title: Examining the Reading Level of Internet Medical Information for Common Internal Medicine Diagnoses.
abstract: The National Institutes of Health (NIH) recommend that health materials be written at a grade 6-7 reading level, which has generally not been achieved in online reading materials. Up to the present time, there have not been any assessments focused on the reading level of online educational materials across the most popular consumer Web sites for common internal medicine diagnoses. In this study, we examined the readability of open-access online health information for 9 common internal medicine diagnoses.
  
  
  
  Nine of the most frequently encountered inpatient and ambulatory internal medicine diagnoses were selected for analysis. In November and December 2014, these diagnoses were used as search terms in Google, and the top 5 Web sites across all diagnoses and a diagnosis-specific site were analyzed across 5 validated reading indices.
  
  
  
  On average, the lowest reading grade-level content was provided by the NIH (10.7), followed by WebMD (10.9), Mayo Clinic (11.3), and diagnosis-specific Web sites (11.5). Conversely, Wikipedia provided content that required the highest grade-level readability (14.6). The diagnoses with the lowest reading grade levels were chronic obstructive pulmonary disease (10.8), followed by diabetes (10.9), congestive heart failure (11.7), osteoporosis (11.7) and hypertension (11.7). Depression had the highest grade-level readability (13.8).
  
  
  
  Despite recommendations for patient health information to be written at a grade 6-7 reading level, our examination of online educational materials pertaining to 9 common internal medicine diagnoses revealed reading levels significantly above the NIH recommendation. This was seen across both diagnosis-specific and general Web sites. There is a need to improve the readability of online educational materials made available to patients. These improvements have the potential to greatly enhance patient awareness, engagement, and physician-patient communication.
authors.affiliation: Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, RI.
authors.forename: Nora
authors.initials: N
authors.lastname: Hutchinson
authors.affiliation: Lifespan Biostatistics Core, Rhode Island Hospital, Providence.
authors.forename: Grayson L
authors.initials: GL
authors.lastname: Baird
authors.affiliation: Department of Medicine, University of California, San Francisco, San Francisco VA Medical Center. Electronic address: megha.garg@ucsf.edu.
authors.forename: Megha
authors.initials: M
authors.lastname: Garg
mesh_terms: D003142:Communication; D032882:Comprehension; D054626:Consumer Health Information / Q000592:standards*; D057220:Health Literacy; D006801:Humans; D007388:Internal Medicine; D020407:Internet; D009316:National Institutes of Health (U.S.) / Q000592:standards; D010817:Physician-Patient Relations; D011932:Reading; D014481:United States
keywords: Health literacy; Internal medicine; Online education; Patient health information; Readability