(Poster 48) Bilingual Readability of Online Rectovaginal Fistula Resources

Objectives: Rectovaginal fistula (RVF) is a distressing condition that significantly impacts patients’ quality of life. Access to clear, comprehensible health information is essential to support patient understanding, decision-making, and self-advocacy. However, the readability of patient education materials (PEMs) on RVF—particularly in Spanish—has not been well studied. This study assessed the readability of online RVF PEMs in English and Spanish to determine whether they meet recommended comprehension levels for the general public.

Methods: We conducted a systematic Google search to identify online PEMs related to rectovaginal fistula in both English and Spanish. Materials were categorized by source: health system/clinic websites and medical society/foundation websites. For English-language materials, readability was assessed using eight validated metrics: Bormuth, Coleman-Liau, New Dale-Chall, Gunning Fog, Flesch-Kincaid, Lix, Rix, and SMOG. Spanish-language materials were evaluated using the Gilliam-Peña-Mountain, Lix, Rix, and SOL scores. The average readability scores were compared across website types and languages.

Results: A total of 84 English-language and 15 Spanish-language PEMs were analyzed. Among the English materials, 82% originated from health system/clinic websites and 18% from medical society/foundation websites. The overall mean reading grade level was 11.41 (SD 2.01) for health system/clinic sites and 11.70 (SD 1.92) for medical society/foundation sites. SMOG scores, which estimate the years of education needed to understand a text, averaged 13.56 and 13.79, respectively. These scores were significantly higher than the recommended 6th-grade level (p < 0.001 for both groups). Among the Spanish-language PEMs, 80% were from health system/clinic sources and 20% from medical societies/foundations. The mean reading grade level, based on Gilliam-Peña-Mountain, was 9.98 (SD 1.2) for health system/clinic sites and 10.05 (SD 1.13) for medical society/foundation sites. Readability scores in Spanish materials also significantly exceeded the recommended level (p < 0.001 for both groups).

Conclusions: Online patient education materials on rectovaginal fistula in both English and Spanish significantly exceed recommended readability levels, regardless of source. This may limit patient understanding and engagement, particularly among populations with limited health literacy or English proficiency. Efforts to improve the accessibility of PEMs—through plain language use, visual aids, and culturally appropriate translation—are needed to promote equitable patient education and support informed decision-making.