Reading Difficulty of Online Patient Education Materials for Procedures in Dermatology

Teaching patients about their health is an important responsibility of healthcare providers. However, easily finding health information online may affect patients’ behaviours and choices related to their health, even with established patient-physician relationships [1]. Additionally, many online educational resources for patients, known as ‘patient education materials’, are written at a level harder than sixth-grade reading, with grade level referring to the school year in US education [2]. Providing written information above the American Medical Association's recommended sixth-grade level limits who can use it to improve their health [2]. This is particularly important in dermatology, with social media trends influencing how people understand skin health [3, 4]. This study addresses the need to assess the reading difficulty of online educational information about procedures in dermatology. We conducted a cross-sectional study to determine the reading difficulty of articles for 10 common dermatologic procedures from 10 popular online resources/websites. The resources were chosen using Moz, an online tool that finds the most popular websites for certain searches. They include Mayo Clinic, Cleveland Clinic, SkinIO, American Society for Dermatologic Surgery (ASDS), HealthLine, WebMD, American Osteopathic College of Dermatology (AOCD), UMich Medicine, DermNet NZ and SkinSight. The 10 procedures were chosen based on relevant search results and article availability. They include Botulinum Toxin, Cryotherapy, Dermal Filler, Mohs Micrographic Surgery, Excision/Biopsy, Laser Therapy, Chemical Peels, Photodynamic Therapy (PDT), Microneedling, and Electrodesiccation/Electrocautery and Curettage (ED&C). Main text of each article was analysed by an online readability calculator, Readable. The program determined the Flesch–Kincaid Grade Level (FKGL) and Letter Grade Rating for each article. FKGL is an estimate of the US grade level needed to understand text based on words per sentences and syllables per word. Letter Grade Rating is a grade that shows how easy a text is for most people to understand, based on syllables per word, letters per word, and very long sentence count. Of the 100 articles sought, 87 relevant articles were available from the 10 predetermined sources. The 13 missing articles included microneedling (5), chemical peels (3), dermal fillers (2), botulinum toxin (1), laser therapy (1), and photodynamic therapy (1). Overall, the average FKGL was 9.19 (standard deviation [SD] = 2.00). Letter Grade Rating of “A” was given to 28% of articles, “B” to 34%, and “C” to 15%. Table 1 shows the average FKGL of each dermatologic procedure. There were no significant differences in reading difficulty based on procedure. Table 2 contains examples of complex text from the original articles, with revision suggestions. Previous work exploring reading difficulty of online articles from top Google results of common skin conditions found slightly lower scores (FKGL = 8.30 [SD = 1.84]) than that of common skin procedures in the present study (FKGL = 9.19 [SD = 2.00]) [5]. Procedures sometimes involve complex steps or technology, which may help explain this difference. In conclusion, we found that many popular online resources provide information about dermatology procedures that may be too difficult for some readers to understand. We provided text samples to highlight readability issues and proposed suitable alternative text. Clinicians can support these efforts by providing educational handouts of an appropriate reading level within their dermatology clinics and incorporating patient feedback. However, additional strategies are needed to ensure accurate and easy-to-understand information on skin procedures is widely available to those who rely on online sources. Many words per sentence Many advanced terms Suggestion: Simplify language Many words per sentence Suggestion: Use less words per sentence Many words per sentence Suggestion: Use less words per sentence Eleven words with 3+ syllables Suggestion: Use words with fewer syllables, if possible Many phrases with jargon Suggestion: Use less jargon to convey the same message Confusing terminology Suggestion: Be more literal to explain an advanced topic Confusing terminology Suggestion: Be more literal to explain an advanced topic Many words per sentence Suggestion: Split sentence into two Technical language Suggestion: Simplify language Long, complex sentence Suggestion: Simplify language Elizabeth Botto is responsible for the integrity of the work as a whole, from inception to publication. Elizabeth Botto, Nicole Natarelli, and Emily Coughlin made substantial contributions to the conception and design, as well as the acquisition, analysis, and interpretation of data. Elizabeth Botto drafted the article. Elizabeth Botto and Nicole Natarelli addressed revisions. Nicole Natarelli, Emily Coughlin, and Lilia Correa-Selm also critically revised the article for important intellectual content. Lilia Correa-Selm provided final approval for the published version. The authors have nothing to report. Dr. Correa is a consultant for Accutec Blades and Enspectra Health, a consultant and researcher for Novartis Pharmaceutical and a researcher for Pfizer. She also serves on the Advisory Board for the Jacinto Convit World Organization and the Dermatology Advisory for Melanoma Research Foundation. All other authors declare no conflicts of interest. The data that support the findings of this study are available from the corresponding author upon reasonable request.