Assessing the Understandability and Actionability of Online Neurosurgical Patient Education Materials

Abstract

Background: Most Americans consult the Internet to address their health concerns. Limited health literacy among the public highlights the need for patient education Web sites to deliver understandable health information. We assessed the understandability and actionability of online neurosurgical patient education materials (PEMs) provided by the American Association of Neurological Surgeons (AANS) and MedlinePlus.

Methods: Articles on neurosurgical conditions and treatments listed on both the AANS site and MedlinePlus were analyzed. Two reviewers scored articles using 2 validated health literacy tools, the Centers for Disease Control and Prevention Clear Communication Index (CCI) and the Agency for Healthcare Research and Quality (AHRQ) Patient Education Materials Assessment Tool (PEMAT). These tools evaluate the quality of written health information and assess for content, organization, and actionability of PEMs.

Results: One hundred and thirty-eight articles were evaluated from the AANS (n = 61) and MedlinePlus (n = 77). The median CCI score for MedlinePlus and AANS articles was 68.9 (interquartile range [IQR], 62.5-81.3) and 56.3 [IQR, 46.7-73.7], respectively (P < 0.001). Only 1 article scored ≥90%, which is the CCI threshold for PEMs to be considered easy to read. Although the AANS and Medline performed similarly on the understandability component of the PEMAT (66.7 [IQR, 53.8-69.2] vs. 69.2 [IQR, 66.7-83.3], respectively; P < 0.001), significant differences were observed for the actionability section of the PEMAT (Medline 60 [IQR, 60-60] vs. AANS 0 [IQR, 0-60]; P < 0.001). Less than 13% of articles provided summaries, visual aids, and tangible tools to aid patient action.

Conclusions: Neurosurgical online PEMs may be difficult to understand and potentially act as barriers for patients' engagement with health systems. There is a need to deliver patient-centered health information that effectively informs patients, aiding in meaningful health decision making.

Keywords: CCI; Health literacy; Neurosurgery; PEMAT; Patient education materials.