I. O. Falade2, J. Wilson2, M. Mehari2, D. Soroudi2, S. Song1, E. Kim1 1University Of California – San Francisco, Department Of Plastic & Reconstructive Surgery, San Francisco, CA, USA 2University Of California – San Francisco, School Of Medicine, San Francisco, CA, USA
Introduction
In the United States, acute and chronic wound care management represents an annual expenditure of up to $97 billion. With over 5,000 treatment modalities, patients require adequate education to make informed decisions about their treatment options, and often use the Internet as a source of guidance. However, online patient education materials have historically been at higher reading levels than the average health literacy level of the 8th grade. Therefore, elucidating the relationship between digital health literacy and online education materials is crucial in improving patient care. This study aims to assess the readability and language accessibility of online wound care materials in relation to the average adult literacy level.
Methods
A comprehensive Internet search was conducted on Google for terms related to wound care strategies. The first 12 unique websites from each search strategy were selected for further analysis. Readability was assessed utilizing 11 readability tests from the Readability Studio software (Oleander Software Solutions Ltd.). The means of each readability test were calculated and articles were categorized based on website classification for subsequent analysis.
Results
A total of 66 articles pertaining to wound care strategies were downloaded from 43 websites. All articles had an average reading grade level of 13.5 (± 2.5) and an average reading age of 18.7 (± 2.5). Websites were categorized by the following sources: academic (34.9%), reagent and biologic manufacturers (27.9%), wound care (18.6%), news media organizations (14%), and non-academic (4.7%). Academic websites were available in the most languages compared to all other website categories (p < 0.01). Furthermore, Flesch Reading Ease Score (FRES), graded from 0 for most difficult to 100 for least difficult, was found to be highest for academic websites (44.2, p=0.01) and lowest for news media websites (24.9, p=0.01).
Conclusion
Online materials related to wound care strategies far exceed the 8th grade National Institute of Health (NIH) recommended reading levels, potentially preventing patients from actively participating in shared decision-making. Despite being the easiest to read, materials published by academic websites still failed to reach the suggested reading levels (FRES 60). This study highlights the need for healthcare professionals to produce educational materials at appropriate health literacy levels. Wound care websites should not only decrease the complexity of their educational materials, but also provide greater language accessibility. With the growing disparity in health literacy across the country, improving the readability of online patient education materials will be an essential step in optimizing patient care.