Clear as Mud: Readability Scores in Cloacal Exstrophy Literature and Its Treatment

Abstract

Purpose

This study examines the readability of online medical information regarding cloacal exstrophy (CE). We hypothesize that inappropriate levels of comprehension are required in these resources, leading to poor understanding and confusion amongst caregivers.

Methods

The Google and Bing search engines were used to search the terms “cloacal exstrophy” and “cloacal exstrophy treatment”. The first 100 results for each were collected. Each webpage was analyzed for readability using four independent validated scoring systems: the Gunning-Fog index (GFI), SMOG grade (Simple Measure of Gobbledygook), Dale-Chall index (DCI), and the Flesch-Kincaid grade (FKG).

Results

Forty-seven unique webpages fit the inclusion criteria. Mean readability scores across all websites were GFI, 14.6; SMOG score, 10.8; DCI, 9.3; and FKG, 11.8, correlating to adjusted grade levels of college sophomore, 11th grade, college, and 11th grade, respectively. There were significant differences across all readability formulas. Non-profit websites were significantly less readable than institutional and commercial webpages (GFI p = 0.012, SMOG p = 0.018, DCI p = 0.021, FKG p = 0.0093).

Conclusion

Caregiver-directed health information regarding CE and its treatment available online is written at the 11th grade reading level or above. Online resources pertaining to CE must be simplified to be effective.

Plain Language Summary

Cloacal exstrophy is a rare severe birth defect that does not always show up in prenatal screening. Parents are often unfamiliar with this disease and must learn about the disease, procedures, and outcomes their child may have in a short amount of time. Online medical information has been recommended to be written at a 6th grade reading level so that the general public may understand. The authors of this study wanted to investigate if average websites that parents might find using common search engines would be easily understood. The authors used different search phrases on Google and Bing search engines, and used them to look at the top 100 search results for each. The text from each page was graded based on 4 different readability scoring systems. The authors found 47 unique webpages that matched the criteria and found that most pages had reading levels of about 11th grade-college level. Due to its rarity, the information available about cloacal exstrophy are similar and would likely be poorly understood by most parents. Hospital institutions and non-profit exstrophy programs need to make a concerted effort to work together to develop simple yet helpful information regarding this disease.

Keywords:

• cloacal exstrophy
• readability
• online health information
• exstrophy treatment

Abbreviations

CBE, Classic bladder exstrophy; CE, Cloacal Exstrophy; GFI, Gunning-Fog Index; SMOG, Simple Measure of Gobbledygook; DCI, Dale-Chall Index; FKG, Flesch-Kincaid Grade; EEC, Exstrophy Epispadias Complex; HL, Health Literacy; PIAAC, Program for the International Assessment of Adult Competencies; AMA, American Medical Association; NIH, National Institute of Health; ANOVA, one-way analysis of variance.

Acknowledgments

This work was presented at the 19th Annual Academic Surgical Congress in Houston, TX on February 8, 2023.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.