UI Researcher Shows Web Medical Information Difficult To Read

March 03, 1999

IOWA CITY, Iowa -- People access the World Wide Web to obtain fast, easy-to-understand information. They don't want to turn to a dictionary to decipher what they are reading on any particular site.

But if individuals are looking up medical materials, they likely may need such assistance, according to a recent University of Iowa study.

Researchers led by Mark Graber, M.D., UI associate professor of family medicine and surgery, found that much of the medical information on the World Wide Web geared towards the general public is written at a reading level higher than is easily understood by much of the patient population. On average, the sampled Web medical information was written at a tenth-grade, second-month reading level.

Although the reading ability of patients varies widely, one previous study of patients with diabetes found that 60 percent of the patients could comprehend information written for a sixth grader while only 21 percent could understand material written at a ninth-grade level. Other studies have found a ninth-grade, eighth-month reading level in emergency department patients and a seventh- to eighth-grade reading level in cancer patients, patients in urban clinics and parents of pediatric patients at a university hospital.

"Physicians need to recognize this problem and learn to write at a level that patients can understand," Graber said. "Patient education is important. The more information patients have, the more they can participate in their health care. But when patients cannot understand the information, they can become frustrated or misinterpret the information and make wrong medical decisions as a result."

Graber is the first person to evaluate the readability of patient education materials on the Web. He decided to look at the issue because he realized that the medium was fast replacing yesterday's office-room pamphlets as the resource-of-choice for many people seeking medical information. One estimate revealed that there are currently 87 million regular Web users in North America. Of these, 50 percent have used the Web to look up medical information in the past year.

"Although it is true that the more educated individuals in our society currently have access to the Web, if Web information is to become universally accessible, it will need to be at a reading level that most people can comprehend," Graber said.

In addition, doctors are beginning to use the Web as a source of information for all patients, printing out materials from various sites. The unintended effect of this is that patients of all educational levels, Web users or not, are being expected to use information written at this higher level, Graber added.

Graber and his colleagues based their readability conclusion on an analysis of 50 sites. A researcher without Web experience searched for patient information using the Webcrawler and Excite search engines. The researcher's lack of Web-searching savvy prevented any inadvertent bias that could have resulted from visiting favorite sites. All 50 sites were intended for general public viewing. The information from the sites covered all aspects of family medicine -- including obstetrics and gynecology, pediatrics, internal medicine and psychiatry -- and came from commercial, academic government and professional organization sites, as well as those devoted to specific illnesses.

Graber used the Flesch reading score and the Flesch-Kinkaid reading level assessment to determine the readability level of the materials. The Flesch score and the Flesch-Kinkaid reading level assessment are two of the most widely used systems for scoring readability. The Flesch formula relies mainly on average sentence length and average number of syllables per word to estimate the reading difficulty. In the case of medical writing, it is possible that the readability formulas may underestimate the difficulty because even short words may be unfamiliar to the reader.

"Writers of information for the Web should be aware of the limited reading ability of much of the population and write accordingly," Graber said.

The UI study appeared in the January issue of the Journal of Family Practice.
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University of Iowa

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