Summary

Hip arthroscopy online resources scored poorly with respect to readability, understandability, and actionability.

Abstract

Introduction

The American Medical Association (AMA) and National Institutes of Health (NIH) recommend online health information to be written at a 6th grade or lower reading level in order to be fully understood by the average adult in the United States. While syntax-based reading grade-level has been previously assessed in hip arthroscopy, these analyses do not measure whether text has been written such that readers can process key information (understandability) or identify available actions to take (actionability). The purpose of this study was to evaluate online resources regarding hip arthroscopy utilizing measures of readability, understandability, and actionability.

Methods

Using the term “Hip Arthroscopy”, two independent online searches (Google.com) were performed. From the top 50 results, patient education material (PEM) websites were included. Non-text websites, articles (news/research/industry), and unrelated resources were excluded. Readability was quantified using validated objective algorithms: Flesch-Kincaid Grade-Level (FKGL), Simple Measure of Gobbledygook (SMOG) grade, Coleman-Liau Index (CLI), and Gunning-Fog Index (GFI). The Patient Education Materials Assessment Tool (PEMAT) was utilized to assess understandability and actionability (0-100%). A PEMAT-P score of 70% or below is considered poorly understandable or poorly actionable. The relationship between PEM’s search rank and its readability, understandability, and actionability were examined.

Results

Of the 60 unique websites, 37 websites (61.67%) met inclusion criteria. Of the included websites 27.0% (n=10) were from academic institutions, 64.9% (n=24) were from private practices, and 8.1% (n=3) were health information publishers. The mean FKGL, SMOG, CLI, and GFI were 12.5±2.7, 11.6±1.9, 14.4±2.1, and 15.5±2.7, respectively. None of the websites scored at or below the 6th grade level. Mean understandability and actionability scores were 57.13±12.58 and 21.80± 20.68, respectively. Only 18.9% (n=7) and 0% (n=0) of websites were above the PEMAT threshold for understandability and actionability. Readability (rho:-0.03, p=0.85), understandability (rho= 0.09, p=0.61), and actionability (rho=-0.21, p=0.22) scores were not associated with Google rank. Interrater reliability demonstrated agreement and was interpreted as good (kappa=0.519±0.038, p<0.01).

Conclusion

Overall, hip arthroscopy online resources scored poorly with respect to readability, understandability, and actionability. No PEMs in the top 50 search results scored at the AMA and NIH recommended reading level. Future efforts should be made to improve the readability, understandability and actionability of online resources in order to optimize patient knowledge and facilitate informed decision-making.