Readability, complexity, and suitability analysis of online lymphedema resources
Bao Ngoc N. Tran, Mansher Singh, Bernard T. Lee, Rima Rudd, and Dhruv Singhal. journal of surgical research, June 2017 (213) 251e260
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ABSTRACT
Readability, complexity, and suitability analysis of online lymphedema resources.
Bao Ngoc N. Tran, Mansher Singh, Bernard T. Lee, Rima Rudd, and Dhruv Singhal. journal of surgical research, June 2017 (213) 251e260
BACKGROUND:
Over 72% of Americans use online health information to assist in health care decision-making. Previous studies of lymphedema literature have focused only on reading level of patient-oriented materials online. Findings indicate they are too advanced for most patients to comprehend. This, more comprehensive study, expands the previous analysis to include critical elements of health materials beyond readability using assessment tools to report on the complexity and density of data as well as text design, vocabulary, and organization.
METHODS:
The top 10 highest ranked websites on lymphedema were identified using the most popular search engine (Google). Website content was analyzed for readability, complexity, and suitability using Simple Measure of Gobbledygook, PMOSE/iKIRSCH, and Suitability Assessment of Materials (SAM), respectively. PMOSE/iKIRSCH and SAM were performed by two independent raters. Fleiss’ kappa score was calculated to ensure inter-rater reliability.
RESULTS:
Online lymphedema literature had a reading grade level of 14.0 (SMOG). Overall complexity score was 6.7 (PMOSE/iKIRSCH) corresponding to “low” complexity and requiring a 8th-12th grade education. Fleiss’ kappa score was 80% (P = 0.04, “substantial” agreement). Overall suitability score was 45% (SAM) correlating to the lowest level of “adequate” suitability. Fleiss’ kappa score was 76% (P = 0.06, “substantial” agreement).
CONCLUSIONS:
Online resources for lymphedema are above the recommended levels for readability and complexity. The suitability level is barely adequate for the intended audience. Overall, these materials are too sophisticated for the average American adult, whose literacy skills are well documented. Further efforts to revise these materials are needed to improve patient comprehension and understanding.
Main findings
- The following American websites were reviewed for readability, complexity, and suitability of their lymphedema literature. The readability should be no higher than sixth grade and complexity shouldn’t be higher than eighth grade:
- Mayoclinic.org – Mayo Clinic – suitable
- Breastcancer.org – not suitable
- Wikipedia.org – The Wikimedia Foundation, Inc – borderline
- Lymphnet.org – National Lymphedema Network – borderline
- Emedicine.medscape.com – WebMD LLC – not suitable
- Cancer.gov (NIH) – National Institute of Health – borderline
- Cancer.org (ACS) – American Cancer Society – borderline
- Medicinenet.com – MedicineNet,Inc – borderline
- Medlineplus.gov – U.S. National Library of Medicine – suitable
- WebMD.com – WebMD LLC – borderline
- Online resources for lymphedema are generally inadequate in terms of readability, complexity and suitability.
- There needs to be a comprehensive revision of online resources.
- Majority of adults have relatively weak literacy skills.
