Evaluating the Readability of Online Patient Education Materials for Avascular Necrosis

Authors

• Gabriella B. Smith, Stanford University School of MedicineFollow
• Grady H. Hofmann, Stanford University School of MedicineFollow
• Anna V. Gussner, Stanford University School of MedicineFollow
• Nicole S. Pham, Stanford University School of MedicineFollow
• Nneoma O. Duru, Stanford University School of MedicineFollow
• Kevin G. Shea, Stanford University School of MedicineFollow

Publication Date

9-15-2026

Keywords

readability, patient education, avascular necrosis, osteonecrosis, google

Abstract

Purpose: Avascular necrosis (AVN) is a progressive pathology affecting pediatric and adult patients. Given the risks of joint collapse and surgery, patients frequently research their condition online. The average reading level in the United States is approximately the eighth-grade level. The National Institutes of Health (NIH) recommend that patient materials be written at or below a sixth-grade level. This study aimed to assess the readability and quality of online AVN resources.

Methods: A Google search using the terms “avascular necrosis” and “osteonecrosis” was conducted, and firstpage results were aggregated. Flesch-Kincaid Grade Level, Gunning Fog Index, and Flesch Reading Ease tests were performed to assess the reading levels of these resources. DISCERN scores were determined by two reviewers.

Results: Sixteen original general educational articles emerged. Of these, one article (6.25%) was at or below the NIH-recommended reading level. Five articles (31.25%) were at or below the average reading level in the United States. The mean Flesch-Kincaid Grade Level was 9.3 ± 1.8, the mean Gunning Fog Index was 10.6 ± 2.3, and the mean Flesch Reading ease was 46.7 ± 11.3. The mean DISCERN score was 59.7 ± 7.8, which is classified as “good quality.”

Conclusions: The readability of first-page Google results for AVN-related patient resources is at an education level higher than that recommended by the NIH and higher than the average national reading level. This study highlights the necessity for developing high-quality, accessible patient educational materials about AVN that are tailored to an appropriate level for patients and their families.

Recommended Citation

Smith GB, Hofmann GH, Gussner AV, et al. Evaluating the readability of online patient education materials for avascular necrosis. J Patient Cent Res Rev. 2026;13:108-14.