INTRODUCTION
Mpox (formerly known as monkeypox), a zoonotic orthopoxvirus related to smallpox, was first identified in humans in the Democratic Republic of the Congo in 1970 and was historically endemic to Central and West Africa, with mainly animal-to-human transmission.1-4 However, the 2022 global outbreak marked an epidemiological shift, spreading to non-endemic regions like the United States and disproportionately affecting specific demographics, including men who have sex with men (MSM).1,5 By the end of 2022, the US reported over 30,000 cases, with New York City having the largest outbreak.1 Significant delays in diagnosis and reporting were noted, particularly a median 4-day delay in NYC, which can increase transmission risk in vulnerable populations.2 These outbreaks highlight the critical role of timely, accessible public health communication tailored by local health departments, though studies reveal that such communication often remains insufficient.6
A significant portion of the general population struggles with health literacy making the clarity and readability of public health materials essential for effective communication, with one study finding that up to 36% of adults in the United States are health illiterate.7,8 Prior studies have validated readability metrics, such as the Flesch-Kincaid score, to assess the accessibility of these materials.1 Lessons from the COVID-19 pandemic emphasize the importance of clear, empathetic messaging in building public trust to ensure compliance.2 One study explicated the function of health literacy as a social vaccine, serving a crucial role in mitigating the spread of disease by "understanding and applying information as provided through governments and health authorities".3 This work, and the increasingly frequent rise of epidemic and pandemic infections, highlights the need for timely and accurate information dissemination to combat misinformation and guide public behavior.
Despite growing awareness of these challenges, there remains a lack of research evaluating the accessibility of public health communications during health crises. Governmental resources must be tailored to reach a broad audience, especially those with limited health literacy. Resources that exceed the 8th-grade level may leave many without the information needed to appropriately protect against or seek care for emerging communicable diseases.9 This study aimed to evaluate the readability of Mpox-related educational materials intended for the public, from various public health agencies, and to identify potential barriers that may hinder public understanding and response.
A significant portion of the general population struggles with health literacy making the clarity and readability of public health materials essential for effective communication, with one study finding that up to 36% of adults in the United States are health illiterate.7,8 Prior studies have validated readability metrics, such as the Flesch-Kincaid score, to assess the accessibility of these materials.1 Lessons from the COVID-19 pandemic emphasize the importance of clear, empathetic messaging in building public trust to ensure compliance.2 One study explicated the function of health literacy as a social vaccine, serving a crucial role in mitigating the spread of disease by "understanding and applying information as provided through governments and health authorities".3 This work, and the increasingly frequent rise of epidemic and pandemic infections, highlights the need for timely and accurate information dissemination to combat misinformation and guide public behavior.
Despite growing awareness of these challenges, there remains a lack of research evaluating the accessibility of public health communications during health crises. Governmental resources must be tailored to reach a broad audience, especially those with limited health literacy. Resources that exceed the 8th-grade level may leave many without the information needed to appropriately protect against or seek care for emerging communicable diseases.9 This study aimed to evaluate the readability of Mpox-related educational materials intended for the public, from various public health agencies, and to identify potential barriers that may hinder public understanding and response.
MATERIALS AND METHODS
Given the significant public health impact of human immunodeficiency virus (HIV) and the recent resurgence of Mpox, as outlined by recent studies on public health communication strategies and disease efforts,10 evaluating health information dissemination on these infections is critical. Health information targeted to the general population on Mpox and HIV was collected from publicly accessible websites of three types of health departments in each of the 50 US states: state-level departments, the largest metropolitan departments, and one randomly selected non-metropolitan department per state. This sampling approach was designed to capture a diverse cross-section of public health messaging across urban and rural settings.
For each website, standardized search terms, including "Mpox/HIV prevention," "Mpox/HIV treatment," "Mpox/HIV diagnosis," and "Mpox/HIV reporting," were used to identify relevant educational and informational materials. Data were extracted and categorized by type: prevention, treatment, and diagnosis, and further evaluated for content and accessibility.
To assess inclusivity and cultural relevance, the presence of diverse visual representation was evaluated using the Fitzpatrick Skin Type categorization, which classifies human skin color into six types based on pigmentation and risk of sun damage, and the Monk Scale, an alternate validated scale of skin tone and pigment. This method enabled the objective quantification of the diversity of individuals depicted in health materials, aiming
For each website, standardized search terms, including "Mpox/HIV prevention," "Mpox/HIV treatment," "Mpox/HIV diagnosis," and "Mpox/HIV reporting," were used to identify relevant educational and informational materials. Data were extracted and categorized by type: prevention, treatment, and diagnosis, and further evaluated for content and accessibility.
To assess inclusivity and cultural relevance, the presence of diverse visual representation was evaluated using the Fitzpatrick Skin Type categorization, which classifies human skin color into six types based on pigmentation and risk of sun damage, and the Monk Scale, an alternate validated scale of skin tone and pigment. This method enabled the objective quantification of the diversity of individuals depicted in health materials, aiming
