Online Plain Language Tool and Health Information Quality
Authors: Julie Ayre, Carissa Bonner, Danielle M. Muscat, Erin Cvejic, Olivia Mac, Dana Mouwad, Heather L. Shepherd, Parisa Aslani, Adam G. Dunn, Kirsten J. McCaffery
Journal: JAMA Network Open (2024)

Importance 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. Objective 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. Design, Setting, and Participants 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. Intervention 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. Main Outcomes and Measures 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). Results 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 &amp;amp;lt; .001; Cohen d , 0.99), lower text complexity scores (MD, 6.86; 95% CI, 4.99-8.74; P &amp;amp;lt; .001; Cohen d , 0.95), and less use of passive voice (MD, 0.95 instances; 95% CI, 0.44-1.47 instances; P &amp;amp;lt; .001; Cohen d , 0.53) compared with texts revised in the control group in intention-to-treat analyses. Experts rated texts in the intervention group more favorably for word choice and style than those in the control group (MD, 0.44; 95% CI, 0.25-0.63; P &amp;amp;lt; .001; Cohen d , 0.63), with no loss of meaning or content. Conclusions and Relevance In this randomized clinical trial, the Health Literacy Editor helped users simplify health information and apply health literacy guidelines to written text. The findings suggest the tool has high potential to improve development of health information for people who have low health literacy. As an online tool, the Health Literacy Editor is also easy to access and implement at scale. Trial Registration ANZCTR Identifier: ACTRN12623000386639