EP716 - Understanding Health Literacy In Rectal Cancer Patients

Purpose/Background: Health literacy, as recently redefined by the U.S. Department of Health and Human Services, includes both personal and organizational dimensions (1). The National Assessment of Adult Literacy reports that 36% of U.S. adults have limited health literacy (2). The NIH and AMA recommend patient materials are written at a sixth- to eighth grade reading level (3,4), yet many online patient educational materials (OPEMs) exceed this range (5,6). This study evaluates the readability, understandability, and actionability of the most common rectal cancer OPEMs and proposes a reproducible framework to guide improvement.

Methods/Interventions: Two analytic arms were created: readability and understandability/actionability. A Google search for "rectal cancer" identified the first 11 non-sponsored articles. In the readability arm, text from each OPEM was analyzed using seven readability indices. Mean readability scores were compared to the NIH/AMA sixth-grade threshold via one-sample t-test. For the understandability/actionability arm, the validated Agency of Healthcare Quality & Research (AHRQ) Patient Education Materials Assessment Tool (PEMAT) was used by seven healthcare professionals (APPs, support staff, physicians, and medical students) to score each OPEM (7). Positive controls (a New York Times article and a Chicken Riggies recipe) and negative controls (an Introduction to Feynman Diagrams and Title IV of the One Big Beautiful Bill Act) were included for reference. An institutional rectal cancer handout served as an internal control. Scores were averaged for each domain and compared using ANOVA across OPEMs, controls, and the institutional handout.

Results/Outcomes: All eleven OPEMs exceeded the sixth-grade readability threshold, except the Cedars-Sinai article by the Dale-Chall index (Table 1, Figure 1). The OPEMs average readability scores were significantly different from the NIH/AMA recommended level and ranged from 7.24 to 12.04 grade levels (p < 0.005) (Figure 2). Four OPEMs and the institutional handout achieved understandability >80%, while the remainder scored below this benchmark. Actionability was uniformly poor, with all OPEMs and the handout below 80% and some as low as 15% (Figure 3). Most OPEMs and the handout had significantly higher understandability than the negative control (Title IV of the One Big Beautiful Bill Act), and four exceeded even the positive control (NYT Front Page). In contrast, seven OPEMs scored significantly lower in actionability compared to the positive control (Chicken Riggies recipe), although all scored higher than the negative control (Introduction to Feyman Diagrams). The handout trended lower than the positive control in actionability but without statistical significance (Table 2).

Conclusion/Discussion: Readability of popular rectal cancer OPEMs generally exceeds NIH/AMA recommended patient reading levels, highlighting a persistent health literacy gap. While understandability is moderate to high for these same materials, actionability remains consistently low. These findings underscore the need for targeted efforts to improve the literacy of online rectal cancer education. Our analytic framework may serve as a model for evaluating and enhancing health literacy across other disease domains.

References
Tables and Figures
Figures and Tables referenced in Results section of Abstract Submission