Assessment of the Readability of Web-Based Patient Education Material From Major Canadian Pediatric Associations: Cross-sectional Study

Abstract

Background: Web-based patient education materials (PEMs) are frequently written above the recommended reading level in North America. Poor PEM readability limits the accessibility of medical information for individuals with average literacy levels or lower. Pediatric hospital and association websites have not only been shown to be a preferred source of information among caregivers but have also become a necessity during the COVID-19 pandemic. The readability of Canadian pediatric association websites has not yet been assessed.

Objective: The aim of this study is to determine if the content of PEMs from Canadian pediatric associations is written at a reading level that the majority of Canadians can understand.

Methods: A total of 258 PEMs were extracted from 10 Canadian pediatric associations and evaluated for their reading level using 10 validated readability scales. The PEMs underwent a difficult word analysis and comparisons between PEMs from different associations were conducted.

Results: Web-based PEMs were identified from 3 pediatric association websites, where the reading level (calculated as a grade level) was found to be an average of 8.8 (SD 1.8) for the Caring for Kids website, 9.5 (SD 2.2) for the Pediatric Endocrine Group website, and 13.1 (SD 2.1) for the Atlantic Pediatric Society website. The difficult word analysis identified that 19.9% (SD 6.6%) of words were unfamiliar, with 13.3% (SD 5.3%) and 31.9% (SD 6.1%) of words being considered complex (≥3 syllables) and long (≥6 letters), respectively.

Conclusions: The web-based PEMs were found to be written above the recommended seventh-grade reading level for Canadians. Consideration should be made to create PEMs at an appropriate reading level for both patients and their caregivers to encourage health literacy and ultimately promote preventative health behaviors and improve child health outcomes.

Keywords: accessibility; health literacy; online health information; patient education; pediatrics.

Figure 1

The reading level of patient education materials (PEMs) developed by the Atlantic Pediatric Society, Pediatric Endocrine Group, and Canadian Pediatric Society (Caring for Kids) as calculated by various numerical readability scales, compared to the average Canadian reading level and the recommended reading level for PEMs.

Figure 2

(A) The Fry Readability Graph of all high-sentence estimate web-based patient education materials (PEMs) collected from Canadian pediatric associations. The Fry Readability Graph visually demonstrates the readability of PEMs by the intersection of the number of syllables per 100 words and the number of sentences per 100 words. (B) The Raygor Readability Estimate Graph of all high-sentence estimate web-based PEMs collected from Canadian pediatric associations. The Raygor Readability Estimate Graph visually demonstrates the readability of the PEMs by the intersection of the number of long words per 100 words and sentences per 100 words. Within both graphs, the numbers within the graph indicate the approximate reading level (reported as a grade level) and the circles indicate reading levels of individual PEMs.