Improving health literacy and stakeholder-directed knowledge of One Health through analysis of readability: a cross sectional infodemiology study.

Background: The One Health approach involves collaboration across several sectors, including public health, veterinary and environmental sectors in an integrated manner. These sectors may be disparate and unrelated, however to succeed, all stakeholders need to understand what the other stakeholders are communicating. Likewise, it is important that there is public acceptance and support of One Health approaches, which requires effective communication between professional and institutional organisations and the public. To help aid and facilitate such communication, written materials need to be readable by all stakeholders, in order to communicate effectively. There has been an exponential increase in the publication of papers involving One Health, with <5 per year, in the 2000s, to nearly 500 published in 2023. To date, readability of One Health information has not been scrutinised, nor has it been considered as an integral intervention of One Health policy communication. The aim of this study was therefore to examine readability of public-facing One Health information prepared by 24 global organisations.

Methods: Readability was calculated using software, to obtain four readability scores [(ⅰ) Flesch Reading Ease (FRE), (ⅱ) Flesch-Kincaid Grade Level (FKGL), (ⅲ) Gunning Fog Index and (ⅳ) SMOG Index] and two text metrics [words/sentence, syllables/word] for 100 sources of One Health information, from four categories [One Health public information; PubMed abstracts; (SOH) abstracts (articles); SOH abstracts (reviews)].

Results: Readability of One Health information for the public is poor, not reaching readability reference standards. No information was found that had a readability of less than 9th grade (around 14 years old). Mean values for the FRE and FKGL were (19.4 ± 1.4) (target >60) and (15.6 ± 0.3) (target <8), respectively, with mean words per sentence and syllables per word of 20.5 and 2.0, respectively. Abstracts with "One Health" in the title were more difficult to read than those without "One Health" in the title (FRE:  = 0.0337; FKGL:  = 0.0087). Comparison of FRE and FKGL readability scores for the four categories of One Health information [One Health public information; PubMed abstracts; SOH abstracts (articles); SOH abstracts (reviews)] showed that SOH abstracts from articles were easier to read than those from SOH reviews. No One Health public-facing information from the 100 sources examined met the FKGL target of ≤8. The most easily read One Health information required a Grade Level of 9th grade (14-15 years old), with a mean Grade Level of 15.5 (university/college level).

Conclusion: Considerable work is required in making One Health written materials more readable, particularly for children and adolescents (<14 years of age). It is important that any interventions or mitigations taken to support better public understanding of the One Health approach are not ephemeral, but have longer lasting and legacy value. Authors of One Health information should consider using readability calculators when preparing One Health information for their stakeholders, to check the readability of their work, so that the final material is within recommended readability reference parameters, to support the health literacy and stakeholder-directed knowledge of their readers.