INTRODUCTION
Acne keloidalis nuchae (AKN) is an inflammatory disorder primarily seen in individuals of color, characterized by acneiform and keloidal lesions on the occipital scalp/nuchal region.1 The global prevalence is 0.5% to 13.5% in Black males and is 20 times more frequent in males than in females.1 Patients frequently seek information on their skin conditions using the internet. Fifty-five percent of individuals with keloids in a recent report used the internet to better understand their condition.2
The average US adult reads at an 8th-grade level. The reading skills of Medicare beneficiaries is at the 5th-grade level.3 Previous studies indicate that greater comprehension of patient education materials (PEMs) written at simpler reading levels leads to positive health-related behaviors and improved patient-provider communication.3 Accessible PEMs are needed for better education and improved outcomes for our diverse patient populations.4 This study was aimed at identifying the readability and accessibility of internet PEMs currently available for AKN.
The average US adult reads at an 8th-grade level. The reading skills of Medicare beneficiaries is at the 5th-grade level.3 Previous studies indicate that greater comprehension of patient education materials (PEMs) written at simpler reading levels leads to positive health-related behaviors and improved patient-provider communication.3 Accessible PEMs are needed for better education and improved outcomes for our diverse patient populations.4 This study was aimed at identifying the readability and accessibility of internet PEMs currently available for AKN.
MATERIALS AND METHODS
The term 'acne keloidalis nuchae' was searched and screened for the top 100 search results on the Google® search engine (accessed 02/06/2022). Search results not specifically directed at professional or academic audiences were included in this analysis. For evaluation, 6 readability metrics (Flesch-Kincaid grade level, Gunning Fog Index, Coleman-Liau index, Simple Measure of Gobbledygook (SMOG) index, automated readability, and Linsear Write Formula) were collected by entering text from each reference site into an automatic readability calculator for computation. The readability metric provides an objective quantification of the reading level an individual would need in order to understand the text. Although different indices quantify readability metrics slightly differently, the readability score directly translates to the US education years an individual would need to understand the text (ie, a score of 12 would indicate that a 12th-grade education is required).5
RESULTS
Thirty-five search results were selected as PEMs and evaluated using the screening flowchart shown in Figure 1. Current internet PEMs were presented at a median of 2.3- to 5.5-grade levels above the mean skill of US residents (Figure 2). Median readability scores of AKN PEMs ranged from 10.3th to 13.5th grade levels. The PEM with the lowest readability score was 5.1th-grade level, while the highest was 25.8th-grade level, indicating that a graduate level education would be needed. Overall, readability median above the 8th-grade level were consistently seen across all 6 readability measures, with some median scores reaching university undergraduate levels.
