained from the search engines. Twenty-two (44.9%) web sites had obtained Health on the net foundation code of conduct (HON-code) certification. The included websites had a median FRES score of 55.3(range 25.3–85.3) and the LIDA reliability and usability scores were 22.0(range 14–30) and 39.0(range 28–50), respectively. The median DISCERN score was 48.0(range 33–63). A total DISCERN score of 50% or less (low score) was found in 28.5%(n = 14) of the websites. A significant association was found between LIDA usability and, reliability scores and DISCERN score (p<0.001, p=0.001, respectively).ConclusionThe quality of the websites, readability and usability scores were moderate or low based on the criteria used. Access to quality information may help with better informed decisions on treatment, follow up and prognosis. As the internet use by the public is ever increasing, implementing measures to ensure the quality information without a bias should be considered a priority.     

A content analysis of Internet resources about the risks of seafood consumption

Seafood consumption is a main source of human exposure to certain environmental contaminants. Therefore, it is valuable to assess the online health risk messages focused on this topic, as people in the US are increasingly accessing the Internet for health-related information. Previous research indicates that online health information tends to be written at a reading level that is more advanced than ability of the general population. The purpose of this research was to examine the content and readability of Internet resources targeted toward consumers in the US regarding the health risks from consumption of contaminated seafood. Sources for analysis were gathered through a targeted search of state and national government websites, as well as through a Google search. The overall mean readability level was Grade 9.21, which is slightly above the average reading level of US adults. Future research should evaluate the accuracy of the health risk messages, as well as consumer perceptions of risk.     

Quality and scientific accuracy of patient-oriented information on the internet on minimally invasive surgery for colorectal cancer

ObjectivesAppropriate information on minimally invasive surgery for colorectal cancer would help the patients and their caretakers to understand the treatment process. We aimed to assess the readability, quality and scientific content of patient-oriented information on minimally invasive surgery for colorectal cancer on the internet.MethodsInternet search on “minimally invasive surgery for colorectal cancer”, “laparoscopic surgery for colorectal cancer” and “robotic surgery for colorectal cancer” was performed on search engines (Google, Yahoo! and Bing). Quality and readability were assessed by DISCERN instrument and validated Flesch Reading Ease Score (FRES) respectively.ResultsFifty-five websites were analysed. The median DISCERN score was 41(range:24–66) and the median FRES score was 33.9(range:10.4–59.8) indicating low readability. Twenty-seven sites (49.1%) were affiliated with hospitals or clinics. Benefits of surgery and the surgical procedure were mentioned in 76.4% and 81.8% respectively. However, pre-op preparation, surgical complications, and quality of life were not mentioned in 49(82.1%), 42(76.4%) and 44(80%) sites respectively. Overall on DISCERN, 7(12.73%) were identified as “Excellent”, 25(45.45%) as “Good” or “Moderate” and 23(41.82%) as “Poor”.ConclusionAnalysis of the quality and scientific content of patient information on MIS for CRC revealed a considerable deficiency in the information provided and sub-standard readability. Several aspects such as pre-op preparation, surgical complications and post-operative quality of life which are of concern to the patient were not discussed in a considerable proportion of articles. As the internet is expanding as a readily available source of information, steps should be taken to ensure the highest quality information.     

Help or hinder? An assessment of the accessibility,usability, reliability and readability of disability funding website information for Australian mental health consumers

This study aimed to assess the accessibility, usability, reliability and readability of those websites most likely encountered by Australian mental health consumers when using the internet to find information regarding the National Disability Insurance Scheme (NDIS). Websites were systematically identified with 127 deemed relevant for assessment in 2018. The LIDA instrument, the Simple Measure of Gobbledygook and Flesch-Kincaid Grade Level were used to evaluate the quality of information provided to mental health consumers. The study identified mediocre results for the accessibility, usability, reliability and readability of websites as they pertain to the needs of mental health consumers. Furthermore, it was identified that mental health support websites did not provide a more appropriate online experience for mental health consumers than general information websites, despite their focus on this demographic. These findings suggest a lack of understanding regarding the needs of mental health consumers and their experience of the online environment, which may in turn affect their access to information, agency and, ultimately, their uptake of the NDIS. The establishment of guidelines around enhancements to the online environment for mental health consumers would provide an experience that instils confidence, returns dignity and aids this group in realising their personal recovery journey.     

Physician Review of a Celiac Disease Risk Estimation and Decision-Making Expert System

Abstract

Objective: Celiac disease is a genetic disease affecting people of all ages, resulting in small intestine enteropathy. It is considered to be a clinical chameleon. Average prevalence of celiac disease is 1 out of 100 people with data indicating the risk may be as high as 22% for those with first-degree relatives with the disease. Eighty-three percent of people with celiac disease may be undiagnosed. Average duration to diagnosis is 10?years. Data indicate that there is a lack of consensus regarding diagnostics and symptomatology.

Method: A clinical decision support system (CDSS) was developed using Exsys Corvid for expert analysis (CD-CDSS). The CD-CDSS was divided into symptoms and manifestations with 80 points of navigation, and a serology section, and was validated by 13 experts in the field of celiac disease using a 10-statement 5-point Likert scale.

Results: This scale was analyzed using Cronbach’s alpha reliability coefficient, which was calculated using SPSS and revealed good internal consistency and reliability with a result of 0.813. One hundred percent of experts agreed that the CD-CDSS is capable of guiding a health care professional through the diagnostic process, contains an accurate list of symptoms based on the clinical literature, and can foster improved awareness and education about celiac disease and that there is a need for this system.

Conclusions: A celiac disease risk estimation and decision-making expert system was successfully developed and evaluated by medical professionals, with 100% agreeing that this CD-CDSS is medically accurate and can guide health care professionals through the diagnostic process.     

Assessment of quality of life in children,adolescents, and adults with celiac disease through specific questionnaires: Review

ObjectivesThe gluten-free diet (GFD) is a lifelong treatment for celiac patients which affects the quality of their life (QoL). This was evaluated by generic methods. Over time, specific instruments for celiac disease (CD) have been developed. The objective of this review is to identify the different CD-specific instruments that have estimated QoL in celiac patients, study their psychometric properties, and highlight the factors influencing the final scores.Materials and methodsAn advanced database search (PubMed, Web of science, etc.) was launched in order to identify articles that evaluated QoL in children, adolescents, and adults with celiac disease. The items and subscales of each questionnaire were determined with the comparison of psychometric properties (Internal consistency, Reproductibility, Acceptance, Floor effect, Ceiling effect, Convergent validity, Construct validity and Discriminative validity).ResultsEighteen specific instruments have been identified. The assessment of QoL in celiac patients by these specific instruments allowed detecting the influence of specific characteristics related to CD on QoL. The developed and validated instruments showed acceptable psychometric properties in different countries. The obtained results showed that the QoL related to CD is reduced. However, monitoring GFD helps improving these scores.ConclusionCD-specific instruments are increasing considerably. They contain relevant items that can properly assess the QoL in patients with celiac disease.     

Internet and patient empowerment in individuals with symptoms of an eating disorder: A cross-sectional investigation of a pro-recovery focused e-community

IntroductionMany individuals with eating disorder problems seek information and support online. There are however numerous websites that promote eating disordered behaviors. The website and e-community ‘Proud2Bme’ was developed as a healthy alternative for pro-eating disorder websites, providing a safe, positive, and pro-recovery focused environment. It offers a wide array of information and personal stories, as well as platforms for interaction such as a forum and chat. The first aim of this study was to investigate whether, and to what extent, empowering processes and outcomes are experienced by participants on Proud2Bme. The second aim was to examine correlates of empowering processes and outcomes.MethodsParticipants (n = 311) were recruited via an online survey on Proud2Bme. Correlations were examined and T-tests and ANOVAs were conducted.ResultsExchanging information, finding recognition, and sharing experiences were the empowering processes most often reported by participants. The most pronounced empowering outcome was feeling better informed. To a smaller degree, increased help-seeking behavior, increased optimism and control over the future, and increased confidence in treatment and the relationship with the therapist were reported. Lower levels of general empowerment, younger age, and more interactive usage patterns of the website were positively associated with the experience of empowering processes and outcomes.DiscussionOffering a platform where individuals can share their experiences and find recognition might be one of the most important ingredients for successful e-health initiatives aimed at improving patient empowerment. Moreover, in the field of eating disorders specifically, such initiatives offer a healthy alternative to the harmful and negative effects of pro-eating disorder websites.     

Reading Difficulty Level of Medical Resources on Television Web Sites

ABSTRACT

Mass media plays a critical role in communicating health messages to the public. Local television stations are posting more health content on the Web; however, the difficulty level of this information has not been evaluated. Study objectives were to assess the content of health stories on local television Web sites, and to evaluate the reading level of these health messages. The top three health articles from 79 local television news Web pages were selected for analysis. Readability was assessed using SMOG, Flesch-Kincaid (FK), and Flesch Reading Ease (FRE). A total of 278 articles were located over a two-day search. The majority of stories were national (47.0%) and educational (48.0%) pieces. Fewer articles were breaking news (19.8%). More articles focused on both prevention and treatment (30.6%) rather than on prevention (21.6%) or treatment (21.2%) alone. Mean readability was at a senior high school level according to SMOG (Grade 11.9) and FK (Grade 10.3). Overall FRE was 51.6, implying a “fairly difficult” reading style. As broadcast news media mobilizes viewers toward online health content, they must consider the difficulty of the information and literacy abilities of their audience.     

Readability of Consumer Health Information on the Internet: A Comparison of U.S. Government–Funded and Commercially Funded Websites

The Internet has become an extremely prevalent means of communicating health information to consumers. Guidelines for selecting reliable health information websites give preference to U.S. government sites over commercially funded sites. However, these websites are not useful to consumers unless they are able to read and understand them. The authors’ objective was to compare the readability of Internet health information intended for consumers found on U.S. government–funded websites versus that found on commercially funded websites. Consumer health websites were identified through a systematic Internet search. Webpages for 10 common health topics were extracted from each website. Readability of webpages was determined by 3 validated measures: Flesch Reading Ease, Flesch-Kincaid Reading Level, and SMOG Formula. Mean readability of government-funded and commercially funded websites was compared using the Mann-Whitney U test. Commercially funded websites were significantly more difficult to read as measured by Flesch Reading Ease (49.7 vs. 55.6 for government-funded sites, p = .002) and Flesch-Kincaid Reading Level (10.1 vs. 9.3, p = .012). There was no significant difference according to SMOG Formula (12.8 vs. 13.2, p = .150). The overall readability of Internet health information intended for consumers was poor. Efforts should be made to ensure that health information communicated via the Internet is easy for consumers to read and understand.