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Readability Assessment of Online Patient Education Resources for Breast Reconstruction: Lost in Translation?
Lilian C. Azih, MD, Anne R. Tong, MBBS, Ivy L. Chippendale, BA, Laura B. Gavin, RNP, Pablo A. Baltodano, MD, Anas M. Abdullah, MBBS, Stella M. Seal, MLS, Carisa M. Cooney, MPH, Gedge D. Rosson, MD.
Johns Hopkins University School of Medicine, Baltimore, MD, USA.
BACKGROUND: The increasing ease of internet accessibility in the United States (US) allows for patients using the internet to search for health information. It is imperative that the materials be at a comprehensible level to aid in the patients understanding of their disease or surgery. The increasing volume of healthcare information online emphasizes the importance of ensuring the quality, accuracy and reliability of these materials. Our study aims to assess the readability and the quality of patient education resources in breast reconstruction.
METHODS: An internet search for patient education resources was conducted on the Google search engine using the following key words: “breast reconstruction”, “breast cancer reconstruction”, “breast reconstruction options”. Our search strategy comprised of a robust search for top websites using a public IP address in a local library and a personal computer. All searches were evaluated for their level of readability using the Flesch Reading Ease (FRES) and Flesch-Kincaid Grade Level (FKGL), Gunning-Fog Score (GFS) and Coleman-Liau Index (CLI). Verification on the quality of healthcare information was determined by the display of a HONcode certification from each site. Authorship dates when contents were reviewed were assessed. The Student T-tests were used to analyze all continuous variables. Statistical significance was set at P<0.05.
RESULTS: Forty-nine websites were eligible. The FRES averaged (47.5), the FKGL averaged (11.2), the GFS averaged (14.1) and the CLI average (14). This indicates that the majority of patient education materials on breast reconstruction are written at a significantly higher readability and comprehension level than the recommended 6th grade level. Authorship for materials were not clarified in almost half of the sampled websites (n=22, 45.8%). Of those that did, 50% (n=25) of patient education materials were written/reviewed by clinicians and 20 (83%) websites clearly declared the preparation of these information by board-certified plastic surgeons. Only 18 of the total websites (37.5%) provided evidence-based references for their information. A subgroup analysis of the websites that displayed a time stamp found that patient materials were mostly reviewed/written greater than 365 days.
CONCLUSIONS: Our results demonstrate that most women in America undergoing breast reconstruction may not benefit completely from patient education resources available on many websites as the readability scores were found to be inferior to those recommended.
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