Readability assessment of internet-based consumer health information.

BACKGROUND A substantial amount of consumer health-related information is available on the Internet. Studies suggest that consumer comprehension may be compromised if content exceeds a 7th-grade reading level, which is the average American reading level identified by the United States Department of Health and Human Services (USDHHS). OBJECTIVE To determine the readability of Internet-based consumer health information offered by organizations that represent the top 5 medical-related causes of death in America. We hypothesized that the average readability (reading grade level) of Internet-based consumer health information on heart disease, cancer, stroke, chronic obstructive pulmonary disease, and diabetes would exceed the USDHHS recommended reading level. METHODS From the Web sites of the American Heart Association, American Cancer Society, American Lung Association, American Diabetes Association, and American Stroke Association we randomly gathered 100 consumer-health-information articles. We assessed each article with 3 readability-assessment tools: SMOG (Simple Measure of Gobbledygook), Gunning FOG (Frequency of Gobbledygook), and Flesch-Kincaid Grade Level. We also categorized the articles per the USDHHS readability categories: easy to read (below 6th-grade level), average difficulty (7th to 9th grade level), and difficult (above 9th-grade level). RESULTS Most of the articles exceeded the 7th-grade reading level and were in the USDHHS "difficult" category. The mean +/- SD readability score ranges were: SMOG 11.80 +/- 2.44 to 14.40 +/- 1.47, Flesch-Kincaid 9.85 +/- 2.25 to 11.55 +/- 0.76, and Gunning FOG 13.10 +/- 3.42 to 16.05 +/- 2.31. The articles from the American Lung Association had the lowest reading-level scores with each of the readability-assessment tools. CONCLUSIONS Our findings support that Web-based medical information intended for consumer use is written above USDHHS recommended reading levels. Compliance with these recommendations may increase the likelihood of consumer comprehension.