Losing your head? An evaluation of the readability and reliability of patient information available online for avascular necrosis of the head of the femur.

TITLE: Losing your head? An evaluation of the readability and reliability of patient information available online for Avascular Necrosis of the Head of Femur. BACKGROUND: Avascular necrosis of the head of femur commonly affects patients with an average age of 58.3 years, and is generally managed in the elective setting, allowing patients a timeframe to research their diagnosis and management options. The aim of this study is to evaluate the readability and reliability of the information available online to patients about this condition. METHODS: Google, Bing and Yahoo internet search engines were utilised, using the search terms "Avascular necrosis head of femur" and "hip avascular necrosis", with the first 30 URLs selected for analysis. Readability was assessed using an online readability calculator to produce 3 scores (Gunning FOG, Flesch Kincaid Grade and Flesch Reading Ease). Information quality was assessed using a HONcode detection web-extension and the JAMA benchmark criteria. RESULTS: 86 webpages were identified for inclusion for assessment. CONCLUSION: The majority of the information available online about avascular necrosis of the head of the femur is not at an appropriate reading level for the general population, and less than 20% of the most accessible information available online is accredited to be of sufficient quality to be providing advice to patients. Medical professionals must work together to improve health literacy among the patients encountered, and ensure recommendation of only reliable and accessible sources of information should patients ask for guidance on finding these resources.

Readability and quality of online information for patients pertaining to revision knee arthroplasty: An objective analysis.

BACKGROUND: Modern patients use the internet more frequently for their health information. Our aim was to assess the quality and readability of online patient education materials relating to revision knee arthroplasty. We hypothesised that this information would be too difficult to read for the average patient and of a lesser quality than desired. METHOD: A search of the top 50 results on 3 search engines (Google, Bing, Yahoo) was completed (MeSH "revision knee arthroplasty", "revision knee replacement"). Readability of these websites was calculated using a specialised website, www.readable.com to produce 3 scores (Gunning-Fog (GF), Flesch Reading Ease (FRE), Flesch-Kincaid Grade (FKG). Quality was assessed using the Journal of American Medical Association (JAMA) benchmark criteria and the Health On the Net (HON) code toolbar extension. RESULTS: 89 unique websites were identified. Mean FRE was 44.01 ± 11.05. The mean GF was 12.01 ± 2.94. The mean FKG level was 10.06 ± 1.95. As per the FRE score, no webpage was pitched at or below a sixth grade reading level. The GF index identified only 3 websites (3.4%) at 6th grade reading level. As per FKG score, most webpages (n = 58, 65.2%) found themselves in the 10th grade reading level and above. Four websites (4.5%) displayed a HONcode certificate. However, all had expired. Most websites (n = 34, 38.2%) didn't meet any of the JAMA criteria. CONCLUSION: The reading level of these materials is too high for the average patient and of a low quality. Given what we know about levels of health literacy and their relationship with patient outcomes, it is vital that we address these deficiencies promptly.

Patient Education for Kidney Failure Treatment: A Mixed-Methods Study.

RATIONALE & OBJECTIVE: Education programs are needed for people with advanced chronic kidney disease to understand kidney failure treatment options and participate in shared decision-making (SDM). Little is known about the content and accessibility of current education programs or whether they support SDM. STUDY DESIGN: Stakeholder-engaged, mixed-methods design incorporating qualitative observations and interviews, and a quantitative content analysis of slide presentations. SETTING & PARTICIPANTS: Four sites located in Boston, Chicago, Portland (Maine), and San Diego. ANALYTICAL APPROACH: Thematic analysis based on the Ottawa Framework (observations and interviews) and descriptive statistical analysis (slide presentations). RESULTS: Data were collected from observations of 9 education sessions, 5 semistructured interviews with educators, and 133 educational slide presentations. Sites offered group classes or one-on-one sessions. Development, quality, and accuracy of educational materials varied widely. Educators emphasized dialysis (often in-center hemodialysis), with little mention of conservative management. Educators reported patients were often referred too late to education sessions and that some patients become overwhelmed if they learn of the implications of kidney failure in a group setting. Commonly, sessions were general and did not provide opportunities for tailored information most supportive of SDM. Few nephrologists were involved in education sessions or aware of the educational content. Content gaps included prognosis, decision support, mental health and cognition, advance care planning, cost, and diet. Slide presentations used did not consistently reflect best practices related to health literacy. LIMITATIONS: Findings may not be broadly generalizable. CONCLUSIONS: Education sessions focused on kidney failure treatment options do not consistently follow best practices related to health literacy or for supporting SDM. To facilitate SDM, the establishment of expectations for kidney failure treatment options should be clearly defined and integrated into the clinical workflow. Addressing content gaps, health literacy, and communication with nephrologists is necessary to improve patient education in the setting of advanced chronic kidney disease.

Ankle conFUSION: The quality and readability of information on the internet relating to ankle arthrodesis.

BACKGROUND: The internet is an important source of information for patients undergoing surgery. Multiple studies have identified inappropriately high reading levels of patient information online. The average reading level in the United States is 7-8th grade. Multiple organisations have recommended that patient information not exceed 6th grade level. This study aims to evaluate the reading levels and quality of information regarding ankle fusion surgery online. METHODS: Google, Bing and Yahoo were searched (MeSH "ankle fusion", "ankle arthrodesis") and the top 30 URLs analysed. Readability was assessed using an online readability calculator to produce 3 scores (Gunning FOG, Flesch Kincaid Grade and Flesch Reading Ease). Quality was assessed using a HONcode detection web-extension and the JAMA benchmark criteria. RESULTS: Ninety-eight webpages were identified. The mean Flesch Kincaid Grade level was 9.24 ± 2.33 (95% CI 8.78-9.71). The mean Gunning FOG grade was 10.88 ± 3.1 (95% CI 10.26-11.5). The mean Flesch Reading Ease score was 49.88 ± 14.46 (95% CI 46.98-52.78). 7 webpages were at or below the 6th grade reading level. The mean JAMA score was 1.34 ± 1.32 out of 4 (95% CI 1.07-1.6). 14 websites were HONcode accredited. CONCLUSION: The overall readability of medical information online is too high for the average patient. Given the important role that health literacy provides in patient reported outcomes, improving the readability and quality of these materials is imperative. Awareness by the general public is essential for them to critically appraise the information they receive online.

The reading level matched design: Limitations and possible alternatives.

Wybrow & Hanley (2015) reported that proportions of phonological and surface dyslexics change depending on how control groups are selected. This observation questions the appropriateness of the reading-level match design for establishing causality in cognitive studies of reading. Here, I focus on three features: (1) the lack of an explicit definition of the reading-level concept; (2) the metric problems associated with using this design; and (3) the ambiguity of the delay-deviance contrast in interpreting reading deficits. I also delineate alternative methodological features that could effectively inform developmental designs. Thus, I argue that (a) control variables should be as independent of the target-dependent measure as possible; (b) they should be shaped within the theoretical aims of the study and be explicitly considered in the interpretation of findings; and, (c) conditions of interest should be viewed along with critically associated conditions using approaches that allow predicting the size of the expected deficit..

Dyslexia in a consistent orthography: Evidence from reading-level match design.

Studies in consistent orthographies using reading-level (RL) match design have produced conflicting results, possibly because of problems with general ability and RL matching in many studies. We matched the participants on both verbal and nonverbal ability and on reading tasks with no ceiling effects and compared the performance of Grades 4 and 6 Greek-speaking children with dyslexia to those of chronological age (CA) and RL matched control groups across a variety of tasks associated with dyslexia (phonological awareness, rapid naming, phonological memory, and orthographic processing). The results showed that although both Grade 4 and Grade 6 dyslexics performed poorer than the CA groups in most tasks, they did not perform poorer than the RL group in any of the tasks included. We conclude with a discussion of the theoretical ramifications of the results and the appropriateness of the RL match design in studying dyslexia in consistent orthographies.

Readability of Online Information Related to Pediatric Radiation Safety From Societal Websites.

OBJECTIVE: The Internet has become a major readily available source of health care education. Pediatric radiation safety is a complex topic with evolving safety guidelines. The purpose of this study is to assess the readability of publically available online information pertaining to pediatric radiation safety available on the websites of radiologic and pediatric societies. MATERIALS AND METHODS: Online information related to pediatric radiation safety that is available on the Society for Pediatric Radiology website and the websites RadiologyInfo (sponsored by the Radiological Society of North America and the American College of Radiology) and HealthyChildren.org (sponsored by the American Academy of Pediatrics) was evaluated for readability. Each article was assessed using six readability tests, which use either a grade level or a numeric scale to categorize readability. ANOVA was used to compare readability levels and intraclass correlation coefficients for analytic reliability. RESULTS: A total of 54 articles were included in the analysis. Three of the articles were written below the eighth-grade reading level. The mean readability ranged from grades 12.1 to 14.8 among the five different grade level-based readability scales used. The mean readability determined using the numeric scale was 37.3 (which identified readability as difficult), with 91% of articles categorized as very difficult, difficult, or fairly difficult and with no article categorized as easy or very easy. No difference in readability was found among the different web sources (p = 0.46-0.85). CONCLUSION: Overall, the readability of information pertaining to pediatric radiation safety that is available on radiology and pediatric medical society websites is at a level that is too difficult for the average adult.

A content analysis of Internet resources about the risks of seafood consumption.

Seafood consumption is a main source of human exposure to certain environmental contaminants. Therefore, it is valuable to assess the online health risk messages focused on this topic, as people in the US are increasingly accessing the Internet for health-related information. Previous research indicates that online health information tends to be written at a reading level that is more advanced than ability of the general population. The purpose of this research was to examine the content and readability of Internet resources targeted toward consumers in the US regarding the health risks from consumption of contaminated seafood. Sources for analysis were gathered through a targeted search of state and national government websites, as well as through a Google search. The overall mean readability level was Grade 9.21, which is slightly above the average reading level of US adults. Future research should evaluate the accuracy of the health risk messages, as well as consumer perceptions of risk.

Participant comprehension of research for which they volunteer: a systematic review.

PURPOSE: Evidence indicates that research participants often do not fully understand the studies for which they have volunteered. The aim of this systematic review was to examine the relationship between the process of obtaining informed consent for research and participant comprehension and satisfaction with the research. DESIGN: Systematic review of published research on informed consent and participant comprehension of research for which they volunteer using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Statement as a guide. METHODS: PubMed, Cumulative Index for Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trails, and Cochrane Database of Systematic Reviews were used to search the literature for studies meeting the following inclusion criteria: (a) published between January 1, 2006, and December 31, 2013, (b) interventional or descriptive quantitative design, (c) published in a peer-reviewed journal, (d) written in English, and (e) assessed participant comprehension or satisfaction with the research process. Studies were assessed for quality using seven indicators: sampling method, use of controls or comparison groups, response rate, description of intervention, description of outcome, statistical method, and health literacy assessment. FINDINGS: Of 176 studies identified, 27 met inclusion criteria: 13 (48%) were randomized interventional designs and 14 (52%) were descriptive. Three categories of studies included projects assessing (a) enhanced consent process or form, (b) multimedia methods, and (c) education to improve participant understanding. Most (78%) used investigator-developed tools to assess participant comprehension, did not assess participant health literacy (74%), or did not assess the readability level of the consent form (89%). Researchers found participants lacked basic understanding of research elements: randomization, placebo, risks, and therapeutic misconception. CONCLUSIONS: Findings indicate (a) inconsistent assessment of participant reading or health literacy level, (b) measurement variation associated with use of nonstandardized tools, and (c) continued therapeutic misconception and lack of understanding among research participants of randomization, placebo, benefit, and risk. While the Agency for Healthcare and Quality and National Quality Forum have published informed consent and authorization toolkits, previously published validated tools are underutilized. CLINICAL RELEVANCE: Informed consent requires the assessment of health literacy, reading level, and comprehension of research participants using validated assessment tools and methods.

Evaluation of printed health education materials for use by low-education families.

PURPOSE: Millions of adults lack adequate reading skills and many written patient education materials do not reflect national guidelines for readability and suitability of materials, resulting in barriers to patients being partners in their own health care. The purpose of this study was to evaluate commonly used printed health materials for readability and suitability for patients with limited general or health literacy skills, while providing easy recommendations to health care providers for how to improve the materials. METHODS: Materials (N = 97) from three clinical areas that represented excellence in nursing care in our organization (stroke, cancer, and maternal-child) were reviewed for a composite reading grade level and a Suitability Assessment of Materials (SAM) score. RESULTS: Twenty-eight percent of the materials were at a 9th grade or higher reading level, and only 23% were 5th grade or below. The SAM ratings for not suitable, adequate, and superior were 11%, 58%, and 31%, respectively. Few materials were superior on both scales. The SAM scale was easy to use and required little training of reviewers to achieve interrater reliability. CONCLUSIONS: Improving outcomes and reducing health disparities are increasingly important, and patients must be partners in their care for this to occur. One step to increasing patient understanding of written instructions is improving the quality of the materials in the instruction for all patients and their families, especially those with limited literacy skills. CLINICAL RELEVANCE: Using materials that are written in a manner that facilitates the uptake and use of patient education content has great potential to improve the ability of patients and families to be partners in care and to improve outcomes, especially for those patients and families with limited general literacy or health literacy skills.

Using ChatGPT and Google Bard to improve the readability of written patient information: a proof of concept.

Patient information materials often tend to be written at a reading level that is too advanced for patients. In this proof-of-concept study, we used ChatGPT and Google Bard to reduce the reading level of three selected patient information sections from scientific journals. ChatGPT successfully improved readability. However, it could not achieve the recommended 6th-grade reading level. Bard reached the reading level of 6th graders but oversimplified the texts by omitting up to 83% of the content. Despite the present limitations, developers of patient information are encouraged to employ large language models, preferably ChatGPT, to optimize their materials.

A comparative study of the NAART and WRAT4 Word Reading subtest to estimate reading level.

Patients are often asked to fill out paperwork in medical settings, but varying reading levels can affect the ability to self-report. By screening for reading level, clinicians can prevent potential patient confusion, frustration, and embarrassment. Clinicians can also avoid problems leading to misdiagnosis and providing materials that patients will not understand. The Wide Range Achievement Test - Fourth Edition (WRAT4) Word Reading (WR) subtest provides an estimation of word reading grade level as well as premorbid ability. The North American Adult Reading Test (NAART) only provides an estimation of premorbid abilities, but it is quick to administer and available in the public domain. By correlating these word reading measures (NAART & WRAT4 WR subtest), word reading level can be estimated by using the NAART alone. This project was a systematic replication of a study conducted by Jones et al. using a demographically-different sample of participants. Results indicate that NAART error scores and WRAT4 WR subtest raw scores were significantly correlated. Although the distributions of WRAT4 WR subtest raw scores from the Jones et al. study and the current study significantly differed, there was not a statistically significant difference between the proportion of predicted reading levels at/above or below fourth or fifth grade and actual reading levels at/above or below fourth or fifth grade. This finding suggests that the original regression equation created by Jones et al. can be applied to the current sample to accurately predict reading level classification.

Readability, Content, and Accountability Assessment of Online Health Information for Retinitis Pigmentosa & Retinitis Pigmentosa Treatment Options.

PURPOSE: New therapies for retinitis pigmentosa (RP) have led to patients desiring more information about their disease. We assessed the readability, content, and accountability of online health information for RP and its treatments. METHODS: Two internet queries were performed: one pertaining to the condition RP, and another pertaining to treatments of RP. Three analyses were performed on the top search results that met eligibility criteria: (1) A readability analysis produced an average reading level; (2) A content analysis was conducted to score each source on the accuracy, completeness, clarity, and organization of the content; and (3) An accountability analysis was performed to evaluate adherence to accountability benchmarks, including authorship, attribution, disclosure, and currency. RESULTS: The mean reading level was 12.0 (SD = 3.2, 95% CI = 11.0-13.0) for the 8 RP webpages and 12.5 (SD = 3.1, 95% CI = 11.7-13.4) for the 10 RP treatment webpages. The mean content score for RP sites was 21.3 of 32 points (SD = 4.1, 95% CI = 19.5-23.0). The mean content score for RP treatment sites was 5.5 out of 16 points (SD = 3.7, 95% CI = 4.1-6.9). The inter-rater reliability was 0.973 (Cronbach's alpha). For RP sites, the mean accountability score was 2.6 out of 4 points (SD = 0.9, 95% CI = 1.9-3.4). For RP treatment sites, the mean accountability score was 2 out of 4 points (SD = 0.9, 95% CI = 1.4-2.6). CONCLUSION: Our data suggest that the online information available to patients regarding RP and RP treatment options exceeds the AMA-recommended sixth-grade reading level and contains gaps in content relevant to patients.

Eye Movement Evidence for Simultaneous Cognitive Processing in Reading.

Measuring simultaneous processing, a reliable predictor of reading development and reading difficulties (RDs), has traditionally involved cognitive tasks that test reaction or response time, which only capture the efficiency at the output processing stage and neglect the internal stages of information processing. However, with eye-tracking methodology, we can reveal the underlying temporal and spatial processes involved in simultaneous processing and investigate whether these processes are equivalent across chronological or reading age groups. This study used eye-tracking to investigate the simultaneous processing abilities of 15 Grade 6 and 15 Grade 3 children with RDs and their chronological-age controls (15 in each Grade). The Grade 3 typical readers were used as reading-level (RL) controls for the Grade 6 RD group. Participants were required to listen to a question and then point to a picture among four competing illustrations demonstrating the spatial relationship raised in the question. Two eye movements (fixations and saccades) were recorded using the EyeLink 1000 Plus eye-tracking system. The results showed that the Grade 3 RD group produced more and longer fixations than their CA controls, indicating that the pattern of eye movements of young children with RD is typically deficient compared to that of their typically developing counterparts when processing verbal and spatial stimuli simultaneously. However, no differences were observed between the Grade 6 groups in eye movement measures. Notably, the Grade 6 RD group outperformed the RL-matched Grade 3 group, yielding significantly fewer and shorter fixations. The discussion centers on the role of the eye-tracking method as a reliable means of deciphering the simultaneous cognitive processing involved in learning.

Health Information From Web Search Engines and Virtual Assistants About Pre-Exposure Prophylaxis for HIV Prevention in Adolescents and Young Adults: Content Analysis.

BACKGROUND: Adolescents and young adults are disproportionately affected by HIV, suggesting that HIV prevention methods such as pre-exposure prophylaxis (PrEP) should focus on this group as a priority. As digital natives, youth likely turn to internet resources regarding health topics they may not feel comfortable discussing with their medical providers. To optimize informed decision-making by adolescents and young adults most impacted by HIV, the information from internet searches should be educational, accurate, and readable. OBJECTIVE: The aims of this study were to compare the accuracy of web-based PrEP information found using web search engines and virtual assistants, and to assess the readability of the resulting information. METHODS: Adolescent HIV prevention clinical experts developed a list of 23 prevention-related questions that were posed to search engines (Ask.com, Bing, Google, and Yahoo) and virtual assistants (Amazon Alexa, Microsoft Cortana, Google Assistant, and Apple Siri). The first three results from search engines and virtual assistant web references, as well as virtual assistant verbal responses, were recorded and coded using a six-tier scale to assess the quality of information produced. The results were also entered in a web-based tool determining readability using the Flesch-Kincaid Grade Level scale. RESULTS: Google web search engine and Google Assistant more frequently produced PrEP information of higher quality than the other search engines and virtual assistants with scores ranging from 3.4 to 3.7 and 2.8 to 3.3, respectively. Additionally, the resulting information generally was presented in language at a seventh and 10th grade reading level according to the Flesch-Kincaid Grade Level scale. CONCLUSIONS: Adolescents and young adults are large consumers of technology and may experience discomfort discussing their sexual health with providers. It is important that efforts are made to ensure the information they receive about HIV prevention methods, and PrEP in particular, is comprehensive, comprehensible, and widely available.

Readability of the Most Commonly Accessed Online Patient Education Materials Pertaining to Surgical Treatments of the Spine.

OBJECTIVE: The American Medical Association and National Institutes of Health have recommended that patient education materials should be written at the sixth-grade reading level to maximize patient comprehension. The objective of the present study was to evaluate the readability of Internet information for the 9 most common spinal surgeries. METHODS: We reviewed 90 online patient educational materials regarding the 9 most common spinal surgeries as reported by the North American Spine Society. A Google search was performed on March 23, 2019 for each surgery, and the top 10 most visited websites for each surgery were assessed for reading level using the Flesch-Kincaid formula. RESULTS: Using the Flesch-Kincaid formula, the average grade reading level of the 90 websites included was 12.82, with a reading ease of 37.04 ("difficult college"). Only 6 websites relayed information to patients at or below the national average of an eighth-grade reading level. The websites for bone morphogenic protein had the highest average grade reading level at 15.88 ± 2.6. Lumbar microscopic discectomy had the lowest average grade reading level at 10.37 ± 2.89. All surgical options discussed had an average readability above the recommended sixth-grade reading level. CONCLUSIONS: The most accessed online materials for common spinal surgeries, not only exceeded the readability limits recommended by both the American Medical Association and the National Institutes of Health, but they also exceeded the average reading ability of most adults in the United States. Patients, therefore, might not fully comprehend the information from commonly accessed websites regarding surgical spine treatment options.

Information regarding Zika virus on the Internet: A cross-sectional study of readability.

The purpose of this study was to determine the readability of 100 articles posted on the Internet related to the Zika virus. An on-line readability calculator was used to generate scores on each website from 5 readability tests. Most of the material analyzed was written at a level beyond grade 10. The data in this study make a compelling case that websites containing information on the Zika virus are being written at levels beyond what is recommended. It would behoove those who create health information to consider ways to adapt their materials in a way that is consistent with recommended readability levels.

A meta-analysis of reading-level match dyslexia studies in consistent alphabetic orthographies.

We provide a meta-analytic review of all group-comparison studies that used reading-level match design, were conducted in highly consistent European orthographies, included children with dyslexia younger than 13 years of age as participants, and included measures of one or more of the potential causes of dyslexia. We identified 21 studies meeting these criteria that examined one or more of phonological awareness, rapid naming, verbal short-term memory, or auditory temporal processing. A random effects model analysis showed first that the groups were matched imperfectly and they differed significantly in word reading measures not used for matching. Second, there were no significant differences between the individuals with dyslexia and their reading-level-matched controls in rapid naming, phonological memory, and auditory temporal processing. Finally, the analyses for phonological awareness showed a significant effect for comparisons that involved manipulating phonemes but not for tasks that involved manipulating syllables. The results are compatible with phonological deficit theories of dyslexia, but this conclusion is qualified by observed differences in reading skills and sample selection concerns.

Impact of social media use on reading levels in third-year student pharmacists.

INTRODUCTION: The majority of Americans report using social media, but there is limited research describing impact of social media on academic performance and reading. Our objectives were to describe the association between social media use and reading levels of third-year student pharmacists (P3), describe the association between reading level and pharmacy school admissions data, and assess texts used in the curriculum for readability. METHODS: This was a prospective, cohort study. Reading level was determined by a standardized test. Social media data were collected via questionnaire. Admissions data were obtained from the admissions office. Readability of texts was assessed using readability software. RESULTS: Eighty-nine student pharmacists completed the study. The average reading level was 16.4. Students reported using social media for an average of 126 min daily. Students reported using an average of four social media sites and spending 88 min weekly on extracurricular reading. Negligible linear correlations were found between reading level and time spent on social media (ρ = 0.063), number of sites used (ρ =0.062), and time spent on extracurricular reading (ρ= 0.130). A moderate correlation (ρ = 0.524) was found between reading level and Pharmacy College Admission Test (PCAT) score. The average readability of guidelines and textbook chapters were 18.1 ±â€¯1.0 and 20.4 ±â€¯0.3, respectively. CONCLUSIONS: In P3 students, reading level was not associated with social media use. However, PCAT scores were positively associated with reading level. Furthermore, the readability of assigned texts exceeded the average reading level of the students.

Reading Level and Suitability of Congestive Heart Failure (CHF) Education in a Mobile App (CHF Info App): Descriptive Design Study.

BACKGROUND: Education at the time of diagnosis or at discharge after an index illness is a vital component of improving outcomes in congestive heart failure (CHF). About 90 million Americans have limited health literacy and have a readability level at or below a 5th-grade level, which could affect their understanding of education provided at the time of diagnosis or discharge from hospital. OBJECTIVE: The aim of this paper was to assess the suitability and readability level of a mobile phone app, the CHF Info App. METHODS: A descriptive design was used to assess the reading level and suitability of patient educational materials included in the CHF Info App. The suitability assessment of patient educational materials included in the CHF Info App was independently assessed by two of the authors using the 26-item Suitability Assessment of Materials (SAM) tool. The reading grade level for each of the 10 CHF educational modules included in the CHF Info App was assessed using the comprehensive online Text Readability Consensus Calculator based on the seven most-common readability formulas: the Flesch Reading Ease Formula, the Gunning Fog Index, the Flesch-Kincaid Grade Level Formula, the Coleman-Liau Index, the Simplified Measure of Gobbledygook Index, the Automated Readability Index, and the Linsear Write Formula. The reading level included the text-scale score, the ease-of-reading score, and the corresponding grade level. RESULTS: The educational materials included in the CHF Info App ranged from a 5th-grade to an 8th-grade reading level, with a mean of a 6th-grade level, which is recommended by the American Medical Association. The SAM tool result demonstrated adequate-to-superior levels in all four components assessed, including content, appearance, visuals, and layout and design, with a total score of 77%, indicating superior suitability. CONCLUSIONS: The authors conclude that the CHF Info App will be suitable and meet the recommended health literacy level for American adult learners. Further testing of the CHF Info App in a longitudinal study is warranted to determine improvement in CHF knowledge.