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Armache M, Assi S, Wu R, Jain A, Lu J, Gordon L, Jacobs LM, Fundakowski CE, Rising KL, Leader AE, Fakhry C, Mady LJ. Readability of Patient Education Materials in Head and Neck Cancer: A Systematic Review. JAMA Otolaryngol Head Neck Surg 2024; 150:713-724. [PMID: 38900443 DOI: 10.1001/jamaoto.2024.1569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
Importance Patient education materials (PEMs) can promote patient engagement, satisfaction, and treatment adherence. The American Medical Association recommends that PEMs be developed for a sixth-grade or lower reading level. Health literacy (HL) refers to an individual's ability to seek, understand, and use health information to make appropriate decisions regarding their health. Patients with suboptimal HL may not be able to understand or act on health information and are at risk for adverse health outcomes. Objective To assess the readability of PEMs on head and neck cancer (HNC) and to evaluate HL among patients with HNC. Evidence Review A systematic review of the literature was performed by searching Cochrane, PubMed, and Scopus for peer-reviewed studies published from 1995 to 2024 using the keywords head and neck cancer, readability, health literacy, and related synonyms. Full-text studies in English that evaluated readability and/or HL measures were included. Readability assessments included the Flesch-Kincaid Grade Level (FKGL grade, 0-20, with higher grades indicating greater reading difficulty) and Flesch Reading Ease (FRE score, 1-100, with higher scores indicating easier readability), among others. Reviews, conference materials, opinion letters, and guidelines were excluded. Study quality was assessed using the Appraisal Tool for Cross-Sectional Studies. Findings Of the 3235 studies identified, 17 studies assessing the readability of 1124 HNC PEMs produced by professional societies, hospitals, and others were included. The mean FKGL grade ranged from 8.8 to 14.8; none of the studies reported a mean FKGL of grade 6 or lower. Eight studies assessed HL and found inadequate HL prevalence ranging from 11.9% to 47.0%. Conclusions and Relevance These findings indicate that more than one-third of patients with HNC demonstrate inadequate HL, yet none of the PEMs assessed were developed for a sixth grade or lower reading level, as recommended by the American Medical Association. This incongruence highlights the need to address the readability of HNC PEMs to improve patient understanding of the disease and to mitigate potential barriers to shared decision-making for patients with HNC. It is crucial to acknowledge the responsibility of health care professionals to produce and promote more effective PEMs to dismantle the potentially preventable literacy barriers.
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Affiliation(s)
- Maria Armache
- Department of Otolaryngology-Head & Neck Surgery, The Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Sahar Assi
- Cochlear Center for Hearing and Public Health, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Richard Wu
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
| | - Amiti Jain
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Joseph Lu
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Larissa Gordon
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Lisa M Jacobs
- Mixed Methods Research Lab, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Christopher E Fundakowski
- Department of Otolaryngology-Head and Neck Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Kristin L Rising
- Jefferson Center for Connected Care, Thomas Jefferson University, Philadelphia, Pennsylvania
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Amy E Leader
- Department of Population Health, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
- Department of Medical Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Carole Fakhry
- Department of Otolaryngology-Head & Neck Surgery, The Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Leila J Mady
- Department of Otolaryngology-Head & Neck Surgery, The Johns Hopkins School of Medicine, Baltimore, Maryland
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Williams N, Griffin G, Wall M, Watson S, Warland J, Bradfield Z. Patient evaluation of gynaecological information provision and preferences. J Adv Nurs 2024; 80:1188-1200. [PMID: 37731325 DOI: 10.1111/jan.15866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/03/2023] [Accepted: 08/30/2023] [Indexed: 09/22/2023]
Abstract
AIM To evaluate gynaecological patients' preferences and satisfaction regarding information provision, exploring enablers and barriers to information access. DESIGN A descriptive cross-sectional survey design was used. METHODS A total of 293 women accessing gynaecological services responded to the survey. Quantitative analysis included descriptive and inferential statistics. Content analysis was conducted on qualitative data. RESULTS Health professionals were the most common and preferred sources of gynaecological health information. Enablers to information provision included positive communication strategies by health professionals, participants having prior knowledge and doing their own research. Despite its widespread availability, only 24.2% of women preferred the internet as an information source. Poor communication and inadequate information provision were identified as barriers to information access. Statistically significant associations were identified between location of residence, education level, year of birth, diagnostic group and health information preferences. Recommendations from women included improved communication strategies, system changes and provision of individualized information. CONCLUSION Health professionals are central to women accessing information about gynaecological diagnoses. Areas for improvement include communication strategies, facilitating access to internet-based resources for information and consideration of women's preferences when providing health information. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE Consumer co-design of gynaecological health information and communication training for health professionals is recommended. Improved communication and facilitated use of internet-based resources may improve women's understanding of information. IMPACT This study explored gynaecological patients' preferences and satisfaction regarding information provision, exploring enablers and barriers to information access. It was found that gynaecological patients preferred individualized information provided to them directly by health professionals and despite its widespread availability, the internet is an underutilized health information resource. These findings are applicable to health professionals and patients utilizing tertiary gynaecological health services in Australia but may be generalized if demographic data aligns with other jurisdictions. REPORTING METHOD The STROBE reporting method was used in the preparation of the manuscript. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Natalie Williams
- Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, Subiaco, Australia
| | - Georgia Griffin
- Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, Subiaco, Australia
| | - Megan Wall
- Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, Subiaco, Australia
| | - Stuart Watson
- Women's Health, Genetics & Mental Health, King Edward Memorial Hospital, Subiaco, Australia
| | - Jane Warland
- Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, Subiaco, Australia
- School of Nursing, Curtin University, Bentley, Australia
| | - Zoe Bradfield
- Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, Subiaco, Australia
- School of Nursing, Curtin University, Bentley, Australia
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Skrzypczak T, Skrzypczak A, Szepietowski JC. Readability of Patient Electronic Materials for Atopic Dermatitis in 23 Languages: Analysis and Implications for Dermatologists. Dermatol Ther (Heidelb) 2024; 14:671-684. [PMID: 38402338 PMCID: PMC10965833 DOI: 10.1007/s13555-024-01115-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 02/08/2024] [Indexed: 02/26/2024] Open
Abstract
INTRODUCTION Patients search on the Internet for information about various medical procedures and conditions. The main aim of this study was to evaluate the readability of online health information related to atopic dermatitis (AD). Online resources are becoming a standard in facilitating shared decision-making processes. With a pipeline of new therapeutic options like immunomodulators, understanding of the complexity of AD by the patients is crucial. METHODS The term "atopic dermatitis" translated into 23 official European Union languages was searched using the Google search engine. The first 50 records in each language were evaluated for suitability. Included materials were barrier-free, focused on patient education, and were not categorized as advertisements. Article sources were classified into four categories: non-profit, online shops, pharmaceutical companies, and dermatology clinic. Readability was assessed with Lix score. RESULTS A total of 615 articles in Swedish, Spanish, Slovenian, Slovak, Romanian, Portuguese, Polish, Lithuanian, Latvian, Irish, Italian, Hungarian, Greek, German, French, Finnish, Estonian, English, Dutch, Danish, Czech, Croatian, and Bulgarian were evaluated. The overall mean Lix score was 56 ± 8, which classified articles as very hard to comprehend. Significant differences in mean Lix scores were observed across all included languages (all P < 0.001). Articles released by non-profit organizations and pharmaceutical companies had the highest readability (P < 0.001). Low readability level was correlated with high article prevalence (R2 = 0.189, P = 0.031). CONCLUSIONS Although there was an abundance of online articles related to AD, the readability of the available information was low. As online health information has become essential in making shared decisions between patients and physicians, an improvement in AD-related materials is needed.
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Affiliation(s)
- Tomasz Skrzypczak
- University Hospital in Wroclaw, Borowska 213, 50-556, Wroclaw, Poland
| | - Anna Skrzypczak
- Faculty of Dentistry, Wroclaw Medical University, Krakowska 26, 50-425, Wroclaw, Poland
| | - Jacek C Szepietowski
- Chair of the Department of Dermatology, Venerology and Allergology, Wroclaw Medical University, Chalubinskiego 1, 50-368, Wroclaw, Poland.
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Haffar A, Hirsch A, Morrill C, Garcia A, Werner Z, Gearhart JP, Crigger C. Clear as Mud: Readability Scores in Cloacal Exstrophy Literature and Its Treatment. Res Rep Urol 2024; 16:39-44. [PMID: 38370509 PMCID: PMC10871133 DOI: 10.2147/rru.s430744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 01/05/2024] [Indexed: 02/20/2024] Open
Abstract
Purpose This study examines the readability of online medical information regarding cloacal exstrophy (CE). We hypothesize that inappropriate levels of comprehension are required in these resources, leading to poor understanding and confusion amongst caregivers. Methods The Google and Bing search engines were used to search the terms "cloacal exstrophy" and "cloacal exstrophy treatment". The first 100 results for each were collected. Each webpage was analyzed for readability using four independent validated scoring systems: the Gunning-Fog index (GFI), SMOG grade (Simple Measure of Gobbledygook), Dale-Chall index (DCI), and the Flesch-Kincaid grade (FKG). Results Forty-seven unique webpages fit the inclusion criteria. Mean readability scores across all websites were GFI, 14.6; SMOG score, 10.8; DCI, 9.3; and FKG, 11.8, correlating to adjusted grade levels of college sophomore, 11th grade, college, and 11th grade, respectively. There were significant differences across all readability formulas. Non-profit websites were significantly less readable than institutional and commercial webpages (GFI p = 0.012, SMOG p = 0.018, DCI p = 0.021, FKG p = 0.0093). Conclusion Caregiver-directed health information regarding CE and its treatment available online is written at the 11th grade reading level or above. Online resources pertaining to CE must be simplified to be effective.
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Affiliation(s)
- Ahmad Haffar
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children’s Hospital, Baltimore, MD, USA
| | - Alexander Hirsch
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children’s Hospital, Baltimore, MD, USA
| | - Christian Morrill
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children’s Hospital, Baltimore, MD, USA
| | - Adelaide Garcia
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children’s Hospital, Baltimore, MD, USA
| | - Zachary Werner
- West Virginia University School of Medicine, Department of Urology, Division of Pediatric Urology, Morgantown, WV, USA
| | - John P Gearhart
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children’s Hospital, Baltimore, MD, USA
| | - Chad Crigger
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children’s Hospital, Baltimore, MD, USA
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Kinghorn M, Garvey G, Butler TL. Gynaecological cancer resources for Aboriginal and Torres Strait Islander women: A resource audit. Health Promot J Austr 2023. [PMID: 37883991 DOI: 10.1002/hpja.822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/04/2023] [Accepted: 10/13/2023] [Indexed: 10/28/2023] Open
Abstract
ISSUE ADDRESSED Aboriginal and Torres Strait Islander women experience considerable disparities in gynaecological cancer outcomes. Accessible and culturally appropriate health promotion resources about gynaecological cancers may support health literacy in this area. This study aimed to determine the understandability, actionability, readability, and cultural relevance of gynaecological cancer health literacy resources for Aboriginal and Torres Strait Islander consumers, families, and caregivers. METHODS We conducted a general Google search and targeted searches of Australian gynaecological cancer organisation websites in January and February 2022. Resources were assessed for understandability, actionability and cultural relevance to Aboriginal and Torres Strait Islander audiences. RESULTS We found 16 resources. The resources were generally understandable, actionable, readable, and culturally relevant, however, most resources were focused on cervical cancer prevention through vaccination and screening. Few resources focused other gynaecological cancer types or aspects of the cancer care continuum. While many resources contained elements that made them culturally relevant, areas for improvement were identified. These included: greater transparency relating to the Aboriginal and Torres Strait Islander leadership, governance, and involvement in the development of the resources as well as availability of different resource formats with an emphasis on visual aids. CONCLUSIONS This study highlighted a need for the development of resources relating to a wider range of gynaecological cancer types and different stages of the cancer care continuum for Aboriginal and Torres Strait Islander women. SO WHAT?: The development of a broader range of culturally appropriate gynaecological cancer health literacy resources, ideally developed through co-design with Aboriginal and Torres Strait Islander peoples, may contribute to addressing the disparities in gynaecological cancer outcomes for Aboriginal and Torres Strait Islander women.
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Affiliation(s)
- Mina Kinghorn
- Faculty of Medicine, The University of Queensland, School of Public Health, Herston, Queensland, Australia
| | - Gail Garvey
- Faculty of Medicine, The University of Queensland, School of Public Health, Herston, Queensland, Australia
| | - Tamara L Butler
- Faculty of Medicine, The University of Queensland, School of Public Health, Herston, Queensland, Australia
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van Ballegooie C, Wen J. Assessment of online patient education material for eye cancers: A cross-sectional study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001967. [PMID: 37844025 PMCID: PMC10578596 DOI: 10.1371/journal.pgph.0001967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/31/2023] [Indexed: 10/18/2023]
Abstract
The objective of this study was to assess online American patient education material (PEM) related to eye cancers in order to determine the quality of the content and appropriateness of the contents' reading level as it relates to the American population. PEMs were extracted from fifteen American cancer and ophthalmology associations and evaluated for their reading level using ten validated readability scales. PEMs then had all words extracted and evaluated for their difficulty and familiarity. The quality of the PEMS were assessed according to DISCERN, Heath On the Net Foundation Code of Conduct (HONCode), and JAMA benchmarks. Overall, online PEMs from the associations were written at a 11th grade reading level, which is above the recommended 6th grade reading level. The difficult word analysis identified that 26% of words were unfamiliar. Only one of the fifteen association held a HONCode certification while no organization met the standards of all four JAMA benchmarks. The average score for DISCERN was 2.4 out of a total of 5 for the fifteen questions related to treatment option information quality. Consideration should be made to create PEMs at an appropriate grade reading level to encourage health literacy and ultimately promote health outcomes. Associations should also focus on incorporating easily identifiable quality indicators to allow patients to better identify reputable resources.
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Affiliation(s)
- Courtney van Ballegooie
- Experimental Therapeutics, BC Cancer, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Chemistry, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Jasmine Wen
- Department of Science, University of Western Ontario, Western University, London, Ontario, Canada
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Avila S, Ruiz MJ, Petereit D, Arya R, Callender B, Hasan Y, Kim J, Lee N, McCall A, Son C, Stack K, Asif S, Besecker T, Juneja A, Li Z, Naik P, Ranka T, Saxena P, Siegfried B, Ichikawa T, Golden DW. Communicating the Gynecologic Brachytherapy Experience (CoGBE): Clinician perceived benefits of a graphic narrative discussion guide. Brachytherapy 2023; 22:352-360. [PMID: 36681540 PMCID: PMC10175118 DOI: 10.1016/j.brachy.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 12/05/2022] [Accepted: 12/09/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE Many current radiotherapy patient education materials are not patient-centered. An interprofessional team developed Communicating the Gynecologic Brachytherapy Experience (CoGBE), a graphic narrative discussion guide for cylinder, intracavitary, and interstitial high-dose-rate (HDR) gynecologic brachytherapy. This study assesses perceived clinical benefits, usability, and anxiety-reduction of CoGBE. METHODS AND MATERIALS An electronic survey was sent to members of the American Brachytherapy Society. Participants were assigned to assess one of the three modality-specific CoGBE versions using a modified Systems Usability Scale (SUS), modified state-trait anxiety index (mSTAI), and Likert-type questions. Free response data was analyzed using modified grounded theory. RESULTS Median modified SUS score was 76.3 (interquartile range [IQR], 71.3-82.5) and there were no significant differences between guide types. Median mSTAI was 40 (IQR, 40-43.3) for all guides collectively. The cylinder guide had a significantly higher median mSTAI than the intracavitary and interstitial guides (41.6 vs. 40.0 and 40.0; p = 0.04) suggesting the cylinder guide may have less impact on reducing anxiety. Most respondents reported that CoGBE was helpful (72%), would improve patient understanding (77%) and consultation memorability (82%), and was at least moderately likely to be incorporated into their practice (80%). Qualitative analysis themes included personalization and relatability (positive); generalizability (negative); illustrations (both). CONCLUSIONS Clinicians rate CoGBE as usable with potential to reduce patient anxiety, especially with more invasive treatment modalities including intracavitary or interstitial high-dose-rate. CoGBE has the potential to improve patient-clinician communication for a wider range of patients due to its accessible, adaptable, and patient-centered design.
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Affiliation(s)
- Santiago Avila
- Pritzker School of Medicine, The University of Chicago, Chicago, IL
| | - María J Ruiz
- Pritzker School of Medicine, The University of Chicago, Chicago, IL
| | | | - Ritu Arya
- Texas Oncology Arlington Cancer Center North, Arlington, TX
| | - Brian Callender
- Department of Medicine, The University of Chicago, Chicago, IL
| | - Yasmin Hasan
- Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL
| | - Josephine Kim
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, IL
| | - Nita Lee
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, IL
| | - Anne McCall
- Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL
| | - Christina Son
- Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL
| | - Kate Stack
- Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL
| | - Sabah Asif
- Institute of Design, Illinois Institute of Technology, Chicago, IL
| | - Tyler Besecker
- Institute of Design, Illinois Institute of Technology, Chicago, IL
| | - Arushi Juneja
- Institute of Design, Illinois Institute of Technology, Chicago, IL
| | - Zhongyang Li
- Institute of Design, Illinois Institute of Technology, Chicago, IL
| | - Pinakee Naik
- Institute of Design, Illinois Institute of Technology, Chicago, IL
| | - Tanvi Ranka
- Institute of Design, Illinois Institute of Technology, Chicago, IL
| | - Prachi Saxena
- Institute of Design, Illinois Institute of Technology, Chicago, IL
| | - Brian Siegfried
- Institute of Design, Illinois Institute of Technology, Chicago, IL
| | - Tomoko Ichikawa
- Institute of Design, Illinois Institute of Technology, Chicago, IL
| | - Daniel W Golden
- Pritzker School of Medicine, The University of Chicago, Chicago, IL; Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL.
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Jain M, Chkipov P, Stacey D, Posner G, Bacal V, Chen I. Online patient information for hysterectomies: a systematic environmental scan of quality and readability. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:870-876. [PMID: 35487458 DOI: 10.1016/j.jogc.2022.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/20/2022] [Accepted: 03/21/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Hysterectomy is a common gynaecological procedure, and therefore online information is highly valuable to patients. Our objective was to evaluate the quality, readability, and comprehensiveness of online patient information on hysterectomy. METHODS The first 25 patient-directed websites on hysterectomy, identified using 5 online search engines (Google, Yahoo, AOL, Bing, Ask.com) as well as clinical professional societies, were assessed using validated tools for quality (DISCERN, JAMA benchmark), readability (Flesch-Kincaid Grade Level [FKGL], Gunning Fog, Simple Measure of Gobbledygook [SMOG], Flesch Reading Ease Score [FRES]), and completeness of information. RESULTS We identified 50 websites for inclusion. Overall, websites were of good quality (median DISCERN score 53/80 [interquartile range {IQR} 47-61]; median JAMA score 3/4 [IQR 1-4]). Most websites described surgical risks (39, 78%), benefits (45, 90%), and types of hysterectomy(48, 96%). Content readability corresponded to Grade 11 using FKGL (median 11.1 [IQR 10.2-13.0]) and SMOG (median 10.9 [IQR 10.2-12.4]), or 15 years education using Gunning Fog (median 14.7 [IQR 13.8-16.4]). Websites were assessed as difficult to read using FRES (median 45.6/100 [IQR 37.9-50.9]). No differences were observed in readability scores when we compared websites from clinical professional societies, government, health care, or academic organizations with other websites (P > 0.05). CONCLUSION Online patient information on hysterectomy is of good quality and comprehensive. However, the content is above the American Medical Association's recommended grade 6 reading level. Website authors should consider readability to make their content more accessible to patients.
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Affiliation(s)
- Mehr Jain
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON, Canada.
| | - Philip Chkipov
- Faculty of Medicine, McMaster University, Hamilton, ON, Canada
| | - Dawn Stacey
- Ottawa Hospital Research Institute, Ottawa, ON, Canada; School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | - Glenn Posner
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON, Canada; Department of Innovation in Medical Education, University of Ottawa, Ottawa, ON, Canada
| | - Vanessa Bacal
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada
| | - Innie Chen
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada
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