Written patient resources for complex endovascular aneurysm repair and challenging to read and understand
Bibliographic record
Abstract
Background Health literacy is a critical mediator of cardiovascular risk factor control and outcomes 1–3 . Complex Endovascular Aortic Aneurysm Repair (cEVAR) represents a challenging subject for providers to describe and for patients to understand. There have been no studies examining readability or understandability of patient-facing resources for cEVAR. In Canada, 49% of adults have a reading level below grade 12 4 . The 2024 United States National literacy Institute assessment reported a 21% illiteracy rate, with 54% of Americans reading below 6 th grade 5 . This provides a rationale for the recommendation of the National Institutes of Health and American Medical Association, that patient-facing educational resources fall below a 6 th grade reading level. Objective We hypothesized that the readability and understandability of patient-facing resources on cEVAR would exceed the national reading level of Canadians and Americans. Methods Two common electronic search engines were used to find patient-facing resources pertaining to cEVAR, resulting in 55 non-redundant resources. Plain text copies of each resource were assessed using the common readability indices Flesch-Kincaid Grade Level (FKGL), and Simple Measures of Gobbledygook (SMOG), and their understandability analyzed with the Patient Education Materials Assessment Tool (PEMAT) and PEMAT-Audiovisual Tool (PEMAT-AV). Results The FKGL generated a mean reading grade level of 9.3 ± 2.61, and SMOG generated a mean reading grade level of 11.9 ± 2.0. The mean PEMAT understandability percentage was 54.2 ± 19.0. By SMOG analysis, 45% of the resources (or 25 of 55 resources) required a grade 12 education. Conclusions Every resource examined was above the grade level recommendations of the CDC/NIH/AHA/AHRQ/AMA. On average, only 54% of any resource content was understandable. Limitations include the assumption that (1), health resources with appropriate literacy levels will generate changes in behaviour/outcomes of for patients with aneurysm disease, and (2) there is likely variable health literacy in the AAA patient population.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".