Readability of cancer information on the Internet

Background. Literacy is considered an essential component of individuals' ability to increase control over their health. However, the majority of printed cancer information is written at readability levels of high school or higher and may be difficult to comprehend by people who are searching for medical information. Since low literacy is associated with poorer health and since a growing number of people are searching the Internet for health information, our research questions were twofold: (1) What is the readability level of popular Web sites on breast, colon, and prostate cancers? and (2) Does readability level differ as a function of the Web sites' organizational origin? Methods. Breast, colon, and prostate cancer Web sites were selected for analysis by comparing the first 100 hits of 10 popular search engines. A total of 55 Web sites on breast (n = 20), cotorectal (n = 18), and prostate (n = 17) cancers were included in the final analysis and assessed for readability using SMOG, Flesch-Kincaid (F-K), and Flesch Reading Ease (FRE) measures. Results. The overall mean reading level of the cancer Web sites was Grade 13.7 using the SMOG formula and Grade 10.9 according to F-K. The mean FRE score was 41.6. The majority of Web sites (63.6%) were written at college level (Grade 13+) according to SMOG, especially those with a domain of ".com" and ".org." Breast cancer sites were written at easier reading grade levels than sites on prostate cancer and colorectal cancer. Breast cancer sites also showed the largest increase in reading difficulty between opening and concluding paragraphs of text. Conclusions. Readability of cancer information on the Internet is at a college level. Individuals with basic literacy skills must be considered when posting cancer information on the Internet. Otherwise this information wilt remain inaccessible to a segment of the population who is at risk for cancer.