The Availability and Readability of Multilingual Online Patient Materials for Legg-Calve-Perthes Disease

Abstract

Background: Patients newly diagnosed with Legg-Calve-Perthes disease (LCPD) often use the internet to learn about their disease. The American Medical Association (AMA) and the National Institutes of Health (NIH) recommend writing patient education resources at sixth- to eigth-grade reading levels. The purpose of this study was to determine the availability of online patient education resources for LCPD, assess the availability of translation to other languages, and analyze the readability of English-language resources.

Methods: A cross-sectional analysis was conducted to determine the availability and readability of online, written patient education materials for LCPD. The top 50 pediatric orthopaedic hospitals, as reported by the U.S. News and World Report, major professional societies (the American Academy of Orthopaedic Surgeons [AAOS], the American Academy of Pediatrics [AAP], and the Pediatric Orthopaedic Society of North America [POSNA]), and international societies (POSNA "Alliance Societies") were included. The number of translations to other languages was determined among the institutions with English resources. Three different readability measures were used on resources written in English. Statistical analysis was performed using descriptive, univariate, and correlation analyses.

Results: Seventy-four percent (37/50) of hospitals, 67% (2/3) of U.S.-based professional societies, and 16% (5/31) of international societies provided LCPD education resources. Of the hospitals and societies that provided English resources, 36% (14/39) provided translation to other languages. The most common language available was Spanish. Resources written in English had an average Flesch Reading Ease score of 60.5, Fry Graph grade level of 9.6, and Simple Measure of Gobbledygook (SMOG) grade level of 11.4. There was no significant relationship between hospital rank and availability (P > .05) or reading level (P > .05) of resources and no significant relationship between a state's percentage of Spanish speakers and availability of Spanish translations (P > .05).

Conclusions: Most selected hospitals and U.S.-based professional societies provided information about LCPD; however, many did not provide translation to other languages. There is a discrepancy between the reading level of the resources queried and national reading level recommendations. There is a need for translated LCPD resources from hospitals and societies domestically and abroad to provide adequate patient education, particularly for individuals with lower reading levels or non-English speakers.

Key concepts: (1)Online patient educational materials across United States hospitals and major pediatric orthopaedic societies for Legg-Calve-Perthes disease (LCPD) were written above the recommended English reading levels.(2)There is a limited availability of patient educational material written in non-English languages despite a large percentage of non-English speakers in the United States.(3)While Spanish is the most common non-English language spoken in the United States, there was no increase in the availability of educational materials written in Spanish in states with a population >20% Spanish speakers.

Level of evidence: III.

Keywords: Health equity; Health literacy; Legg-Calve-Perthes disease; Limited English proficiency; Patient education materials.