Written patient resources for complex endovascular aneurysm repair and challenging to read and understand

<h2>ABSTRACT</h2><h3>Background</h3> Health literacy is a critical mediator of cardiovascular risk factor control and outcomes^1–3. Complex Endovascular Aortic Aneurysm Repair (cEVAR) represents a challenging subject for providers to describe and for patients to understand. There have been no studies examining readability or understandability of patient-facing resources for cEVAR. In Canada, 49% of adults have a reading level below grade 12⁴. The 2024 United States National literacy Institute assessment reported a 21% illiteracy rate, with 54% of Americans reading below 6^th grade⁵. This provides a rationale for the recommendation of the National Institutes of Health and American Medical Association, that patient-facing educational resources fall below a 6^th grade reading level. <h3>Objective</h3> We hypothesized that the readability and understandability of patient-facing resources on cEVAR would exceed the national reading level of Canadians and Americans. <h3>Methods</h3> Two common electronic search engines were used to find patient-facing resources pertaining to cEVAR, resulting in 55 non-redundant resources. Plain text copies of each resource were assessed using the common readability indices Flesch-Kincaid Grade Level (FKGL), and Simple Measures of Gobbledygook (SMOG), and their understandability analyzed with the Patient Education Materials Assessment Tool (PEMAT) and PEMAT-Audiovisual Tool (PEMAT-AV). <h3>Results</h3> The FKGL generated a mean reading grade level of 9.3 ± 2.61, and SMOG generated a mean reading grade level of 11.9 ± 2.0. The mean PEMAT understandability percentage was 54.2 ± 19.0. By SMOG analysis, 45% of the resources (or 25 of 55 resources) required a grade 12 education. <h3>Conclusions</h3> Every resource examined was above the grade level recommendations of the CDC/NIH/AHA/AHRQ/AMA. On average, only 54% of any resource content was understandable. Limitations include the assumption that (1), health resources with appropriate literacy levels will generate changes in behaviour/outcomes of for patients with aneurysm disease, and (2) there is likely variable health literacy in the AAA patient population.