Health Literacy in Shoulder Arthroscopy: A Quantitative Assessment of the Understandability and Readability of Online Patient Education Material.

Abstract

Background: The National Institutes of Health (NIH) and American Medical Association (AMA) recommend that online health information be written at a maximum 6th grade reading level. The aim was to evaluate online resources regarding shoulder arthroscopy utilizing measures of readability, understandability, and actionability, using syntax reading grade level and the Patient Education Materials Assessment Tool (PEMAT-P).

Methods: An online Google™ search utilizing "shoulder arthroscopy" was performed. From the top 50 results, websites directed at educating patients were included. News and scientific articles, audiovisual materials, industry websites, and unrelated materials were excluded. Readability was calculated using objective algorithms: Flesch-Kincaid Grade-Level (FKGL), Simple Measure of Gobbledygook (SMOG) grade, Coleman-Liau Index (CLI), and Gunning-Fog Index (GFI). The PEMAT-P was used to assess understandability and actionability, with a 70% score threshold. Scores were compared across academic institutions, private practices, and commercial health publishers. The correlation between search rank and readability, understandability, and actionability was calculated.

Results: Two independent searches yielded 53 websites, with 44 (83.02%) meeting inclusion criteria. No mean readability score performed below a 10th grade reading level. Only one website scored at or below 6th grade reading level. Mean understandability and actionability scores were 63.02%±12.09 and 29.77%±20.63, neither of which met the PEMAT threshold. Twelve (27.27%) websites met the understandability threshold, while none met the actionability threshold. Institution categories scored similarly in understandability (61.71%, 62.68%, 63.67%) among academic, private practice, and commercial health publishers respectively (p=0.9536). No readability or PEMAT score correlated with search rank.

Conclusion: Online shoulder arthroscopy patient education materials score poorly in readability, understandability, and actionability. One website scored at the NIH and AMA recommended reading level, and 27.27% of websites scored above the 70% PEMAT score for understandability. None met the actionability threshold. Future efforts should improve online resources to optimize patient education and facilitate informed decision-making. Level of Evidence: IV.