Northeastern Society of Plastic Surgeons

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Online Patient Education Materials for Microtia: A Critical Assessment of Readability and Ethnic Inclusivity
Sydney Aquilina*, Sam Boroumand, Beatrice Katsnelson, Omar Allam, Michael Alperovich
Division of Plastic & Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT

Background:
Online health-related sites are routinely accessed by patients as educational resources. It is imperative that these resources not only be at an acceptable reading level for public consumption but also congruently capture the diversity of the patient population they are intended for, especially for conditions that impact ethnic minorities with greater frequency. In fitting this profile, the purpose of this study was to assess the current suitability of online materials for microtia.

Methods:
A comprehensive Google search of "microtia" was completed screening over 150 search results, identifying 99 unique sites for inclusion. The readability of each site was evaluated utilizing five different validated readability instruments. The proportion of sites containing visual patient representations of microtia was noted and the Fitzpatrick scale was employed to assess for diversity of this representation. Single sample t-tests were used to determine if online microtia materials met NIH/AMA readability guidelines.

Results:
From the 99 identified sites, 40 were academic hospitals, 15 were government/non-profit organizations, 12 were third-party informational sites, and 32 were private hospitals/physicians. Across the five readability instruments, microtia online material was written at a mean grade level of 10.89 (SD: 1.98) which was significantly above the NIH/AMA recommended 6th grade reading level (p<0.0001). 43.4% of identified microtia sites included some type of visual patient representations of microtia and only 27.3% included representation other than White.

Conclusion:
The reading grade level of online microtia material on hospital and organization websites must be significantly reduced to meet recommended reading levels for the public and enhance accessibility. Improving the presence of diverse visual representations of microtia online is also necessitated not only given the broad phenotypic presentation of the congenital anomaly but also because of its higher prevalence in ethnic minorities.

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