COVID Treatment Information Not Readily Accessible to Many Americans

Those who have questions about COVID-19 treatment often are referred at pharmacies and elsewhere to their state’s public health website. Find out why a new study questions whether that is a good idea in some states or territories. The researchers found the website information to often be poorly accessible, especially for those with low literacy or limited language proficiency.

ROCHESTER, NY – Even though life-saving oral and injectable antiviral therapeutics are available to treat non-hospitalized patients with a high risk of COVID-19 complications, uptake remains suboptimal.

A new study in JAMA Network Open offers a novel explanation: Public health messaging that is difficult for many in the United States to read and understand.

Noting that public health websites are “vital information sources for patients seeking timely COVID-19 treatment,” University of Rochester, NY, Medical Center-led researchers sought to assess the readability and accessibility of those websites, especially for those in the United States with low literacy or limited English language proficiency.

“We found that COVID-19 treatment information on U.S. public health websites was poorly accessible, particularly for people with low literacy or limited English language proficiency, with worse accessibility for states and territories with Republican governors,” the authors note. “These findings are consistent with those of other studies.”

The study team reviewed and coded 56 public health websites for 50 states, 5 territories, and Washington, DC., within 8 categories:

  1. ease of navigation to the web page containing treatment options;
  2. oral and injectable options for treatment;
  3. eligibility requirements for treatment;
  4. how and where to obtain treatment;
  5. treatment costs and availability for uninsured patients;
  6. text languages other than English, including American Sign Language (ASL);
  7. telephone support, including mention of Telecommunications Devices for the Deaf, and
  8. ASL access.

The sites were rated from June to July 2022 on a 0-2 scale, with 0 indicating that accessibility was not met; 1, partially met; and 2, fully met. Readability also was rated on a scale from 0-100, with the top score being the most readable.

(One state, Nebraska, and 2 territories did not provide COVID-19 treatment information, were not assessed for readability, and were rated 0 for accessibility.)

The authors report substantial agreement (70%) for accessibility ratings among the study team.

Results indicate mean (SD) and median (range) ease of readability scores of 46.03 (12.95) and 43.70 (12.40-93.20), respectively, suggesting difficult readability. (Table). The readability scores ranged from 12.4 to 93.2, corresponding to very difficult to read (ie, college graduate or International Standard Classification of Education [ISCED-6]) to very easy to read (ie, fifth-grade reading level or ISCED-1). Only 3 websites (5%) had a readability score of 70 or higher, defined as fairly easy to read at or below a 7th-grade reading level: South Dakota, 93.2; Tennessee, 72.6 and Maine, 72.5. Oklahoma, at 12.4, was considered the most difficult to read.

Vermont, Minnesota, and Oregon had the highest mean (SD) accessibility ratings (1.75 [0.46], 1.88 [0.35], and 1.88 [0.35], respectively). Arizona, at 0.25 ().46) has the lowest accessibility among those providing COVID-19 treatment information. Only 2 states, Oklahoma and Vermont, received high ratings for ASL support.

“Generally, accessibility ratings were lowest for deaf access (0.20), payment information (0.73), and telephone support (1.03),” the researchers advise. “Few websites had text in non-English languages and relied on Google Translate. Democratic affiliation was associated with increased odds (odd ratio, 7.59; 95% CI, 1.70-33.97; P = .008) of scoring above the median accessibility score. Other variables were not statistically significant.”

The authors provide some suggestions on how to make information easier to assess for those seeking COVID-19 treatment information. “We found that website navigation was easier when COVID-19 treatment information was displayed on the website rather than providing hyperlinks to external federal government websites.”

They add that poor accessibility and readability of COVID-19 treatment information on U.S. public health websites might contribute to inequities in access to life-saving treatment, adding, “The results suggest the need for national guidelines on accessibility and readability for public health websites.”

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