Assessing the Readability of Online English and Spanish Language Patient Education Resources Provided By ASAPS, ASPS, and ASRM

Goals/Purpose: Low patient health literacy is linked to many poor health outcomes. Further, patient education can be impeded if the readability of education materials does not match the patient’s health literacy. Importantly, the greatest disparities in health literacy are present in minority groups and those patients who do not speak English as a first language. One study found that 74% of Spanish-speaking patients have less-than-adequate health literacy as compared to 7% of English-speaking patients. The National Institutes of Health (NIH) recognizes the importance of health literacy in patient education and recommends patient education materials (PEMs) be written at the 6th-7th grade level. However, PEMs online generally surpass recommended reading levels. The usefulness of online PEMs depends on their comprehensibility. This study assesses the readability of PEMs from national Plastic and Reconstructive Surgery (PRS) organization websites.

Methods/Technique: PEMs were collected from three prominent PRS organizations—American Society of Aesthetic Plastic Surgeons (ASAPS), the American Society of Plastic Surgeons (ASPS), and the American Society of Reconstructive Microsurgeons (ASRM). ASPS PEMs were organized into English, Spanish, cosmetic, and reconstructive groups. ASAPS and ASRM PEMs provided cosmetic and reconstructive comparison groups to ASPS, respectively. Readability scores were generated using the Simple Measure of Gobbledygook (SMOG) and the Spanish SMOG scales, which are the gold standards for assessing health care literature.

Results/Complications: Overall, all PEMs from national PRS organizations failed to meet NIH readability guidelines. ASPS English PEMs had an average reading level of 13.2 (university freshman); ASPS Spanish PEMs had an average reading level of 9.2 (high school freshman); ASAPS PEMs had an average reading level of 12.9 (university freshman); ASRM PEMs had an average reading level of 13.4 (university freshman). Within ASPS PEMs, Spanish PEMs were easier to read than English PEMs (p < 0.001) and cosmetic PEMs were easier to read than reconstructive PEMs (p < 0.05). There was no significant difference between ASPS cosmetic and ASAPS PEMs (p = 0.36), nor between ASPS reconstructive and ASRM PEMs (p = 0.65). There were no Spanish PEMs on the ASAPS and ASRM websites—92% of all ASPS PEMs were in English.

Conclusion: In 2013 out of thirty specialties, Blacam et al. ranked PRS lowest in public understanding of its role in patient care. Though national PRS organizations strive to better educate the public on the scope of PRS, laypersons are more familiar with cosmetic rather than reconstructive procedures. Notably, internet resources are increasingly important in patients’ search for information about reconstructive procedures before consulting with plastic surgeons. Yet, since Aliu et al. published their findings in 2010, online ASAPS PEMs still fail to meet recommended readability levels. Furthermore, Hispanics have disproportionately lower health literacy and are the second largest demographic to undergo PRS procedures. Despite this, there is a severe lack of Spanish-language PEMs in the three PRS organizational websites analyzed. It is important for our organizations to provide PEMs at recommended reading levels and provide equivalent Spanish-language PEMs to ensure online patient resources are equally readable and equitable for various patient populations. Additionally, offering a choice of PEMs at varying levels of readability may be a unique solution, as this allows patients to choose materials commensurate with their health literacy.