A new analysis of online patient education materials for cleft lip and palate finds that they are consistently written at reading levels that are too complex for the average caregiver. The study, a systematic review and meta-analysis of nine studies, looked at materials found in PubMed, Scopus, and Embase databases. It measured readability using four common tests: Flesch-Kincaid Grade Level, Flesch Reading Ease, SMOG Index, and Gunning Fog Index. All four tests showed that the materials exceeded recommended readability levels. For example, the average Flesch-Kincaid Grade Level was 9.48, meaning the text requires a 9th to 10th grade reading level, while experts recommend 6th to 7th grade for health materials. The researchers also looked at whether artificial intelligence tools like ChatGPT could simplify the text, but they noted that these tools have not been tested for usability or comprehension. The study did not report any safety concerns, as it focused on readability, not clinical outcomes. The main limitation is that AI tools were not tested with real users. What this means for readers: if you are a caregiver for a child with cleft lip or palate, you may find online materials hard to understand. Doctors and health organizations should work to make these resources easier to read.
Systematic review finds online cleft care materials exceed recommended readability levelsCleft lip and palate online materials too complex for caregivers
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Key Takeaway
Note that online cleft care materials exceed recommended readability levels.
This systematic review and meta-analysis evaluated online patient education materials for cleft care. The authors analyzed nine studies to determine if the text complexity aligns with recommended readability standards. The scope included materials for cleft lip and cleft palate care found in PubMed, Scopus, and Embase databases.
The pooled results indicate that the Flesch-Kincaid Grade Level was 9.48 (95% CI: 8.51-10.45). The Flesch Reading Ease score averaged 52.98 (95% CI: 42.62-63.34). The SMOG Index yielded a result of 9.27 (95% CI: 5.97-12.57). The Gunning Fog Index result was 9.94 (95% CI: 8.90-10.98). All these metrics exceed recommendations.
Heterogeneity analysis showed an I² value of 0%. The authors noted that artificial intelligence tools lacked usability and comprehension testing. The review highlights that online patient education materials for cleft care are consistently written at reading levels too complex for the average caregiver.
The study did not report adverse events or discontinuations. Funding or conflicts were not reported. The authors caution against inferring causality from pooled readability estimates or assuming clinical outcomes from readability metrics. Improved readability and accessibility are needed for this patient population.
What this means for you:
Online cleft care materials are too hard to read for many caregivers; simpler resources are needed. 
View Original Abstract ↓
ObjectiveTo evaluate the readability of online patient education materials (PEMs) for cleft lip and/or palate and assess their alignment with recommended readability levels.DesignThis study is a systematic review and meta-analysis.SettingLiterature search conducted in PubMed, Scopus, and Embase databases following PRISMA guidelines.MaterialsStudies evaluating online PEMs for cleft care with reported readability metrics, including Flesch-Kincaid Grade Level, Flesch Reading Ease, SMOG Index, or Gunning Fog Index.InterventionsAssessment of readability metrics of online PEMs and evaluation of artificial intelligence tools (eg, ChatGPT) for text simplification.Main Outcome Measure(s)Pooled readability estimates (eg, Flesch-Kincaid Grade Level, Flesch Reading Ease, SMOG Index, Gunning Fog Index), heterogeneity (I²), and confidence intervals (CIs).ResultsNine studies were included, consistently showing that PEMs exceed readability recommendations. Pooled estimates revealed a Flesch-Kincaid Grade Level of 9.48 (95% CI: 8.51-10.45), Flesch Reading Ease score of 52.98 (95% CI: 42.62-63.34), SMOG Index of 9.27 (95% CI: 5.97-12.57), and Gunning Fog Index of 9.94 (95% CI: 8.90-10.98). Heterogeneity was minimal (² = 0%). Artificial intelligence tools like ChatGPT demonstrated potential in simplifying text to the recommended sixth-grade reading level but lacked usability and comprehension testing.ConclusionsOnline PEMs for cleft care are consistently written at reading levels too complex for the average caregiver, underscoring the need for improved readability and accessibility. Future research should focus on developing multimodal resources, conducting usability assessments, and including non-English materials to address global disparities in cleft care education.
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