Availability and Readability of Non-English Patient Education Materials for Radiotherapy in the United States.

PURPOSE/OBJECTIVE(S) Accessible, patient-centered educational resources improve health literacy and patient outcomes. Readability standards help create educational resources that are effective and comprehensible for most patients. However, many United States (US) professional societies fail to meet these standards. Language access is also an important consideration in treating an increasingly diverse and multilingual patient population. This study assesses the availability and readability of radiotherapy patient education resources, available in non-English languages, from three major US professional societies. We hypothesized that there would be limited available non-English resources, and that these resources would fail to meet recommended national readability levels. MATERIALS/METHODS Patient education resources in non-English languages were collected from the American Society for Radiation Oncology (ASTRO), the American Cancer Society (ACS), and a collaboration between the American College of Radiology and Radiological Society of North America (ACR/RSNA). Number of English resources were tabulated. The text from each non-English resource was extracted and analyzed using 4 previously validated Spanish readability indices that provide grade level equivalents: Gilliam-Pena-Mountain (GPM), Lasbarhetsindex (Lix), Rate Index (Rix), and Spanish Simple Measure of Gobbledygook (SOL). One-sided t-test was used for comparisons to national standards. Fisher's exact test was used to assess for differences in proportions. RESULTS Of 51 identified English resources, 35 (69%) had a Spanish counterpart. English materials from ACR/RSNA were more likely than ACS and ASTRO materials to have a provided Spanish counterpart (100% vs 75% vs 24%, respectively; P < 0.01) There were no resources available in other languages. Mean readability levels for all resources in Spanish ranged from 10.0 to 12.0 grade levels, depending on the index, and were at a high school level: ACS (GPM, Lix, Rix, SOL) 9.0, 11.0, 11.2, 10.5; ASTRO 10.0, 11.0, 10.3, 9.6; and ACR/RSNA 10.0, 12.0, 11.8, 11.2. Using the most permissive scores for each resource, ACS had the only resources at or below the 8th grade level (50%, P < 0.01). The most permissive mean scores of all organizations significantly exceeded 6th grade levels (P < 0.01) and only ACS did not exceed an 8th grade level (P = 0.05). CONCLUSION Limited resources are available in non-English languages for patients undergoing radiotherapy in the US. Spanish was the only language with available translations. Available Spanish resources did not meet readability standards from the American Medical Association (6th grade) and National Institutes of Health (8th grade). These findings demonstrate a paucity of non-English language resources, and the need to improve readability levels in Spanish radiotherapy patient education resources.