COVID-19 outpatient treatment information on US state public health department websites is difficult to read and access, especially for people with low literacy or limited English language proficiency and in states with Republican governors, according to a research letter published yesterday in JAMA Network Open.
Researchers at the University of Rochester Medical Center in New York reviewed and coded 56 public health websites in 50 states, 5 territories, and Washington, DC, for ease of navigation to, and readability of, COVID-19 treatment options in June and July 2022.
"Life-saving oral and injectable antiviral therapeutics are available to treat non-hospitalized patients with a high risk of COVID-19 infection," the authors wrote. "Yet uptake of treatments is suboptimal and inequitable."
Only 3 sites fairly easy to read
To assess ease of understanding of the website information, the researchers used the Flesch Reading Ease test, which has a scale of 1 to 100, with 100 indicating the highest readability. To rate accessibility, the team used a grading system with a scale of 0 to 2, with 0 indicating inaccessibility, 1 showing partial accessibility, and 2 indicating full accessibility. They also collected data on governors' political affiliation.
Specifically, the researchers evaluated website materials on:
- Available oral and injectable antiviral drugs
- Treatment eligibility requirements
- Where and how to access treatment
- Therapeutic costs and availability for uninsured patients
- Access to non-English text languages and American Sign Language (ASL) support
- Phone support, such as Telecommunications Devices for the Deaf
The average readability score was 46.0, indicating difficult-to-understand text. Readability scores ranged from 12.4 to 93.2, meaning the text was very difficult to understand (ie, college graduate reading levels or International Standard Classification of Education [ISCED-6]) to very easy to read (ie, fifth-grade reading level, or ISCED-1). Only three websites (5%) had a Flesch score of 70 or higher (ie, fairly easy to read, or a seventh-grade reading level or below).
Maine scored a 72.5 for readability, Tennessee a 72.6, and South Dakota 93.2—the only site rated "very easy" to read.
Uptake of treatments is suboptimal and inequitable.
The states with the highest accessibility ratings were Vermont, Minnesota, and Oregon, at 1.75, 1.88, and 1.88, respectively. Oklahoma and Vermont were the only states to earn high ratings for ASL support.
Accessibility scores tended to be lowest for deaf access (0.20), treatment payment information (0.73), and phone support (1.03). Only a few websites had text in non-English languages, instead relying on Google Translate, which may not generate accurate results. States with Democratic governors were more likely to score above the median for accessibility (odds ratio, 7.59).
Nebraska and two territories never provided COVID-19 treatment information on their public health website and thus weren't evaluated for readability and scored a 0 for accessibility.
National guidelines needed
Websites that displayed COVID-19 treatment information on their own page rather than linking to federal websites were the easiest to navigate.
The researchers noted that public websites are important resources for people seeking timely COVID-19 treatment. While antivirals can help high-risk patients who have mild to moderate illness avoid serious complications such as hospitalization or death, these treatments must be given soon after symptom onset to work.
The results suggest the need for national guidelines on accessibility and readability for public health websites.
"Findings of this cross-sectional study underscore the poor accessibility and readability of COVID-19 treatment information on US public health websites, which may contribute to inequities in access to life-saving treatment," they wrote. "The results suggest the need for national guidelines on accessibility and readability for public health websites."