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Health Literacy in Shoulder Arthroplasty: A Quantitative Assessment of the Readability, Understandability, And Actionability of Online Patient Education Material

Health Literacy in Shoulder Arthroplasty: A Quantitative Assessment of the Readability, Understandability, And Actionability of Online Patient Education Material

Trevor Gulbrandsen, MD, UNITED STATES Olivia O'Reilly, MD, UNITED STATES Burke Gao, MD, UNITED STATES Alan Shamrock, MD, UNITED STATES Brendan Patterson, MD, UNITED STATES

University of Iowa Hospitals and Clinics, Iowa City, Iowa, UNITED STATES


2021 Congress   ePoster Presentation     Not yet rated

 

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Summary: Shoulder replacement online resources scored poorly with respect to readability, understandability, and actionability.


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. Recent literature across multiple orthopedic specialties has found health literacy to be a significant barrier to the understanding of orthopedic injuries and procedures. Reading grade-level is commonly utilized to assess health information; however, these measures do not represent whether text is written such that readers can process key information (understandability) or identify available actions to take (actionability). The Patient Education Materials Assessment Tool (PEMAT-P) is a valid and reliable method to measure the understandability and actionability of online patient education materials. The aim of this study was to evaluate online resources regarding shoulder replacement utilizing measures of readability, understandability, and actionability. It was hypothesized that current online resources would score poorly on these objective measures. Additionally, it was hypothesized that these measures would not correlate with the order of the listed search results (rank).

Methods

Using the trends analysis (trends.google.com), the most common searched term “shoulder replacement” was determined. Subsequently two independent online searches (Google.com) were performed. From the top 50 search results, websites were included if directed at educating patients regarding shoulder replacement. News articles, non-text material (video), articles (new/research/industry), and websites unrelated to shoulder replacement were excluded. Readability was quantified using valid objective algorithms: Flesch-Kincaid Grade-Level (FKGL), Simple Measure of Gobbledygook (SMOG) grade, Coleman-Liau Index (CLI), and Gunning-Fog Index (GFI). The PEMAT-P form was used to assess actionability and understandability. A PEMAT-P score of 70% or below is considered poorly understandable or poorly actionable. The relationship between a website’s Google search rank and its readability, understandability, and actionability was determined with statistical significance defined as p<0.05.

Results

Following removal of duplicates there were 66 unique websites, of which 57 (86.4%) met inclusion criteria. Two education websites were affiliated with AAOS, while the ASES had no websites in the top 50 search results. The mean FKGL was 8.31±2.44, with only 5.26% (n=3) websites scoring = 6th grade reading level. This included two health information publishers and one private practice website. Mean understandability and actionability scores were 72.28±15.39 and 45.61±26.66, respectively. Only 44.83% (n=26) and 7.02% (n=4) of websites met the >70% threshold for understandability and actionability, respectively. Of the 26 websites that met the understandability threshold, 50% were private practice, 34.6% were academic institutions, and 19.2% were from health information publishers. There was no difference in understandability (p=0.97) or actionability (p=0.07) between categorical groups (private practice, academic institution, health information publisher). Both AAOS affiliated websites scored >70% in both understandability (81.25%, 78.13%) and actionability (80.00%, 70.00%). Better CLI readability scores were associated with higher (earlier) search rank (rho=0.27, p=0.045).

Conclusion

Overall, shoulder replacement online resources scored poorly with respect to readability, understandability, and actionability. Only three total resources were written at the AMA and NIH recommended reading level. There was no difference in PEMAT scores in regard to private practice, academic, or health information websites. The AAOS affiliated sites performed well in understandability and actionability. Google search rank positively correlated with CLI readability score, however there was no correlation with other readability scores nor understandability/actionability measures. Future efforts by thought leaders in shoulder arthroplasty should be made to improve online resources in order to optimize patient knowledge and facilitate informed decision-making. The AAOS affiliated sites performed well in regards to the outcome measures of interest in this study and could be used as a guide to inform other sources of online patient education material.


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