title: Readability assessment of patient-provider electronic messages in a primary care setting.
abstract: BACKGROUND
  The high prevalence of limited health literacy among patients threatens the success of secure electronic messaging between patients from diverse populations and their providers.
  
  
  OBJECTIVE
  The purpose of this study is to generate hypotheses about the readability of patient and provider electronic messages.
  
  
  METHODS
  We collected 31 patient-provider e-mail exchanges (n = 119 total messages) from a safety-net primary care clinic. We compared the messages' mean word count and Flesch-Kincaid Grade Levels (FKGLs), calculated the frequency of provider messages below an FKGL = 8, and assessed readability concordance between patients' and providers' messages.
  
  
  RESULTS
  Patients used more words in their initial e-mails compared to providers, but the FKGLs were similar, and 68% of provider messages were written below an FKGL = 8. Of 31 exchanges, 9 (29%) contained at least one patient message with an FKGL > 3 grade levels lower than the corresponding provider message(s).
  
  
  CONCLUSIONS
  Our study demonstrates that most providers are able to respond to patient electronic messages with a matching reading level.
authors.affiliation: University of California, San Francisco, School of Medicine.
authors.forename: Jacob B
authors.initials: JB
authors.lastname: Mirsky
authors.affiliation: Division of General Internal Medicine, University of California, San Francisco, School of Medicine and UCSF Center for Vulnerable Populations at San Francisco General Hospital.
authors.forename: Lina
authors.initials: L
authors.lastname: Tieu
authors.affiliation: Division of General Internal Medicine, University of California, San Francisco, School of Medicine and UCSF Center for Vulnerable Populations at San Francisco General Hospital.
authors.forename: Courtney
authors.initials: C
authors.lastname: Lyles
authors.affiliation: Division of General Internal Medicine, University of California, San Francisco, School of Medicine and UCSF Center for Vulnerable Populations at San Francisco General Hospital usarkar@medsfgh.ucsf.edu.
authors.forename: Urmimala
authors.initials: U
authors.lastname: Sarkar
mesh_terms: D032882:Comprehension; D034742:Electronic Mail; D006282:Health Personnel; D006801:Humans; D010361:Patients; D011320:Primary Health Care
keywords: health literacy; primary care; readability; safety-net; secure messaging