Volume 27, Issue 4 (1-2025)
jha 2025, 27(4): 51-66 |
Back to browse issues page
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Rahmatizadeh S, Valizadeh-Haghi S, Ranjbar S, Motahari-Nezhad H, Khazaal Y, Kohzadi Z. Readability evaluation of online health information on COVID-19: a survey of Persian websites. jha 2025; 27 (4) :51-66
URL: http://jha.iums.ac.ir/article-1-4591-en.html
URL: http://jha.iums.ac.ir/article-1-4591-en.html
Shahabedin Rahmatizadeh1 
, Saeideh Valizadeh-Haghi2 , Sama Ranjbar2 , Hossein Motahari-Nezhad3 , Yasser Khazaal4 , Zeinab Kohzadi5
, Saeideh Valizadeh-Haghi2 , Sama Ranjbar2 , Hossein Motahari-Nezhad3 , Yasser Khazaal4 , Zeinab Kohzadi5
1- Department of Health Information Technology and Management, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran. , shahab.rahmatizadeh@gmail.com
2- Department of Medical Library and Information Sciences, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
3- Obuda University, Budapest, Hungary.
4- Department of Psychiatry, Lausanne University Hospitals and Lausanne University, Lausanne, Switzerland.
5- Department of Health Information Technology and Management, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
2- Department of Medical Library and Information Sciences, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
3- Obuda University, Budapest, Hungary.
4- Department of Psychiatry, Lausanne University Hospitals and Lausanne University, Lausanne, Switzerland.
5- Department of Health Information Technology and Management, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Abstract: (9 Views)
Introduction: The presence of readability challenges leads to difficulties in comprehending health-related online materials and has negative consequences, notably reducing the likelihood of disease prevention and healthcare utilization. The primary objective of this study is to assess the readability levels of Persian-language websites that provides information about COVID-19.
Methods: Utilizing the Google search engine, the terms “covid”, “coronavirus”, and “corona disease" were searched in Persian. Subsequently, 46 websites providing information on COVID-19 were selected for analysis. The Flesch Reading Ease Formula (FRE) is one of the most reliable formulas for assessing the readability level of texts. In this study, website readability was evaluated and ranked using the Flesch-Dayani Reading Ease (FDRE) formula, which was developed by Dayani based on the original FRE for Persian language..
Results: The mean (SD) readability score of Persian COVID-19-related websites was 80.56 ± 11.22. On average, the readability level corresponds to a sixth-grade reading level. Approximately, 34.8% of the websites had readability scores ranging from 70 to 80. Among the five national and international websites analyzed, the World Health Organization (WHO) website ranked fourth, with a readability score of 75.33. Pearson correlation analysis revealed no statistically significant relationship between readability scores and Google search rankings of Persian COVID-19-related websites.
Conclusion: The readability of the reviewed websites is, on average, at the level of international standard, although some websites exceed this standard. Given the general puplic’s tendency to seek health-related information from online platforms, developers of Persian-language materials about the coronavirus should place considerable emphasis on readbility.
Methods: Utilizing the Google search engine, the terms “covid”, “coronavirus”, and “corona disease" were searched in Persian. Subsequently, 46 websites providing information on COVID-19 were selected for analysis. The Flesch Reading Ease Formula (FRE) is one of the most reliable formulas for assessing the readability level of texts. In this study, website readability was evaluated and ranked using the Flesch-Dayani Reading Ease (FDRE) formula, which was developed by Dayani based on the original FRE for Persian language..
Results: The mean (SD) readability score of Persian COVID-19-related websites was 80.56 ± 11.22. On average, the readability level corresponds to a sixth-grade reading level. Approximately, 34.8% of the websites had readability scores ranging from 70 to 80. Among the five national and international websites analyzed, the World Health Organization (WHO) website ranked fourth, with a readability score of 75.33. Pearson correlation analysis revealed no statistically significant relationship between readability scores and Google search rankings of Persian COVID-19-related websites.
Conclusion: The readability of the reviewed websites is, on average, at the level of international standard, although some websites exceed this standard. Given the general puplic’s tendency to seek health-related information from online platforms, developers of Persian-language materials about the coronavirus should place considerable emphasis on readbility.
Type of Study: Research |
Subject:
Medical Librarianship and Information Science
Received: 2025/02/27 | Accepted: 2024/07/9 | Published: 2025/07/21
Received: 2025/02/27 | Accepted: 2024/07/9 | Published: 2025/07/21
References
1. National committee on COVID-19 epidemiology, ministry of health and medical education II. daily situation report on coronavirus disease (COVID-19) in Iran; March 22, 2020. Archives of Academic Emergency Medicine. 2020;8:e32. doi: 10.22037/aaem.v8i1.532
2. Suziedelyte A. How does searching for health information on the Internet affect individuals' demand for health care services? Social Science & Medicine. 2012;75(10):1828-1835. doi: 10.1016/j.socscimed.2012.07.022 [DOI:10.1016/j.socscimed.2012.07.022]
3. Yigzaw KY, Wynn R, Marco-Ruiz L, Budrionis A, Oyeyemi SO, Fagerlund AJ, et al. The association between health information seeking on the Internet and physician visits (the seventh Tromsø Study - Part 4): population-based questionnaire study. Journal of Medical Internet Research. 2020;22(3):e13120. doi:10.2196/13120 [DOI:10.2196/13120]
4. Higgins O, Sixsmith J, Barry M, Domegan C. A literature review on health information-seeking behaviour on the web: a health consumer and health professional perspective. European Centre for Disease Prevention and Control. 2011;1.[cited 2025 Feb 3]. Available from: https://www.ecdc.europa.eu/en/publications-data/literature-review-health-information-seeking-behaviour-web-health-consumer-and
5. Tan SS, Goonawardene N. Internet health information seeking and the patient-physician relationship: a systematic review. Journal of Medical Internet Research. 2017;19(1):e9. doi: 10.2196/jmir.5729 [DOI:10.2196/jmir.5729]
6. Anderson JG, Rainey MR, Eysenbach G. The impact of CyberHealthcare on the physician-patient relationship. Journal of Medical Systems. 2003;27:67-84. doi: 10.1023/A:1021061229743 [DOI:10.1023/A:1021061229743]
7. Moreland J, French T, Cumming G. Exploring online health information seeking in Scotland. Proceedings of the 3rd European Workshop on Practical Aspects of Health Informatics (PAHI 2015). 2016;1574:8.[cited 2025 Feb 3]. Available from: https://pure.uhi.ac.uk/en/publications/exploring-online-health-information-seeking-in-scotland
8. Norman CD, Skinner HA. eHealth literacy: essential skills for consumer health in a networked world. Journal of Medical Internet Research. 2006;8(2):e9. doi: 10.2196/jmir.8.2.e9 [DOI:10.2196/jmir.8.2.e9]
9. Boxell EM, Smith SG, Morris M, Kummer S, Rowlands G, Waller J, et al. Increasing awareness of gynecological cancer symptoms and reducing barriers to medical help seeking: does health literacy play a role? Journal of Health Communication. 2012;17:265-79. doi: 10.1080/10810730.2012.712617 [DOI:10.1080/10810730.2012.712617]
10. DeWalt DA, Berkman ND, Sheridan S, Lohr KN, Pignone MP. Literacy and health outcomes: a systematic review of the literature. Journal of General Internal Medicine. 2004; 19(12):1228-39. doi:10.1111/j.1525-1497.2004.40153.x [DOI:10.1111/j.1525-1497.2004.40153.x]
11. Berkman ND, Donahue KE, Sheridan SL, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Annals of Internal Medicine. 2011;155(2):97. doi:10.7326/0003-4819-155-2-201107190-00005 [DOI:10.7326/0003-4819-155-2-201107190-00005]
12. Friedman DB, Hoffman-Goetz L. An exploratory study of older adults' comprehension of printed cancer information: is readability a key factor? Journal of Health Communication. 2007;12(5):423-37. doi: 10.1080/10810730701438658 [DOI:10.1080/10810730701438658]
13. Badarudeen S, Sabharwal S. Assessing readability of patient education materials: Current role in orthopaedics. Clinical Orthopaedics and Related Research. 2010;468(10):2572-80. doi:10.1007/s11999-010-1380-y [DOI:10.1007/s11999-010-1380-y]
14. Report of the The National Work Group on Literacy and Health. Communicating with patients who have limited literacy skills. Journal of Family Practice. 1998;46(2):168-176. https://pubmed.ncbi.nlm.nih.gov/9487325
15. Lee S, French N. The readability of academic papers in the Journal of Property Investment & Finance. Journal of Property Investment and Finance. 2011;29(6):693-704. doi:10.1108/14635781111150339 [DOI:10.1108/14635781111171814]
16. Berland GK, Elliott MN, Morales LS, Algazy JI, Kravitz RL, Broder MS, et al. Health information on the internet: accessibility, quality, and readability in English and Spanish. JAMA. 2001;285(20):2612-21. doi:10.1001/jama.285.20.2612 [DOI:10.1001/jama.285.20.2612]
17. Grabeel KL, Russomanno J, Oelschlegel S, Tester E, Heidel RE. Computerized versus hand-scored health literacy tools: a comparison of Simple Measure of Gobbledygook (SMOG) and Flesch-Kincaid in printed patient education materials. Journal of the Medical Library Association. 2018;106(1):38. doi: 10.5195/jmla.2018.262 [DOI:10.5195/jmla.2018.262]
18. Nghiem AZ, Mahmoud Y, Som R. Evaluating the quality of internet information for breast cancer. The Breast. 2016;25:347. doi: [DOI:10.1016/j.breast.2015.10.001]
19. Aguirre PEA, Coelho MM, Rios D, Machado MAAM, Cruvinel AFP, Cruvinel T. Evaluating the dental caries-related information on Brazilian websites: qualitative study. Journal of Medical Internet Research. 2017;19(12):e415. doi:10.2196/jmir.7681 [DOI:10.2196/jmir.7681]
20. Valizadeh-Haghi S, Rahmatizadeh S, Adibi S, Kalantari A. The readability and credibility analysis of online education materials for kidney transplantation. Frontiers in Health Informatics. 2023;12:147. doi:10.30699/fhi.v12i0.446 [DOI:10.30699/fhi.v12i0.446]
21. Rahmatizadeh S, Valizadeh-Haghi S, Nasibi-Sis H, Motahari-Nezhad H. Readability and credibility evaluation of most-visited health websites based on eBizMBA and Alexa global ranking. Frontiers in Health Informatics. 2024 ;13:191. doi:10.30699/fhi.v13i0.567 [DOI:10.30699/fhi.v13i0.567]
22. Farnsworth M. Differences in perceived difficulty in print and online patient education materials. The Permanente Journal. 2014;18:45. doi: [DOI:10.7812/TPP/14-008]
23. Squires A. Strategies for overcoming language barriers in healthcare. Nursing Management. 2018;49(4):20-7. doi: 10.1097/01.NUMA.0000531166.24481.15 [DOI:10.1097/01.NUMA.0000531166.24481.15]
24. Dillon A. Reading from paper versus screens: A critical review of the empirical literature. Ergonomics. 1992 Oct 1;35(10):1297-326. doi:10.1080/00140139208967394 [DOI:10.1080/00140139208967394]
25. Al Shamsi H, Almutairi AG, Al Mashrafi S, Al Kalbani T. Implications of language barriers for healthcare: a systematic review. Oman Medical Journal. 2007;35(2):e122. doi: 10.5001/omj.2020.40 [DOI:10.5001/omj.2020.40]
26. Blandford A. Google, public libraries, and the deep web. Dalhousie Journal of Interdisciplinary Management. 2015;11. doi:10.5931/djim.v11i0.5525 [DOI:10.5931/djim.v11i0.5525]
27. Purcell K, Brenner J, Rainie L. Search engine use 2012. Washington, D.C.: Pew Research Center's Internet & American Life Project; 2012 [cited 2025 Feb 5]. Available from: https://www.pewresearch.org/internet/2012/03/09/search-engine-use-2012
28. iProspect. Blended search results study. 2008 [cited 2025 Feb 5]. Available from: https://www.diva-portal.org/smash/get/diva2:929087/FULLTEXT01.pdf
29. Dayani MH. A criteria for assessing the Persian texts' readability. Journal of Social Science and Humanities. 2000;10:35-48. doi:10.22037/jssh.v10i1.331
30. The flesch reading ease readability formula. 2020 [cited 2025 March 5]. Available from: https://readabilityformulas.com/learn-about-the-flesch-reading-ease-formula/
31. Flesch RF. How to write plain English: a book for lawyers and consumers. Harpercollins; 1979. Available from:
32. https://heinonline.org/HOL/LandingPage?handle=hein.journals/manitob10&div=50&id=&page=
33. Motahari-Nezhad H, Shekofteh M, Andalib-Kondori M. Social media as a platform for information and support for coronavirus: analysis of COVID-19 Facebook groups. Global Knowledge, Memory and Communication. 2022;71(8/9):772-788. doi: 10.1108/GKMC-11-2020-0183 [DOI:10.1108/GKMC-11-2020-0183]
34. Melki J. The effect of trust in media and information sources on coronavirus disease 2019 prevention behaviors in Lebanon. Media International Australia. 2023;178(1):132-147. doi: 10.1177/1329878X231214351 [DOI:10.1177/1329878X231214351]
35. McInnes N, Haglund BJA. Readability of online health information: implications for health literacy. Informatics for Health and Social Care. 2011;36(4):173-89. doi: [DOI:10.3109/17538157.2010.542529]
36. Beaunoyer E, Dupéré S, Guitton MJ. COVID-19 and digital inequalities: reciprocal impacts and mitigation strategies. Computers in Human Behavior. 2020;111:106424. doi: 10.1016/j.chb.2020.106424 [DOI:10.1016/j.chb.2020.106424]
37. Basch CH, Fera J, Garcia P. Information regarding Zika virus on the internet: a cross-sectional study of readability. American Journal of Infection Control. 2020;48(6):714-5. doi: 10.1016/j.ajic.2019.11.014 [DOI:10.1016/j.ajic.2019.11.014]
38. Abel T, McQueen D. Critical health literacy and the COVID-19 crisis. Health Promotion International. 2020; 35(6):1612-1613. doi: 10.1093/heapro/daaa040 [DOI:10.1093/heapro/daaa040]
39. Ybarra ML, Suman M. Help seeking behavior and the Internet: a national survey. International Journal of Medical Informatics. 2006;75(1):29-41. doi: 10.1016/j.ijmedinf.2005.07.029 [DOI:10.1016/j.ijmedinf.2005.07.029]
40. Eysenbach G, Kohler C. What is the prevalence of health-related searches on the world wide web? qualitative and quantitative analysis of search engine queries on the internet. AMIA Annual Symposium Proceedings. American Medical Informatics Association; 2003. p. 225. doi: 10.1016/j.ijmedinf.2005.07.029 [DOI:10.1016/j.ijmedinf.2005.07.029]
41. Cotugna N, Vickery CE, Carpenter-Haefele KM. Evaluation of literacy level of patient education pages in health-related journals. Journal of Community Health. 2005;30:213-9. doi: 10.1007/s10900-004-1950-2 [DOI:10.1007/s10900-004-1959-x]
42. Health literacy and patient safety: help patients understand. Manual for Clinicians. 2nd ed. Weiss BD. Chicago, IL: American Medical Association Foundation; 2015. [cited 2025 May 5]. Available from: https://psnet.ahrq.gov/issue/health-literacy-and-patient-safety-help-patients-understand-manual-clinicians-2nd-ed
43. Rahmatizadeh S, Valizadeh-Haghi S, Sadagheyani HE, Kalantari A, Motahari-Nezhad H, Kohzadi Z. Internet as a source of public health information on acupuncture for pain relief: credibility assessment and readability analysis. Medical Acupuncture. 2024;36(6):350-8. doi: 10.1089/acu.2023.0136 [DOI:10.1089/acu.2023.0136]
44. Rahmatizadeh S, Valizadeh-Haghi S, Kalavani A, Fakhimi N. Middle East Respiratory Syndrome on health information websites: how much credible they are? Library Philosophy and Practice (e-journal). 2019;2885:1-16. Available from: https://digitalcommons.unl.edu/libphilprac/2885/
45. Hansberry DR, Agarwal N, Baker SR. Health literacy and online educational resources: an opportunity to educate patients. American Journal of Roentgenology. 2015;204(1):111-6. doi: 10.2214/AJR.14.13086 [DOI:10.2214/AJR.14.13086]
46. Bresler RM, Lynch NP, Connolly M, Keelan S, Richter L, McHugh SM, et al. Arteriovenous Fistula for dialysis - let's Google it. readability and quality of online information. Surgeon. 2021;19(1):15-9. doi: 10.1016/j.surge.2020.02.009 [DOI:10.1016/j.surge.2020.02.009]
47. San Giorgi MRM, de Groot OSD, Dikkers FG. Quality and readability assessment of websites related to recurrent respiratory papillomatosis. Laryngoscope. 2017;127(10):2293-7. doi:10.1002/lary.26521 [DOI:10.1002/lary.26521]
48. Fong P, Tong HHY, Cheong HL, Choi KH, Ieong KK, Lam LK, et al. Quality of online information about sexually transmitted diseases: which websites should patients read? Online Information Review. 2014;38(5):650-60. doi: [DOI:10.1108/OIR-03-2014-0054]
49. Worrall AP, Connolly MJ, O'Neill A, O'Doherty M, Thornton KP, McNally C, et al. Readability of online COVID-19 health information: a comparison between four English speaking countries. BMC Public Health. 2020;20:1635. doi: 10.1186/s12889-020-09710-5 [DOI:10.1186/s12889-020-09710-5]
50. Halboub E, Al-Ak'hali MS, Al-Mekhlafi HM, Alhajj MN. Quality and readability of web-based Arabic health information on COVID-19: an infodemiological study. BMC Public Health. 2021;21:151. doi: 10.1186/s12889-021-10218-9 [DOI:10.1186/s12889-021-10218-9]
51. Kouzy R, Abi Jaoude J, Kraitem A, El Alam MB, Karam B, Adib E, et al. coronavirus goes viral: quantifying the COVID-19 misinformation epidemic on Twitter. Cureus. 2020;12:e7255. doi: 10.7759/cureus.7255 [DOI:10.7759/cureus.7255]
52. Eysenbach G, Köhler C. How do consumers search for and appraise health information on the world wide web? qualitative study using focus groups, usability tests, and in-depth interviews. BMJ. 2002;324:573-7. doi: 10.1136/bmj.324.7337.573 [DOI:10.1136/bmj.324.7337.573]
53. Fu LY, Zook K, Spoehr-Labutta Z, Hu P, Joseph JG. Search engine ranking, quality, and content of webpages that are critical vs noncritical of HPV vaccine. Journal of Adolescent Health. 2016;58:33-9. doi: 10.1016/j.jadohealth.2015.09.016 [DOI:10.1016/j.jadohealth.2015.09.016]
54. Benigeri M, Pluye P. Shortcomings of health information on the Internet. Health Promotion International. 2003;18(4):381-6. doi: 10.1093/heapro/dag409 [DOI:10.1093/heapro/dag409]
55. Hirsch M, Aggarwal S, Barker C, Davis CJ, Duffy JMN. Googling endometriosis: a systematic review of information available on the Internet. American Journal of Obstetrics and Gynecology. 2017;216(5):451-8. doi: 10.1016/j.ajog.2016.11.1007 [DOI:10.1016/j.ajog.2016.11.1007]
56. Daraz L, MacDermid JC, Wilkins S, Shaw L. Tools to evaluate the quality of web health information: a structured review of content and usability. International Journal of Technology, Knowledge and Society. 2009;5:127-41. doi:10.18848/1832-3669/CGP/v05i03/55997 [DOI:10.18848/1832-3669/CGP/v05i03/55997]
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
Site Keywords
Health, Administration, Scientific Article, Iran University of Medical Sciences,
