Original Article
Assessing the Readability of Online Information About Hip Arthroscopy

https://doi.org/10.1016/j.arthro.2018.02.039Get rights and content

Purpose

To investigate the current readability of online information pertaining to hip arthroscopy.

Methods

The terms “hip arthroscopy” and “hip scope” were entered into the advanced search functions of Google, Yahoo!, and Bing on March 25, 2017, and results from the first 3 pages were analyzed. Results were required to be unique, accessible websites with information about hip arthroscopy conveyed primarily via analyzable text. Two reviewers applied inclusion criteria to the initial 97 results, discussing to reach consensus in cases of disagreement. Overall, 60 unique results were reviewed with 48 meeting inclusion criteria. Websites were categorized as physician-sponsored, academic, commercial, governmental and nonprofit organization (NPO), or unspecified. Readability was measured via 6 different indices: the Flesch-Kincaid grade level (FKGL), Flesch Reading Ease (FRE), Gunning Fog Score, SMOG Index, Coleman-Liau Index (CLI), and Automated Readability Index (ARI) along with an average grade level and readability classification score.

Results

Forty-eight unique websites were assessed for readability, with physician-sponsored webpages composing the majority (47.92%) followed by academic sources (35.42%). The webpages' average grade level, incorporating information from all 6 metrics, was 12.79 ± 1.98.

Conclusions

The current readability of online information pertaining to hip arthroscopy is at an inappropriately high reading level compared with the sixth-grade level recommended by the American Medical Association and National Institutes of Health, thus introducing significant barriers to understanding for many patients. Online materials should be edited to reduce word and sentence length and complexity, use simpler terms, and minimize use of passive voice to facilitate patient knowledge acquisition and understanding of online information about hip arthroscopy.

Clinical Relevance

This study shows that the current readability of online information on hip arthroscopy exceeds the suggested sixth-grade reading level. It also emphasizes the need for simplifying written materials and offers specific suggestions on doing so to increase accessibility of information for patients.

Section snippets

Search Terms and Website Categorization

In a study design similar to prior investigations,23, 24, 28, 29 advanced search tools were used to query the exact phrases “hip arthroscopy” and “hip scope” from 3 Internet search engines, Google, Yahoo!, and Bing, on March 25, 2017. The given search engines were included in our study as nearly 80% of searches in the United States are carried out using Google, with 95% of all remaining searches performed through Bing and Yahoo!35 Uniform resource locaters (URLs) from the first 3 pages of

Results

In total, 48 unique websites were assessed for readability, with physician-sponsored webpages comprising the majority (47.92%) followed by academic (35.42%), unspecified (8.33%), commercial (6.25%), and governmental and NPO (2.08%) pages. Among the indices measured, the mean FRE was 43.45 ± 11.38 (range 19.5-73.6), mean FKGL was 11.89 ± 2.17 (range 5.8-16.1), mean Gunning Fog Score was 15.25 ± 2.48 (range 8.7-20.7), mean SMOG Index was 11.23 ± 1.76 (range 6.5-14.7), mean CLI was 13.99 ± 1.56

Discussion

This investigation found that the readability of current online orthopaedic educational materials pertaining to hip arthroscopy is at an average grade level of 12.79, significantly higher than the sixth-grade reading level recommended by the AMA and NIH.13, 14, 15 Accessibility to and, thus, utility of online information about hip arthroscopy is dependent on resources being written for patients at an appropriately comprehensible reading level. Based on our study, full comprehension of material

Conclusions

The current readability of online information pertaining to hip arthroscopy is at an inappropriately high reading level compared with the sixth-grade level recommended by the AMA and NIH, thus introducing significant barriers to understanding for many patients. Online materials should be edited to reduce word and sentence length and complexity, use simpler terms, and minimize use of passive voice to facilitate patient knowledge acquisition and understanding of online information about hip

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      An analysis of the readability of PEMs provided by the American Orthopaedic Society for Sports Medicine in 2018 found that all PEMs were written above the recommended sixth-grade reading level with 36% written above a twelfth-grade reading level.17 In addition, a 2018 investigation of PEMs for hip arthroscopy found an average reading level of grade 12.79, with no individual websites containing information below an eighth-grade reading level.1 Furthermore, a 2015 analysis of online foot and ankle PEMs produced by the AAOS, the American Orthopaedic Foot and Ankle Society, Medline Plus, and 11 academic centers found an average reading level of grade 10.1, with no organization or institution producing a reading level within the recommended range.2

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      However, there is concern about the quality of health information that patients encounter. Many studies29,34,35,41-43 have shown that the quality of online health information, particularly in orthopaedics, is substandard. This may negatively influence patients' expectations about their diagnosis and treatment plan and change the dynamic of the patient-physician relationship.16,17

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    See commentary on page 2150

    The authors report the following potential conflicts of interest or sources of funding: J.R. is an educational consultant for Smith & Nephew. T.S.L. is a consultant for Smith & Nephew. Full ICMJE author disclosure forms are available for this article online, as supplementary material.

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