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Readability of Cervical Cancer Information
It is important to provide information on HPV vaccination and on early detection and early treatment for cervical cancer. Readability is a key aspect in the success of cervical cancer communication using written health information.
2. Study Characteristics
|Reference||Year||Country||Language||Readability Formula||Material (n)||Provider of Material||Main Results||Assessment of Factors Other than Readability|
|Wang et al. ||2021||China||Chinese||Calculated using word levels and character numbers in sentences||HPV vaccine-related online messages (294)||Most (92%) messages were from commercial websites.||The readability level of 71% of messages were rated at doctoral level, and 20% were undergraduate level.||There were biases in the content of the message. Only 55% of messages had no errors. Regarding the DISCERN scores, only one message (<1%) had good quality.|
|Dawson et al. ||2020||Canada||English||SMOG, FKGL,||Cervical cancer-related online information (100)||42% of websites were commercial, followed by those of non-profit organizations, government, and academic centers.||More than 95% of websites were at a high school reading level (8th grade) or higher.||Many lacked accountability or recent updates. Usability and interactivity were high. Important topics such as prognosis and staging were underrepresented.|
|MacLean et al. ||2019||United States||English||SMOG, FKGL, FRE, GFI, CLI,||HPV vaccination websites (100)||Not reported||75% of websites rated difficult to read (>10th grade). Only a few websites were rated easy to read (<6th grade).||None|
|Martin et al. ||2019||United States||English||SMOG, FKGL, GFI, DC||Cervical cancer patient education online materials (4928)||Not reported||Mean grade-level readability was 8.9, i.e., a high school reading level.||None|
|Tulsieram et al. ||2018||Canada||English||SMOG, GFI||Provincial department/Ministry of Health HPV information websites (7)||Provincial governments||Most (six of seven provinces) websites were rated as difficult to read (>12th grade).||Text coherence was not adequate for lay individuals to understand.|
|Calo et al. ||2018||United States||English||SMOG, FKGL, GFI, CLI, ARI||HPV vaccination messages online (267)||Government, medical association, Medscape, medical journals, educational clearinghouses||The readability level of most materials (62%) was ≥9th grade. Only 12% were easy to read (≤6th grade).||None|
|Chhabra et al. ||2018||United States||English||SMOG, FKGL, FRE, GFI, FRG||HPV vaccination counseling print materials (38)||State government||Four documents (10.5%) were at a 6th-grade reading level or lower, and 15 documents (39.5%) at a 10th-grade or higher reading level.||68% of materials were categorized as “unsuitable” with the SAM. Mean PEMAT score was 42%, which was much lower than the threshold for high understandability.|
|Okuhara et al. ||2017||Japan||Japanese||jReadability||Pro-and anti-HPV vaccination online messages (270)||Health professionals and non-health professionals||Pro-vaccination messages were difficult to read. Anti-vaccination messages were significantly easier to read than pro-vaccination messages.||None|
|Fu et al. ||2016||United States||English||FKGL||Critical and noncritical HPV vaccination web pages (116)||Not reported||Most web pages required a 12th-grade reading level.||None|
|MacDougall et al. ||2012||United States||English||SMOG||Patient consent forms for radiation therapy for cervical cancer (4)||Gynecologic oncology group||Readability ranged from grades 12.18 to 16.13; required at least a high school education.||Three of four consent forms scored in the lower portion of the “adequate” range, and one consent
Form was “not suitable” using the SAM.
|Abdelmutti and Hoffman-Goetz ||2009||Canada||English||SMOG||Newspaper articles on HPV vaccines (164)||National newspapers||The readability of the article rated as inadequate (>8th-grade level).||None|
|Helitzer et al. ||2009||United States||English||FRG||Cervical cancer prevention written materials (69)||Web-based fact sheets, magazine articles, advertisements, health system forms, books, newspaper articles||Most materials were written at too high a readability level. The mean reading level was 11th grade.||20% of materials were rated “superior,” 68% were “adequate,” and 12% were “not suitable” using the SAM and comprehensibility assessment.|
Abbeviations: HPV, human papillomavirus; SMOG, Simple Measure of Gobbledygook Grade Level; FKGL, Flesch–Kincaid Grade Level; FRE, Flesch–Kincaid Reading Ease; FRG, Fry Readability Graph; GFI, Gunning Fog Index; DC, Dale–Chall formula; CLI, Coleman–Liau Index; ARI, Automated Readability Index; SAM, Suitability Assessment of Materials; PEMAT, Patient Education Materials Assessment Tool.
3. Readability Assessment
4. Other Factors
This entry is adapted from 10.3390/healthcare9101246
- World Health Organization. Cervical Cancer. Available online: https://www.who.int/health-topics/cervical-cancer#tab=tab_1 (accessed on 10 September 2021).
- Dempsey, A.F.; Koutsky, L.; Zimet, G.D.; Davis, R.L. Factors That Are Associated with Parental Acceptance of Human Papillomavirus Vaccines: A Randomized Intervention Study of Written Information About HPV. Pediatrics 2006, 117, 1486–1493.
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- Centers for Disease Control and Prevention. Simply Put: A Guide for Creating Easy-to-Understand Materials. 2009. Available online: https://www.cdc.gov/healthliteracy/pdf/Simply_Put.pdf (accessed on 10 September 2021).
- Friedman, D.B.; Hoffman-Goetz, L. A Systematic Review of Readability and Comprehension Instruments Used for Print and Web-Based Cancer Information. Heal. Educ. Behav. 2006, 33, 352–373.
- Ménoni, V.; Lucas, N.; Leforestier, J.-F.; Doz, F.; Chatellier, G.; Jacqz-Aigain, E.; Giraud, C.; Treluyer, J.-M.; Chappuy, H. Readability of the Written Study Information in Pediatric Research in France. PLoS ONE 2011, 6, e18484.
- Betschart, P.; Zumstein, V.; Ali, O.H.; Schmid, H.-P.; Abt, D. Readability Assessment of Patient Education Material Published by German-Speaking Associations of Urology. Urol. Int. 2017, 100, 79–84.
- Votta, K.; Metivier, M.; Romo, S.; Garrigan, H.; Drexler, A.; Nodoushani, A.; Sheridan, R. Readability of Spanish language online information for the initial treatment of burns. Burns 2018, 44, 956–961.
- Murphy, D.A.; O’Keefe, Z.H.; Kaufman, A.H. Improving comprehension and recall of information for an HIV vaccine trial among women at risk for HIV: Reading level simplification and inclusion of pictures to illustrate key concepts. AIDS Educ. Prev. 1999, 11, 389.
- Okuhara, T.; Ishikawa, H.; Goto, E.; Okada, M.; Kato, M.; Kiuchi, T. Processing fluency effect of a leaflet for breast and cervical cancer screening: A randomized controlled study in Japan. Psychol. Health Med. 2017, 23, 1–11.
- MacLean, S.A.; Basch, C.H.; Ethan, D.; Garcia, P. Readability of online information about HPV Immunization. Hum. Vaccines Immunother. 2018, 15, 1505–1507.
- Martin, A.; Stewart, J.R.; Gaskins, J.; Medlin, E. A Systematic Assessment of Google Search Queries and Readability of Online Gynecologic Oncology Patient Education Materials. J. Cancer Educ. 2018, 34, 435–440.
- Calo, W.A.; Gilkey, M.B.; Malo, T.; Robichaud, M.; Brewer, N.T. A content analysis of HPV vaccination messages available online. Vaccine 2018, 36, 7525–7529.
- Chhabra, R.; Chisolm, D.J.; Bayldon, B.; Quadri, M.; Sharif, I.; Velazquez, J.J.; Encalada, K.; Rivera, A.; Harris, M.; Levites-Agababa, E.; et al. Evaluation of Pediatric Human Papillomavirus Vaccination Provider Counseling Written Materials: A Health Literacy Perspective. Acad. Pediatr. 2018, 18, S28–S36.
- Fu, L.Y.; Zook, K.; Spoehr-Labutta, Z.; Hu, P.; Joseph, J.G. Search Engine Ranking, Quality, and Content of Web Pages That Are Critical Versus Noncritical of Human Papillomavirus Vaccine. J. Adolesc. Health 2015, 58, 33–39.
- MacDougall, D.S.; Connor, U.M.; Johnstone, P.A. Comprehensibility of patient consent forms for radiation therapy of cervical cancer. Gynecol. Oncol. 2012, 125, 600–603.
- Helitzer, D.; Hollis, C.; Cotner, J.; Oestreicher, N. Health Literacy Demands of Written Health Information Materials: An Assessment of Cervical Cancer Prevention Materials. Cancer Control. 2009, 16, 70–78.
- Dawson, J.Q.; Davies, J.M.; Ingledew, P.-A. Quality of Online Information Regarding Cervical Cancer. Cureus 2020, 12, e9511.
- Tulsieram, K.L.; Arocha, J.F.; Lee, J. Readability and Coherence of Department/Ministry of Health HPV Information. J. Cancer Educ. 2016, 33, 147–153.
- Abdelmutti, N.; Hoffman-Goetz, L. Risk Messages About HPV, Cervical Cancer, and the HPV Vaccine Gardasil: A Content Analysis of Canadian and U.S. National Newspaper Articles. Women Health 2009, 49, 422–440.
- Wang, W.; Lyu, J.; Li, M.; Zhang, Y.; Xu, Z.; Chen, Y.; Zhou, J.; Wang, S. Quality evaluation of HPV vaccine-related online messages in China: A cross-sectional study. Hum. Vaccines Immunother. 2020, 17, 1089–1096.
- Okuhara, T.; Ishikawa, H.; Okada, M.; Kato, M.; Kiuchi, T. Readability comparison of pro- and anti-HPV-vaccination online messages in Japan. Patient Educ. Couns. 2017, 100, 1859–1866.