Readability of Online Patient Education Materials for Cleft Care: A Systematic Review and Meta-Analysis

ObjectiveTo evaluate the readability of online patient education materials (PEMs) for cleft lip and/or palate and assess their alignment with recommended readability levels.DesignThis study is a systematic review and meta-analysis.SettingLiterature search conducted in PubMed, Scopus, and Embase databases following PRISMA guidelines.MaterialsStudies evaluating online PEMs for cleft care with reported readability metrics, including Flesch-Kincaid Grade Level, Flesch Reading Ease, SMOG Index, or Gunning Fog Index.InterventionsAssessment of readability metrics of online PEMs and evaluation of artificial intelligence tools (eg, ChatGPT) for text simplification.Main Outcome Measure(s)Pooled readability estimates (eg, Flesch-Kincaid Grade Level, Flesch Reading Ease, SMOG Index, Gunning Fog Index), heterogeneity (I²), and confidence intervals (CIs).ResultsNine studies were included, consistently showing that PEMs exceed readability recommendations. Pooled estimates revealed a Flesch-Kincaid Grade Level of 9.48 (95% CI: 8.51-10.45), Flesch Reading Ease score of 52.98 (95% CI: 42.62-63.34), SMOG Index of 9.27 (95% CI: 5.97-12.57), and Gunning Fog Index of 9.94 (95% CI: 8.90-10.98). Heterogeneity was minimal (I² = 0%). Artificial intelligence tools like ChatGPT demonstrated potential in simplifying text to the recommended sixth-grade reading level but lacked usability and comprehension testing.ConclusionsOnline PEMs for cleft care are consistently written at reading levels too complex for the average caregiver, underscoring the need for improved readability and accessibility. Future research should focus on developing multimodal resources, conducting usability assessments, and including non-English materials to address global disparities in cleft care education.