Online Kidney Transplant Information in the United States: A National Readability Analysis of Transplant Center Websites.

Abstract

Background: Clear information is essential for patients navigating kidney transplantation, yet patient-facing materials may be difficult to understand. Patient education guidelines recommend reading levels near a sixth-grade level to support comprehension across diverse populations. This study evaluated readability of patient-directed content on United States kidney transplant center websites.

Methods: Patient-facing webpages from United States kidney transplant programs were identified using a previously assembled national dataset. Website text was extracted and processed to isolate patient-directed educational content, excluding non-English pages and pages with fewer than five sentences. Readability was assessed using validated indices, including the Flesch-Kincaid Grade Level, Simple Measure of Gobbledygook (SMOG), Gunning Fog Index, and a pretrained transformer-based readability model. Summary statistics characterized reading difficulty and proportion of webpages exceeding recommended levels.

Results: A total of 92,461 English-language webpages from 194 transplant center websites were included. Median readability exceeded recommended levels across measures. At the webpage level, the median SMOG score was 14.69 (interquartile range, 13.01-16.63); >99% of webpages exceeded the recommended sixth-grade level, 98% exceeded tenth-grade level, 86% exceeded twelfth-grade level, and 61% exceeded fourteenth-grade level. Among the 144 eligible hosts, the median SMOG score was 14.92 (interquartile range, 14.11-15.45). Similar patterns were observed across the Flesch-Kincaid Grade Level, Gunning Fog Index, and transformer-based readability model, demonstrating consistent findings across methods.

Conclusions: Patient-facing kidney transplant center websites were written at reading levels substantially exceeding recommended standards. This widespread, modifiable barrier in transplant center communication may limit patients' ability to understand transplant-related information.