A Comparative Health Literacy Analysis of Online Carpal Tunnel Syndrome Resources Available in English and Spanish

BACKGROUND: The internet has become an increasingly popular medium for consumers to obtain health information. Hispanics comprise the fastest growing minority group in the United States. Studies show that this demographic is increasingly utilizing the internet to obtain health information. However, it is unknown whether appropriate patient health materials for this patient population are keeping pace. Spanish-speaking Hispanics have lower health literacy levels which may preclude them from actively engaging in the decision-making process for their condition. There remains a paucity of materials evaluating existing online resources and their adequacy for patients with a lower health literacy levels. The aim of this study was to evaluate and compare online materials provided in both English and Spanish for carpal tunnel surgery, the most commonly performed hand surgery procedure using a multi-metric approach to assess readability, understandability, actionability, and cultural sensitivity.

METHODS: A web search using the English term “carpal tunnel surgery” was performed. The first 10 highest ranked institutional/organizational websites that provided carpal tunnel surgery information in English and Spanish were identified. All relevant online materials were evaluated using the SOL (Simplified Measure of Gobbledygook, Spanish), Patient Education and Materials Assessment for Understandability and Actionability (PEMAT), and Cultural Sensitivity Assessment Tool (CSAT) to assess readability, understandability, actionability, and cultural sensitivity, respectively. A Cohen’s kappa score was calculated to assess inter-rater reliability.

RESULTS: The average reading level of online English carpal tunnel surgery materials was greater than that for Spanish materials (p=0.011). However, Spanish materials included more complex words compared to English materials (p<0.001). No individual website was written at the recommended 6^th reading grade level. There were no statistically significant differences in understandability or actionability. Average CSAT scores for Spanish materials were significantly lower than English materials, indicating poor cultural sensitivity (p=0.015). Cohen’s kappa was >0.81, indicating substantial agreement between raters.

CONCLUSION: Online patient-directed information regarding carpal tunnel surgery exceeded the recommended reading grade level for both English and Spanish-speaking populations and were difficult to understand. Most Spanish materials were often direct translations and were not contoured to the literacy needs of this demographic. Institutions must caution their authors to tailor their web material in a way that is sensitive to their target population to optimize comprehension and engagement in the care process.