C. R. Vargas1, P. Koolen1, D. J. Chuang1, B. T. Lee1 1Beth Israel Deaconess Medical Center,Surgery / Plastic And Reconstructive Surgery,Boston, MA, USA
Introduction:
Limited health literacy affects nearly half of American adults and has been shown to adversely affect patient participation, satisfaction, healthcare costs, and overall outcomes. As unprecedented numbers of patients search the internet for health information, the accessibility of online material is more important than ever before. The aim of this study was to evaluate available breast reconstruction resources on the internet with regard to reading grade level, degree of complexity, and suitability for the intended patient audience using three validated tools.
Methods:
The ten most popular patient websites for "breast reconstruction" were identified using the largest internet search engine. The content of each site was assessed for readability using the Simple Measure of Gobbledygook (SMOG) analysis, complexity using the PMOSE/iKIRSCH formula, and suitability using the Suitability Assessment of Materials (SAM) instrument. Resulting scores were analyzed both overall and by website.
Results:
Readability analysis revealed an overall average grade level of 13.4, with a range from 10.7 (MedlinePlus) to 15.8 (Wikipedia). All sites exceeded the recommended 6th grade reading level. Complexity evaluation revealed a mean PMOSE/iKIRSCH score of 6.2, consistent with "Low" complexity and equivalent to a high school level. Websites ranged from "Very Low" complexity (BreastReconstruction.org, WebMD, National Cancer Institute, MedicineNet.com) to "High" complexity (Wikipedia). Suitability assessment overall produced a mean 39.7% score, interpreted as "Not Suitable" for the intended patient audience. Four sites (American Society of Plastic Surgeons, American Cancer Society, MedlinePlus, and National Cancer Institute) were found to have "Adequate" suitability scores when examined individually; the remaining six were "Not suitable".
Conclusion:
Available online patient material for breast reconstruction is too difficult for many patients to read. Although overall table and list complexity of the websites is acceptable for average Americans, the content, literacy demand, and format is largely unsuitable for the intended patient audiences. Attention to specific measures shown to improve readability and suitability is needed in designing appropriate material and minimizing disparities related to limited patient health literacy.