title: Readability assessment of online patient resources for breast augmentation surgery.
abstract: BACKGROUND
  Patients increasingly rely on Internet resources for medical information. Well-informed patients are more likely to be active participants in their health care, contributing to higher satisfaction and better overall outcomes. Access to online patient material, however, can be limited by inadequate functional health literacy. The National Institutes of Health and the American Medical Association recommend that educational content be written at a sixth-grade reading level. This study aims to assess the readability of online patient resources for breast augmentation surgery.
  
  
  METHODS
  A Web search for "breast implant surgery" was performed using the largest public search engine. After sponsored results were excluded, the 12 most accessed sites were identified. Patient-directed information from all relevant articles immediately linked from the main site was downloaded and formatted into plain text. The readability of 110 articles was evaluated using 10 established analyses, both overall and by Web site.
  
  
  RESULTS
  The overall average readability of the 12 most popular Internet resources for breast augmentation was at a thirteenth-grade reading level (Coleman-Liau, 13.4; Flesch-Kincaid, 12.7; FORCAST, 11.3; Fry, 13; New Dale-Chall, 12.9; New Gunning Fog, 13.8; Raygor Estimate, 15; and Simple Mesaure of Gobbledygook Formula, 14.3). The Flesch Reading Ease index was 41, which falls into a "difficult" reading category. No individual article or Web site was at the recommended sixth-grade level.
  
  
  CONCLUSIONS
  Online resources for breast augmentation are above recommended reading levels. This may potentially serve as a barrier to patients seeking this type of surgery. Plastic surgeons should be aware of potential gaps in understanding and direct patients toward more appropriate resources.
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: Joseph A
authors.initials: JA
authors.lastname: Ricci
authors.forename: Christina R
authors.initials: CR
authors.lastname: Vargas
authors.forename: Danielle J
authors.initials: DJ
authors.lastname: Chuang
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Lin
authors.forename: Bernard T
authors.initials: BT
authors.lastname: Lee
mesh_terms: D032882:Comprehension; D054626:Consumer Health Information / Q000379:methods; D005260:Female; D057220:Health Literacy; D006801:Humans; D020407:Internet; D016462:Mammaplasty / Q000379:methods*; D008490:Medical Informatics; D010353:Patient Education as Topic / Q000379:methods*; D057386:Search Engine; D014481:United States