Introduction
Effective in-person veterinarian-client communication in companion animal practice has been associated with adherence to patient care recommendations.1,2 Veterinary clients’ perceptions of the value of care are driven by how veterinary professionals explain the reasons for their recommendations, and lack of perceived value, or the misperception that a recommendation is unnecessary for their pet, may lead to nonadherence.1 Value communication in veterinary medicine has previously been characterized as being related to aspects such as the time or services provided (ie, the feature), information obtained from a procedure or process by which it works (ie, the function), and benefits to a pet’s future health and function (ie, the benefit).3 Focusing fee-related conversations on the benefits to the animal has been a long-proposed strategy for veterinarians to bridge clients’ understanding of the “why” behind a recommendation and to promote adherence.4
Focus group research has shown that when considering a veterinary recommendation or service for their pet, client participants predominantly focused on the outcome of that service for their pet or its effect in terms of benefit to their pet’s health and well-being.5 In contrast, veterinarian participants tended to emphasize the service, time, and expertise related to their recommendations.5 Observational research has identified that veterinarians infrequently communicate the pet benefit of a recommendation to clients when discussing the cost.3,6 This discrepancy in perception of the value of veterinary services and the way value is communicated by veterinary professionals may account, in part, for a lack of client adherence and follow-through.
The internet is commonly used by pet owners as a source of information about their pet’s health.7 While this ease-of-access presents opportunities for pet owners to educate themselves, online information may be inaccurate, incomplete or lacking in quality, and may lead to concerns about misinformation.7–10 The readability level of online content is also important to consider, and educational materials written at a level too high for reader understanding may risk misinterpretation of the information and inadvertent negative consequences for patients. The American Medical Association recommends that health information be written at a sixth-grade reading level to increase accessibility for the public.11 An analysis12 of written veterinary client handout materials found that 9 out of 10 were written above the recommended reading level for public-facing health materials. Similarly high reading levels were found in a study13 of websites with cat and dog obesity–related content. Many veterinary clinics maintain websites with information about the services available to clients and their pets, especially preventive care services. However, little is known about the readability, and therefore accessibility, of information on these websites or the ways in which the value of these services is communicated to clients. A better understanding of how value is communicated online and clients’ preferences for how value is conveyed via written means may help further educate clients and increase their engagement with veterinary professionals about preventive care for their pet.
The objectives of this study were to (1) explore veterinary client preferences regarding the way in which value of a preventive care service is conveyed in written communication, and (2) compare these preferences to the way in which value of preventive care services is currently communicated on veterinary clinic websites.
Methods
This study was conducted in 2 stages. The first stage was a cross-sectional, veterinary client questionnaire exploring preferences for how the value of senior pet screening is conveyed via written means. The second stage was a content analysis of veterinary clinic website pages related to 4 common preventive care services (flea and tick prevention, heartworm prevention, dental cleaning, and senior bloodwork) to explore the ways in which the value of these services is currently conveyed online. The study protocol was reviewed and cleared by the University of Guelph Research Ethics Board (REB No. 23-06-003).
Questionnaire design
The anonymous online questionnaire was developed in Qualtrics and offered in English. Participants provided consent to participate by selecting “agree” to proceed. The questionnaire consisted of 4 sections: client-reported pet demographics, participant demographics, participant preference for function- versus benefit-focused information, and participant likelihood of speaking with a veterinarian after viewing a paragraph recommending senior screening.
Participants were asked to respond to the questionnaire with information specific to the oldest pet in their household. Pet-related information about the participants’ oldest pet included species (cat or dog), age (years), whether the pet is considered a senior (based on the AVMA client-facing guidelines for species and breed size in dogs14), length of ownership (years), frequency of visiting a veterinarian (twice or more per year, once a year, less than once a year but at least every 2 years, less than every 2 years, and only when the pet is sick), and time of last visit to a veterinarian (in the past 6 months, in the past year, in the past 2 years, over 2 years ago). Participants were also asked how often they look for information on veterinary-based websites, such as those of veterinary clinics, veterinary associations, or written by a veterinary professional (never, less than once a year, once a year, twice a year, 3 to 4 times a year, once a month or more). Participant demographic information included age (years), highest level of education, and personal income.
Participants were presented with 2 descriptions and asked to rank the descriptions in the order of which they would most prefer to see written on a veterinarian’s website. Participants were also asked to explain their reasons for ranking the descriptions in the order they selected (open text). The descriptions were brief paragraphs written by the research team and were specific to communicating the value of senior screening (Supplementary Material S1); one paragraph was intended to be “function-focused” (91 words) and focused on the function of senior screening with no reference to benefits, and the other was “benefit-focused” (99 words) and emphasized the benefits of senior pet screening, with some reference to function. The paragraphs were written to have similar readability, with calculated Flesch-Kincaid Grade Levels (FKGLs; corresponding to US grade levels) of 11.5 and 11.3 for the function- and benefit-focused paragraphs, respectively. Each paragraph shared approximately half (53 words) of the same text and was coded with the same 4-code framework used for stage 2 of the study (described subsequently). The order in which the 2 paragraphs were presented to participants was randomized within Qualtrics.
Following the ranking question, participants were randomized to view 1 of the 2 paragraphs again (function-focused or benefit-focused) and after viewing the paragraph were asked to indicate how likely they would be to speak to a veterinarian about senior screening for their pet on a 5-point Likert scale (extremely unlikely, somewhat unlikely, neither likely nor unlikely, somewhat likely, extremely likely).
Participant recruitment
Veterinary client participants were recruited through 15 US veterinary practices that were known to the research team. Practices that agreed to distribute the questionnaire to their active client list did so by sending out a researcher-generated email that provided a link to the online questionnaire. The questionnaire was available and collected data from August 17 to November 2, 2023, inclusive. Throughout recruitment, the study was presented as an investigation into veterinary clients’ preferences regarding how the value of veterinary care is communicated online. Participants were eligible to participate if they were at least 18 years of age, owned a cat or dog, and possessed English-language proficiency. An incentive of entry into a draw for a $50.00 Amazon eGift card (odds of winning 1 in 100) was offered for participation in the survey; participants interested in being entered into the draw provided contact information in a separate online survey that was not connected to their anonymous questionnaire responses. Due to the survey’s focus on senior screening, participants who indicated that the oldest pet in their household was not a senior or who did not report seeing a veterinarian with their oldest pet in the last year were excluded from analysis.
Website data collection
Four search phrases were used for website collection: “flea and tick prevention veterinary clinic,” “heartworm prevention veterinary clinic,” “dental cleaning veterinary clinic,” and “senior pet bloodwork veterinary clinic.” The search phrases were chosen by the research team with the aim of representing various preventive care topics that are commonly discussed during cat and dog wellness examinations.15,16 A search engine database was used to confirm that the first 3 search phrases were popular terms searched online.17 Senior pet bloodwork was also included for consistency in investigation with the text descriptions used in the pet owner questionnaire (stage 1). A Google search was conducted to generate search results throughout July and August 2023 that were catalogued until a minimum of 35 veterinary clinic–based websites were collected for each of the 4 search phrases. During the web search, the research team was connected to a virtual private network and used a private browser to prevent user search histories from influencing the search results. Location services were turned off, and the US was selected as the search region. Sponsored websites (indicated by the word “sponsored” above the link), public forums, personal blogs/vlogs, veterinary pharmaceutical companies, veterinary corporations, and online stores were excluded from data collection to ensure that the data stemmed from independently owned veterinary clinic websites.13 Duplicate websites were also excluded. Only the landing pages accessed from the search results were coded, excluding any hyperlinks within the page.
Website characterization
For each website, 2 members of the research team recorded the clinic location, pet species discussed (cat, dog, or unspecified), visual features used (including the number of images, videos, and infographics), the number of headings (excluding the title), mentions of cost for services (yes/no), and the presence of advertisements (yes/no). Word counts, character counts (excluding spaces), and sentence counts were also recorded by copying and pasting each website’s content into a Word 2023 document (version 16.76.1; Microsoft Corp) and using its Document Stats function.
Readability
The Word documents for each site were formatted for the calculation of 3 readability scores: Flesch Reading Ease Score (FRE), FKGL, and the Simple Measure of Gobbledygook (SMOG) Index. These 3 scores were calculated to present a more robust assessment of readability for the websites. Following recommended practices, all titles, headings, lists, and phrases that were not complete sentences (of 4 or more words) were removed to improve the accuracy and reliability of the results.18,19 Titles, headings, lists, and phrases that contained 4 or more words were considered sentences, and periods were added if necessary.18,19 Phrases in a bulleted list were retained only if they contained 4 or more words.18,19 Both the FRE and FKGL use word, syllable, and sentence counts to calculate readability scores, and so all phone numbers, price lists, URLs, and periods that did not mark the end of a sentence (ie, in abbreviations such as Dr.) were removed to improve accuracy.18,19 The FRE and FKGL were obtained with computer software.19 The SMOG Index was calculated manually by the research team using a subset of 30 sentences from each site.19 For each subset of text, all polysyllabic words (containing 3 or more syllables) were counted.19 The square root of this count was obtained, and a constant of 3 was added to determine the SMOG Index.19 For sites with fewer than 30 sentences, the polysyllabic word count was extrapolated.19
Codebook development
The value communication coding framework was developed by the research team with reference to previous studies3,6 conducted by a research team member (JBC) that characterized the nature of value communication in veterinary practice. During development of the coding framework, 2 members of the research team independently coded select websites and then compared results to identify any need for clarification or review of the framework. Websites used for the development and evaluation of the framework were a combination of sites that discussed similar topics of preventive care (yet did not fall under the topics of the 4 search phrases) and a small number that met the inclusion criteria for the present study (and were excluded from the final data analysis). Once the framework was finalized, each website collected in the search was imported into NVivo software (release 1.7.1; Lumivero) for coding by the primary coder (KBV).
The value communication framework was applied to the entire text of each website to code for the following: (1) features, representing products, treatments, procedures, and services offered by the clinic and veterinary team (eg, “bloodwork,” “blood tests”); (2) functions, conveying the medical information obtained from a service or procedure, the effect of a product on a pet, and/or how the feature works (eg, “to evaluate organ function, check for infections, and diagnose diseases like diabetes”); (3) benefits to the pet, information conveying the impact on the pet including improved health, comfort, safety, well-being, longevity, and reduction of stress and discomfort (eg, “to keep your pet feeling their best”); and (4) benefits to the client, such as reduced costs or ease of use (eg, “[early diagnosis] can help save you money”). Products and recommendations that were meant to be performed or used by veterinary clients outside the clinic (such as toothpaste for at-home tooth brushing) were not coded as features in the present study. Prevention of pain and discomfort were coded as benefits if they were unambiguously linked to a feature (eg, “Heartworm disease is a painful and often fatal disease. That’s why heartworm prevention is crucial for your pet.”). Similarly, any mentions of avoidance or prevention of disease that were clearly linked to a feature were coded as functions (eg, “Plaque and tartar buildup can lead to dental disease. That’s why we recommend annual dental cleanings.”).
Throughout coding, daily meetings with research team members (excluding members from Zoetis) were held to discuss any uncertainties in coding, and consensus determined the final code. The 4 codes were mutually exclusive, and website text was assigned only 1 code (eg, a phrase could not be considered both a function and a benefit, only one or the other).
Intercoder reliability
Intercoder reliability was performed with the use of a random selection of 10% of the websites included in the present study. An intraclass correlation coefficient was used to determine reliability for the manual calculations of the SMOG Index.20 Intercoder reliability for the value communication coding was determined with NVivo’s Coding Comparison Query, which provides an unweighted κ coefficient and percent agreement.
Statistical analysis
Veterinary client questionnaire
Descriptive statistics were calculated in SPSS Statistics (version 29.0.1.0; IBM Corp), including mean, SD, median, and min-max for continuous variables and frequencies for categorical variables. Two separate logistic regressions were used to explore associations between participant demographics and the following binary outcome variables: (1) participant’s preference for the benefit- or function-focused paragraphs, and (2) the likelihood of speaking to a veterinarian about senior screening after viewing either the function- or benefit-focused paragraph. Preference for the benefit- or function-focused paragraphs was indicated by participants’ response to the ranking question. Responses to the question “how likely would you be to speak to a veterinarian about senior screening?” were dichotomized prior to modeling to create a binary outcome variable, where “extremely likely” was compared to a category including all other responses (“somewhat likely,” “neither likely nor unlikely,” “somewhat unlikely,” and “extremely unlikely”). Associations with the binary outcomes were assessed for the variables client age, income (categorized into 3 categories of low, medium, and high relative income), and level of education (categorized into 2 categories of below college and college or higher). In addition to the logistic regressions, a χ2 analysis was used to test for an association between participants’ likelihood of speaking to a veterinarian about senior screening and which of the 2 paragraphs they saw. Values of P < .05 were considered significant.
In addition to the statistical analysis, a qualitative (thematic) analysis was performed on participants’ responses to the open-text question regarding reasons for ranking the paragraphs in their order of preference to identify themes that emerged from the responses.
Website coding
The percentage of each website’s text that was coded as 1 of the 4 codes (feature, function, pet benefit, client benefit) was determined by NVivo on the basis of character counts (characters included in the code category divided by the total number of characters of the text, excluding spaces, multiplied by 100). Descriptive statistics for the percentage coverage of each code were calculated in SPSS, including mean, SD, median, and min-max. Repeated-measures ANOVA with Bonferroni-corrected post hoc pairwise comparisons was used to assess differences in the percentage of text coverage for each code; “pet benefit” and “client benefit” were summed to create a single “benefit” category for the ANOVA. Values of P < .05 were considered significant.
Results
Veterinary client questionnaire
Participant demographics
Of 728 participants who consented to participate, a total of 296 questionnaires were retained for analysis after excluding participants who indicated that the oldest pet in their household was not a senior or who did not report seeing a veterinarian with their oldest pet in the last year. Participant and pet demographics are shown in Table 1.
Demographics of 296 US veterinary client participants and their senior pets responding to a survey investigating preferences for online communication about senior screening.
| Characteristic | n (%) | ||
|---|---|---|---|
| Highest level of education (n = 220) | |||
| Some high school | 1 (0.5) | ||
| Completed high school | 8 (3.6) | ||
| Some college/university | 26 (11.8) | ||
| Apprenticeship training and trades | 4 (1.8) | ||
| Completed college/university | 72 (32.7) | ||
| Some graduate education | 14 (6.4) | ||
| Completed graduate education | 62 (28.2) | ||
| Professional degree | 32 (14.5) | ||
| Prefer not to answer | 1 (0.5) | ||
| Personal income (n = 205) | |||
| ≤ $5,000–$19,999 | 8 (3.9) | ||
| $20,000–$39,999 | 26 (12.7) | ||
| $40,000–$59,999 | 30 (14.6) | ||
| $60,000–$79,999 | 31 (15.1) | ||
| $80,000–$99,999 | 22 (10.7) | ||
| $100,000–$149,999 | 36 (17.6) | ||
| ≥ $150,000 | 52 (25.4) | ||
| Species of oldest pet in the household (n = 296) | |||
| Cat | 108 (36.5) | ||
| Dog | 188 (63.5) | ||
| Frequency of oldest pet visiting a veterinarian (n = 296) | |||
| 2 or more times a year | 189 (63.9) | ||
| Once a year | 85 (28.7) | ||
| Less than once a year but at least once every 2 years | 9 (3.0) | ||
| Less than every 2 years | 2 (0.7) | ||
| Only when my pet is sick | 11 (3.7) | ||
| Last time oldest pet visited a veterinarian (n = 296) | |||
| In the past 6 months | 255 (86.1) | ||
| In the past year | 41 (13.9) | ||
| Frequency of searching for information on veterinary-based websites (n = 295) | |||
| Less than once a year | 60 (20.3) | ||
| Once a year | 21 (7.1) | ||
| 2 or more times per year | 48 (16.3) | ||
| 3–4 times per year | 83 (28.1) | ||
| Once a month or more | 42 (14.2) | ||
| Never | 41 (13.9) | ||
| Mean (SD) | Median | Min-max | |
| Client age (y; n = 197) | 55.7 (15.2) | 57.0 | 20.0–92.0 |
| Age of oldest pet (y; n = 290) | 12.1 (2.8) | 12.0 | 6.0–21.0 |
Data were collected between August 17 and November 2, 2023. Discrepancies in denominators are due to missing values. Income is in US dollars.
Participants’ preference for the benefit- or function-focused paragraphs
The majority of participants who ranked the paragraphs identified the benefit-focused paragraph as their preferred communication (58.0% [166/286]) and the remaining 42.0% (120/286) participants indicated a preference for the function-focused paragraph. The binary logistic regression models using client age, education, and income as predictor variables and the binary paragraph preference (benefit focused or function focused) as the outcome variable had poor model fit and were not assessed further.
Five themes emerged from thematic analysis of the open-text responses related to participants’ explanation of the reasons for ranking the paragraphs in their order of preference: information provided, framing, tone, readability and understanding, and alignment with client knowledge and beliefs related to veterinary care. Participants who preferred the benefit-focused paragraph often indicated that they perceived the way senior screening was described in this paragraph as more “proactive” or “preventive” and framed as prioritizing pet health, compared to descriptions provided by participants viewing the function-focused paragraph. One participant noted that “the early diagnosis part really resonated,” and another commented that the description was “more proactive sounding, less telling me what to do.” The tone was also considered positive and language choices were considered appropriate for pet owners in addition to being a concise explanation, with one participant suggesting it was “easier to understand for those who don’t work in this field” and others indicating it was “less clinical and a bit more caring” and “easier to read and explained why the tests are needed, not just what they test for.” Some participants acknowledged that prior medical knowledge or beliefs influenced their preference, with one who preferred the benefit-focused paragraph saying, “I believe the sooner we know of an issue the faster it can be treated,” while another said, “I understand the reason for screening and being aware.” Participants who preferred the function-focused paragraph often indicated that the information was more detailed and provided an explanation of senior screening that better informed pet owners. One participant noted it “explains what is recommended and why.” Another mentioned they “like knowing what info is received from the various tests,” and one participant described it as a “more complete description of the tests and reasoning for them.” Participants’ medical knowledge also impacted preference for the function-focused paragraph, with one participant explaining, “I was in medicine,” and another sharing their awareness that “blood chemistry is important.” Regardless of whether participants preferred the benefit- or function-focused paragraph, understanding “why the tests are done” was frequently provided as explanation for ranking the paragraphs in the way they did; both paragraphs appeared to convey to participants, to varying extents, the reasons preventive screening is important for senior pets. Preferences for the way the value was communicated, in terms of language choices, specific detail provided about the tests, tone, or framing, varied across participants.
Likelihood of speaking to a veterinarian after viewing either the function- or benefit-focused paragraph
For participants who saw the benefit-focused paragraph, 53.2% (66/124) indicated they would be “extremely likely” to speak to a veterinarian about senior screening compared to 46.8% (58/124) who indicated any other likelihood (extremely unlikely to somewhat likely). Of participants who saw the function-focused paragraph, 39.4% (37/94) would be “extremely likely” to speak to a veterinarian about senior screening compared to 60.6% (57/94) who indicated all other responses. For the χ2 test for association between which paragraph participants randomly saw and how likely they would be to speak to a veterinarian about senior screening, participants who saw the benefit-focused paragraph were more likely to indicate they would be “extremely likely” to talk to a veterinarian about senior screening compared to those who saw the function-focused paragraph (χ2 = 4.12; P = 0.04). The binary logistic regression models using client age, education, and income as predictor variables and likelihood of speaking to a veterinarian about senior screening (“extremely likely” vs all other responses) as the outcome variable had poor model fit and were not interpreted further.
Website coding
A total of 172 websites were catalogued from the initial search, with 141 being veterinary clinic based and considered for inclusion. Four duplicate sites were excluded, and another was excluded because the landing page had no content (ie, “Coming soon”). Of the 136 remaining veterinary clinic–based websites, 8 sites were used during the development of the coding framework and were excluded from the final analysis. Readability and value communication coding data were collected for a total of 128 websites. Website characteristics, including readability, are presented in Table 2.
Overall characteristics of 128 coded US veterinary clinic web pages with content focused on 4 preventive care topics (flea and tick prevention, heartworm prevention, dental cleaning, and senior bloodwork).
| Webpage characteristic | Mean (SD) | Median | Min-max | |
|---|---|---|---|---|
| Word count | 485.6 (301.0) | 420.5 | 108–2,110 | |
| Character count (excluding spaces) | 2,472.0 (1,552.1) | 2084.5 | 610–10,966 | |
| Sentence count | 30.5 (19.1) | 26.0 | 6–132 | |
| Flesch Reading Ease Score† | 57.5 (8.2) | 57.9 | 38.5–77.6 | |
| Flesch-Kincaid Grade Level | 9.2 (1.4) | 9.2 | 5.7–13.5 | |
| SMOG Index | 11.3 (1.1) | 11.2 | 8.6–14.7 | |
| No. of headings (excluding title) | 4.0 (3.3) | 3.0 | 0–14 | |
| No. of images | 1.4 (1.3) | 1.0 | 0–8 | |
| No. of videos | 0.04 (0.2) | 0.0 | 0–2 | |
| No. of infographics | 0.06 (0.2) | 0.0 | 0–1 | |
| n (%) | ||||
| Cost mentioned | Yes | 11 (8.6) | ||
| No | 117 (91.4) | |||
| Advertisements present | Yes | 22 (17.2) | ||
| No | 106 (82.8) | |||
| Species of pet mentioned | Cat | 0 (0.0) | ||
| Dog | 10 (7.8) | |||
| Unspecified | 118 (92.2) |
SMOG = Simple Measure of Gobbledygook.
†This score should be interpreted as lower scores indicating increasingly difficult-to-read material; scores ≥ 70 indicate materials that are easier to read (grade 7 reading level or below), and scores ≤ 50 indicate an above–high school reading level.21,22 The recommended reading grade level is sixth grade.11
Fourteen of the 128 websites (10%) were double-coded to determine intercoder reliability. The intercoder reliability test for the manual SMOG Index calculations resulted in an intraclass correlation coefficient of 0.98, indicative of excellent reliability between the 2 coders. The intercoder reliability for the value communication coding resulted in an unweighted κ coefficient of 0.75 and percent agreement ranging from 94.5% to 98.6% across all 4 codes, indicating substantial agreement.23 The primary coder’s (KBV) coding was used for analysis.
The ANOVA to assess differences in text coverage for each code was significant (F[2] = 66.1; P < .001), and all post hoc Bonferroni-corrected pairwise comparisons were significant (P < .05). The code with the most text coverage across all websites was “feature” (Table 3). All 128 coded websites included at least 1 mention of a “feature,” while 8 (6.3%) websites had no mention of a function, 21 (16.4%) had no mention of benefit to the pet, 85 (66.4%) had no mention of benefit to the client, and 19 (14.8%) had no mention of any benefit to either the pet or client. Of the 128 websites, 105 (82.0%) included a mention of a feature, function, and any benefit to pet or client; 120 (93.8%) included a mention of a feature and function (with or without a mention of benefit); and 4 (3.1%) included a mention of feature and any benefit to either the pet or client only (ie, no mention of function).
Percent text coverage based on character counts of each code related to communicating the value of a preventive care service (flea and tick prevention, heartworm prevention, dental cleaning, or senior bloodwork) when applied to 128 US veterinary clinic–based website pages.
| Code | Mean (SD) | Median | Min-max |
|---|---|---|---|
| Feature | 13.3ab (6.1) | 13.0 | 1.8–45.3 |
| Function | 10.5bc (9.7) | 7.4 | 0.0–54.9 |
| Pet benefit | 6.4 (5.2) | 5.1 | 0.0–20.6 |
| Client benefit | 1.0 (2.1) | 0.0 | 0.0–11.5 |
| Total benefit* | 7.4ac (5.9) | 6.7 | 0.0–25.2 |
Values indicated by superscripts are significantly different (P < .05) in Bonferroni-corrected pairwise comparison; only the total benefit was used for pairwise comparisons.
*Calculated as the sum of the percent text coverage for the pet benefit and client benefit codes.
Discussion
Results of this study indicate that many clients prefer to see a benefit-focused paragraph about a preventive veterinary care service (ie, senior screening) when communicated in written form, and opportunities exist to enhance communication of the benefits for patients and clients of preventive care services on veterinary clinic websites. Findings indicated that participants would be more likely to engage a veterinarian in a discussion of senior screening when benefits of the screening are communicated in written form. In open-text follow-up responses, several participants expressed a preference for the benefit-focused paragraph due to the service being framed as preventive or proactive for their pet and prioritizing pet health. These findings, along with the notable number of participants (42%) that did indicate a preference for the function-focused paragraph, further support the need to communicate the functions and benefits of preventive care services together in written form for clients. As such, when developing online communication, veterinary professionals should frame recommendations for preventive care services to convey value through emphasis on the function and benefits of these services to the veterinary patient and client.
The pattern of coding found in the present study, where veterinary clinic websites predominantly discussed the features and functions of services and infrequently indicated clear benefits to the pet or client, aligns with a discrepancy previously identified between veterinary professionals’ and clients’ perceptions of value.5 In conversation with clients, observational research has also shown that veterinarians tend to focus their communication on the time or services they are providing and to a lesser degree on the benefit to the veterinary patient.3,6 However, several studies1,5 indicate that clients want the impact and benefit of veterinary services on their pet to be communicated. Communication of the benefit goes beyond explaining the function of a service to address the “why” behind a recommendation. Because clients’ adherence to recommendations has been found to be associated with whether they perceive necessity and value for their pet,1 clear communication, whether written or oral, of the benefits in a way that aligns with clients’ perception is likely to be critical to improving uptake of preventive care services. Veterinary professionals should also recognize that perceptions of value and desirable benefits are not likely to be consistent across clients; therefore, being inclusive of all client preferences when communicating in written form, including the feature, function, and benefit (to patient and client), is likely to meet the preferences of a broader client population.
The average reading level calculated for the 128 websites included in this study (an FKGL of 9.2) exceeded, by several grade levels, the recommended readability (ie, US grade 6) for ensuring that medical information is accessible to the public.11 Only 1 website had a lower reading level than the recommended sixth-grade level. This finding of readability level is consistent with a study evaluating the readability of online pet obesity information13 and prior research evaluating the accessibility of veterinary client handouts,12 as well as online human health information24 and patient-education materials in human medicine.25,26 Veterinary clinics should likely consider evaluating the readability of client-education content posted on their websites. Content that is inaccessible due to reading level may undermine the benefits of clients accessing reliable information directly from a veterinary clinic’s website. While veterinarians are considered a preferred and trusted source of pet health information for owners,27–29 the internet is also a source of pet health information for many owners.7,30 If internet sources other than the information or websites obtained from the veterinary team are deemed more accessible by owners in terms of readability, it is possible that clients may seek and consume information from these other online sources, which may have variable accuracy. An exploration of the reading levels and client preferences for various online information sources compared to veterinary clinic websites may be a relevant direction for future research to support developing guidelines for veterinary professionals when writing online communications.
The reading levels of the researcher-generated paragraphs used in the present study were also notably higher than the recommended threshold and the average reading levels of the coded veterinary clinic websites studied, which may have reduced the accessibility of the content for participating clients and impacted participants’ responses to the ranking question asking which paragraph participants preferred. The research team found it challenging to write medical information at a lower grade level, highlighting the significant challenge this is likely to pose for veterinary professionals as well. Engaging with other professionals experienced in creating accessible medical content for the public, referring to health literacy resources from organizations such as the NIH,31 or using AI applications to assist in converting written material to the recommended reading level may be options for veterinary professionals when building or revising clinic websites or creating client handouts. Even though the reading levels across the 2 study paragraphs were held constant to minimize the impact on participants’ preference, many participants indicated that their preference was in part dictated by one paragraph being easier to read (the benefit-focused paragraph). Therefore, it should also be acknowledged that reading grade level is not the only factor related to comprehension of written material. The Flesch Reading Level and Flesch-Kincaid Reading Grade Level rely on word and sentence length and do not account for many other relevant factors, including the reader’s prior knowledge, layout of information, grammar, and images.21 The SMOG formula may be more appropriate for assessing healthcare materials, yet the purpose of the document and context of the text that is sampled for readability calculations are also important considerations to ensure representative reading grade levels are determined.32 Reading level may offer a useful starting point for veterinary professionals to consider when evaluating client-facing written information, though it is not the only predictor of understanding or adherence. Writing medical information in a way that maintains credibility, provides the necessary level of information, and is comprehensible requires attentiveness to the target audience and consideration of multiple factors that relate to reader engagement and understanding.
Participants in this study indicated a higher likelihood of speaking to a veterinarian about senior screening after reading the benefit-focused paragraph and all participants owned a senior pet, yet this was a response to a hypothetical scenario and may not reflect real-life actions of clients in choosing whether to speak to a veterinarian. Also of note, these paragraphs did not include any discussion of cost, and cost was rarely mentioned on the coded websites (fewer than 10%). Clients have indicated a preference for costs of care to be discussed up front (before or during an appointment) rather than at the end of a visit.5,33 Veterinary practices’ use of their websites to communicate the cost of veterinary services is an area worthy of future research.
Future research to explore the actual frequency of client-initiated discussion of care services after encountering written forms of online communication up front, and subsequent client adherence to recommendations, would further inform the development of online written resources that may assist veterinary clients in understanding the value and support their use of preventive care services. Additionally, the present study involved the comparison of 2 written paragraphs written at similar reading levels (approximately grade 11) to control for reading level during the survey portion of the study; however, the higher-than-recommended reading level likely limited accessibility of the study for some participants. Future research evaluating client responses to researcher-generated written communications should aim for study materials with lower, more accessible readability scores that align more closely with the recommended reading level for public-facing medical information. The recruitment method of the present study did not allow for an accurate survey response rate to be calculated, which may limit the generalizability of those findings. The coding framework used in this study focused on the percentage of text coverage rather than the absolute frequency of mentions of features, functions, and benefits; this is a potential consideration for future research, as it is possible to mention multiple features without a function or benefit being tied to each, and text coverage alone may not capture this information. Increasing the extent to which functions, and particularly benefits, of services are described online may enhance client engagement and future communication with their veterinarian.
Veterinary clients’ comprehension of the medical services and recommendations offered to them, as well as the communication of the benefits of these recommendations for the client and their pet, are likely to impact decision-making about preventive care. To support client understanding and promote the uptake of preventive care recommendations, veterinary professionals should consider the accessibility of written information available to clients online and frame the value of preventive care services in a way that includes the benefit to veterinary patients and clients.
Supplementary Materials
Supplementary materials are posted online at the journal website: avmajournals.avma.org.
Acknowledgments
The authors would like to thank Ayla Mollen for assistance with website coding, Radhika Gandhi for assistance with the thematic analysis, and Dr. Lindsay Plater for statistical analysis.
Disclosures
Dr. Coe regularly receives research funding, consults for, and receives honoraria from various veterinary organizations and commercial companies including Zoetis. Dr. Coe currently holds the VCA Canada Chair in Relationship-Centered Veterinary Medicine at the Ontario Veterinary College, University of Guelph. Dr. Sutherland’s position was funded through a Mitacs Elevate fellowship in partnership with Royal Canin Canada, and she receives honoraria from various veterinary organizations and commercial companies. Drs. Gober and Berst are employees of Zoetis and were involved in study conceptualization and design, veterinary practice recruitment, and critical revision of the manuscript.
No AI-assisted technologies were used in the generation of this manuscript.
Funding
This study was funded by an unrestricted grant from Zoetis.
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