Abstracts

Rationale: The use of the internet for health-related questions is increasing but it is not clear whether individuals can understand the information available online. Most health organizations recommend that health educational materials (HEMs) be written <6th grade reading level. This study was designed to evaluate the readability level of available online HEMs pertaining to traumatic brain injury (TBI), epilepsy and post-traumatic epilepsy (PTE). Methods: This cross-sectional readability assessment included HEMs from TBI and epilepsy stakeholder organizations and those obtained from four internet searches. The search strategy was designed to replicate a non-medical individual’s keyword searches. Each HEM was assessed with an online automated readability tool using three indices [Flesch Reading Ease Score, Flesch–Kincaid Grade Level and Simple Measure of Gobbledygook]. Findings were compared as a function of organization type (journalistic news or health organization), targeted medical condition (TBI, epilepsy or PTE), or content topic (patient health education, clinical research education, or both). Results: Readability analysis of 405 identified HEMs revealed scores >6th grade reading level recommendation. Only 6.2% of individual HEMs met the 6th grade recommendation. Journalistic news organizations’ HEMs had similar readability levels to health organizations’ HEMs. PTE-related HEMs required the highest readability level, above the 11th grade (p<0.001). There were significant differences in the readability scores (p<0.01 for all indices) among HEMs with information either on health education, research education, or both topics. The highest required readability level (>12th grade level) was for HEMs that included both health and research education. Conclusions: The majority of TBI, epilepsy and PTE-related online HEMs do not meet the 6th-grade reading recommendations. Improving the readability of HEMs may advance health literacy around TBI, epilepsy and PTE leading to effective participant recruitment/retention strategies for future antiepileptogenesis trials in persons with TBI and perhaps better patient-centered outcomes. Funding: This work is supported in part by the NIH 1U54NS100064 grant and by NIH/National Center for Advancing Translational Science (NCATS) Einstein-Montefiore CTSA Grant Number UL1TR001073. Daniel J. Correa, MD MSc also received tuition funding and support from the US Army Post 9/11 G.I. Bill (Serviceman's Readjustment Act).