Patient information in Graves' disease and thyroid-associated ophthalmopathy: readability assessment of online resources

Research output: Contribution to journalArticlepeer-review


BACKGROUND: The Internet is a vital source of information for patients hoping to learn more about their disease. Health literacy of the general population is known to be poor, with the U.S. Department of Health and Human Services (USDHHS) recommending that patient-oriented literature be written at a fourth- to sixth-grade reading level to optimize comprehensibility. In this study we assessed the readability of online literature specifically for Graves' disease (GD) and thyroid-associated ophthalmopathy (TAO).

METHODS: Readability of the content of the top 20 English-language GD patient-oriented online resources and top 30 of the equivalent TAO resources returned by Google search was analyzed. Web pages were identified using the Google search terms "Graves' disease" and "Thyroid-Associated Ophthalmopathy," respectively. Extraneous text (e.g., hyperlinks, affiliations, disclaimers) was removed. Relevant text proceeded to readability analysis using four validated measures: Flesch Reading Ease Score, Flesch-Kincaid Grade Level, Simple Measure of Gobbledygook, and Gunning-Fog Index. Readability was compared with USDHHS standards.

RESULTS: Overall, median word count (with interquartile range [IQR] and range) was 990 (IQR 846, 195-3867), with a median of 18 words per sentence (IQR 4.0, 7.5-28). Median Flesch Reading Ease Score was 46 (IQR 13, 24-64), Flesch-Kincaid Grade Level 11 (IQR 3.0, 7.2-17), Simple Measure of Gobbledygook 13 (IQR 2.0, 9.6-17), and Gunning-Fog Index 13 (IQR 3.0, 9.2-19), each equivalent to a reading level of >11th grade and "difficult" on the USDHHS classification. None of the web pages evaluated had readability scores in accordance with published guidelines. There was no significant difference with the country of origin of each web page, website commercial status, or with pages predominantly focused on GD or TAO.

CONCLUSIONS: Readability scores for online GD and TAO patient-focused materials are inferior to those recommended. Screening of this online material, as well as subsequent revision, is crucial to increase future patient knowledge, satisfaction, and compliance.


Original languageEnglish
Pages (from-to)67-72
Number of pages6
Issue number1
Early online date29 Oct 2013
Publication statusPublished - Jan 2014


  • Graves Ophthalmopathy, Health Literacy, Humans, Internet, Patient Education as Topic