Abstracts

Rationale: Health literacy is defined as the degree to which individuals can obtain, process and understand basic health information and services needed to make appropriate health decisions. Based on the 2003 US National Assessment of Adult Literacy, 63 million people (22%) have a literacy level rated as “basic” and 30 million people (14%) are “below basic”. A recent Pew survey estimated that 80% of adult internet users (93 million people) have searched for at least one major health topic online. The Institute of Medicine and the U.S. Department of Education have recommended that health related information be written at the 6th to 8th grade level. The national Epilepsy Foundation website was evaluated by our group using objective measures of readability and the average web page was written between the 11th and 12th grade level. Only 6% of web pages were written at a 6th grade reading level or below and only 16.5% were at 8th grade or below. Persons with epilepsy will likely benefit more from appropriately written web-based and printed health education resources. Methods: Two online programs were used to assess the reading level of the epilepsy.com website (www.epilepsy.com) using established readability formulas. The Forecast score (a new tool for assessing websites), Flesch-Kincaid (FK) reading grade level, Simple Measure of Gobbledygook (SMOG) and the Flesch Reading Ease (FRE) were conducted. Educational content from epilepsy.com was divided into eight sections based on the website: all about epilepsy and seizures, diagnosis, treatment, families/caregivers, living with epilepsy, specific populations (kids, teens, women and seniors), resources and seizure preparedness. Results: A total of 1,328 web pages on the www.epilepsy.com were evaluated. Mean grade level (sd) results were 11.7 (0.8), 11.1(2.9) and 12.9 (2.5) for the Forcast, Flesch-Kincaid and SMOG assessments respectively. Separate analyses of content written at three levels (basic, intermediate and professional) for each anti-epileptic drug (AED) were significantly different: FK (F = 50.15, p < 0.000). While differences here are to be expected, the mean (sd) FK grade level of 10.3 (2.1) for the “basic” content is much higher than recommended levels (6-8th grade). A set of pdf-based AED educational handouts designed to be printed for patients have 8th grade level FK assessments and appear suitable for more patients than the web based content. By the Flesch Reading Ease assessment, only 3.3% of epilepsy.com web pages had a 6th grade reading level or below and 15.4% were below an 8th grade level. Similar results have been found in previous reviews of health websites and printed education brochures. Conclusions: The epilepsy.com website contains a significant amount of content that is not appropriate for those with marginal health literacy. With up to 36% of US adults having poor health literacy, editorial changes are needed to bring the information to suggested levels, especially if content from the website is to be recommended or printed for patients in the clinic setting.