title: Readability assessment of internet-based patient education materials related to mammography for breast cancer screening.
abstract: OBJECTIVE
  The US Department of Health and Human Services (USDHHS) recommends that Internet-based patient education materials (IPEMs) be written below the sixth-grade reading level to target the average American adult. This study was designed to determine the readability of IPEMs regarding mammography for breast cancer screening.
  
  
  METHODS
  Three-hundred mammography-related Web sites were reviewed for IPEMs. Forty-two IPEMs that met the Health on the Net Foundation Code of Conduct were assessed for readability level with four readability indices that use existing algorithms based on word and sentence length to quantitatively analyze Internet sources for language intricacy including the following: Flesch-Kincaid Grade Level (FKGL), Flesch Reading Ease Score (FRES), Simple Measure of Gobbledygook (SMOG), and Gunning Frequency of Gobbledygook (Gunning FOG; GFOG). Results were compared to national recommendations, and intergroup analysis was performed.
  
  
  RESULTS
  No IPEMs (0%) regarding mammography were written at or below the sixth-grade reading level, based on FKGL. The mean readability scores were as follows: FRES, 49.04 ± 10.62; FKGL, 10.71 ± 2.01; SMOG, 13.33 ± 1.67; and Gunning FOG, 14.32 ± 2.18. These scores indicate that the readability of mammography IPEMs is written at a "difficult" level, significantly above the recommended sixth-grade reading level (P < .05) determined by the USDHHS.
  
  
  CONCLUSIONS
  IPEMs related to mammography are written well above the recommended sixth-grade level and likely reflect other IPEMs in diagnostic radiology.
authors.affiliation: Department of Radiology, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, 150 Bergen St. UH CC-318, Newark, NJ 07101.
authors.forename: Rend
authors.initials: R
authors.lastname: AlKhalili
authors.affiliation: Department of Radiology, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, 150 Bergen St. UH CC-318, Newark, NJ 07101.
authors.forename: Pratik A
authors.initials: PA
authors.lastname: Shukla
authors.affiliation: Department of Radiology, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, 150 Bergen St. UH CC-318, Newark, NJ 07101.
authors.forename: Ronak H
authors.initials: RH
authors.lastname: Patel
authors.affiliation: Department of Radiology, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, 150 Bergen St. UH CC-318, Newark, NJ 07101.
authors.forename: Saurin
authors.initials: S
authors.lastname: Sanghvi
authors.affiliation: Department of Radiology, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, 150 Bergen St. UH CC-318, Newark, NJ 07101. Electronic address: bhubbi@gmail.com.
authors.forename: Basil
authors.initials: B
authors.lastname: Hubbi
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis*; D032882:Comprehension; D005260:Female; D058015:Health Communication / Q000379:methods*; D006801:Humans; D020407:Internet; D008327:Mammography; D008403:Mass Screening; D010353:Patient Education as Topic / Q000592:standards*; D011932:Reading; D014481:United States
keywords: Flesch reading Ease score; Flesch–Kincaid grade level; Gobbledygook; Internet-based patient education materials (IPEMs); Mammography; readability