EP357 - Literacy Assessment and Quality of ASCRS Online Material for Spanish and Chinese Speakers: A Call for Improvement

Sunday, May 11, 2025

9:00 AM – 9:05 AM PT

Location: Monitor 9, Sails Pavilion, Upper Level

ePoster Presenter(s)

Ana Sofia Ore, MD MSc MPH (she/her/hers)

General Surgery Resident
Beth Israel Deaconess Medical Center/Harvard Medical School
Beth Israel Deaconess Medical Center/Harvard Medical School
Boston, MA, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

VY

Victoria Yuan, MD

General Surgery Resident
New York Presbytarian Queens
NYC, New York, United States

Disclosure information not submitted.
Pia Canal Zarate, MD (she/her/hers)

Research fellow
Bieth Israel Deaconess Medical Center
Boston, MA, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
GJ

Gary Jean, MD

Resident
New York Presbyterian
Flushing, New York, United States

Disclosure information not submitted.
SK

Shahenda Khedr, BA

Research
New York Presbytarian Queens
New York, New York, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
JZ

Jian Zheng, MD

Surgical Oncologist, New York Presbyterian Queens
Assistant Professor of Clinical Surgery, Weill Cornell Medicine
Flushing, New York, United States

Disclosure information not submitted.
Evangelos Messaris, MD, PhD, MBA

Associate Professor of Surgery
Division of Colon and Rectal Surgery, Beth Isreal Deaconess Medical Center
Boston, Massachusetts, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Senior Author(s)

SC

Steven Y. Chao, MD FACS

Assistant Professor of Clinical Surgery
Weill Cornell Medicine
Flushing, New York, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.

Ana Sofia Ore, MD MSc MPH: This individual has no financial relationships with ineligible companies.

Pia Canal Zarate, MD: This individual has no financial relationships with ineligible companies.

Shahenda Khedr, BA: This individual has no financial relationships with ineligible companies.

Evangelos Messaris, MD, PhD, MBA: This individual has no financial relationships with ineligible companies.

Steven Y. Chao, MD FACS: This individual has no financial relationships with ineligible companies.

Image or Table (Do Not add text here):

Purpose/Background: Prior research has shown that the current ASCRS online material available in English requires a median sophomore college education level to understand. Patients with limited English proficiency, such as Spanish and Chinese speakers, struggle with health literacy. Having high-quality material available in their languages and at an appropriate health literacy level is warranted. We aim to evaluate the quality and literacy level required to understand the currently available information in Spanish and Chinese.

Methods/Interventions: All material available on the ASCRS website in Spanish and Chinese was evaluated. Literacy assessment of Spanish material was performed using the Gilliam-Peña-Mountain Graph and the Spanish Simple Measure of Gobbledygook (SMOG). For Chinese material, the Cathoven Hànyǔ Shuǐpíng Kǎoshì (HSK) Analyzer and the Chinese Readability Index Explorer (CRIE) for Native Speakers scale were used. English material was evaluated using the Flesch-Kincaid, SMOG, and Fry Readability Graph as a control. A qualitative assessment using consensus evaluation of the available media and content structure, compared to English material, was performed.

Results/Outcomes: The ASCRS website was surveyed, and 24 different patient-facing materials were available in Chinese, while 25 were available in Spanish. The Spanish material was found to have a mean reading level of 10th grade on both the Gilliam-Peña Graph and the Spanish SMOG. The Chinese material had a mean HSK score of 6.5 (proficient Chinese with 5,000+ words and 2,500+ characters known; level required for college). Additionally, 40.8% of the words in the text were considered difficult, and 43.6% of the sentences were found to be in complex semantic categories using the CRIE for native Chinese speakers. English material was found to have a mean 12th grade reading level. A qualitative analysis of the Chinese and Spanish materials identified a lack of media (videos/figures) compared to the English materials, along with outdated statistics relative to the English content.

Conclusion/Discussion: The online patient education material provided by ASCRS for Spanish- and Chinese-speaking patients requires a high reading level for comprehension, beyond both the National Institute of Health (7th grade) and American Medical Association (6th grade) recommendation. Additionally, the available material lacks media, which can be important for understanding. Efforts should be made to update and provide information at an appropriate reading level, recognizing that limited English proficient populations often struggle with lower health literacy and accessing adequate content.