Individual factors that affect laypeople's understanding of definitions of medical jargon

Objective

Patients have difficulty understanding medical jargon in electronic health record (EHR) notes. Lay definitions can improve patient comprehension, which is the goal of the NoteAid project. We assess whether the NoteAid definitions are understandable to laypeople and whether understandability differs with respect to layperson characteristics.

Methods

Definitions for jargon terms were written for laypersons with a 4th-to-7th-grade reading level. 300 definitions were randomly sampled from a corpus of approximately 30,000 definitions. 280 laypeople (crowdsource workers) were recruited; each layperson rated the understandability of 20 definitions. Understandability was rated on a 5-point scale. Using a generalized estimating equation model (GEE) we analyzed the relationship between understandability and age, sex, race/ethnicity, education level, native language, health literacy, and definition writer.

Results

Overall, 81.1 % (95 % CI: 76.5–85.7 %) of the laypeople reported that the definitions were understandable. Males were less likely to report understanding the definitions than females (OR: 0.73, 95 % CI: 0.63–0.84). Asians, Hispanics, and those who marked their race/ethnicity as “other” were more likely to report understanding the definitions than whites (Asians: OR: 1.43, 95 % CI: 1.17–1.73; Hispanics: OR: 1.86, 95 % CI: 1.33–2.59; Other: OR: 2.48, 95 % CI: 1.65–3.74). Laypeople whose native language was not English were less likely to report understanding the definitions (OR: 0.51, 95 % CI: 0.36–0.74). Laypeople with lower health literacy were less likely to report understanding definitions (health literacy score 3: OR: 0.51, 95 % CI: 0.43–0.62; health literacy score 4: OR: 0.40, 95 % CI: 0.29–0.55).

Conclusion

Understandability of definitions among laypeople was high. There were statistically significant race/ethnic differences in self-reported understandability, even after controlling for multiple demographics.

Public interest summary

We conducted a study to ensure that definitions written for the NoteAid EHR jargon identification tool are understandable. We recruited a diverse group of crowdsource workers and found that overall, the definitions were understandable, but understanding levels varied based on several demographic characteristics.