title: Are Online Zenker's Diverticulum Materials Readable and Understandable?
abstract: Patients use a multitude of resources to learn about Zenker's diverticulum (ZD). The objectives of this study were to assess the readability and understandability of online materials on ZD, evaluate them against the existing criteria, and investigate the relationship between readability and understandability.
  
  
  
  The first 50 webpages from an online search for ZD were analyzed. Twenty-one webpages had materials intended for patients and were included in the study. The patient education materials (PEMs) were analyzed using 6 readability tools. Four individuals used the Patient Education Materials Evaluation Tool (PEMAT) to assess the understandability. Fleiss κ interrater reliability analysis determined consistency among the raters. Finally, Pearson correlation coefficient analyzed the relationship between readability and understandability.
  
  
  
  The reading grade level of the materials reviewed ranged from 10th to 16th grade while the understandability ranged from 31% to 74%. Correlation analysis demonstrated a strong negative correlation between readability and understandability (r = -0.62, P < .05). Fleiss' κ interrater reliability for the raters demonstrated substantial agreement between the 4 raters (κ = 0.64).
  
  
  
  Online PEMs pertaining to ZD are written well above the recommended reading level. Materials written at a lower reading level are more understandable. A wide range of understandability exists among materials with identical reading grade levels.
  
  
  
  Health care providers need to create new PEMs for ZD that are available online that are both readable and understandable. The PEMAT and readability formulas can provide a framework for authors to create these materials.
authors.affiliation: University of California, Irvine, California, USA.
authors.forename: Vini
authors.initials: V
authors.lastname: Balakrishnan
authors.affiliation: University of California, Irvine, California, USA.
authors.forename: Zachariah
authors.initials: Z
authors.lastname: Chandy
authors.affiliation: University of California, Irvine, California, USA verma@uci.edu.
authors.forename: Sunil P
authors.initials: SP
authors.lastname: Verma
mesh_terms: D032882:Comprehension; D057220:Health Literacy; D006801:Humans; D020407:Internet; D010353:Patient Education as Topic; D013664:Teaching Materials; D016672:Zenker Diverticulum
keywords: Internet; Patient Education Materials Evaluation Tool (PEMAT); Zenker’s diverticulum; patient education; patient education materials; patient safety/quality improvement (PS/QI); readability; readability formula; understandability