Tran Bao Ngoc N, Singh Mansher, Lee Bernard T, Rudd Rima, Singhal Dhruv
Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
J Surg Res. 2017 Jun 1;213:251-260. doi: 10.1016/j.jss.2017.02.056. Epub 2017 Mar 6.
Over 72% of Americans use online health information to assist in health care decision-making. Previous studies of lymphedema literature have focused only on reading level of patient-oriented materials online. Findings indicate they are too advanced for most patients to comprehend. This, more comprehensive study, expands the previous analysis to include critical elements of health materials beyond readability using assessment tools to report on the complexity and density of data as well as text design, vocabulary, and organization.
The top 10 highest ranked websites on lymphedema were identified using the most popular search engine (Google). Website content was analyzed for readability, complexity, and suitability using Simple Measure of Gobbledygook, PMOSE/iKIRSCH, and Suitability Assessment of Materials (SAM), respectively. PMOSE/iKIRSCH and SAM were performed by two independent raters. Fleiss' kappa score was calculated to ensure inter-rater reliability.
Online lymphedema literature had a reading grade level of 14.0 (SMOG). Overall complexity score was 6.7 (PMOSE/iKIRSCH) corresponding to "low" complexity and requiring a 8th-12th grade education. Fleiss' kappa score was 80% (P = 0.04, "substantial" agreement). Overall suitability score was 45% (SAM) correlating to the lowest level of "adequate" suitability. Fleiss' kappa score was 76% (P = 0.06, "substantial" agreement).
Online resources for lymphedema are above the recommended levels for readability and complexity. The suitability level is barely adequate for the intended audience. Overall, these materials are too sophisticated for the average American adult, whose literacy skills are well documented. Further efforts to revise these materials are needed to improve patient comprehension and understanding.
超过72%的美国人使用在线健康信息来辅助医疗保健决策。先前关于淋巴水肿文献的研究仅关注在线患者导向材料的阅读水平。研究结果表明，这些材料对大多数患者来说过于高深，难以理解。这项更全面的研究扩展了先前的分析，使用评估工具报告数据的复杂性和密度以及文本设计、词汇和组织等健康材料的关键要素，而不仅仅局限于可读性。
使用最流行的搜索引擎（谷歌）确定淋巴水肿领域排名前十的网站。分别使用简明语言测量法（Simple Measure of Gobbledygook）、PMOSE/iKIRSCH和材料适用性评估（Suitability Assessment of Materials，SAM）对网站内容进行可读性、复杂性和适用性分析。PMOSE/iKIRSCH和SAM由两名独立评估者进行。计算Fleiss' kappa评分以确保评估者间的可靠性。
在线淋巴水肿文献的阅读年级水平为14.0（SMOG）。总体复杂性评分为6.7（PMOSE/iKIRSCH），对应“低”复杂性，需要八年级至十二年级的教育水平。Fleiss' kappa评分为80%（P = 0.04，“实质性”一致）。总体适用性评分为45%（SAM），与“充分”适用性的最低水平相关。Fleiss' kappa评分为76%（P = 0.06，“实质性”一致）。
淋巴水肿的在线资源在可读性和复杂性方面高于推荐水平。适用性水平对目标受众来说勉强足够。总体而言，这些材料对于美国普通成年人来说过于复杂，其识字技能已有充分记录。需要进一步努力修订这些材料，以提高患者的理解程度。
