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Release: Immediate

July 13, 2001

UI study: Children's health information on Internet is hard to understand

IOWA CITY, Iowa -- Information provided on the Internet about children's health care is often too difficult for most adults to understand, according to a University of Iowa Health Care study. The investigation found that pediatric health care material was written on average at a 12th-grade level; however, the typical American adult reads at an eighth- or ninth-grade level.

The study also identified ways health care providers can improve their writing to make online pediatric patient education materials more understandable. The findings were published in the July issue of the Archives of Pediatrics and Adolescent Medicine.

Previous studies have looked at adult literacy and consumer health information, said Donna D'Alessandro, M.D., UI associate professor of pediatrics and lead investigator. However, the UI study is believed to be the first to specifically analyze pediatric information on the Internet for readability by the layperson.

Using, a digital library developed by D'Alessandro, the team randomly selected and analyzed children's health information from 89 different authoritative Web sites. They found that much of the information was written in language that most adults cannot understand. While many adults are high school graduates, their reading level may actually be three to five grades lower.

"This literacy issue has significant implications for children's health care because adults are the people pediatricians need to educate the most about how to help their children," D'Alessandro said. "In addition, people are turning more and more to the Internet for consumer health information for children as well as for themselves."

D'Alessandro said the team thought that pediatric materials might be more readable than other health information since pediatricians deal with children and tend to use simpler language. However, in addition to finding that most materials were written at a challenging 12th-grade level, the study revealed that authorship did not necessarily determine how readable a text would be.

"Physicians weren't any worse than the nurses, and professional societies weren't any better than commercial companies," D'Alessandro said. "So it was across-the-board that the materials were consistently too difficult."

Based on their findings, the team proposes that all patient education material include a practical reading level and specify how it was determined to help readers select material they can understand.

The researchers also made specific recommendations to improve the readability of online pediatric information, including the following suggestions:

use simple words (doctor, not physician);

use several words to explain a concept (curving of the spine, not scoleosis);

avoid jargon (instead of "The kidneys filter the blood," "The kidneys wash the blood");

use tables and pictures;

provide a glossary of words that will be found in the text;

keep sentences short -- 10-word length is ideal and no more than 15 words maximum.

D'Alessandro said writers may think that people with a college education will feel "talked down to" if text is written at an eighth-grade level. However, other research already has shown that people of all reading abilities like information written in simple language, particularly when it comes to medical terminology.

The findings already are being applied to the UI Virtual Hospital, where Lindsay Huth, a research assistant with elementary education expertise, is reviewing pediatric content such as information on ear infections. Outdated, difficult-to-read materials then will be replaced with new UI original content that is written in language people can understand.

D'Alessandro said that the study limitations include the fact that fewer than 100 sites of an estimated 50 million Internet pages were reviewed and that only sites written in English were analyzed. Nevertheless, the findings have implications for patient education and Internet readability.

"The Internet is a marvelous source of information but trying to find authoritative as well as understandable information is a real problem," D'Alessandro said. "Adults need online materials that they can understand so they can take care of their children and their own health care needs."

The study was supported in part by a Robert Wood Johnson Foundation Generalist Faculty Scholars Grant.

University of Iowa Health Care describes the partnership between the UI College of Medicine and the UI Hospitals and Clinics and the patient care, medical education and research programs and services they provide.