Readability of Online Patient Education Materials Related to

Pediatric Radiation Safety

Paul H Yi, MD, Meghan M Yi, BA, & Jie Nguyen, MD, MSDepartment of Diagnostic Radiology

University of Wisconsin-Madison

Disclosures

The authors have no financial disclosures relevant to this electronic exhibit.

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Introduction• Poor patient comprehension of healthcare education

materials could lead to low health literacy, worse clinical outcomes, and increased healthcare expenditures…

• ... especially for vulnerable groups such as pediatric patients.

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Introduction• Prior studies indicate that patient education materials from multiple fields of

medicine, including Radiology, are written at a level too high for the average patient.

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Goals & Objectives• The purpose of this study was to assess the readability of online patient

education materials related to pediatric radiation safety.

• Target Audience: Radiologists, both in clinical practice and in training

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Methods• All patient education articles related to Pediatric Radiation Safety

recommended on the websites of the Society of Pediatric Radiology, RadiologyInfo, and the American Academy of Pediatrics in 2016 were reviewed:• Radiology Info (www.radiologyinfo.org)• American Academy of Pediatrics (www.aap.org)• From the SPR website (www.spr.org):

• Image Gently (www.imagegently.org)• ALARA concept (Ped Rad White Paper Executive Summary)• National Cancer Institute (www.cancer.gov)• Cincinnati Children’s Hospital (www.cincinnatichildrens.org)• Health Physics Society (www.hps.org)• 3 articles on Airplane Scanner safety

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Methods• Follow-up editing was performed and one observer assessed each article with 6

separate readability scales:1. Flesch-Kincaid (FK) grade level2. Gunning-Fog Index3. Coleman-Liau Index4. Automated Readability Index5. Simple Measure of Gobbledygook (SMOG)6. Flesch Reading Ease

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Readability Tools

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Readability Tools

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Readability Interpretation

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Readability Interpretation

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Methods• A second observer evaluated a subset of articles in order to assess intraobserver and

interobserver reliability using intraclass correlation coefficients (ICC). • The number of articles with readability less than-or-equal to the 8th grade level

(average reading ability of US adults) and the 6th grade level (recommended level for patient education materials) were determined.

• Mean readability levels of each online source's articles were compared using ANOVA (significance set at p < 0.05).

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Results

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Mean Minmum Maximum

FKGL 13.2 8.4 20.8

Gunning-Fog Index 15.3 9.2 24.6

Coleman-Liau Index 13.4 9.2 18.3

ARI 12.6 8.1 18.8

SMOG 14.6 8.5 21.2

• 47 Articles were reviewed in total. • The mean readability grade level was greater than the 12th

grade reading level for all 5 readability scales using grade level.

Intra- and interobserver reliability of FK grade assessment were excellent!

Results

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• The mean readability grade level did not differ between the three sources of articles!

FKGL (Mean

[Range; SD])

Gunning-Fog Index

(Mean [Range; SD])

Coleman-Liau Index

(Mean [Range; SD])

ARI(Mean [Range;

SD])

SMOG(Mean [Range;

SD])

Flesch Reading Ease

(Mean [Range; SD])

RadiologyInfo 13.4(9.1 to 18.4; 2.3)

15.5(9.2 to 20.8; 2.8)

13.4(9.2 to 18.1; 2.0)

12.9(8.4 to 18.8; 2.5)

14.8(8.5 to 19.1; 2.0)

33.3(6.2 to 63.4; 12.2)

SPR-Recommended Websites

12.9(9.7 to 20.8; 3.7)

15.8(11.4 to 24.6; 4.2)

13.9(10.8 to 18.3; 2.4)

11.8(8.2 to 18.8; 3.4)

14.8(11.9 to 21.2; 3.1)

33.4(11.4 to 48.6; 12.1)

HealthyChildren.org 11.9(8.4 to 15.7; 3.1)

13.7(10.4 to 17.6; 3.6)

13.0(10.3 to 15.6; 2.4)

11.5(8.1 to 14.9; 3.4)

13.5(11.2 to 16.4; 2.2)

40.8(27.5 to 61.9; 13.9)

Results• No articles were < to the 8th grade level OR < to the 6th grade

level!

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Significance of Conclusions• The majority of online patient education materials related to pediatric radiation

safety are written at a level too high to be comprehended by the average patient.

• Future efforts should be made to improve the quality of such patient education materials, especially for vulnerable groups, such as the pediatric patient population.

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Thank You!Please address all correspondence to:

Paul H Yi, MDResident Physicianpyi2@uwhealth.org