Introduction
Prior to undergoing elective procedures, patients often access online resources to familiarize themselves with the surgical procedure and expected postoperative course. In order to be fully understood by the average adult in the United States, the American Medical Association (AMA) and National Institutes of Health (NIH) recommend that online health resources be written at or below the 6th grade reading level. Previous studies have examined the syntax reading grade level of educational materials in multiple orthopedic procedures, however reading grade level does not measure whether text is written such that readers can process key information (understandability) or identify available actions to take (actionability). The Patient Education Materials Assessment Tool (PEMAT-P) is a valid and reliable method to measure the understandability and actionability of online patient education materials. The purpose of this study was to evaluate online resources regarding elbow arthroscopy utilizing measures of readability, understandability, and actionability. It was hypothesized that current online resources would score poorly on these objective measures. Additionally, it was hypothesized that these measures would not correlate with the order of the listed search results (rank).
Methods
Patient education materials were identified using two independent online Google engine searches (Google.com) using the term “elbow arthroscopy”. From the top 50 results, websites were included if directed at educating patients regarding elbow arthroscopy. News articles, non-text material (audiovisual), journal articles, industry websites, and unrelated websites were excluded. The readability of included resources was quantified using Flesch-Kincaid Grade-Level (FKGL), a valid objective algorithm. The PEMAT-P instrument was utilized to assess actionability and understandability (0-100%). A PEMAT score of 70% or below is considered poorly understandable or poorly actionable.
Results
A total of 59 unique websites were identified of which 29 patient educational materials (49.1%) met inclusion criteria. The average FKGL was 12.6±2.8. The mean overall determined reading grade level corresponded to the first year of college (13th grade), with only one website (3.4%) scoring below the AMA/NIH recommended 6th grade reading level. Mean understandability and actionability scores were 65.2%±8.5 and 46.2%±25.1, respectively, falling below the 70% PEMAT score threshold for both scales. Nine websites (31.0%) were above the threshold for understandability, while only four resources (13.8%) scored above the 70% threshold for actionability.
Conclusion
Overall, publicly available online patient education materials related to elbow arthroscopy scored poorly with respect to readability, understandability, and actionability. Only one patient education websites scored at the AMA and NIH recommended reading level. Nine websites scored above the 70% PEMAT score on understandability, while only four websites met the threshold for actionability. If online resources are misunderstood due to poor readability, understandability, or actionability, these resources may lead to poor decision making by patients. Future efforts should be made to improve online resources in order to optimize patient knowledge and facilitate informed decision-making.