Online Patient Education Materials Related to Lipoprotein(a): Readability Assessment

Abstract

Background: Lipoprotein(a) (Lp(a)) is a highly proatherogenic lipid fraction that is a clinically significant risk modifier. Patients wanting to learn more about Lp(a) are likely to use online patient educational materials (OPEMs). However, the readability of OPEMs may exceed the health literacy of the public.

Objective: This study aims to assess the readability of OPEMs related to Lp(a). We hypothesized that the readability of these online materials would exceed the sixth grade level recommended by the American Medical Association.

Methods: Using an online search engine, we queried the top 20 search results from 10 commonly used Lp(a)-related search terms to identify a total of 200 websites. We excluded duplicate websites, advertised results, research journal articles, or non-patient-directed materials, such as those intended only for health professionals or researchers. Grade level readability was calculated using 5 standard readability metrics (automated readability index, SMOG index, Coleman-Liau index, Gunning Fog score, Flesch-Kincaid score) to produce robust point (mean) and interval (CI) estimates of readability. Generalized estimating equations were used to model grade level readability by each search term, with the 5 readability scores nested within each OPEM.

Results: A total of 27 unique websites were identified for analysis. The average readability score for the aggregated results was a 12.2 (95% CI 10.9798-13.3978) grade level. OPEMs were grouped into 6 categories by primary source: industry, lay press, research foundation and nonprofit organizations, university or government, clinic, and other. The most readable category was OPEMs published by universities or government agencies (9.0, 95% CI 6.8-11.3). The least readable OPEMs on average were the ones published by the lay press (13.0, 95% CI 11.2-14.8). All categories exceeded the sixth grade reading level recommended by the American Medical Association.

Conclusions: Lack of access to readable OPEMs may disproportionately affect patients with low health literacy. Ensuring that online content is understandable by broad audiences is a necessary component of increasing the impact of novel therapeutics and recommendations regarding Lp(a).

Keywords: health education; health literacy; lipoprotein(a); online patient education material; readability.

Figure 1

Material selection and exclusion for OPEMs related to lipoprotein(a). OPEM: online patient education material.

Figure 2

Average grade level readability of online patient education material (OPEM) by category of publication. Each circle represents a readability score for one OPEM, with a total of five readability scores for each unique OPEM. 95% CIs are included for all categories except “Clinic” and “Other,” which only had one unique OPEM each. University and government sources were significantly more readable than research and nonprofit foundation, industry, and lay press sources.

Figure 3

Readability rankings by search result. Each blue dot corresponds to the mean readability based on the average of five standard readability scores (automated readability index, SMOG index, Coleman-Liau index, Gunning fog score, Flesch-Kincaid score) with whiskers representing the range of readability scores. The red vertical line corresponds to the AMA sixth grade level readability target. Cleveland Clinic1: Elevated Lipoprotein(a): Is a Long-Sought Treatment Finally on the Way?; Cleveland Clinic2: Why Would My Doctor Order a Lipoprotein(a) Blood Test?; National Lipid Association1: lipoprotein(a) Screening for Individuals at High ASCVD Risk; National Lipid Association2: Elevated Lipoprotein (a) Patient-Centered Education From the National Lipid Association. AMA: American Medical Association.