Health Services Research
PV QA 3 - Poster Viewing Q&A 3
Purpose/Objective(s): The current digital era has seen a surge of Americans turning to mobile application resources on their smartphone devices to search for health information. The objective of this study was to determine whether cancer-related mobile applications present information that is readily comprehensible to an American patient. We hypothesized that the majority of patient education materials (PEMs) on mobile applications for five prevalent cancers were written at too difficult reading levels for full comprehension by the average American.
Materials/Methods: Search phrases were generated for five prevalent cancers (breast, colon, lung, prostate, and stomach cancer) in the United States in the following manner: “[cancer type + cancer] OR [cancer type + carcinoma].” The two most accessed mobile application marketplaces (Apple Store and Google Play Store) were queried for candidate applications, and in each search the first 30 applications returned were examined for inclusion if they were 1) designed for general patient usage, 2) provided original health information on the app itself (i.e. not simply providing links to online PEM websites), and 3) contained pertinent cancer-related PEMs. Plain text from all PEMs within each application were copied and pasted into individual documents. Readability levels of all articles were calculated through individual scores generated by 10 validated readability scales, and these scores were averaged to obtain an overall score for each article.
Results: Twenty-one applications were included, which yielded a total of 249 articles with an overall reading level of 11.8 ± 2.3 (range: 6.7-17.5) grade level. Of these, only 12 (4.8%) articles were written below the 8th grade reading level of the average American patient. In contrast, 111 (44.6%) articles were written above the 12th grade level, thus requiring a high school diploma for full comprehension; 8 (3.2%) articles required greater than a four-year college diploma for comprehension. Across the 10 scales employed, mean reading levels for all articles ranged from as low as 9.7 (New Fog Count) to 13.0 (Simple Measure of Gobbledygook). Zero mobile applications demonstrated a reading level that would ensure full comprehension by the average American, with the range across individual applications from 9.0 (Lung Cancer Awareness, Google) to 14.6 (Go Hak Su Colon and Rectal Centre, Apple). The overall reading levels between the two marketplaces were similarly difficult (p=0.71), with the Apple App Store ranging from 9.5-14.6 (mean 11.4 ± 2.0) and the Google Play Store ranging from 9.0-14.4 (mean 11.3 ± 1.8).
Conclusion: The overwhelming majority of PEMs pertaining to five prevalent cancers in the United States were written at too difficult reading levels for full comprehension. Patients may benefit from guidelines that direct the development of PEM-containing applications to better ensure maximal patient comprehension. Further assessments of the quality and accuracy of mobile application PEMs are warranted.
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