British internet-derived patient information on diabetes mellitus: is it readable?

BACKGROUND: Sizeable proportions of Western populations have limited language and math skills, making it difficult for them to fully and safely understand and act upon online health information.

METHODS: We used the Flesch Reading Ease and Flesch-Kincaid Grade Level formulae to test the readability of 20 representative Web documents from 15 trustworthy sites/providers of British origin, providing consumer information on diabetes mellitus.

RESULTS: The corresponding average and median U.K. reading ages of the tested material were found to be 14.2 and 14.65 years of age, respectively (range, 11-16.9 years). The most readable pages in our study (about one-third of all tested pages) had a Flesch Reading Ease score above 60 (range, 60.4-73.3) and a Flesch-Kincaid Grade Level of 8.0 or lower (range, 6.0-8.0), corresponding to a U.K. reading age of 11-13 years. These readability levels are well above the estimated reading age of the U.K. population in general (9 years).

CONCLUSIONS: These results point to a chronic and often forgotten information quality problem. Though quick and easy to use, and certainly better than nothing, readability formulae are not without their limitations. These should be recognised, and any health information quality benchmarking checklist in use should be supplemented with some testing for content readability (e.g., suitable readability formulae as a bare minimum and, if possible, feedback from a panel of readability experts and representative lay reviewers). Online health information providers need to ensure that their written material is pitched at a level appropriate to their intended lay audience. Providers should also consider other means of delivering health education and promotion programmes, so that no one is left behind.