Date Presented 4/17/2015
This study investigated the readability of international traumatic brain injury (TBI) websites. Results show that they are written at grade levels that exceed the literacy of many of those with TBI and a large portion of the general population. Suggestions to enhance readability of website and nonwebsite sources are described.
SIGNIFICANCE: Traumatic brain injury (TBI) is one of the leading causes of disability worldwide. TBI can result in impaired cognition, making it difficult to comprehend important information. Occupational therapists provide services for this population, including patient education materials. A large portion of the United States and the international population has low literacy skills, making it difficult for patients to understand resources about their disability and recovery. Patients often use the Internet to research health information. However, many Internet resources exceed the recommended eighth-grade reading level. We investigated the readability of Internet patient education materials from TBI organizations in Australia, New Zealand, the United Kingdom, and the United States. We provide practical methods to improve the readability of Internet patient education materials and suggestions to advocate for better readability.
INNOVATION: This research shifts current clinical practice paradigms because therapists often either distribute education materials to patients or recommend Internet resources without first analyzing readability. If the material is too advanced, the information will not be comprehended or usable. We attempt to answer the following research question: What is the readability of TBI websites in Australia, New Zealand, the United Kingdom, and the United States as measured by the SMOG readability measure? Our results justify increased focus on the readability of patient education resources.
RATIONALE: An international literacy survey (Blum, Goldstein, & Guérin-Pace, 2001) found that the majority of people from industrialized countries read below an eighth-grade level. A study by the Pew Research Center (n.d.) found that 72% of Internet users searched for health information in the past year. Additionally, 35% of patients with a mild TBI will not seek medical treatment but will use Internet resources for treatment ideas and information. Internet websites should be investigated to evaluate their readability level. Guidelines by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and Healthy People 2020 require health care providers to use comprehendible patient education materials. Research documenting the literacy level of Internet sites for persons with TBI is a first step in providing useful and comprehendible information for this population.
METHOD: In this descriptive analysis of international TBI website readability, we used the online SMOG (gold standard readability measure) to analyze readability of TBI websites across common content areas and across countries. Four common topic areas were identified across the websites. A 24-step procedure prepared the content prior to entering it into SMOG.
RESULTS: The readability for countries and content area ranged from 10.00 to 13.78. This is equal to the grade level of 2 yr of high school to almost 2 yr of college.
CONCLUSIONS: Results show that all websites had readability levels higher than the recommended eighth-grade level, which is consistent with previous studies investigating readability levels of online patient materials for other conditions. A limitation is that online data can quickly change due to the nature of the Internet.
References
Blum, A., Goldstein, H., & Guérin-Pace, F. (2001). International Adult Literacy Survey: An analysis of international comparisons of adult literacy. Assessment in Education: Principles, Policy & Practice, 8, 225–246. http://dx.doi.org/10.1080/09695940123977
Pew Research Center. (n.d.). Health fact sheet. Retrieved from http://www.pewinternet.org/fact-sheets/health-fact-sheet
Safeer, R. S., & Keenan, J. (2005). Health literacy: The gap between physicians and patients. American Family Physician, 72, 463–468.
