Facial Paralysis Online Educational Resources: Readability and Benefit to Patient Education

Increasing numbers of persons rely on the internet for medical information.1 Patients with facial paralysis are presented with many complex management options, and the terminology related to facial paralysis and treatments can be complex.2 Patient decision-making requires good comprehension of medical information. With reported high rates of low health literacy, it is essential to adhere to the minimum recommended standard of a grade 6 reading level for educational resources.3,4 We evaluated the readability of online education resources related to facial nerve disorders published by medical institutions, health systems, professional organizations, and governments. An internet search was performed using the terms “Moebius syndrome,” “facial palsy,” “facial paralysis,” and “Bell’s palsy” and included websites that (1) presented educational information in English about the diagnosis, assessment, and/or treatment and (2) were published by health care and educational institutions, medical associations/societies, or governments. The Flesch-Kincaid grade level and Flesch reading ease scores were assessed for each webpage (acceptable recommendations: Flesch-Kincaid grade level <6.0, Flesch reading ease score >80.0). Our search, conducted in April of 2020, retrieved 78 webpages with the terms “Moebius syndrome” (n = 7) and “facial palsy,” “facial paralysis,” and “Bell’s palsy” (n = 71). Most pages failed to meet the recommended standards, with mean Flesch-Kincaid grade levels above 6.0 and mean Flesch reading ease scores below 80.0. The grade 6 reading level was rare among the websites searched (“facial palsy,” “facial paralysis,” and “Bell’s palsy,” n = 5; “Moebius syndrome,” n = 0). The mean reading ease score of the “Moebius syndrome” websites was significantly lower (p = 0.01) compared to the scores of the “facial palsy,” “facial paralysis,” and “Bell’s palsy” websites (Table 1). Health system websites demonstrated significantly lower mean reading ease scores (p = 0.02) and greater mean Flesch-Kincaid grade levels (p = 0.01) compared to other organization types (Fig. 1). Table 1. - Flesch-Kincaid Grade Level and Flesch Reading Ease Score with Search Terms Search Term “Moebius Syndrome” Search Terms “Facial Palsy,” “Facial Paralysis,” “Bell’s Palsy” p Flesch-Kincaid grade level,* mean ± SD 11.2 ± 1.8 9.8 ± 2.4 0.33 Flesch reading ease,† mean ± SD 41.4 ± 9.8 54.8 ± 12.3 0.01 *Flesch-Kincaid grade level indicates the reading difficulty based on grade level. Recommended, <grade 6.†Flesch reading ease score indicates the level of “ease” to read text (100-point scale, with higher scores indicated easier to read). Recommended, >80.0. Fig. 1.: Comparison of readability metrics and source of online resource. Websites from health systems demonstrated significantly lower mean reading ease scores (p = 0.02) and greater mean Flesch-Kincaid grade level (p = 0.01) compared to medical society and government websites.Our study found that most online educational resources on facial nerve disorders published by hospital/health systems, education institutions, medical societies, and governments failed to meet the recommended grade 6 reading level. This is particularly important in conditions related to facial nerve dysfunction, which are complex and may be challenging to comprehend. Patient education is an essential component of medical and surgical care. Online resources should be written at the recommended reading level to ensure that patients seeking information related to facial paralysis can better understand this information. Studies evaluating the readability of online educational resources on other topics related to plastic and reconstructive surgery report similar results and highlight the potential for reduced comprehension of these online resources.4,5 A limitation of our study was English-language restriction and the target audiences for the websites. Some websites reviewed were targeted to provide information to medical professionals and patients. Resources directed toward medical specialists may include complex medical and anatomic terms that may inflate the readability statistics. Most online education resources related to facial nerve disorders fail to meet readability standards and highlight a common problem related to online surgical resources for patients and their families. To ensure and promote better health education, medical professionals, website content designers, and writers should adhere to the recommended standards for readability to maximize patient comprehension. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.

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