Development of accessible, easy-to-understand Covid-19 resources for all audiences are urgently needed, said researchers in a new study.
CNN  — 

Excuse me? What’s that mean?

When it comes to educating the world about coronavirus, public health organizations around the world uniformly exceed recommended reading levels, researchers reported Tuesday.

That includes guidance from the World Health Organization and the US Centers for Disease Control and Prevention.

While most public health guidelines are supposed to be written at between sixth- and eighth-grade reading levels, many websites for the public aim higher.

Way above their own standards

Joseph Dexter, a fellow at Dartmouth College’s Neukom Institute for Computational Science, and Vishala Mishra, a multidisciplinary researcher at Madras Medical College in India evaluated the readability of 18 websites offering coronavirus health information.

Dexter and Mishra focused on websites with guidelines written in English by three public health agencies and 15 official government sites in countries with more than 5,000 confirmed coronavirus cases.

The team assigned readability levels to each source based on different formulas, including the Flesch-Kincaid grade level, which determines the level of education a person needs to be able to easily read a piece of text. All 18 sources, the researchers found, uniformly exceed recommended reading levels.

The CDC website and other US government websites were written at or above a Flesch-Kincaid 11th grade level, the study found.

Dexter and Mishra noted that the CDC, American Medical Association and National Institutes of Health all recommend public health information be written at or below an eighth grade reading level. The CDC recommends using eight to 10 words per sentence and the use of everyday synonyms in lieu of complicated public health terms.

The CDC website also hosts an “everyday words index” for public health communication. For instance, instead of using the term “respiratory,” it recommends describing respiratory illnesses as conditions that can affect a person’s nose, throat and lungs and make it difficult to breathe.

The research team noted that 99% of the CDC pages analyzed used at least one of the difficult public health terms discouraged by its own agency’s guidance.

Dexter and Mishra analyzed US state coronavirus guidelines separately and found that “nine of the 10 states with the highest illiteracy rates had information written above a grade 10 level.”

On an international level, the World Health Organization’s site reads at just below a 12th grade level. The website of the European Centre for Disease Prevention and Control received the highest grade level, 13.1, and that of the Netherlands government received the lowest, 7.8, the researchers reported in JAMA Open Network.

Readability contributes to behavior

Coronavirus resources below a sixth- to eighth-grade reading level are few and far between, Dexter said. He cited two sources that come closer to meeting health literacy targets – one from the Swiss government outlining coronavirus information in short bullet point form, and another compiled by the US state of Vermont for people with disabilities. Neither were included in the team’s original research.

It’s possible that some communities with lower health literacy are the same that are currently being hit harder by coronavirus, Dexter said.

“The purpose of the readability and clear communication guidelines are to make sure that public health information is accessible in an equitable manner to all audiences,” Dexter told CNN. “The hope is that you will reach as wide an audience as possible.”

“When that doesn’t happen, it opens up the potential for exacerbating inequality in access to information,” Dexter said.

The CDC cites gaps in access to education as one of a number of social and structural factors placing certain communities at greater risk of Covid-19 complications.

Disinformation about the pandemic is widespread.

Well-known public figures, including President Donald J. Trump, have helped spread dangerous conspiracy theories and misinformation. A recent study found that the disinformation has even led to injuries and death. In fact, WHO has warned against the overabundance of information, including falsehoods, about the pandemic, calling it an “infodemic.”

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Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, has expressed concern that a lack of understanding about the spread of the virus, appropriate precautions and vaccines could hinder the nation’s ability to fight the pandemic.

It’s more important than ever for the public to have trusted sources of clear information about coronavirus, according to public health experts. Dexter and Mishra are calling for the urgent development of accessible, plain-language Covid-19 resources for all audiences.