A Readability Analysis of Online Patient Education Materials Regarding Endoscopic Retrograde Cholangiopancreatography

Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure used to diagnose and treat hepato-biliary and pancreatic conditions. Many patients use internet search engines for educational purposes prior to procedures, such as ERCP. The American Medical Association (AMA) recommends patient education materials be written at a 5th-6th grade reading level. There is no prior literature examining the reading level of ERCP education materials. The primary objective of this study is to assess the readability of online patient education materials regarding ERCP.

Using the Google search engine, the top 75 search results for 5 ERCP-related keywords (total 375 websites) were screened. After exclusion, readability was assessed using the Simple Measure of Gobbledygook (SMOG) and three other tools (Flesch-Kincaid, Coleman-Liau and Automated Readability Index). Websites were categorized as academic or non-academic. A word substitution analysis assessed readability after replacing complex words with simpler alternatives.

A total of 129 websites met inclusion criteria. The mean SMOG reading grade level was 9.43 (n = 129). Academic websites (n = 77) had a statistically significantly lower mean reading level than non-academic websites (n = 52) (SMOG 9.17 vs. 9.83, d = 0.49, p < 0.01). Similar trends were found with the other readability tools. Substituting easier words for complex words resulted in a significantly lower mean reading level (SMOG 8.97, d = 1.52, p < 0.01).

Online ERCP patient education materials are at a 9th-11th grade reading level, exceeding the AMA recommendations. Word substitution analysis significantly decreased the mean reading level, but not to the recommended levels. Medical organizations should prioritize accessible health information to improve patient understanding.