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Readability of Ebola Informationon Websites of Public Health Agencies,United States, United Kingdom, Canada,Australia, and EuropeEnrique Castro-Sánchez,Elpiniki Spanoudakis, Alison H. HolmesPublic involvement in efforts to control the current Ebolavirus disease epidemic requires understandable information.We reviewed the readability of Ebola informationfrom public health agencies in non–Ebola-affected areas.A substantial proportion of citizens would have difficultyunderstanding existing information, which would potentiallyhinder effective health-seeking behaviors.The outbreak of Ebola virus disease (EVD) that originatedin Guinea in April 2014 has become the largestknown epidemic of this pathogen and was declared an internationalpublic health emergency (1). In addition, repatriationof health care workers and volunteers to Europeand the United States has resulted in human-to-humantransmission in western health care organizations (2), thusbringing Ebola to the fore of public attention in settings farremoved from local outbreak areas.Currently, because there is no antiviral treatment orvaccine, surveillance and strict observation of recommendedinfection prevention and control measures, aided bypublic awareness regarding symptoms and prompt healthcare–seeking behavior, are essential efforts to control Ebola.In Africa, low awareness has led to community misunderstandingsand unwillingness to cooperate with medicalteams (3). In non–EVD-affected countries, nonrigorousinformation has resulted in unfounded fear among healthcare workers and citizens, disrupting the activity of hospitalscaring for persons with EVD (4).For health messages to be followed effectively, theymust be tailored to the health literacy of the audience.Health literacy, which refers to “the cognitive and socialskills which determine the motivation and ability of individualsto gain access to, understand and use informationin ways which promote and maintain good health” (5), hasbeen associated with better self-care (6). However, a substantialproportion of citizens worldwide have insufficientor inadequate health literacy (7).Author affiliations: Imperial College London, London, UK; andNational Institute for Health Research, LondonDOI: http://dx.doi.org/10.3201/eid2107.141829Several factors, including readability of informationprovided (8), can help reduce health literacy deficits.Readability refers to “the determination of thereading comprehension level a person must have tounderstand written materials” (9). It is recommendedthat health information materials should be written ata level typically understandable by an 11-year-oldperson (10). Such recommendations for clarity andunderstandability might be more effective if one considersthat anxiety or panic attributed to a highly virulentinfection, such as Ebola, might hinder comprehension ofrelated information (11).We examined readability of EVD public informationavailable from selected public health agencies in non–EVD-affected countries. Countries that have EVD shouldexplore how well this information would serve to reducepanic and anxiety and perform as an effective source ofadvice for the public.The StudyCurrent information on Ebola aimed at the public wasdownloaded from various websites; a list is provided inonline Technical Appendix (http://wwwnc.cdc.gov/EID/article/21/7/14-1829-Techapp1.pdf). Information wasretrieved from the European Centre for Disease Control(Ebola factsheet for the general public); the US Centersfor Disease Prevention and Control (CDC; Questions andanswers on Ebola); Public Health England (PHE) in theUnited Kingdom (Ebola: public health questions and answers);and the government of Canada (Ebola virus disease)on September 1, 2014 and from the government ofAustralia (Ebolavirus disease outbreaks in West Africa:important information for travellers, patients and consumers)and the World Health Organization (WHO; Advicefor individuals and families. Ebola guidance package) onNovember 11, 2014.Any figures, such as maps or pictograms, were removed,and content was then formatted as plain text anduploaded to a free online tool (http://www.readabilityformulas.com/free-readability-formula-tests.php/)fromwhich different readability indicators were obtained(online Technical Appendix). The causes, symptoms,risks, treatment, prevention, and surveillance pages inthe Canadian website were individually opened andEmerging Infectious Diseases • www.cdc.gov/eid • Vol. 21, No. 7, July 2015 1217