Every day people go online looking for information about the COVID-19 pandemic. And every day more discoveries are reported in journals, in the press and by public health agencies. Unfortunately, it is not always so easy to understand this material. If people cannot understand the information, they won’t know what they need to do to protect themselves and why they need to do it.

Medical information that is designed to be used by the public should be written at no higher than an eighth-grade reading level. This is something on which the American Medical Association, the National Institutes of Health and the U.S. Centers for Disease Control and Prevention (CDC) all agree.

One big concern is that difficult-to-understand information from official sources encourages people to rely on articles presented in a more accessible way by less trustworthy sources.

It has been challenging to keep emerging knowledge on the novel coronavirus within that range. A review of online resources determined that information about COVID-19 meant for the general public offered on official government and public health agency web sites was too complex and technical for most people to understand.

During a pandemic, potentially lifesaving information must be easily understood by all audiences. “How public health information is presented can influence understanding of medical recommendations,” Joseph Dexter, senior author on the study, told TheDoctor.

On average, information on COVID-19 is presented at about three grade levels above the recommended current guidelines for communicating health information, Dartmouth College researchers reported.

The lack of easily-understood information from official sources is of particular concern for vulnerable communities with low health literacy. COVID-19 guidance that is unclear or difficult-to-understand could make the impact of the pandemic on these communities much worse, Dexter warned.

Eighteen websites were reviewed. They included three public health agency sites, and 15 official government sites from countries with 5,000 or more COVID-19 cases as of April 5. The pages on these websites included fact sheets about COVID-19 and lists of Frequently Asked Questions.

The accessibility of information was measured using standard readability formulas that estimate reading level based on features such as word length and sentence length.

On all 18 sites, including the World Health Organization site, the information presented on COVID-19 was above the recommended sixth to eighth grade reading level by at least one measure. Information was presented at just above an 11th grade reading level on 137 U.S. federal and state web pages. And the information provided by all 50 states was also above an eighth grade reading level. Even the perspectives and data shared by U.S. sources, including the CDC, used too many technical terms related to public health to achieve an eighth-grade reading level.

During a pandemic, potentially lifesaving information must be easily understood by all audiences.

These findings were not surprising. “There is a long history of issues about clearly communicating health information and differences between recommendations and practice,” said Dexter, a fellow at Dartmouth University’s Neukom Institute for Computational Science. These differences were clearly demonstrated in the presentation of new information about COVID-19.

It takes time and effort to make scientific information understandable, particularly when new facts are emerging all the time, as is the case with the novel coronavirus. More high-quality, plain language resources about COVID-19 are needed. Organizations should refer to existing recommendations about how to present health information as they develop these resources.

“This is not a matter of inventing something entirely from scratch,” Dexter said. “It’s a matter of taking communications strategies we know to be effective and applying them to how COVID-19 information is presented.”

Most people know it is best to turn to official sources for facts about COVID-19; but Dexter warns that difficult-to-understand information from official sources encourages people to rely on articles presented in a more accessible way by less trustworthy outlets.

As the pandemic progresses, we'll need sector-specific or topic-specific information. Further studies will be necessary to figure out how this more specific information can be made easier for its intended audience to understand, Dexter adds.

The research letter was published in JAMA Network Open.