Readability assessment of internet-based consumer health information

Respir Care. 2008 Oct;53(10):1310-5.


Background: A substantial amount of consumer health-related information is available on the Internet. Studies suggest that consumer comprehension may be compromised if content exceeds a 7th-grade reading level, which is the average American reading level identified by the United States Department of Health and Human Services (USDHHS).

Objective: To determine the readability of Internet-based consumer health information offered by organizations that represent the top 5 medical-related causes of death in America. We hypothesized that the average readability (reading grade level) of Internet-based consumer health information on heart disease, cancer, stroke, chronic obstructive pulmonary disease, and diabetes would exceed the USDHHS recommended reading level.

Methods: From the Web sites of the American Heart Association, American Cancer Society, American Lung Association, American Diabetes Association, and American Stroke Association we randomly gathered 100 consumer-health-information articles. We assessed each article with 3 readability-assessment tools: SMOG (Simple Measure of Gobbledygook), Gunning FOG (Frequency of Gobbledygook), and Flesch-Kincaid Grade Level. We also categorized the articles per the USDHHS readability categories: easy to read (below 6th-grade level), average difficulty (7th to 9th grade level), and difficult (above 9th-grade level).

Results: Most of the articles exceeded the 7th-grade reading level and were in the USDHHS "difficult" category. The mean +/- SD readability score ranges were: SMOG 11.80 +/- 2.44 to 14.40 +/- 1.47, Flesch-Kincaid 9.85 +/- 2.25 to 11.55 +/- 0.76, and Gunning FOG 13.10 +/- 3.42 to 16.05 +/- 2.31. The articles from the American Lung Association had the lowest reading-level scores with each of the readability-assessment tools.

Conclusions: Our findings support that Web-based medical information intended for consumer use is written above USDHHS recommended reading levels. Compliance with these recommendations may increase the likelihood of consumer comprehension.

Publication types

  • Comparative Study

MeSH terms

  • Consumer Health Information / methods
  • Consumer Health Information / standards*
  • Health Education / standards*
  • Humans
  • Internet*
  • Reproducibility of Results
  • United States