Background The internet has become a valuable source for patient education material. Patients are increasingly seeking health information on the web. Within all specialties, including rheumatology, health care providers are increasingly referring patients to reputable websites to obtain further knowledge with regards to their rheumatolgical conditions. Available evidence suggests many patients find internet educational material difficult to understand. Expert opinion recommends that patient educational material readability levels should be at grade six equivalent or less, ideally not exceeding the grade 8 level. Analysis of online Rheumatological patient related material is lacking and to the best of our knowledge, no previous studies have been published on the readability of online Ankylosing Spondylitis (AS) patient education material.
Objectives The aim of our study is to assess the readability of Ankylosing Spondylitis patient education material available online and to compare it to the recommended readability standards.
Methods Ten reputable and publically accessible websites were chosen for this study. The material was accessed in October 2014. The readability of their AS text was then individually assessed using Microsoft Word® 2010 version to calculate their reading grades and reading ease using the validated Flesch-Kincaid grade level formula (FKGL) and the Flesch-reading ease scores (FRES). To measure reliability of our results, two independent researchers scored the chosen websites using two different computers and the intraclass correlation coefficient (ICC) was calculated. A comparison of the mean FKGL with the recommended readability level was done using unpaired t-test was used.
Results The Mean ± SD grade level readability of the selected AS text of all the ten websites was 10.1±2.1 (Table 1). All but two of the articles had a readability score above the sixth-grade level. No articles were below grade 6, with only 20% articles just reaching grade 6 level (6.7 and 6.9), also the only two articles with readability below grade 8 level (Figure 1). The remaining 80% exceeded the recommended readability. Readability of the articles exceeded the maximum recommended level by a mean ± SD of 4.1±2.12 grade levels (95% Cl, 2.8-5.42, P<0.0001).
The FRES mean ± SD for all the articles was 51.74±11.19 (95% CI, 44.8 to 58.68). The FRES is scored from 0 to 100, the higher the score, the easier to read. The ICC was 1 indicating the website scores obtained were in perfect agreement.
Conclusions The majority of the assessed online Ankylosing Spondylitis patient educational material exceeded the recommended reading levels. This has the potential for making comprehension difficult for a substantial number of patients referred to these websites. Our study suggests that more effort needs to be applied to make online AS educational material easier to read.
Disclosure of Interest None declared