Will the Effect of New Federal Breast Density Legislation Be Diminished by Currently Available Online Patient Educational Materials?
RATIONALE AND OBJECTIVES
To evaluate readability of commonly accessed online patient educational materials (OPEM) on breast density in setting of recently passed federal breast density legislation.


MATERIALS AND METHODS
The term "breast density" was queried using an online search engine to identify the top 50 commonly accessed websites based on order of search results on December 15, 2018. Location, cookies, and user account information were disabled prior to our query. Only websites with OPEM, defined as any educational material on breast density targeted towards the general public, were evaluated in our study. Sponsored hits and research journal articles were excluded. Available patient-directed information from websites meeting inclusion criteria was then downloaded. Grade-level readability was then determined from formatted content using generalized estimating equations, with observations nested within readability metrics from each website. Results were compared to American Medical Association recommended readability parameters (sixth-grade reading level). All interval estimates were calculated for 95% confidence.


RESULTS
Fouty-one websites met inclusion criteria representing patient-directed OPEM on breast density. Average grade-level readability of health information on breast density in our study ranged from 8.5-16.5 years with an average grade reading level of 11.1 years across all websites. Of websites fitting into a specific category, academic websites had the highest average grade reading level (12.0), while nonprofit websites had the lowest average grade reading level (10.4). Nearly half (19/41) of all websites in our study had diagrams to aid in patient comprehension, while few websites (2/41; 4.8%) displayed videos in addition to written content. The website with the lowest average grade reading level was WebMD, which had an average reading level of 8.5. No individual website in our study met American Medical Association recommended parameters of a sixth-grade reading level CONCLUSION: Readability of currently available OPEM on breast density may be written at a level too difficult for the general public to comprehend, which may represent a barrier to educational goals of newly passed federal breast density legislation.
['Miles|Randy C|RC|', 'Choi|Paul|P|', 'Baird|Grayson L|GL|', 'Dibble|Elizabeth H|EH|', 'Lamb|Leslie|L|', 'Garg|Megha|M|', 'Lehman|Constance|C|']
D000071060:Breast Density D032882:Comprehension D057220:Health Literacy D006801:Humans D020407:Internet D011932:Reading D057386:Search Engine D014481:United States
Breast density Patient education OPEM Healthy literacy Mammography