title: Readability, suitability, and health content assessment of web-based patient education materials on colorectal cancer screening.
abstract: BACKGROUND
  Colorectal cancer (CRC) screening rates in the Unites States are still below target level. Web-based patient education materials are used by patients and providers to provide supplemental information on CRC screening. Low literacy levels and patient perceptions are significant barriers to screening. There are little data on the quality of these online materials from a health literacy standpoint or whether they address patients' perceptions.
  
  
  OBJECTIVE
  To evaluate the readability, suitability, and health content of web-based patient education materials on colon cancer screening.
  
  
  METHODS
  Descriptive study.
  
  
  METHODS
  Web-based patient materials.
  
  
  METHODS
  Twelve reputable and popular online patient education materials were evaluated. Readability was measured by using the Flesch-Kincaid Reading Grade Level, and suitability was determined by the Suitability Assessment of Materials, a scale that considers characteristics such as content, graphics, layout/typography, and learning stimulation. Health content was evaluated within the framework of the Health Belief Model, a behavioral model that relates patients' perceptions of susceptibility to disease, severity, and benefits and barriers to their medical decisions. Each material was scored independently by 3 reviewers.
  
  
  METHODS
  Flesch-Kincaid Reading Grade Level score, Suitability Assessment of Materials score, health content score.
  
  
  RESULTS
  Readability for 10 of 12 materials surpassed the maximum recommended sixth-grade reading level. Five were 10th grade level and above. Only 1 of 12 materials received a superior suitability score; 3 materials received inadequate scores. Health content analysis revealed that only 50% of the resources discussed CRC risk in the general population and <25% specifically addressed patients at high risk, such as African Americans, smokers, patients with diabetes, and obese patients. For perceived barriers to screening, only 8.3% of resources discussed embarrassment, 25% discussed pain with colonoscopy, 25% addressed cost of colonoscopy, and none specifically mentioned the need to get colonoscopy when no symptoms are present. No material discussed the social benefits of screening.
  
  
  CONCLUSIONS
  Descriptive design.
  
  
  CONCLUSIONS
  Most online patient education materials for CRC screening are written beyond the recommended sixth-grade reading level, with suboptimal suitability. Health content is lacking in addressing key perceived risks, barriers, and benefits to CRC screening. Developing more appropriate and targeted patient education resources on CRC may improve patient understanding and promote screening.
authors.affiliation: Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Chenlu
authors.initials: C
authors.lastname: Tian
authors.affiliation: Department of Advertising and Public Relations, University of Texas at Austin, Austin, Texas, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Champlin
authors.affiliation: Department of Advertising and Public Relations, University of Texas at Austin, Austin, Texas, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Mackert
authors.affiliation: Department of Advertising and Public Relations, University of Texas at Austin, Austin, Texas, USA.
authors.forename: Allison
authors.initials: A
authors.lastname: Lazard
authors.affiliation: Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Deepak
authors.initials: D
authors.lastname: Agrawal
mesh_terms: D003113:Colonoscopy / Q000009:adverse effects / Q000191:economics; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D032882:Comprehension; D055088:Early Detection of Cancer; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy; D006801:Humans; D020407:Internet / Q000592:standards*; D010353:Patient Education as Topic / Q000379:methods / Q000592:standards*; D011932:Reading; D012307:Risk Factors