Readability and Availability of English and Spanish Online Patient Education Materials for Cranioplasty

Background: Cranioplasty is a commonly performed reconstructive procedure to restore cranial integrity in patients with acquired skull defects after strokes, traumatic brain injury, and tumors, among other diagnoses. Given the procedure’s high complication rate and extensive perioperative planning, patient education is critical for informed decision-making. The American Medical Association (AMA) recommends that online patient education materials (OPEMs) be written at a sixth grade reading level to ensure equitable access to health information. Despite this, OPEMs for surgical interventions frequently exceed these recommendations. This study characterizes the readability and availability of English and Spanish-language OPEMs for cranioplasty. Methods: The top 20 English (“cranioplasty”) and Spanish (“craneoplastia”) OPEMs from Google searches were analyzed. English OPEMs were assessed using Flesch Reading Ease (FRE), Fry Graph (FG), Simple Measure of Gobbledygook (SMOG), and Gunning Fog Index (GFI). Spanish OPEMs were analyzed using Fernández-Huerta Reading Ease (FHRE), Gilliam-Peña-Mountain Grade Level (GPM), Spanish Orthographic Length (SOL), and Índice de Legibilidad de Flesch-Szigriszt (INFLESZ). Results: No OPEMs met the recommended sixth grade reading level. Among Spanish OPEMs, 55% (11) were written at the high school level and 45% (9) at a college level. Conversely, 35% (7) of English OPEMs were written at the high school level and 65% (13) at the college level. When adapted analog indices were compared across languages, Spanish OPEMs were on average easier to read than English OPEMs. No US healthcare institutions had Spanish OPEMs for cranioplasty and Spanish OPEMs were underrepresented among first-page search results (50%) relative to English OPEMs (70%). Conclusions: OPEMs for cranioplasty are written above recommended readability levels in both English and Spanish. Despite the United States’ large Spanish speaking patient population, no U.S. healthcare institutions currently have Spanish OPEMs for cranioplasty.