Abstract：
BACKGROUND: Presenting health information at a sixth-grade reading level is advised to accommodate the general public\'s abilities. Breast cancer (BC) is the second-most common malignancy in women, but the readability of online BC information in English and Spanish, the two most commonly spoken languages in the United States, is uncertain.
METHODS: Three search engines were queried using: \"how to do a breast examination,\" \"when do I need a mammogram,\" and \"what are the treatment options for breast cancer\" in English and Spanish. Sixty websites in each language were studied and classified by source type and origin. Three readability frameworks in each language were applied: Flesch Kincaid Reading Ease, Flesch Kincaid Grade Level, and Simple Measure of Gobbledygook (SMOG) for English, and Fernández-Huerta, Spaulding, and Spanish adaptation of SMOG for Spanish. Median readability scores were calculated, and corresponding grade level determined. The percentage of websites requiring reading abilities >sixth grade level was calculated.
RESULTS: English-language websites were predominantly hospital-affiliated (43.3%), while Spanish websites predominantly originated from foundation/advocacy sources (43.3%). Reading difficulty varied across languages: English websites ranged from 5th-12th grade (Flesch Kincaid Grade Level/Flesch Kincaid Reading Ease: 78.3%/98.3% above sixth grade), while Spanish websites spanned 4th-10th grade (Spaulding/Fernández-Huerta: 95%/100% above sixth grade). SMOG/Spanish adaptation of SMOG scores showed lower reading difficulty for Spanish, with few websites exceeding sixth grade (1.7% and 0% for English and Spanish, respectively).
CONCLUSIONS: Online BC resources have reading difficulty levels that exceed the recommended sixth grade, although these results vary depending on readability framework. Efforts should be made to establish readability standards that can be translated into Spanish to enhance accessibility for this patient population.
METHODS: Three search engines were queried using: \"how to do a breast examination,\" \"when do I need a mammogram,\" and \"what are the treatment options for breast cancer\" in English and Spanish. Sixty websites in each language were studied and classified by source type and origin. Three readability frameworks in each language were applied: Flesch Kincaid Reading Ease, Flesch Kincaid Grade Level, and Simple Measure of Gobbledygook (SMOG) for English, and Fernández-Huerta, Spaulding, and Spanish adaptation of SMOG for Spanish. Median readability scores were calculated, and corresponding grade level determined. The percentage of websites requiring reading abilities >sixth grade level was calculated.
RESULTS: English-language websites were predominantly hospital-affiliated (43.3%), while Spanish websites predominantly originated from foundation/advocacy sources (43.3%). Reading difficulty varied across languages: English websites ranged from 5th-12th grade (Flesch Kincaid Grade Level/Flesch Kincaid Reading Ease: 78.3%/98.3% above sixth grade), while Spanish websites spanned 4th-10th grade (Spaulding/Fernández-Huerta: 95%/100% above sixth grade). SMOG/Spanish adaptation of SMOG scores showed lower reading difficulty for Spanish, with few websites exceeding sixth grade (1.7% and 0% for English and Spanish, respectively).
CONCLUSIONS: Online BC resources have reading difficulty levels that exceed the recommended sixth grade, although these results vary depending on readability framework. Efforts should be made to establish readability standards that can be translated into Spanish to enhance accessibility for this patient population.
摘要：
背景：建议以六年级的阅读水平呈现健康信息，以适应公众的能力。乳腺癌（BC）是女性第二常见的恶性肿瘤，但是在线BC信息的英语和西班牙语的可读性，美国最常用的两种语言，不确定。
方法：使用“如何做乳房检查，我什么时候需要做乳房X光检查,\"和\"什么是治疗乳腺癌\"在英语和西班牙语。研究了每种语言的60个网站，并按来源类型和来源进行了分类。每种语言都应用了三个可读性框架：FleschKincaidReadingEase，FleschKincaid等级,和英语的Gobbledygook（SMOG）的简单度量，和Fernández-Huerta,斯波尔丁,以及SMOG的西班牙语改编。计算中值可读性得分，并确定相应的等级。计算了要求阅读能力>六年级的网站百分比。
结果：英文网站主要是医院附属网站（43.3％），而西班牙网站主要来自基金会/宣传来源(43.3%)。阅读难度因语言而异：英语网站从5至12年级不等（FleschKincaid年级水平/FleschKincaid阅读速度：六年级以上78.3％/98.3％），而西班牙网站跨越4-10年级（Spaulding/Fernández-Huerta：六年级以上95％/100％）。SMOG/西班牙语对SMOG分数的改编显示，西班牙语的阅读难度较低，很少有超过六年级的网站(英语和西班牙语为1.7%和0%，分别)。
结论：在线BC资源的阅读难度超过推荐的六年级，尽管这些结果因可读性框架而异。应努力建立可读性标准，可将其翻译成西班牙语，以增强该患者人群的可及性。
方法：使用“如何做乳房检查，我什么时候需要做乳房X光检查,\"和\"什么是治疗乳腺癌\"在英语和西班牙语。研究了每种语言的60个网站，并按来源类型和来源进行了分类。每种语言都应用了三个可读性框架：FleschKincaidReadingEase，FleschKincaid等级,和英语的Gobbledygook（SMOG）的简单度量，和Fernández-Huerta,斯波尔丁,以及SMOG的西班牙语改编。计算中值可读性得分，并确定相应的等级。计算了要求阅读能力>六年级的网站百分比。
结果：英文网站主要是医院附属网站（43.3％），而西班牙网站主要来自基金会/宣传来源(43.3%)。阅读难度因语言而异：英语网站从5至12年级不等（FleschKincaid年级水平/FleschKincaid阅读速度：六年级以上78.3％/98.3％），而西班牙网站跨越4-10年级（Spaulding/Fernández-Huerta：六年级以上95％/100％）。SMOG/西班牙语对SMOG分数的改编显示，西班牙语的阅读难度较低，很少有超过六年级的网站(英语和西班牙语为1.7%和0%，分别)。
结论：在线BC资源的阅读难度超过推荐的六年级，尽管这些结果因可读性框架而异。应努力建立可读性标准，可将其翻译成西班牙语，以增强该患者人群的可及性。
