Health literacy and the World Wide Web: Comparing the readability of leading incident cancers on the Internet

Primary objective: to assess the readability level of Web-based information on leading incident cancers. Research design: websites on breast, prostate, and colorectal cancers were selected for analysis by comparing the first 100 hits across 10 popular search engines. A total of 100 websites on breast (n=33), prostate (n=34), and colorectal (n=33) cancers were included in the final analysis. Methods: readability was assessed using SMOG, Flesch-Kincaid (F-K), and Flesch Reading Ease (FRE) measures. SMOG was hand-calculated on 10-30 lines of continuous text. Identical text was entered into Microsoft (R) Word 2002 where F-K and FRE scores were determined automatically by the word processor. Results: the mean readability score of the cancer websites was Grade 12.9 using SMOG and Grade 10.7 according to F-K. The mean FRE score was 45.3, a score considered 'difficult'. Colorectal cancer websites were most difficult to read compared to breast and prostate cancer websites. All measures indicated that prostate cancer websites were written at the lowest readability. Significantly higher reading levels were required for concluding paragraphs of Web articles compared to introduction paragraphs. Conclusions: findings suggest the need for readable cancer information on the Web. Health promoters, health informaticians, medical journalists, and web page editors must collaborate to ensure the use of plain language to match the literacy skills of consumers.