Assessing Readability of Patient Education Materials on Breast Reconstruction by Major US Academic Institutions

Abstract

PURPOSE: Breast cancer affects 1 in 8 women with 232,400 new invasive cases each year.1 Women undergoing breast reconstruction postmastectomy face several choices, and a myriad of written patient education materials exist online. Understanding of these materials, termed health literacy, affects surgical decision-making and outcomes.2 The National Institutes of Health recommend writing patient education materials at a sixth-seventh grade reading level to accommodate the average reading level of the US adult.3 The primary goal of this study is to assess the readability of breast reconstruction educational materials online. METHODS AND MATERIALS: Patient resources were collected from every academic hospital with an integrated plastic surgery residency program, 81 in total. These data were compared to the top nonacademic websites ranked by search engine results, 10 in total. Materials were analyzed using 3 validated readability assessment scales: Coleman-Liau Index, SMOG Readability Formula, and Flesch-Kincaid Grade Level.4 Average readability was analyzed, and results were compared using a one-way analysis of variance to assess for significance between the different tools and a 2-sided t test to assess for significance between academic and nonacademic readability results. RESULTS: The mean readability scores across the academic programs were a Coleman-Liau Index of 13.27 (SD = 2.9; 13th grade), Flesch-Kincaid Grade Level of 13.05 (SD = 4.07; 13th grade), and SMOG Readability of 14.25 (SD = 2.97; 14th grade). For the 10 nonacademic sites, results showed a Coleman-Liau Index of 12.1 (SD = 0.9; 12th grade), Flesch-Kincaid of 11.93 (SD = 2.3; 12th grade), and SMOG Readability of 10.9 (SD = 1.7; 11th grade). One-way analysis of variance demonstrated no significant differences in the scoring between the 3 readability tools used (academic F = 2.7804, P = 0.06; nonacademic F = 1.14, P = 0.33). CONCLUSIONS: This study found that readability across all websites were poor, with an average of a 13th–14th reading grade level for academic institutions, and 11th–12th grade reading level for the top nonacademic websites ranked by search engine results. Plastic surgeons should provide patient education materials fitting a wider range of reading abilities, at a recommended sixth-seventh grade reading level. By focusing on health literacy, plastic surgeons may contribute to improving patient understanding surrounding treatment options, lessening healthcare expenditure, and lowering perioperative complications.2 REFERENCES: 1. UCLA Health. Breast reconstruction. Available at https://www.uclahealth.org/plasticsurgery/breast-reconstruction. Accessed January 29, 2020. 2. Ismail IK, Burns SL, Rezak KM, et al. An evaluation of health literacy in plastic surgery patients. Plast Reconstr Surg. 2015;136:55–59. 3. Hutchinson N, Baird GL, Garg M. Examining the reading level of internet medical information for common internal medicine diagnoses. Am J Med. 2016;129:637–639. 4. Wang L, Miller MJ, Schmitt MR, et al. Assessing readability formula differences with written health information materials: application, results, and recommendations. Res Social Adm Pharm. 2013;9:503–516.