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.     

Readability of online health information: implications for health literacy

Accessibility is one of six quality criteria articulated by the European Commission in its code of conduct for health websites. Readability plays an integral part in determining a website's accessibility. Health information that is hard to read may remain inaccessible to people with low health literacy. This study aimed to calculate the readability of websites on various causes of disease. The names of 22 health conditions were entered into five search engines, and the readability of the first 10 results for each search were evaluated using Gunning FOG, SMOG, Flesch-Kincaid and Flesch Reading Ease tests (n=352). Readability was stratified and assessed by search term, search term complexity, top-level domain and paragraph position. The mean reading grade was 12.30, and the mean FRE was 46.08, scores considered 'difficult'. Websites on certain topics were found to be even harder to read than average. Where conditions had multiple names, searching for the simplest one led to the most readable results. Websites with .gov and .nhs TLDs were the most readable while .edu sites were the least. Within texts, a trend of increasing difficulty was found with concluding paragraphs being the hardest to read. It was also found that some of the most frequent search results (such as Wikipedia pages) were amongst the hardest to read. Health professionals, with the help of public and specialised libraries, need to create and direct patients towards high-quality, plain language health information in multiple languages.     

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.     

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.     

Peer Reviewed: A Comprehensive Assessment of the Difficulty Level and Cultural Sensitivity of Online Cancer Prevention Resources for Older Minority Men

Introduction

Older men are at increased risk for prostate cancer. As seniors turn to the Internet for cancer information, it is important that the resources they locate about lifestyle behaviors and screening are culturally appropriate and easy to understand. This study was a comprehensive analysis of prostate cancer risk as portrayed on the Internet with assessment of content readability and cultural sensitivity.

Methods

We selected Web sites about prostate cancer risk and prevention by comparing common sites across three top-rated search engines (Google, Yahoo!, and MSN). A total of 70 Web sites on prostate cancer containing a Web page on risk factors or prevention or both for racial and ethnic populations were included. We assessed readability of one page per Web site using Simple Measure of Gobbledygook (SMOG), Flesch-Kincaid (FK), and Flesch Reading Ease (FRE) measures. Cultural sensitivity of the Web page was evaluated using the Cultural Sensitivity Assessment Tool (CSAT) and questions from a cultural sensitivity checklist.

Results

Mean readability of Web pages was Grade 12.90 (high school graduate level) using SMOG and Grade 11.20 according to FK. Mean FRE was 45.04 (fairly difficult to read). The mean CSAT score was 2.78 and classified as culturally sensitive. Of the 36 Web pages considered culturally sensitive (CSAT >2.50), 75% did not portray images of representative racial or ethnic individuals as intended readers or as being at high risk for prostate cancer. Older adults and seniors were identified as intended readers on 73% of Web pages.

Conclusion

Online cancer resources are targeting appropriate age groups (high-risk older adults). However, the pages required fairly high-level reading skills and had limited cultural sensitivity. These factors make the pages unsuitable for diverse Internet users.     

A systematic review of readability and comprehension instruments used for print and web-based cancer information.

Adequate functional literacy skills positively influence individuals' ability to take control of their health. Print and Web-based cancer information is often written at difficult reading levels. This systematic review evaluates readability instruments (FRE, F-K, Fog, SMOG, Fry) used to assess print and Web-based cancer information and word recognition and comprehension tests (Cloze, REALM, TOFHLA, WRAT) that measure people's health literacy. Articles on readability and comprehension instruments explicitly used for cancer information were assembled by searching MEDLINE and Psyc INFO from 1993 to 2003. In all, 23 studies were included; 16 on readability, 6 on comprehension, and 1 on readability and comprehension. Of the readability investigations, 14 focused on print materials, and 2 assessed Internet information. Comprehension and word recognition measures were not applied to Web-based information. None of the formulas were designed to determine the effects of visuals or design factors that could influence readability and comprehension of cancer education information.     

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.     

Readability of commercial versus generic health instructions for condoms

Despite the fact that condoms are increasingly recommended for the prevention of acquired immune deficiency syndrome (AIDS) and other sexually transmitted diseases (STDs) and have long been used as a barrier method of contraception, little is known about the readability of the range of materials that have been written exclusively for consumers on how to use a condom. The authors described and compared the reading comprehension levels of condom patient package inserts (PPIs) prepared commercially and those generic instructions (GIs) prepared by health care providers. Fifteen sets of PPIs and 30 sets of GIs were analyzed using six standard readability formulas (Fry, Fog, Dale‐Chall, Flesch, Flesch‐Kincaid, SMOG). Readability levels of the instructions ranged from grade 6.3 to 13.7. The PPIs required a significantly higher grade level for comprehension (mean 10.32) than the GIs (mean 8.69). This study suggests that instructions prepared by both sources may require a reading level above that of many consumers who need information on how to use a condom.     

Accessibility for parents of weight management information on the Internet

Objective: The aim of the present study was to describe the accessibility, quality and readability of web base content on the Internet for childhood obesity management from a parental viewpoint. As more than 25% of Australian children are overweight or obese, it is likely that parents access the Internet for advice on obesity management for their child. Design: Links to websites were generated using three search engines and three phrases. The first 10 website links were selected from each of nine searches. Ten aspects of obesity management were identified for the analysis of childhood obesity and related websites. The Fry readability graph was used to assess content readability. Data analysis: The data were analysed using spss Version 10, Minitab and Microsoft Excel 2000. anova was used to compare clinical criteria between website type. Results: A total of 90 links were generated with 60 relevant for analysis. In total, 30 were specific to childhood obesity and 47 websites were either obesity‐specific or weight‐related. Childhood obesity websites were community‐based or commercial. Most websites relevant to childhood obesity management came at no cost, in comparison with general weight‐related sites. Childhood obesity websites scored generally high on accuracy of content. Overall, website readability was at an undergraduate level. Conclusions: There appears to be a paucity of accessible information on the Internet related to childhood weight management, which parents could access. Childhood obesity management websites should ideally include clinically approved management guidelines and follow e‐health codes of ethical practice.     

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.     

Becoming visible: assessing the availability of online sexual health information for lesbians

Research suggests that lesbians turn to the Internet for information regarding their sexual health. However, limited research has examined the availability of online sexual health resources for this population. This study evaluated the volume, scope, and readability of sexual health information available to lesbians on the Internet. The top three Nielsen-rated search engines were used to identify websites generated using the search term "lesbian sexual health." A content analysis was conducted of 25 unique, functioning websites (46 webpages total) and Flesch Reading Ease and Flesch-Kincaid grade levels were calculated. Nearly one third of the websites were located outside the United States; two were U.S. government sites. Although most sites provided information about sexually transmitted infections and HIV/AIDS (52% to 72%), fewer provided information about safer sex practices (12% to 56%), reproductive cancers (24% to 36%), intimate partner violence (16%), family planning issues (0% to 12%), or other preventive health practices, such as mammograms and gynecological exams (4% to 44%) for lesbians. Readability of websites was much higher than recommended for health materials. Lesbians are in need of comprehensive and reliable sexual health information on the Internet. In particular, sexual health messages written in plain language are needed to encourage safer sex and other preventive practices among lesbians.     

Assessment of Selected Patient Educational Materials of Various Chain Pharmacies

Pharmacy literature commonly used to inform patients about medication side-effects and complications was examined for readability. Forty-five (45) informational sheets were obtained from nine national and regional pharmacies. According to the McLaughlin's SMOG (Simple Measure of Gobbledegook) formula, the reading level of the informational sheets ranged from grade 8–14 (8 = 8th grade level and 14 = collegiate level), with a mean reading level of 12. The sampled pharmacy educational materials may be too difficult for most Americans to read and comprehend. The pharmacist may assist in increasing patient compliance by offering education in a form that is understandable, which increases the likelihood of adherence to desired health behaviors.     

Literacy,Pregnancy and Potential Oral Health Changes: The Internet and Readability Levels

The purpose of this study is to evaluate the readability level and content of articles concerning pregnancy and the periodontium which are presented on internet websites. Websites were selected from Google, Yahoo, and Bing. The sites which were excluded were: commercial sites; blogs; dental office sites; sites with articles having fewer than 20 sentences; duplicated search results; and non-secure sites (N = 137). The grade level was determined from the SMOG reading index. Content was scored for specific pregnancy related periodontal content. The mean reading level was 8th grade. The mean number of words with 3 or more syllables in 20 sentences was 38.90. Articles written below the 8th grade level were more likely to recommend brushing twice a day and using a soft-bristled brush. Articles at or above the 8th grade level were more likely to discuss preterm birth and periodontal disease. One article from a national dental organization and 3 from government sites were returned from the searches. Internet articles are written across the literary spectrum. Dental organizations were not adequately represented. Many advertisements, .coms, and non-secure sites pose challenges in seeking health information. Although the internet is a useful tool, practitioners need to provide trustworthy, useful information during clinical visits and encourage national and state medical and dental organizations to provide content in response to search terms that would be typically used.     

Age-related macular degeneration: what do patients find on the internet?

OBJECTIVE: To assess the quality of information and readability of the top internet sites for age-related macular degeneration (AMD). DESIGN: An examination of the technical information provision, quality and readability of websites found during an internet search for 'age-related macular degeneration'. Setting Six internet search engines were used to find 26 unique sites on AMD. MAIN OUTCOME MEASURES: Technical information and quality were assessed using a simple grading system. Readability was assessed using a Simple Measure Of Gobbledygook (SMOG) rating. RESULTS: Twelve organizational, seven academic and seven commercial sites were identified. The average technical scores were 82.3%, 67.9% and 65.2% for each type of site, respectively (P=0.097, one way ANOVA). The average quality scores were 62.2%, 62.6%, and 49.5% for each type of site, respectively (P=0.356, one-way ANOVA). The average SMOG ratings were 16.3, 16.1, and 16.2 for each type of site, respectively (P=0.983, one-way ANOVA). Fifteen of the sites provided details of new and emerging treatments, with seven providing a detailed discussion. CONCLUSIONS: Many websites are now meeting the challenge of providing comprehensive information about AMD and its new treatments. Quality scores were disappointing, with sites needing to provide more evidence of authorship and attribution of information. The majority of sites had SMOG scores above 10, making them difficult for the average person to understand. As physicians we need to help design and direct patients to sites that provide high quality, current information.     

Readability of Online Information on Celiac Disease: A Brief Report

Abstract

Celiac disease (CD) is an autoimmune condition characterized by an intolerance to dietary gluten for those with a genetic predisposition. The Internet has become a key source of information about CD as well as a gluten-free diet (GFD), although the quality is varied. There has been little investigation into the readability of online CD information. Keyword “celiac disease” was used for a search in the browser, Google Chrome. URLs of the first 100 English websites were recorded; sponsored or advertised websites were not included in the sample. Five recommended tests generated by Readable.io were utilized to assess the sample’s readability scores. Only one of the 100 websites received an acceptable reading score on two of the five reading assessments. Websites with extensions of .com or .org were equally likely to be written at the same unacceptable level. Informational websites on celiac disease may serve as an unintentional barrier for consumers seeking readable, online material on this health topic.     

Assessment of selected patient educational materials of various chain pharmacies

Pharmacy literature commonly used to inform patients about medication side-effects and complications was examined for readability. Forty-five (45) informational sheets were obtained from nine national and regional pharmacies. According to the McLaughlin's SMOG (Simple Measure of Gobbledegook) formula, the reading level of the informational sheets ranged from grade 8-14 (8 = 8th grade level and 14 = collegiate level), with a mean reading level of 12. The sampled pharmacy educational materials may be too difficult for most Americans to read and comprehend. The pharmacist may assist in increasing patient compliance by offering education in a form that is understandable, which increases the likelihood of adherence to desired health behaviors.     

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.