title: Online patient resources for breast reconstruction: an analysis of readability.
abstract: BACKGROUND
  Online resources for health information are commonly used by many patients. The discrepancy between functional health literacy and available patient information is recognized as an important contributor to health disparities. To provide understandable patient information, the National Institutes of Health and the American Medical Association have advised that health literature for patients be written at a sixth-grade reading level. This study identifies the most popular, online, patient-targeted resources for breast reconstruction information, and evaluates readability of these sites in the context of literacy in the United States.
  
  
  METHODS
  A Web search for "breast reconstruction" was performed using the two largest Internet search engines, and the top 10 websites common to both were identified. Patient-targeted content was downloaded from all relevant articles immediately available from the main sites. A total of 114 articles were assessed for readability using 10 established analyses. Readability scores were also calculated for the groups of articles arranged by website for comparison.
  
  
  RESULTS
  The average reading level was 11.5 across all evaluated sites (Coleman-Liau, 11.8; Flesch-Kincaid, 10.9; FORCAST, 10.7; Fry, 12; Gunning Fog, 12.7; New Dale-Chall, 10.6; New Fog Count, 9.7; Raygor Estimate, 12; and Simple Measure of Gobbledygook, 13). Readability comparison by individual website demonstrated disparity in average reading level from 9.7 to 14.9.
  
  
  CONCLUSIONS
  Online patient resources for breast reconstruction exceed recommended reading levels and are too difficult to be understood by a large portion of the population. Significant variability between sites provides an opportunity to direct patients to appropriate websites for their level of health literacy.
authors.affiliation: Boston, Mass. From the Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School.
authors.forename: Christina R
authors.initials: CR
authors.lastname: Vargas
authors.forename: Pieter G L
authors.initials: PGL
authors.lastname: Koolen
authors.forename: Danielle J
authors.initials: DJ
authors.lastname: Chuang
authors.forename: Oren
authors.initials: O
authors.lastname: Ganor
authors.forename: Bernard T
authors.initials: BT
authors.lastname: Lee
mesh_terms: D054626:Consumer Health Information / Q000706:statistics & numerical data*; D005260:Female; D057220:Health Literacy; D006297:Health Services Accessibility; D006801:Humans; D020407:Internet; D016462:Mammaplasty; D011932:Reading; D014481:United States