Cosmetic facial surgery: are online resources reliable and do patients understand them?

What Is Health Literacy Among Orthognathic Surgery Patients?

BACKGROUND

Health literacy of orthognathic surgery patients has not been thoroughly evaluated.

PURPOSE

The purpose of this study was to estimate health literacy and identify risk factors associated with inadequate health literacy in orthognathic surgery patients.

STUDY DESIGN, SETTING, SAMPLE

A cross-sectional study was implemented utilizing patients ages 14-80 years who presented for orthognathic surgery evaluation between September 2021 and December 2022. Subjects were excluded from the study if they did not complete the orthognathic surgery evaluation, were not between the ages of 14-80 years old, or did not complete the Brief Health Literacy Screening Tool (BRIEF) questionnaire during intake. Subjects who have not undergone orthognathic surgery but completed the initial evaluation for orthognathic surgery were included in the study.

PREDICTOR VARIABLES

The predictor variables were a set of risk factors for inadequate health literacy: age, sex, primary language, race, estimated household income, and diagnosis.

MAIN OUTCOME VARIABLE

The main outcome variable was health literacy assessed using the BRIEF questionnaire. During intake, subjects completed the BRIEF questionnaire consisting of four questions scored on an ordinal scale of 1-5. Inadequate health literacy was defined as a BRIEF score ≤16.

COVARIATES

Not applicable.

ANALYSES

Bivariate and multivariate analyses were performed. P < .05 was considered statistically significant.

RESULTS

Of 150 patients presenting for orthognathic surgery, fifteen percent of patients had inadequate health literacy via the BRIEF test. The mean age of those with adequate health literacy was 27.9 years (standard deviation, ±12.5) compared to 18.5 years (standard deviation, ±5.7) for those with inadequate health literacy (P = <.001). After adjusting for sex, language, race, estimated household income, and diagnosis via multivariate analysis, increasing age was associated with decreased odds of inadequate health literacy (adjusted odds ratio = 0.81; confidence interval, 0.72-0.92; P = <.001).

CONCLUSION AND RELEVANCE

In the complex process of orthognathic surgery, it is essential to identify patients with inadequate health literacy that may require additional health literacy interventions. Ultimately, 15% of orthognathic surgery subjects had inadequate health literacy, and younger patients were the most susceptible as the odds of inadequate health literacy decreased with increasing age.

Health Literacy in Oculofacial Plastic Surgery: A Literature Review

Patient satisfaction following oculofacial cosmetic procedures depends on preoperative expectations, which may be influenced by online material. Patients with poor health literacy are particularly vulnerable to misinformation and low-quality resources. However, few studies have evaluated the quality of online information on common oculofacial plastic surgeries and procedures. This study aimed to review the literature on the readability and quality of online material related to oculofacial plastic surgery. We conducted a systematic search of the PubMed/MEDLINE database and included 10 studies in our review. Among the readability scores reported in these studies, the lowest was 10, representing a tenth-grade reading level. Furthermore, the online materials were often rated as "poor" quality based on multiple grading scales. Our systematic review of the literature demonstrates that online materials covering common oculofacial plastic surgery procedures are consistently of poor quality and exceed the recommended readability level. Therefore, considering these online materials that influence patient expectations could enable oculofacial plastic surgeons to better tailor their preoperative counseling.

Rhytidectomy-Information Patients Seek and Where They Find Answers

Patients considering rhytidectomy often search for information online prior to in-office consultation. This study identifies the most searched queries regarding rhytidectomy and evaluates sources to which patients are directed. The search engine optimization tool Ahrefs was utilized to extract Google metadata on searches performed in the United States. Frequently asked questions were categorized by topic; websites were categorized by type. Journal of the American Medical Association (JAMA) benchmark criteria enabled information quality assessment. A total of 565 questions for three search phrases were extracted (265 "facelift," 265 "face lift," and 35 "rhytidectomy"). The majority of monthly searches in the facelift and face lift groups pertained to procedural cost, which was significantly higher than in the rhytidectomy group (52.9% and 50.7 vs. 0.0%, ANOVA p <0.001). The mean JAMA score for private practice sources (1.2 ± 0.42) was significantly lower than that of academic pages of (2.3 ± 1.9, p = 0.026) and commercial sources (3.0 ± 0.82, p = 0.008). The most popular destinations for rhytidectomy were California and Mexico (630 and 440 searches/month). Online searches for facelifts often revolve around the topic of cost and frequently direct patients to websites that provide inadequate information on authorship, attribution, disclosure, and currency.

Infodemiology for oral health and disease: A scoping review

INTRODUCTION

Increasing affordability, accessibility and penetration of internet services worldwide, have substantially changed the ways of gathering health-related information. This has led to the origin of concept infodemiology that allows the information to be collected and analysed in near real time. Globally, oral diseases affect nearly 3.5 billion people; thus, volume and profile of oral health searches would help in understanding specific community dental needs and formulation of pertinent oral health strategies.

AIM

To review the published literature on infodemiological aspects of oral health and disease.

METHODOLOGY

This scoping review was conducted in accordance with PRISMA-ScR guidelines. Electronic search engines (Google Scholar) and databases (PubMed, Web of science, Scopus) were searched from 2002 onwards.

RESULTS

Thirty-eight articles were included in this review. The infodemiological studies for oral health and disease were mainly used in two domains. Out of 38 articles, 24 accessed the quality of available online information and 15 studied online oral health-related information seeking behaviour.

CONCLUSION

The most commonly searched oral diseases were toothache, oral cancer, dental caries, periodontal disease, oral maxillofacial surgical procedures and paediatric oral diseases. Most of the studies belonged to developed countries and Google was the most researched search engine.

Health Literacy in Plastic Surgery: A Scoping Review

Health literacy of plastic surgery patients may affect surgical decision-making and perioperative outcomes. In addition to consulting a plastic surgeon, patients often refer to online-based resources to learn about surgical options. The aim of this scoping review was to identify evidence detailing the state of health literacy of plastic surgery patients and available resources to highlight areas of improvement for clinical practice and future research.

A Multimetric Readability Analysis of Online Patient Educational Materials for Submental Fat Reduction

Background

Patients often utilize the Internet to seek information related to their care. This study assesses the readability of online patient educational materials for submental fat reduction.

Methods

Patient educational materials from the 12 most popular websites related to submental fat reduction were downloaded and assessed for readability grade level using 10 unique scales.

Results

Analysis of the 12 most popular websites (and corresponding 47 articles) revealed that patient educational materials were written, on average, at an 11th grade reading level. The Flesch Reading Ease score was 48.9 (range 39.8–59.2), representing a “difficult” level of reading. Mean readability grade levels (range 9–13th grade for individual websites) were as follows: Coleman-Liau, 11.1; Flesch-Kincaid, 10.8; FORCAST, 10.8; Fry Graph, 10.1; Gunning Fog, 12.7; New Dale-Chall, 10.1; New Fog Count, 11.8; Simple Measure of Gobbledygook, 11.7; Raygor, 6.7. No website was at the 6th grade reading level for patient educational materials recommended by the American Medical Association and National Institutes of Health.

Conclusions

Online patient educational materials for submental fat reduction are written well above the recommended reading level. Recognition of disparities in health literacy is necessary to enable patients to make informed decisions and become active participants in their own care.

Level of Evidence V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors  www.springer.com/00266

Do Websites Serve Our Patients Well? A Comparative Analysis of Online Information on Cosmetic Injectables

BACKGROUND

Patients access online cosmetic health information to help with decision making. This information is unregulated, variable in quality, and may be biased. This study compared the most popular cosmetic injectables websites to assess their readability, quality, and technical performance.

METHODS

A Google search for "Botox" (botulinum toxin type A) and "fillers" was performed in July of 2020, identifying the most popular health information websites. Sites were analyzed for their readability and quality of health information using the validated DISCERN criteria and the Health on the Net Foundation Code of Conduct principles. Technical qualities were evaluated using two website performance algorithms, WooRank and WebsiteGrader.

RESULTS

Eighty-five websites were analyzed (13 academic/hospital websites, seven commercial websites, 25 private practice board-certified websites, seven private practice not-board-certified websites, 16 online health reference websites, and 17 other websites). The mean readability consensus score was 11 (eleventh grade reading level). The mean DISCERN quality scores were higher for online health reference websites compared to academic/hospital websites (p = 0.045), commercial websites (p = 0.045), private practice board-certified websites (p < 0.001), and private practice not-board-certified websites (p = .002). No correlation between a website's rank and its DISCERN score was found (ρ = -0.07; p = 0.49).

CONCLUSIONS

Cosmetic injectable websites are too difficult to read by the sixth grade standard recommended by the National Institutes of Health and the American Medical Association. Online health reference sites are higher in quality than physician sites. This has implications for the ability of many patients to be fully informed consumers. The readability, quality, and technical aspects of websites may affect the overall accessibility of patient health information.

Which Resources Are Better: Sales or Scholarly? An Assessment on the Readability, Quality, and Technical Features of Online Chemical Peel Websites

BACKGROUND

Chemical peels are an exceedingly popular cosmetic treatment with a wide variety of suppliers, each with its own online health resource describing the procedure. With increasing reliance on the internet for medical information, it is crucial that these resources provide reliable information for patients to make informed decisions.

OBJECTIVES

The aim of this study was to examine popular chemical peel resources and determine if those that offered chemical peel treatments (Sales) had lower readability, quality of information, and technical features compared with those that did not (Scholarly).

METHODS

The term "chemical peel" was searched in July 2020 and the top 50 websites were retrieved for analysis. Each resource's readability, quality, and technical features were measured through 8 readability formulas, the DISCERN and Health on the Net Code (HONcode), and 2 website performance monitors.

RESULTS

The 50 websites were analyzed with an average Fry readability score of 13th grade. Scholarly websites displayed higher readability than Sales (Flesch Reading Ease 54.4 > 47.4, P = 0.047 and Coleman-Liau Index 10.6 < 11.7, P = 0.04). Scholarly resources surpassed Sales both in quality (DISCERN 56.4 > 39.7, P < 0.001 and HONcode 11.8 > 9.5, P = 0.032) and technical features (WooRank 76.9 > 68.6, P = 0.0082).

CONCLUSIONS

The average readability of chemical peel resources is too difficult, and their quality must be improved. Scholarly resources exhibited higher readability, quality, and technical features than Sales websites.

Comprehensive Assessment of Vascularized Composite Allotransplantation Patient-Oriented Online Resources

INTRODUCTION

Online resources have become a major source of medical information for the general public. To date, there has not been an assessment of patient-oriented online resources for face and upper extremity transplantation candidates and patients. The goal of this study is to perform a comprehensive assessment of these resources.

METHODS

Our analysis relied on 2 dimensions: comprehensiveness and readability. Comprehensiveness was evaluated using 14 predetermined variables. Readability was evaluated using 8 different readability scales through the Readability Studio Professional Edition Software (Oleander Software, Ltd, Vandalia, Ohio). Data were also collected from solid organ transplantation (SOT), specifically kidney and liver, programs for comparison.

RESULTS

Face and upper extremity transplantation programs were significantly more likely to list exclusion criteria (73.9% vs 41.2%; P = 0.02), the need for life-long immunosuppression (87.0% vs 58.8%; P = 0.02), and benefits of transplantation (91.3% vs 61.8%; P = 0.01) compared with SOT programs. The average readability level of online resources by all face and upper extremity transplantation programs exceeded the sixth grade reading level recommended by the National Institutes of Health and the American Medical Association. The average reading grade level of online resources by these programs was also significantly higher than those of SOT with both exceeding the recommended reading level (13.95 ± 1.55 vs 12.60 ± 1.65; P = 0.003).

CONCLUSIONS

Future efforts in face and upper extremity transplantation should be directed toward developing standardized, comprehensive, and intelligible resources with high-quality content and simple language.

Evaluation of the Quality of Printed Online Education Materials in Cosmetic Facial Plastic Surgery

Importance: In the modern-day health care environment, it is expected that a large proportion of patients will utilize the Internet to gather health care-related information. However, online sources are often not subjected to adequate quality control measures. Objective: To evaluate the quality of printed online education materials (POEMs) pertaining to elective facial cosmetic surgery. Design, Setting, and Participants: This is a descriptive correlational study. Independent Internet searches for the terms "rhinoplasty," "rhytidectomy," "blepharoplasty," and "browlift" were carried out using the Google search engine. The top 20 web resources for each term were analyzed. Main Outcomes and Measures: All web resources were analyzed for HONcode certification. The DISCERN instrument was then used to determine reliability and specificity of information, whereas readability was assessed using the Flesch Reading Ease (FRE) score and the Flesch-Kincaid Grade Level (FKGL). Results: Of the resulting 80 web resources, 30% (n = 24) were HONcode certified. None of the surgical society web resources (n = 12) were HONcode certified, and only 42% (n = 8) of web resources associated with academic institutions were HONcode certified. Out of a maximum DISCERN score of 80, the mean (standard deviation [SD]) scores were 48 (11) for rhinoplasty, 50 (11) for rhytidectomy, 47 (11) for blepharoplasty, and 45 (10) for browlift. The mean DISCERN scores of the HONcode-certified web resources did not differ significantly from scores of uncertified web resources (p = 0.069). There was no significant difference in overall mean DISCERN scores for the different web resource categories. The mean (SD) FRE score was 45.7 (11.9), whereas the mean FKGL score was 10.7 (1.9). HONcode-certified web resources had significantly higher FRE scores (p = 0.028) and significantly lower FKGL scores (p = 0.0003). Conclusions and Relevance: A significant proportion of POEMs regarding elective cosmetic facial plastic surgery remains uncertified and of inadequate quality. This can negatively impact the informed decision-making process and increase the risk of poor outcomes and lower satisfaction rates.