Readability of Ebola Information on Websites of Public Health Agencies, United States, United Kingdom, Canada, Australia, and Europe

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Enrique Castro-Sánchez

, Elpiniki Spanoudakis, and Alison H. Holmes

Author affiliations: Imperial College London, London, UK; and National Institute for Health Research, London

Abstract

Public involvement in efforts to control the current Ebola virus disease epidemic requires understandable information. We reviewed the readability of Ebola information from public health agencies in non–Ebola-affected areas. A substantial proportion of citizens would have difficulty understanding existing information, which would potentially hinder effective health-seeking behaviors.

The outbreak of Ebola virus disease (EVD) that originated in Guinea in April 2014 has become the largest known epidemic of this pathogen and was declared an international public health emergency (1). In addition, repatriation of health care workers and volunteers to Europe and the United States has resulted in human-to-human transmission in western health care organizations (2), thus bringing Ebola to the fore of public attention in settings far removed from local outbreak areas.

Currently, because there is no antiviral treatment or vaccine, surveillance and strict observation of recommended infection prevention and control measures, aided by public awareness regarding symptoms and prompt health care–seeking behavior, are essential efforts to control Ebola. In Africa, low awareness has led to community misunderstandings and unwillingness to cooperate with medical teams (3). In non–EVD-affected countries, nonrigorous information has resulted in unfounded fear among health care workers and citizens, disrupting the activity of hospitals caring for persons with EVD (4).

For health messages to be followed effectively, they must be tailored to the health literacy of the audience. Health literacy, which refers to “the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health” (5), has been associated with better self-care (6). However, a substantial proportion of citizens worldwide have insufficient or inadequate health literacy (7).

Several factors, including readability of information provided (8), can help reduce health literacy deficits. Readability refers to “the determination of the reading comprehension level a person must have to understand written materials” (9). It is recommended that health information materials should be written at a level typically understandable by an 11-year-old person (10). Such recommendations for clarity and understandability might be more effective if one considers that anxiety or panic attributed to a highly virulent infection, such as Ebola, might hinder comprehension of related information (11).

We examined readability of EVD public information available from selected public health agencies in non–EVD-affected countries. Countries that have EVD should explore how well this information would serve to reduce panic and anxiety and perform as an effective source of advice for the public.

Dr. Castro-Sánchez is the lead research nurse at the National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, London, UK. His research interests include health literacy in infectious diseases and healthcare-associated infections, and effect of social networks on clinicians and patients’ attitudes to infection.

Acknowledgments

This study was supported by the National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London in partnership with PHE.

E.C.-S. was responsible for the design of the study and collected data. A.H.H. provided technical input during all stages of the project and analysis. All authors were responsible for data analysis, contributed substantially to writing the manuscript, approved its final version, had full access to all data in the study, and take responsibility for the integrity, accuracy, and presentation of data. E.C.-S. is the guarantor.

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Table

Table. Readability of Ebola public information published by selected public health agencies

Technical Appendix

. Website addresses for information on Ebola and readability indicators. 137 KB

Suggested citation for this article: Castro-Sánchez E, Spanoudakis E, Holmes AH. Readability of Ebola information on websites of public health agencies, United States, United Kingdom, Canada, Australia, and Europe. Emerg Infect Dis. 2015 Jul [date cited]. http://dx.doi.org/10.3201/eid2107.141829

DOI: 10.3201/eid2107.141829