Readability, Suitability, and Content Evaluation of Initial, Online Masking Guidance from U.S. States during the COVID-19 Pandemic

Background: In the beginning of the COVID-19 pandemic, cloth face coverings developed into an essential and widely mandated non-pharmaceutical intervention to mitigate the impact of COVID-19. With the introduction of face mask orders to prevent the spread of COVID-19, the general public may have turned to their state government or health department’s website to find information related to face coverings. Aims: This study seeks to evaluate the readability, suitability, and content of initial masking guidance on state government or state health department websites from U.S. states with face mask orders during the beginning of the COVID-19 pandemic. Methods: From states with mask mandates (n=41), masking guidance and education related to face coverings was collected from June 1st, 2020 to July 15th, 2020 from state government and state health department websites. Each state’s education on face coverings was assessed using three readability indices: Fog Index (FOG), the Simplified Measure of Gobbledygook (SMOG), and the Flesch Kincaid Grade level and the Suitability Assessment for Materials tool for suitability. A novel masking guidance- specific score was developed to evaluate the content on face coverings. Results: Masking guidance varied in literacy demand, format, and content. The mean readability of 11.54 (SD=1.85) surpasses the recommended 6-7th grade level. The mean SAM score of 55.9 (SD=9.6) is considered “adequate” for suitability. The mean content score was 5.85 (SD=1.30), and only 18 states’ masking guidance contained all seven points of information related to face coverings. Conclusions: Although most states’ initial masking guidance was suitable and contained necessary information, the inconsistency and high readability prevented the American public from educating themselves, ultimately limiting adherence to the mask mandates. During a public health crisis like the COVID-19 pandemic, readable, suitable, and comprehensive and consistent online information is vital in encouraging adherence to public health orders and promoting other preventive health behaviors.