Background/Purpose: Spanish is the second most popular language in the United States and third most commonly spoken language internationally.  Despite the high prevalence of Spanish and the increasing recognition that language barriers and low health literacy contribute to healthcare disparities, there is little information about Spanish-language patient education materials (PEMs) regarding rheumatologic diseases.  In this investigation, we systematically examine and appraise the accuracy and readability of Spanish-language online PEMs using validated measures.

Methods: Three investigators compiled a set of common rheumatologic terms in both Spanish and English (Table 1). Two investigators independently conducted a search to identify Spanish-language PEMs using a Boolean search strategy (Figure 2) and compared results for consistency.  The Spanish-language PEMs resulting from this search were then reviewed for medical accuracy by two investigators.  Spanish spelling, grammatical, and syntactical errors were noted by a native Spanish speaker. The PEMs were further evaluated for readability based on (1) Fry Graph calculations, (2) the Fernandez-Huerta modification of the Flesch Reading Ease Score, and (3) the Flesch-Kincaid Grade Level.

Results: The investigators identified 134 Spanish-language PEMs from 14 sources for the 107 terms utilized.  Major medical inaccuracies were noted in only 3% of cases (4/134).  However, 53.7% had at least one spelling or grammatical error (72/134) and 7.4% (10/134) had more than three spelling or grammatical errors.  The Grade Level was determined to be >15 (‘College’ Level) in 94% of PEMs (126/134), per Fry Graph calculations.  Similarly, The Flesch-Kincaid Grade Level was 17.3 (SD=2.3) and Flesch readability score was 5.4 (SD=0.6), signifying “very confusing” text.

Conclusion: Freely available rheumatologic Spanish-language PEMs do not meet accepted standards for patient education. While the majority of Spanish-language PEMs were considered medically accurate, the vast majority of Spanish-language PEMs greatly exceeded the recommended maximum 5^th grade reading level. Based on these data, we advocate for the development and dissemination of new Spanish-language PEMs that prioritize both accuracy and readability.

107 terms were searched in both English and in Spanish (table lists English only)

Demonstration of the Boolean Search Strategy independently conducted by two investigators

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/comprende-assessing-the-readability-of-freely-available-spanish-language-online-patient-education-materials-for-rheumatologic-diseases/