Coronavirus (922) Readability of Official Public Health Information About COVID-19 on Websites

21 August, 2020

Super interesting read, and very relevant to our group!!

[*see note below]


Sara Fischer, MPH

PhD Candidate

Department of Government

Georgetown University

t: +1.917.373.2614


HIFA profile: Sara Fischer is a PhD Candidate at Georgetown University in the USA and has a professional interest in global health policy; health systems research; community health workers; and in aid and development. Email address:

[*Note from HIFA moderator (Neil PW): Thank you Sara. For the benefit of those without immediate web access, here are the citation and abstract. The websites were all from high-income countries.

CITATION: Research Letter Public Health. August 18, 2020. Comparison of Readability of Official Public Health Information About COVID-19 on Websites of International Agencies and the Governments of 15 Countries. Vishala Mishra & Joseph P. Dexter. JAMA Netw Open. 2020;3(8):e2018033. doi:10.1001/jamanetworkopen.2020.18033


Introduction: Containment strategies for the coronavirus disease 2019 (COVID-19) pandemic have required broad public compliance, yet complex, contradictory, and false information proliferates.1 The American Medical Association (AMA), National Institutes of Health (NIH), and Centers for Disease Control and Prevention (CDC) recommend that medical information for the public be written at no higher than an eighth-grade reading level.2 We evaluated the readability of online information about COVID-19 provided by government and public health agencies and departments.

Methods: For this cross-sectional study, between April 1, 2020, and April 5, 2020, we reviewed 18 websites, including 3 public health agency sites and 15 official government sites of countries with 5000 or more confirmed cases as of April 5 and with guidelines written in English. We identified pages about COVID-19 intended for a general audience, such as lists of frequently asked questions and fact sheets, and extracted the content into text files. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline...

Results: Among all 18 websites evaluated, information about COVID-19 uniformly exceeded the recommended reading level of grades 6 through 8 (Table). All pages (n = 149) drawn from the websites scored above 8.0 by at least 1 metric, and 141 (95%) scored above 8.0 by all 5 metrics. A total of 145 pages (97%) exceeded the syntactic complexity typical for text written at a grade 8 level (mean length of clause, 8.0; dependent clauses per T-unit, 0.2)...


We found that official information about COVID-19 exceeded the recommended reading level, exhibited complex syntax, and used technical terminology. The significant difference in use of difficult terms between the CDC and state resources may reflect the influence of federal oversight mandating government communication that is understandable to the public. Limitations included the focus on text, with no evaluation of multimedia communication, and lack of data about actual comprehension or relevant outcomes such as adherence to mitigation strategies.

Nonadherence to readability standards may have a greater influence in communities with lower health literacy, potentially exacerbating the disparate effects of the pandemic. As such, efforts should focus on the urgent development of plain-language COVID-19 resources that conform to established guidelines for clear communication and are more accessible to all audiences.]