March 4, 2020

Study Finds Need for Improved Readability of Online Health Education Materials to Improve Health Literacy Around TBI, Epilepsy and PTE

Objective: The use of the internet for health-related questions is increasing, but it is not clear whether individuals can understand the information available online. Most health organizations recommend that health educational materials (HEMs) be written below the sixth grade reading level. This study was designed to evaluate the readability level of available online HEMs pertaining to traumatic brain injury (TBI), epilepsy, and posttraumatic epilepsy (PTE).

Methods: This cross-sectional readability assessment included HEMs from TBI and epilepsy stakeholder organizations and those obtained from four internet searches. The search strategy was designed to replicate a nonmedical individual’s keyword searches. Each HEM was assessed with an online automated readability tool using three indices (Flesch Reading Ease Score, Flesch-Kincaid Grade Level, and Simple Measure of Gobbledygook). Findings were compared as a function of organization type (journalistic news or health organization), targeted medical condition (TBI, epilepsy, or PTE), or content topic (patient health education, clinical research education, or both).

Results: Readability analysis of 405 identified HEMs revealed scores above the sixth grade reading level recommendation. Only 6.2% of individual HEMs met the sixth grade recommendation. Journalistic news organizations’ HEMs had similar readability levels to health organizations’ HEMs. PTE-related HEMs required the highest readability level, >11th grade (P < .001). There were significant differences in the readability scores (P < .01 for all indices) among HEMs with information on health education, research education, or both topics. The highest required readability level (>12 grade level) was for HEMs that included both health and research education.

Significance: The majority of TBI-, epilepsy-, and PTE-related online health education materials do not meet the sixth grade reading recommendation. Improving the readability of health education materials may advance health literacy around TBI, epilepsy, and PTE, leading to more effective participant recruitment/retention strategies for future antiepileptogenesis trials in persons with TBI and perhaps better patient-centered outcomes.

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