Department of Medicine, Roger Williams Medical Center, Providence, RI, USA.
Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Providence, RI, USA; Lifespan Biostatistics, Epidemiology, and Research Design, Providence, RI, USA.
Breast. 2024 Jun;75:103722. doi: 10.1016/j.breast.2024.103722. Epub 2024 Apr 3.
Online patient education materials (OPEMs) are an increasingly popular resource for women seeking information about breast cancer. The AMA recommends written patient material to be at or below a 6th grade level to meet the general public's health literacy. Metrics such as quality, understandability, and actionability also heavily influence the usability of health information, and thus should be evaluated alongside readability.
A systematic review and meta-analysis was conducted to determine: 1) Average readability scores and reporting methodologies of breast cancer readability studies; and 2) Inclusion frequency of additional health literacy-associated metrics.
A registered systematic review and meta-analysis was conducted in Ovid MEDLINE, Web of Science, Embase.com, CENTRAL via Ovid, and ClinicalTrials.gov in June 2022 in adherence with the PRISMA 2020 statement. Eligible studies performed readability analyses on English-language breast cancer-related OPEMs. Study characteristics, readability data, and reporting of non-readability health literacy metrics were extracted. Meta-analysis estimates were derived from generalized linear mixed modeling.
The meta-analysis included 30 studies yielding 4462 OPEMs. Overall, average readability was 11.81 (95% CI [11.14, 12.49]), with a significant difference (p < 0.001) when grouped by OPEM categories. Commercial organizations had the highest average readability at 12.2 [11.3,13.0]; non-profit organizations had one of the lowest at 11.3 [10.6,12.0]. Readability also varied by index, with New Fog, Lexile, and FORCAST having the lowest average scores (9.4 [8.6, 10.3], 10.4 [10.0, 10.8], and 10.7 [10.2, 11.1], respectively). Only 57% of studies calculated average readability with more than two indices. Only 60% of studies assessed other OPEM metrics associated with health literacy.
Average readability of breast cancer OPEMs is nearly double the AMA's recommended 6th grade level. Readability and other health literacy-associated metrics are inconsistently reported in the current literature. Standardization of future readability studies, with a focus on holistic evaluation of patient materials, may aid shared decision-making and be critical to increased screening rates and breast cancer awareness.
在线患者教育材料（OPEM）是女性寻求乳腺癌信息的日益流行的资源。AMA 建议书面患者材料的水平应达到或低于 6 年级，以满足公众的健康素养。质量、可理解性和可操作性等指标也极大地影响健康信息的可用性，因此应与可读性一起进行评估。
进行了系统评价和荟萃分析，以确定：1）乳腺癌可读性研究的平均可读性评分和报告方法；2）纳入其他与健康素养相关指标的频率。
2022 年 6 月，按照 PRISMA 2020 声明，在 Ovid MEDLINE、Web of Science、Embase.com、CENTRAL 通过 Ovid 和 ClinicalTrials.gov 进行了注册系统评价和荟萃分析。合格的研究对英语乳腺癌相关 OPEM 进行了可读性分析。提取研究特征、可读性数据和非可读性健康素养指标的报告。从广义线性混合模型中得出荟萃分析估计值。
荟萃分析纳入了 30 项研究，共纳入 4462 项 OPEM。总体而言，平均可读性为 11.81（95%CI[11.14,12.49]），按 OPEM 类别分组时存在显著差异（p<0.001）。商业组织的平均可读性最高，为 12.2[11.3,13.0]；非营利组织的可读性最低，为 11.3[10.6,12.0]。可读性也因索引而异，New Fog、Lexile 和 FORCAST 的平均得分最低（9.4[8.6,10.3]、10.4[10.0,10.8]和 10.7[10.2,11.1]）。只有 57%的研究使用两个以上指数计算平均可读性。只有 60%的研究评估了其他与健康素养相关的 OPEM 指标。
乳腺癌 OPEM 的平均可读性几乎是 AMA 推荐的 6 年级水平的两倍。目前文献中可读性和其他与健康素养相关的指标报告不一致。未来可读性研究的标准化，重点是对患者材料进行全面评估，可能有助于共同决策，并对提高筛查率和乳腺癌意识至关重要。
