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 (NAAL) 63 million people (22%) have a literacy level rated as “basic” and 30 million people (14%) are “below basic”. Minorities and the elderly have the highest rates of basic or below basic health literacy. The Institute of Medicine recommends that health related information be written at < 6th grade level. One previous study found 9th grade reading levels for printed educational materials for epilepsy. Since web based health information is being accessed by > 50 million people, a reading level assessment of the National Epilepsy Foundation of America website would be useful. Methods: Two online programs were used to assess the reading level of the National Epilepsy Foundation (EF) website (www.epilepsyfoundation.org) using established readability formulas. The Flesch-Kincaid (FK) reading grade level and the SMOG were utilized primarily. The Forecast score (a new tool for assessing websites that contain content not in sentence form such as images, links and lists) and the Flesch Reading Ease (FRE) were also conducted. Text from “Understanding Epilepsy” and “Living with Epilepsy” was analyzed; text written for health professionals was excluded.Results: One hundred and seventy-six web links were evaluated; 133 under “Understanding Epilepsy” and 43 under “Living with Epilepsy”. The mean (sd) grade level of all the links was 11.2 (2.5), 12.6 (1.9) and 11.3 (0.8) for the FK, SMOG and Forcast. The grade level range was 5.6-25.7, 7.5-20.3 and 8.6-13.4 for the FK, SMOG and Forcast. The Forcast score was highly correlated with the FK (r =.54, p =.000) and the SMOG (r = .63, p =.000) demonstrating potential validity for web-based material. One-way ANOVA comparing “Understanding Epilepsy” and “Living with Epilepsy” found no significant differences for the FK, SMOG and the FRE level; for the Forcast tool, there was a significant difference (F = 8.68, p =.004). FRE scores ranged from 5.4 to 78.0, with a mean (sd) score of 46.9 (13.1) which is considered college level. Only 4 EF web pages had a FK reading level < 6.8 (equivalent to a 6th grade rating). For the other assesments, zero web pages had < 6th grade reading level. Similar results have been found in previous reviews of cancer websites and printed pediatric educational brochures for parents.Conclusions: The National Epilepsy Foundation website contains a significant amount of health content that may not be appropriate for patients with marginal health literacy. With up to 36% of US adults having poor health literacy, major editorial changes are needed to bring the information to the recommended reading level, especially since content from the EF website is used for patients and printed for patients in the clinic setting.