title: Readability, Content, and Quality Assessment of Web-Based Patient Education Materials Addressing Neuraxial Labor Analgesia.
abstract: BACKGROUND
  Studies in a variety of disciplines have shown that the readability of Web-based patient education materials is above that of the sixth grade reading level recommended by the U.S. Department of Health and Human Services. The aim of this study was to evaluate the readability, content, and quality of English- and Spanish-language patient education materials addressing neuraxial labor analgesia.
  
  
  METHODS
  The websites of 122 U.S. academic medical centers with obstetric anesthesia divisions were searched for English- and Spanish-language patient education materials. Readability of English-language patient education materials was assessed with 3 validated indices: Flesch-Kincaid Grade Level, Simple Measure of Gobbledygook, and Gunning Frequency of Gobbledygook. Readability of Spanish-language patient education materials was assessed using the Spanish Lexile Measure. A 1-sample t test was used to evaluate the mean readability level against the recommended sixth grade reading level. A scoring matrix was developed to evaluate the content of patient education materials. Website quality was assessed using the Patient Education Materials Assessment Tool for Print.
  
  
  RESULTS
  We identified 72 English-language and 29 Spanish-language patient education materials. The mean readability levels of all patient education materials were higher than the recommended sixth grade reading level using all indices (Flesch-Kincaid Grade Level: 9.1 ± 1.9, Simple Measure of Gobbledygook: 8.6 ± 1.4, Gunning Frequency of Gobbledygook: 11.8 ± 2.1; P < 0.001 for all). All patient education materials discussed the benefits of neuraxial analgesia. However, only 14% (upper 95% confidence interval: 24%) discussed contraindications to neuraxial anesthesia. Postdural puncture headache and hypotension were the most commonly addressed complications (92%). All other complications were addressed by less than half of patient education materials. Patient Education Materials Assessment Tool for Print scores were consistent with poor website understandability (median score, 64%; interquartile range, 64-73).
  
  
  CONCLUSIONS
  The mean readability of Web-based patient education materials addressing neuraxial labor analgesia was above the recommended sixth grade reading level. Although most patient education materials explained the benefits of neuraxial analgesia, possible contraindications and complications were not consistently presented. The content, readability, and quality of patient education materials are poor and should be improved to help patients make more informed decisions about analgesic options during labor and delivery.
authors.affiliation: From the *Department of Anesthesiology, †Center for Healthcare Studies, and ‡Department of Obstetrics and Gynecology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Samir K
authors.initials: SK
authors.lastname: Patel
authors.forename: Elisa J
authors.initials: EJ
authors.lastname: Gordon
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Wong
authors.forename: William A
authors.initials: WA
authors.lastname: Grobman
authors.forename: Haley
authors.initials: H
authors.lastname: Goucher
authors.forename: Paloma
authors.initials: P
authors.lastname: Toledo
mesh_terms: D015360:Analgesia, Epidural / Q000379:methods / Q000592:standards*; D005260:Female; D057220:Health Literacy / Q000379:methods / Q000592:standards*; D006801:Humans; D020407:Internet / Q000592:standards*; D010353:Patient Education as Topic / Q000379:methods / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000379:methods / Q000592:standards*; D011932:Reading; D013664:Teaching Materials / Q000592:standards