The readability of online English and Spanish patient education materials on anaesthesia for orthopaedic surgery

Background

With the increasing utilisation of regional anaesthesia for orthopaedic procedures, it is imperative that related online patient education materials (PEMs) be easily retrievable, comprehensive, and readable by the general population, irrespective of the language they are written in. Therefore, we compared the readability levels of online PEMs available in English and Spanish for anaesthesia related to total hip, knee, and shoulder joint replacements.

Methods

Six pairs (English and Spanish) of search terms were entered into Google and used to identify relevant online PEMs. Results for English search terms were analysed for readability using the Flesch Reading Ease (FRE), Fry Graph (FG), Simple Measures of Gobbledygook (SMOG) Index, and Gunning Fog Index scores, and for Spanish search terms using the Fernandez-Huerta Reading Ease (FHRE), the Gilliam-Peña-Mountain Grade Level (GPMGL), the Spanish SMOG (SOL), and Indice de Legibilidad de Flesch-Szigriszt (INFLESZ) scores. Scores were compared between languages if the Spanish-language calculator was a validated adaptation of the English one (FRE vs FHRE; FG vs GPMGL; SMOG vs SOL).

Results

Overall, 180 and 146 relevant websites were retrieved across all six English language and Spanish-language search terms, respectively. Generally, the FRE and FG scores for the English search results corresponded to college-level material and the SMOG score reflected a 10th grade reading level. In contrast, the FHRE, GPMGL, and SOL scores for Spanish search results corresponded to 10th–12th grade reading levels, and the INFLESZ to ‘Difficult’/‘Normal’ levels.

Conclusions

These findings reinforce past literature describing English and Spanish-language orthopaedic anaesthesia PEMs being written at far higher reading levels than the recommended 5th to 8th grade reading level. Interestingly, English PEMs were less readable than their Spanish counterparts, yet, they were more available than related Spanish PEMs overall.