Readability of Online Patient Resources for Head & Neck Procedures

Background:  Patient education is essential in enhancing the therapeutic alliance, patient satisfaction, and clinical outcomes.  The NIH and AMA recommend that information be written at a sixth-grade reading level [1,2]; however, online resources often exceed patient literacy.  The purpose of this study is to assess readability of online material for facial procedures found on academic plastic surgery and otolaryngology websites.

Methods:  An internet search was performed of all academic hospitals that had both plastic surgery and otolaryngology training programs.  An average word and syllable count was performed for each procedure. Readability analyses were performed using the Flesh-Kincaid Grade Level, SMOG Index, Gunning-Fog Score, Automated Readability Index, and Coleman-Liau Index.  National society websites for both plastic surgery and otolaryngology were used as controls.  A two-tailed z-test was used to compare scores, and statistical significance was set at p < 0.05.

Results:  Sixty-three programs were identified, and 42 had educational material.  The national plastic surgery website had a significantly higher word count and number of syllables per word compared to the national otolaryngology website (p < 0.001, p = 0.04).The overall average readability for all information was at a 10^th grade reading level, and the average Flesch-Kincaid readability score was 10.4 and 10.5 for plastic surgery and otolaryngology, respectively (p=0.45).

Conclusion:  Online resources for facial procedures are more complex than the recommended reading levels.  This represents an obstacle to online patient education, and attention to this aspect of patient education could benefit patients seeking medical information online.