title: Most American Academy of Orthopaedic Surgeons' online patient education material exceeds average patient reading level.
abstract: BACKGROUND
  Advancing health literacy has the potential to improve patient outcomes. The American Academy of Orthopaedic Surgeons' (AAOS) online patient education materials serve as a tool to improve health literacy for orthopaedic patients; however, it is unknown whether the materials currently meet the National Institutes of Health/American Medical Association's recommended sixth grade readability guidelines for health information or the mean US adult reading level of eighth grade.
  
  
  OBJECTIVE
  The purposes of this study were (1) to evaluate the mean grade level readability of online AAOS patient education materials; and (2) to determine what proportion of the online materials exceeded recommended (sixth grade) and mean US (eighth grade) reading level.
  
  
  METHODS
  Reading grade levels for 99.6% (260 of 261) of the online patient education entries from the AAOS were analyzed using the Flesch-Kincaid formula built into Microsoft Word software.
  
  
  RESULTS
  Mean grade level readability of the AAOS patient education materials was 9.2 (SD ± 1.6). Two hundred fifty-one of the 260 articles (97%) had a readability score above the sixth grade level. The readability of the AAOS articles exceeded the sixth grade level by an average of 3.2 grade levels. Of the 260 articles, 210 (81%) had a readability score above the eighth grade level, which is the average reading level of US adults.
  
  
  CONCLUSIONS
  Most of the online patient education materials from the AAOS had readability levels that are far too advanced for many patients to comprehend. Efforts to adjust the readability of online education materials to the needs of the audience may improve the health literacy of orthopaedic patients. Patient education materials can be made more comprehensible through use of simpler terms, shorter sentences, and the addition of pictures. More broadly, all health websites, not just those of the AAOS, should aspire to be comprehensible to the typical reader.
authors.affiliation: Warren Alpert Medical School, Brown University, Box G-9247, Providence, RI, 02903, USA, adam_eltorai@brown.edu.
authors.forename: Adam E M
authors.initials: AE
authors.lastname: Eltorai
authors.forename: Pranav
authors.initials: P
authors.lastname: Sharma
authors.forename: Jing
authors.initials: J
authors.lastname: Wang
authors.forename: Alan H
authors.initials: AH
authors.lastname: Daniels
mesh_terms: D000328:Adult; D054626:Consumer Health Information; D057220:Health Literacy; D006801:Humans; D020407:Internet; D009985:Orthopedics; D010353:Patient Education as Topic; D011932:Reading; D012955:Societies, Medical; D014481:United States