Background/Purpose:

Comprehension of health resources may be challenging for patients particularly those with limited health literacy. The objective of this study was to examine the readability and suitability of commonly used patient education materials for systemic lupus erythematosus (SLE), vasculitis, rheumatoid arthritis (RA), and osteoarthritis (OA) and to determine whether readability and suitability vary among diseases of different complexities.

Methods:

Several highly popular web-based patient resources were chosen for evaluation: American College of Rheumatology (ACR), Arthritis Foundation (AF), Mayo Clinic Health Information, National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), UpToDate Basics, UpToDate Beyond the Basics, Vasculitis Clinical Research Consortium (VCRC), and Vasculitis Foundation.  Readability was measured using the Flesch-Kincaid Reading Ease and Grade Level and computed after the removal of illustrations, tables, captions, disease and medication names, all forms of “rheumatology,” and defined terms.  Suitability was determined by the Suitability Assessment of Materials (SAM), a score that considers characteristics such as content, graphics, layout/topography, and cultural appropriateness.  Three different reviewers rated the SAM score and means were used in the analysis.  Scores were then converted into a percentage by dividing the given score by the total possible score.  A score of 0-39% was considered not suitable, 40-69% adequate, 70-100% superior.

Results:

The education material for all four diseases studied had readability above the 8^th grade level and readability did not differ among the diseases.  The mean grade level for each resource ranged from 4.8 to 12.5 with a median grade level of 9.6.  Only 5 of the 23 resources received superior suitability scores (ACR for SLE, ACR for OA, AF for RA, AF for OA, UpToDate Basics for OA).  Suitability scores among the four diseases were similar and again did not differ based on disease complexity.

Conclusion:  

Patient education materials for rheumatic diseases other than UpToDate Basics are written at readability levels above the recommended sixth-grade reading level for the general public.  Most resources were considered to have only adequate suitability.  Scores were similar among the four diseases which suggest that disease complexity does not explain poor readability and suitability indices.  Most educational resources for patients with rheumatic diseases should be revised to more appropriately communicate information about these diseases.