Even before the COVID-19 pandemic, an increasing number of patients were relying on information available on the Internet for their medical care. Among urological conditions, “What causes kidney stones?” was the most frequently asked question, ranking as the 6th most common health question overall in 2019 on Google.¹ But how reliable is this readily available information, and moreover, how easy is it for patients with kidney stones to understand?

Figure 1. Graph for estimating readability: extended.

Health literacy is defined as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate decisions. ” ² This is important as an estimated one-third of adults in the United States have limited health literacy, which is linked to worse health outcomes.³ As many patients with decreased health literacy also have limited reading ability, the American Medical Association’s health literacy manual for clinicians recommends that written materials for patients be at a 5th to 6th grade reading level.⁴ A previous study related to all urological conditions found that online educational information provided by the American Urological Association and multiple academic urology departments was written above the 11th grade reading level.⁵

Our study sought to examine the readability of kidney stone educational materials present on the most popular websites. Using the top 10 results of a search for “kidney stones” on the most popular search engine (Google), readability was determined using 6 widely used readability assessment tools (Flesch Reading Ease, FORCAST Readability Formula, Fry Graph, Gunning Fog Index, Raygor Readability Estimate and Simple Measure of Gobbledygook, or SMOG). Readability of specific subsections was then analyzed, paying particular attention to content on the prevention and treatment of kidney stones.

Our results found that for all 10 websites, text was written above the 6th grade reading level, with a range from grade 7 to 13. As shown in the Fry Graph (see figure), 8 of 10 websites contained words with a high number of syllables, thereby resulting in readability above the 9th grade level. Similarly, for the prevention and treatment subsections, all websites contained text written well above recommended reading levels, ranging from the 9th to above the 12th grade.

With the recent COVID-19 pandemic and the subsequent increase in telehealth visits, it is reasonable to expect that even more patients may be seeking health information from the Internet. The results of this study should serve as a sobering reminder to urologists that a large percentage of patients might not be able to understand the readily available kidney stone information being provided to them. It is unwise for clinicians to assume that patients can simply “Google” kidney stones and understand the information contained on the resulting websites. Hopefully, this work brings attention to the need for updated online kidney stone educational materials that use simpler language to improve patient understanding.