EducationA comparative analysis of neurosurgical online education materials to assess patient comprehension
Introduction
Neurological conditions are often difficult for patients and caregivers to fully comprehend. In fact, inadequate health literacy has a strong and independent correlation with medication non-adherence and mortality.1 Over 61% of adult Americans refer to the internet to clarify their questions and further educate themselves on disorders that affect them and their loved ones.2 This trend is possibly due to the limited understanding non-healthcare professionals have of medical terminology and treatments.3 Particularly, individuals often access web-based health information for increased comprehension, meeting support groups of people with similar conditions, and increasing their personal role in staying healthy.2, 4 In a study on spinal cord injury patients, 58% of the patients interviewed used the internet as major source of healthcare information.5 As such, it becomes the responsibility of healthcare providers to supply succinct descriptions that explain various conditions in an easily comprehendible fashion.
In accordance with the internet’s increased role as a source of information, many organizations now offer website sections dedicated to patient education. However, not all of the provided information is at a level appropriate for the typical patient. According to a recent study, the average American reads at a seventh grade level.6 Studies targeted towards assessing health literacy show that only 12% of all Americans demonstrate healthcare-oriented language proficiency, with 53% at an intermediate level, and 36% at or below a basic level.7 Thus, the National Institutes of Health (NIH) recommend that all distributed materials should be written around a sixth grade level in order to maximize patient comprehension.8
The grade level and readability of a document can be analyzed using many different assessment tools. One that is widely used is the Flesch Reading Ease formula, which gives a score from 0–100, where increased ease of reading is correlated with an increase in score.6, 9, 10 Another is the Flesch-Kincaid Grade formula, which indicates the required academic grade of the target audience. Alternatively, the Simple Measure of Gobbledygook (SMOG) Grading11 developed by McLaughlin in 1969, the Gunning-Fog Index12 developed by Robert Gunning in 1952, or the Coleman-Liau Index13 developed by Coleman and Liau in 1975, can also provide an estimation of the target grade level of the document.
Our study aimed to utilize these standards to assess the readability of patient education materials distributed by the American Association of Neurological Surgeons (AANS). We attempted to organize the data according to neurosurgical subspecialties and provide a comparison of writing styles. To our knowledge, this is the only study that explicitly compares the readability levels of the patient education provided by AANS for disorders from various neurosurgical subspecialties.
Section snippets
Methods
Patient education resources specifically written for and available to the public were downloaded from the AANS website. Patient education material from seven neurological subspecialties-Cerebrovascular, Spine and Peripheral Nerves, Neurotrauma and Critical Care, Pain, Pediatric, Stereotactic and Functional, and Tumor-were evaluated for their level of readability. Each of the seven subsections had between six and 21 more subsections that were individually analyzed for their level of readability (
Results
Seventy-one articles from the AANS website were analyzed for their level of readability and compared in seven subsections (Cerebrovascular, Spine and Peripheral Nerves, Neurotrauma and Critical Care, Pain, Pediatric, Stereotactic and Functional, and Tumor) of neurological surgery. The Flesch Reading Ease results had values ranging from 32.31 to 41.77 (Fig. 1). One-way ANOVA results indicated statistical similarity between all the subsections (F [6, 63] = 1.363, p = 0.243). No post hoc analysis was
Discussion
Patients often turn to the internet to become more informed about and take a greater role in the management of their own health. In one survey, patients not only rated the internet as the most useful source, but also admitted that information found on the web is likely to impact their decision to visit a physician.14 Studies analyzing online patient education materials have consistently shown them to exceed the literary competency of average American.15, 16, 17, 18 The average reading level of
Conclusions
Given the low literacy level of the average American, it would be beneficial to rewrite online education materials to improve patient comprehension. The AANS website is frequently utilized by patients to gather information regarding disorders and treatments in various neurosurgical subspecialties. While statistically significant differences were observed amongst the subspecialties using the Coleman-Liau Index, overall, this study has demonstrated that the information presented online may be too
Conflicts of Interest/Disclosures
The authors declare that they have no financial or other conflicts of interest in relation to this research and its publication.
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These authors have contributed equally to the manuscript.