Online Plain Language Tool and Health Information Quality: A Randomized Clinical Trial

• Published in: JAMA network open 2024-10, Vol.7 (10), p.e2437955
• Main Authors: Ayre, Julie, Bonner, Carissa, Muscat, Danielle M, Cvejic, Erin, Mac, Olivia, Mouwad, Dana, Shepherd, Heather L, Aslani, Parisa, Dunn, Adam G, McCaffery, Kirsten J
• Format: Article
• Language: English
• Subjects: Adult; Australia; Clinical trials; Consumer Health Information - methods; Consumer Health Information - standards; Female; Health education; Health literacy; Health Literacy - methods; Humans; Internet; Male; Middle Aged; Online Only; Original Investigation; Public Health
• ISSN: 2574-3805; 2574-3805
• DOI: 10.1001/jamanetworkopen.2024.37955

Complex and ineffective health communication is a critical source of health inequity and occurs despite repeated policy directives to provide health information that is easy to understand and applies health literacy principles. To evaluate the effectiveness of the Sydney Health Literacy Lab Health Literacy Editor, an easy-to-use online plain language tool that supports health information providers to apply health literacy guidelines to written health information. This randomized clinical trial, conducted online in Australia from May 2023 to February 2024, included a convenience sample of health information providers with no previous experience using the Health Literacy Editor. Analysts were blinded to study group. Participants were randomized 1:1 to the intervention or control group. Participants in the intervention group were provided access to the Health Literacy Editor and a 30-minute online training program prior to editing 3 prespecified health texts. The Health Literacy Editor gives objective, real-time feedback on words and sentences. Control participants revised the texts using their own standard health information development processes. The preregistered primary outcome was the text school grade reading score (using a validated instrument, the Simple Measure of Gobbledygook). Secondary outcomes were text complexity (percentage of text using complex language), use of passive voice (number of instances), and subjective expert ratings (5-point Likert scale corresponding to items on the Patient Education Materials Assessment Tool). A total of 211 participants were randomized, with 105 in the intervention group and 106 in the control group. Of 181 participants in the intention-to-treat analysis (mean [SD] age, 41.0 [11.6] years; 154 women [85.1%]), 86 were in the intervention group and 95 in the control group. Texts revised in the intervention group had significantly improved grade reading scores (mean difference [MD], 2.48 grades; 95% CI, 1.84-3.12 grades; P