Cloudy or Clear? Readability and Content Analysis of Patient Education Materials in Myasthenia Gravis

Myasthenia gravis (MG) is a chronic autoimmune neuromuscular disorder that requires complex treatment decisions and sustained disease self-management. Health literacy is essential for patient understanding of MG, yet online patient education materials (PEMs) have not been systematically studied. This study aimed to evaluate the readability of MG-related PEMs, assess the inclusion of key topics, and identify characteristics associated with more accessible and comprehensive resources.

We conducted a cross-sectional analysis of MG-related PEMs identified through Google and Bing, evaluating readability using the Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), and Simple Measure of Gobbledygook (SMOG). Content analysis was conducted for inclusion of key MG topics. PEMs were categorized by organization type, target population age, and geographic location. Statistical tests included Wilcoxon signed-rank, Kruskal-Wallis, Mann-Whitney U, and Fisher's exact test.

All 149 PEMs exceeded the recommended 6th-grade reading level (median FRES 41.8, FKGL 11.4, SMOG 12.9; p < 0.001). Community organization PEMs were more readable than academic PEMs (median FKGL 10.4 vs. 11.6; p = 0.02, median FRES 44.5 vs. 39.4; p = 0.01). Frequently included topics were MG definition (94%), symptoms (93%), and immunotherapy (85%), while medications to avoid (30%), myasthenic crisis (62%), and mental health (10%) were the least included. Readability varied by topic, with immunotherapy and thymectomy sections being the most complex.

MG PEMs are written above recommended readability levels, posing barriers to comprehension. Improving readability and addressing gaps in critical topics, such as medication safety, myasthenic crisis, and mental health could enhance patient understanding and support informed decision-making.