Readability of Patient Electronic Materials for Atopic Dermatitis in 23 Languages: Analysis and Implications for Dermatologists

Introduction: Patients search on the Internet for information about various medical procedures and conditions. The main aim of this study was to evaluate the readability of online health information related to atopic dermatitis (AD). Online resources are becoming a standard in facilitating shared decision-making processes. With a pipeline of new therapeutic options like immunomodulators, understanding of the complexity of AD by the patients is crucial. Methods: The term "atopic dermatitis" translated into 23 official European Union languages was searched using the Google search engine. The first 50 records in each language were evaluated for suitability. Included materials were barrier-free, focused on patient education, and were not categorized as advertisements. Article sources were classified into four categories: non-profit, online shops, pharmaceutical companies, and dermatology clinic. Readability was assessed with Lix score. Results: A total of 615 articles in Swedish, Spanish, Slovenian, Slovak, Romanian, Portuguese, Polish, Lithuanian, Latvian, Irish, Italian, Hungarian, Greek, German, French, Finnish, Estonian, English, Dutch, Danish, Czech, Croatian, and Bulgarian were evaluated. The overall mean Lix score was 56 +/- 8, which classified articles as very hard to comprehend. Significant differences in mean Lix scores were observed across all included languages (all P < 0.001). Articles released by non-profit organizations and pharmaceutical companies had the highest readability (P < 0.001). Low readability level was correlated with high article prevalence (R-2 = 0.189, P = 0.031). Conclusions: Although there was an abundance of online articles related to AD, the readability of the available information was low. As online health information has become essential in making shared decisions between patients and physicians, an improvement in AD-related materials is needed.