title: Colorectal cancer screening patient education materials-how effective is online health information?
abstract: OBJECTIVE
  Patients screened for colorectal cancer (CRC) frequently turn to the Internet to improve their understanding of tests used for detection, including colonoscopy, flexible sigmoidoscopy, fecal occult blood test (FOBT), and CT colonography. It was of interest to determine the quality and readability levels of online health information.
  
  
  METHODS
  The screening tools were googled, and the top 20 results of each test were analyzed for readability, accessibility, usability, and reliability. The 80 articles excluded scientific literature and blogs. We used ten validated readability scales to measure grade levels, and one-way ANOVA and Tukey's honestly statistical different (HSD) post hoc analyses to determine any statistically significant differences among the four diagnostic tests. The LIDA tool assessed overall quality by measuring accessibility, usability, and reliability.
  
  
  RESULTS
  The 80 articles were written at an 11.7 grade level, with CT colonography articles written at significantly higher levels than FOBT articles, F(3, 75) = 3.07, p = 0.033. LIDA showed moderate percentages in accessibility (83.9 %), usability (73.0 %), and reliability (75.9 %).
  
  
  CONCLUSIONS
  Online health information about CRC screening tools are written at higher levels than the National Institute of Health (NIH) and American Medical Association (AMA) recommended third to seventh grade levels. More patients could benefit from this modality of information if it were written at a level and quality that would better facilitate understanding.
authors.affiliation: Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA. Elizabethjohn17@gmail.com.|Department of Gastroenterology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA. Elizabethjohn17@gmail.com.
authors.forename: Elizabeth Sheena
authors.initials: ES
authors.lastname: John
authors.affiliation: Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA.
authors.forename: Ann M
authors.initials: AM
authors.lastname: John
authors.affiliation: Department of Radiology, Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Hansberry
authors.affiliation: Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ, USA.
authors.forename: Prashant J
authors.initials: PJ
authors.lastname: Thomas
authors.affiliation: Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Prateek
authors.initials: P
authors.lastname: Agarwal
authors.affiliation: Department of Gastroenterology, Cooper University Hospital, Camden, NJ, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Deitch
authors.affiliation: Department of Gastroenterology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
authors.forename: Sita
authors.initials: S
authors.lastname: Chokhavatia
mesh_terms: D015179:Colorectal Neoplasms / Q000175:diagnosis*; D054626:Consumer Health Information; D055088:Early Detection of Cancer; D006801:Humans; D020407:Internet; D010353:Patient Education as Topic; D015203:Reproducibility of Results
keywords: Colorectal cancer screening; Health literacy; LIDA; Readability