Readability assessment of patient-provider electronic messages in a primary care setting

Abstract

Background: The high prevalence of limited health literacy among patients threatens the success of secure electronic messaging between patients from diverse populations and their providers.

Objective: The purpose of this study is to generate hypotheses about the readability of patient and provider electronic messages.

Methods: We collected 31 patient-provider e-mail exchanges (n = 119 total messages) from a safety-net primary care clinic. We compared the messages' mean word count and Flesch-Kincaid Grade Levels (FKGLs), calculated the frequency of provider messages below an FKGL = 8, and assessed readability concordance between patients' and providers' messages.

Results: Patients used more words in their initial e-mails compared to providers, but the FKGLs were similar, and 68% of provider messages were written below an FKGL = 8. Of 31 exchanges, 9 (29%) contained at least one patient message with an FKGL > 3 grade levels lower than the corresponding provider message(s).

Conclusion: Our study demonstrates that most providers are able to respond to patient electronic messages with a matching reading level.

Keywords: health literacy; primary care; readability; safety-net; secure messaging.