J Curr Surg

Journal of Current Surgery, ISSN 1927-1298 print, 1927-1301 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Curr Surg and Elmer Press Inc

Journal website http://www.currentsurgery.org

Original Article

Volume 10, Number 1-2, April 2020, pages 1-6

Health Literacy Gaps in Online Resources for Cirrhotic Patients

Figure 1. Comparison between “Google” search and “Hepatology Centers” search. Comparison of mean (± SD) scores between “Google” search results and results from “Hepatology Centers” online searches. *P < 0.05. PEMAT-A/V: Patient Education Material Assessment Tool (Audiovisual Materials); SD: standard deviation.

**Table 1.** Readability and Understandability of Top “Google” Searches
Website (in order of grade level readability)	Flesh-Kincaid Grade Level	Number of sentences	Words per sentence	Word count	Time to read for sixth grade level (min)	PEMAT-A/V score (%)
Mean and standard deviation of the Flesch-Kincaid Grade Level, number of sentences, number of words per sentence, word count, time for an average sixth grader to read, and PEMAT score of the top 20 web results from the “Google” search. PEMAT-A/V: Patient Education Material Assessment Tool (Audiovisual Materials); NIDDK: National Institute of Diabetes and Digestive and Kidney Diseases; NATAP: National AIDS Treatment Advocacy Project; ACG: American College of Gastroenterology; NHS: National Health Service; NCBI: National Center for Biotechnology Information.
Medline Plus (branched to Family Doctor Link)	6.8	97	10.56	1,014	7.24	64
British Liver Trust	9.9	84	19.80	1,604	11.46	93
NIDDK	10.2	151	15.38	2,246	16.04	75
Griswold Homecare	10.4	36	17.09	581	4.15	73
WebMD	10.8	83	17.61	1,444	10.31	80
eMedicineHealth	10.8	109	17.99	1,637	11.69	73
NATAP	11.0	155	16.48	2,076	14.83	70
Medical News Today	11.3	150	18.24	1,988	14.20	61
Wikipedia	12.3	172	13.87	2,330	16.64	50
Healthline Alcoholic Liver Cirrhosis	12.5	62	17.94	969	6.92	70
ACG Patient Center	12.5	135	19.13	2,391	17.08	73
NHS	12.7	36	24.50	735	5.25	80
MyDr	13.1	101	24.52	2,256	16.11	80
Merck Manuals	13.1	169	21.86	3,367	24.05	55
Medicine Net	13.7	389	21.76	7,767	55.48	73
Healthline Cirrhosis	13.9	71	23.18	1,298	9.27	70
Otsuka Pharmaceutical	14.3	19	21.44	386	2.76	75
SciTechnol	15.1	9	22.22	200	1.43	58
Verywell Heatlh	15.9	37	25.69	899	6.42	73
NCBI	20.8	127	29.43	3,061	21.86	55
Average	12.3	105	19.63	1,841	13.15	70.05
Standard deviation	3.13	85.77	4.77	1,670.8	11.93	10.35

Table 1. Readability and Understandability of Top “Google” Searches

Website (in order of grade level readability)

Flesh-Kincaid Grade Level

Number of sentences

Words per sentence

Word count

Time to read for sixth grade level (min)

PEMAT-A/V score (%)

Mean and standard deviation of the Flesch-Kincaid Grade Level, number of sentences, number of words per sentence, word count, time for an average sixth grader to read, and PEMAT score of the top 20 web results from the “Google” search. PEMAT-A/V: Patient Education Material Assessment Tool (Audiovisual Materials); NIDDK: National Institute of Diabetes and Digestive and Kidney Diseases; NATAP: National AIDS Treatment Advocacy Project; ACG: American College of Gastroenterology; NHS: National Health Service; NCBI: National Center for Biotechnology Information.

Medline Plus (branched to Family Doctor Link)

6.8

10.56

1,014

7.24

British Liver Trust

9.9

19.80

1,604

11.46

NIDDK

10.2

151

15.38

2,246

16.04

Griswold Homecare

10.4

17.09

581

4.15

WebMD

10.8

17.61

1,444

10.31

eMedicineHealth

10.8

109

17.99

1,637

11.69

NATAP

11.0

155

16.48

2,076

14.83

Medical News Today

11.3

150

18.24

1,988

14.20

Wikipedia

12.3

172

13.87

2,330

16.64

Healthline Alcoholic Liver Cirrhosis

12.5

17.94

969

6.92

ACG Patient Center

12.5

135

19.13

2,391

17.08

NHS

12.7

24.50

735

5.25

MyDr

13.1

101

24.52

2,256

16.11

Merck Manuals

13.1

169

21.86

3,367

24.05

Medicine Net

13.7

389

21.76

7,767

55.48

Healthline Cirrhosis

13.9

23.18

1,298

9.27

Otsuka Pharmaceutical

14.3

21.44

386

2.76

SciTechnol

15.1

22.22

200

1.43

Verywell Heatlh

15.9

25.69

899

6.42

NCBI

20.8

127

29.43

3,061

21.86

Average

12.3

105

19.63

1,841

13.15

70.05

Standard deviation

3.13

85.77

4.77

1,670.8

11.93

10.35

**Table 2.** Readability and Understandability of Top “Hepatology Centers” Searches
Website	Flesh-Kincaid Grade Level	Number of sentences	Words per sentence	Word count	Time to read for sixth grade level (min)	PEMAT-A/V score (%)
Mean and standard deviation of the Flesch-Kincaid Grade Level, number of sentences, number of words per sentence, word count, time for an average sixth grader to read, and PEMAT score of the top 20 web results from the “Hepatology Centers” search. PEMAT-A/V: Patient Education Material Assessment Tool (Audiovisual Materials).
University of Wisconsin Hospital and Clinics	6.7	79	11.03	827	5.91	64
University of Pittsburgh Medical Center	6.8	79	11.07	830	5.93	50
Johns Hopkins Medical Center	7.9	104	14.03	1,319	9.42	90
Northwestern Medicine	8.0	104	14.06	1,322	9.44	90
University of California Los Angeles Medical Center	8.0	104	14.06	1,322	9.44	90
Emory Healthcare	9.8	19	14.53	276	1.97	40
Mayo Clinic	10.1	194	14.63	2,677	19.12	64
Ohio State University Medical Center	10.3	12	15.91	175	1.25	73
Baylor Medical Center	10.5	113	15.59	1,653	11.81	75
Barnes Jewish Hospital	11.3	20	19.19	307	2.19	70
Cleveland Clinic	11.4	89	18.65	1,399	9.99	82
Stanford Medicine	12.1	64	15.65	767	5.48	70
Vanderbilt University Medical Center	12.1	18	21.41	364	2.6	60
Piedmont Hospital	12.2	47	16.05	674	4.81	80
University of California San Francisco Medical Center	12.8	35	21.12	679	4.85	80
Lahey Clinic	14.1	60	22.60	904	6.46	82
Henry Ford Health System	14.4	41	22.87	686	4.9	90
Cedars-Sinai Medical Center	15.2	29	28.46	683	4.88	55
Mt. Sinai Healthcare	15.4	55	17.58	798	5.7	64
Georgetown Medical Hospital	17.2	17	31.85	414	2.96	80
Average	11.3	64.15	18.02	904	6.46	72.45
Standard deviation	2.44	50.53	3.23	677.61	4.19	14.21

Table 2. Readability and Understandability of Top “Hepatology Centers” Searches

Website

Flesh-Kincaid Grade Level

Number of sentences

Words per sentence

Word count

Time to read for sixth grade level (min)

PEMAT-A/V score (%)

University of Wisconsin Hospital and Clinics

6.7

11.03

827

5.91

University of Pittsburgh Medical Center

6.8

11.07

830

5.93

Johns Hopkins Medical Center

7.9

104

14.03

1,319

9.42

Northwestern Medicine

8.0

104

14.06

1,322

9.44

University of California Los Angeles Medical Center

8.0

104

14.06

1,322

9.44

Emory Healthcare

9.8

14.53

276

1.97

Mayo Clinic

10.1

194

14.63

2,677

19.12

Ohio State University Medical Center

10.3

15.91

175

1.25

Baylor Medical Center

10.5

113

15.59

1,653

11.81

Barnes Jewish Hospital

11.3

19.19

307

2.19

Cleveland Clinic

11.4

18.65

1,399

9.99

Stanford Medicine

12.1

15.65

767

5.48

Vanderbilt University Medical Center

12.1

21.41

364

2.6

Piedmont Hospital

12.2

16.05

674

4.81

University of California San Francisco Medical Center

12.8

21.12

679

4.85

Lahey Clinic

14.1

22.60

904

6.46

Henry Ford Health System

14.4

22.87

686

4.9

Cedars-Sinai Medical Center

15.2

28.46

683

4.88

Mt. Sinai Healthcare

15.4

17.58

798

5.7

Georgetown Medical Hospital

17.2

31.85

414

2.96

Average

11.3

64.15

18.02

904

6.46

72.45

Standard deviation

2.44

50.53

3.23

677.61

4.19

14.21