M. A. Kugar1, A. C. Cohen1, W. Wooden1, S. S. Tholpady1, M. Chu1 1Indiana University School Of Medicine,Indianapolis, IN, USA
Introduction: Patient education, increasingly achieved with online resources, is an essential component of patient satisfaction and clinical outcomes. The average American adult reads at a seventh-grade level, yet due to the complexity of medical information the National Institute of Health (NIH) and the American Medical Association (AMA) recommend that information be written at a sixth-grade reading level. Because mental illness and limited literacy commonly co-occur, appropriate levels of readability in mental health and psychosocial wellness resources are of great importance. In this study, we investigated the readability of mental health resources currently available through the Veterans Health Administration (VA) web site and the web sites of the 2016-2017 Best Hospitals for Psychiatry according to U.S. News and World Report.
Methods: An internet search was performed to identify patient information on mental health from the VA (the VA Health Library Encyclopedia and the VA Mental Health Website) and the top psychiatric hospitals. Seven mental health topics were included in the analysis: generalized anxiety disorder (GAD), bipolar, major depressive disorder, post-traumatic stress disorder, schizophrenia, substance abuse, and suicide. Readability analyses were performed using the Flesch Reading Ease score, Gunning Fog, Flesch-Kincaid Grade Level, the Coleman-Liau Index, the SMOG Index, Automated Readability Index, and the Lisear Write Formula, all of which were combined into a Readability Consensus score. A 2-sample T-test was used to compare mean readability scores and statistical significance was set at p < 0.05.
Results: Twelve of the Best Hospitals for Psychiatry 2016-2017 were identified. Nine had educational material. Six of the nine cited the same resource, The StayWell Company, LLC, for at least one of the mental health topics analyzed. The VA Mental Health web site (http://www.mentalhealth.va.gov) had a significantly higher Readability Consensus than six of the top psychiatric hospitals (p<0.05, p=0.0067, p=0.019, p=0.041, p=0.0093, p=0.0054, p=0.0093). The overall average Readability Consensus for mental health information was 9.55.
Conclusion: Online resources for mental health disorders are more complex than recommended by the NIH and AMA. Efforts to improve readability of mental health and psychosocial wellness resources could benefit patient understanding and outcomes, and are of particular importance in a population with a high occurrence of low literacy. Surgical outcomes are correlated with patient mental health and psychosocial wellness. Thus, surgical outcomes can be improved with more appropriate levels of readability of psychosocial wellness resources.