title: Accessibility of web sites containing colorectal cancer information to adults with limited literacy (United States).
abstract: OBJECTIVE
  The Internet could be a key channel for disseminating information about colorectal cancer (CRC) screening. Little research, however, has systematically examined factors other than writing style related to the reading difficulty of cancer information on the Internet. In the present study we assessed the reading difficulty of 19 CRC Web sites.
  
  
  METHODS
  We assessed pages within selected sites containing information on CRC screening or prevention using the SMOG readability formula and Suitability Assessment of Materials instrument.
  
  
  RESULTS
  The average SMOG reading grade level was 12.8. The SAM results indicated common problems with the sites, including (1) lack of review of key ideas; (2) insufficient use of illustrations for key messages; (3) crowded layout and long line lengths; (4) small type size and lack of cues to highlight key content; and (5) lack of interactive features.
  
  
  CONCLUSIONS
  Many Web sites providing CRC information may be too difficult for the average American adult and much too difficult for adults with limited literacy. The unique features of the Internet that could support learning are not being utilized. The Internet could be a powerful tool for educating individuals about CRC, but the barrier of difficult content must be addressed along with access barriers.
authors.affiliation: Center for Community-Based Research, Dana-Farber Cancer Institute, 44 Binney St., Boston, MA, 02115, USA. kkaphing@mail.nih.gov
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Kaphingst
authors.forename: Christine J
authors.initials: CJ
authors.lastname: Zanfini
authors.forename: Karen M
authors.initials: KM
authors.lastname: Emmons
mesh_terms: D022126:Access to Information; D000328:Adult; D015179:Colorectal Neoplasms; D004522:Educational Status; D006297:Health Services Accessibility; D006801:Humans; D033181:Information Dissemination; D020407:Internet