Reputable health information and medical advice is widespread on the internet. But, in spite of abundant material, patients are far from equipped to consume the complex literature, a team of Pennsylvania-based researchers has  reported.

Health literacy has long been a point of interest in the medical community, first author Arpan V. Prabhu, BS, and colleagues wrote in Current Problems in Diagnostic Radiology. It has been linked to health status, outcomes, health knowledge and healthcare costs, and caught federal attention in 2010 when HHS launched an initiative to improve health literacy across the country.

Still, even with wide access to academic and government websites, medical information is often indigestible for the average American reader, Prabhu and co-authors said.

The 2003 National Assessment of Adult Literacy found that 36 percent of Americans lack proficient health literacy skills to navigate the healthcare system or consume most of the information posted on hospital sites. The Pew Research Center reported in 2012 that 81 percent of U.S. adults frequent the internet, and 72 percent use search engines to find health info—but that doesn’t mean it’s readily comprehensible.

According to Prabhu et al.’s work, the average American adult reads at the eighth-grade level, while a typical Medicaid enrollee reads at a fifth-grade level. Their research found the majority of online patient education materials at renowned teaching hospitals required at least a high school education, if not above, to comprehend.

“The internet creates opportunities for Americans to access medical information about imaging tests and modalities to guide them in their medical decision-making,” the authors wrote. “By ensuring that health information can be read and understood by the average American citizen, even those with low health literacy skills, greater effect can be made to improving overall health and wellness.”

Because of widespread variation in health literacy, the American Medical Association and National Institutes of Health recommend patient education resources be written between the third and seventh grade levels. The organizations suggest avoiding medical jargon, abbreviations and acronyms, and keeping sentences short and low in syllable count.

Prabhu and colleagues evaluated 375 articles from 20 university hospital systems, ranging from Massachusetts General to Mayo Clinic, to see how the institutions’ educational online articles stacked up against national recommendations in 2016. All hospitals were affiliated with radiology residencies.

The articles were collectively written at an eleventh-grade level, the authors reported, with just 2.9 percent of the pool—or 11 articles total—meeting AMA and NIH guidelines. More than a third were written above a full high school reading level.

“The results of this study demonstrate that due to lack of readability, online patient education materials are not being used to their full potential at major university hospital systems,” Prabhu and co-authors said.

According to the research, the only hospital whose articles required less than an eighth grade reading level was the University of Washington Medical Center, which reached a 7.9-grade level. The University of Virginia Health System, University of Pittsburgh Medical Center and McGaw Medical Center of Northwestern University were close behind, all floating around the eighth-grade level, while Thomas Jefferson University Hospitals in Philadelphia reached a level of 16.1.

The team’s findings were in-line with previous research about readability, the study stated, but this work is the first to the researchers’ knowledge that assessed readability of strictly radiology-related articles.

Improving readability could have numerous benefits, Prabhu and co-authors said, including strengthening a patient’s confidence and knowledge and allowing them to be more active participants in their care. Patients well-versed in health literacy are also more likely to be comfortable voicing concerns during consultations and tend to be more compliant with treatment, they said.

“Motivation to consult the internet, in addition to inherent trust in university websites and a recent shift of outpatient volumes from private offices to hospitals, highlights the importance of academic institutions leveraging online patient education materials for radiology,” the authors wrote. “However, to do so, they must ensure that the material provided is written at a reading level that maximizes the number of patients it can affect.”