Readability Assessment of Internet-based Patient Education Materials Related to Mammography for Breast Cancer Screening

Rationale and Objectives: The US Department of Health and Human Services (USDHHS) recommends that Internet-based patient education materials (IPEMs) be written below the sixth-grade reading level to target the average American adult. This study was designed to determine the readability of IPEMs regarding mammography for breast cancer screening. Materials and Methods: Three-hundred mammography-related Web sites were reviewed for IPEMs. Forty-two IPEMs that met the Health on the Net Foundation Code of Conduct were assessed for readability level with four readability indices that use existing algorithms based on word and sentence length to quantitatively analyze Internet sources for language intricacy including the following: Flesch-Kincaid Grade Level (FKGL), Flesch Reading Ease Score (FRES), Simple Measure of Gobbledygook (SMOG), and Gunning Frequency of Gobbledygook (Gunning FOG; GFOG). Results were compared to national recommendations, and intergroup analysis was performed. Results: No IPEMs (0%) regarding mammography were written at-or below the sixth-grade reading level, based on FKGL. The mean readability scores were as follows: FRES, 49.04 +/- 10.62; FKGL, 10.71 +/- 2.01; SMOG, 13.33 +/- 1.67; and Gunning FOG, 14.32 +/- 2.18. These scores indicate that the readability of mammography IPEMs is written at a "difficult" level, significantly above the recommended sixth-grade reading level (P < .05) determined by the USDHHS. Conclusions: IPEMs related to mammography are written well above the recommended sixth-grade level and likely reflect other IPEMs in diagnostic radiology.