CONTACT: JENNIFER CRONIN
2130 Medical Laboratories
Iowa City IA 52242
(319) 335-5661; fax (319) 335-9917
Release: March 3, 1999
UI researcher shows Web medical information difficult to read
IOWA CITY, Iowa -- People access the World Wide Web to obtain fast,
easy-to-understand information. They don't want to turn to a dictionary
to decipher what they are reading on any particular site.
But if individuals are looking up medical materials, they likely may
need such assistance, according to a recent University of Iowa study.
Researchers led by Mark Graber, M.D., UI associate professor of family
medicine and surgery, found that much of the medical information on the
Web geared towards the general public is written at a reading level higher
than is easily understood by much of the patient population. On average,
the sampled Web medical information was written at a tenth-grade, second-month
Although the reading ability of patients varies widely, one previous
study of patients with diabetes found that 60 percent of the patients could
comprehend information written for a sixth grader while only 21 percent
could understand material written at a ninth-grade level. Other studies
have found a ninth-grade, eighth-month reading level in emergency department
patients and a seventh- to eighth-grade reading level in cancer patients,
patients in urban clinics and parents of pediatric patients at a university
"Physicians need to recognize this problem and learn to write at
a level that patients can understand," Graber said. "Patient
education is important. The more information patients have, the more they
can participate in their health care. But when patients cannot understand
the information, they can become frustrated or misinterpret the information
and make wrong medical decisions as a result."
Graber is the first person to evaluate the readability of patient education
materials on the Web. He decided to look at the issue because he realized
that the medium was fast replacing yesterday's office-room pamphlets as
the resource-of-choice for many people seeking medical information. One
estimate revealed that there are currently 87 million regular Web users
in North America. Of these, 50 percent have used the Web to look up medical
information in the past year.
"Although it is true that the more educated individuals in our
society currently have access to the Web, if Web information is to become
universally accessible, it will need to be at a reading level that most
people can comprehend," Graber said.
In addition, doctors are beginning to use the Web as a source of information
for all patients, printing out materials from various sites. The unintended
effect of this is that patients of all educational levels, Web users or
not, are being expected to use information written at this higher level,
Graber and his colleagues based their readability conclusion on an analysis
of 50 sites. A researcher without Web experience searched for patient information
using the Webcrawler and Excite search engines. The researcher's lack of
Web-searching savvy prevented any inadvertent bias that could have resulted
from visiting favorite sites. All 50 sites were intended for general public
viewing. The information from the sites covered all aspects of family medicine
-- including obstetrics and gynecology, pediatrics, internal medicine and
psychiatry -- and came from commercial, academic government and professional
organization sites, as well as those devoted to specific illnesses.
Graber used the Flesch reading score and the Flesch-Kinkaid reading
level assessment to determine the readability level of the materials. The
Flesch score and the Flesch-Kinkaid reading level assessment are two of
the most widely used systems for scoring readability. The Flesch formula
relies mainly on average sentence length and average number of syllables
per word to estimate the reading difficulty. In the case of medical writing,
it is possible that the readability formulas may underestimate the difficulty
because even short words may be unfamiliar to the reader.
"Writers of information for the Web should be aware of the limited
reading ability of much of the population and write accordingly,"
The UI study appeared in the January issue of the Journal of Family