title: Improving the readability of online foot and ankle patient education materials.
abstract: BACKGROUND
  Previous studies have shown the need for improving the readability of many patient education materials to increase patient comprehension. This study's purpose was to determine the readability of foot and ankle patient education materials and to determine the extent readability can be improved. We hypothesized that the reading levels would be above the recommended guidelines and that decreasing the sentence length would also decrease the reading level of these patient educational materials.
  
  
  METHODS
  Patient education materials from online public sources were collected. The readability of these articles was assessed by a readability software program. The detailed instructions provided by the National Institutes of Health (NIH) were then used as a guideline for performing edits to help improve the readability of selected articles. The most quantitative guideline, lowering all sentences to less than 15 words, was chosen to show the effect of following the NIH recommendations.
  
  
  RESULTS
  The reading levels of the sampled articles were above the sixth to seventh grade recommendations of the NIH. The MedlinePlus website, which is a part of the NIH website, had the lowest reading level (8.1). The articles edited had an average reduction of 1.41 grade levels, with the lowest reduction in the Medline articles of 0.65.
  
  
  CONCLUSIONS
  Providing detailed instructions to the authors writing these patient education articles and implementing editing techniques based on previous recommendations could lead to an improvement in the readability of patient education materials.
  
  
  CONCLUSIONS
  This study provides authors of patient education materials with simple editing techniques that will allow for the improvement in the readability of online patient educational materials. The improvement in readability will provide patients with more comprehendible education materials that can strengthen patient awareness of medical problems and treatments.
authors.affiliation: Division of Orthopaedics, University of Alabama at Birmingham School of Medicine, Trussville, AL, USA.
authors.forename: Evan D
authors.initials: ED
authors.lastname: Sheppard
authors.affiliation: Division of Orthopaedics, University of Alabama at Birmingham School of Medicine, Trussville, AL, USA.
authors.forename: Zane
authors.initials: Z
authors.lastname: Hyde
authors.affiliation: Division of Orthopaedics, University of Alabama at Birmingham School of Medicine, Trussville, AL, USA.
authors.forename: Mason N
authors.initials: MN
authors.lastname: Florence
authors.affiliation: Division of Orthopaedics, University of Alabama at Birmingham School of Medicine, Trussville, AL, USA.
authors.forename: Gerald
authors.initials: G
authors.lastname: McGwin
authors.affiliation: Division of Orthopaedics, University of Alabama at Birmingham School of Medicine, Trussville, AL, USA.
authors.forename: John S
authors.initials: JS
authors.lastname: Kirchner
authors.affiliation: Division of Orthopaedics, University of Alabama at Birmingham School of Medicine, Trussville, AL, USA bponce@uabmc.edu.
authors.forename: Brent A
authors.initials: BA
authors.lastname: Ponce
mesh_terms: D000842:Ankle; D032882:Comprehension; D054626:Consumer Health Information / Q000379:methods*; D005260:Female; D005534:Foot Diseases; D057220:Health Literacy; D006801:Humans; D020407:Internet; D008297:Male; D020380:Needs Assessment; D009985:Orthopedics; D010353:Patient Education as Topic / Q000379:methods*; D058996:Quality Improvement; D013664:Teaching Materials / Q000600:supply & distribution; D014481:United States
keywords: ankle; foot; lower extremity; patient education material; readability