Readability assessment of online gynecologic oncology patient education materials from major governmental, non-profit and pharmaceutical organizations

Objective: Patients are increasingly using online materials to learn about gynecologic cancer. Providers can refer patients to online educational materials produced by a number of different major medical organizations and pharmacology companies. The National Institutes of Health (NIH) and the American Medical Association (AMA) recommend that patient educational materials (PEMs) are written between a sixth and eighth grade reading level. In this study, we assess the readability of online PEMs published by major medical organizations and industry partners. Methods: Websites from twelve websites providing educational materials for gynecologic oncology patients were surveyed. Online PEMs were identified and analyzed using seven validated readability indices. One-way ANOVA and Tukey's Honestly Significant Difference (HSD) post-hoc analysis were performed to detect differences in readability between publishers. Results: Two-hundred and sixty PEMs were included in this analysis. Overall, PEMs were written at a mean 11th ± 0.6 grade reading level. Only 6.5% of articles were written at the AMA/NIH recommended reading grade level of 6th to 8th grade or below. ANOVA demonstrated a significant difference in readability between publishing associations (p < 0.01). PEMs from the Centers for Disease Control had a mean 9th ± 1.2 grade reading level and were significantly lower than all other organizations. PEMs from The Foundation for Women's Cancer had a mean 13th ± 1.8 grade reading level and were significantly higher than most other organizations. PEMs from pharmaceutical companies (mean readability = 10.1 ± 1.1, N = 30) required the lowest reading grade level and were significantly more readable than those from governmental organizations (11.1 ± 1.7, p < 0.05) and nonprofit medical associations (12.4 ± 1.7, p < 0.01) in ANOVA and Tukey-Kramer post hoc analysis. Conclusions: Gynecologic oncology PEMs available from twelve major organization websites are written well above the recommended sixth to eighth grade reading difficulty level.