Readability of Patient Education Material on Ankle Arthroplasty

Category: Ankle; Ankle Arthritis Introduction/Purpose: Health literacy has recently gained attention in the literature as it has been consistently shown to be an important predictor of patient outcomes. Total ankle arthroplasty (TAA) has recently increased in popularity, and it tracks that patient education regarding this procedure should be comprehensive and easily understandable. However, few studies have examined online patient educational materials (PEMs) for TAA for easy consumption and comprehension among the general public. The purpose of this study was to assess the readability of total ankle arthroplasty PEMs found on the websites of the top 100 orthopedic hospitals in the United States. Methods: The top 100 ranked orthopedic hospitals were identified from the U.S. News and World Report website. Our search was performed on Google with the name of the hospital as listed on the report followed by the words “total ankle arthroplasty.” We stratified the hospital websites based on their ranking in the report and evaluated their websites using four unique validated readability assessment tools: Coleman-Liau Index, Flesch Reading Ease test, Flesch-Kincaid grade level, and Gunning Fog Index. Statistical analysis was conducted to compare readability scores between hospitals in the upper and lower 50th percentiles. Results: 56 unique websites were evaluated. There were no statistically significant differences in the readability outcomes across percentiles for the Coleman-Liau Index, Flesch-Kincaid, Gunning-Fog Index, and Flesch Reading Ease. The average scores were 11.87, 10.04, 12.93, and 50.04, respectively. 28% of websites were written at or below an 8th grade reading level. Higher ranked institutions had significantly higher word counts for TAA PEMs on average. There was no significant differences between higher and lower ranked hospital websites in the readability of TAA PEMs according to any of the four assessments. Conclusion: Our findings underscore a discrepancy between the readability of online PEMs on TAA and the average literacy level of the U.S. population. Despite the importance of health literacy in informed decision-making, most PEMs are written in language that may be inaccessible to many. Collaboration between healthcare professionals and patients is essential to develop clear and concise PEMs that bridge the literacy gap and empower patients to make informed healthcare decisions. Future efforts should focus on creating accessible materials using plain language techniques and incorporating patient feedback to ensure effectiveness in enhancing patient understanding and decision-making in the context of TAA.