The Northeastern Society of Plastic Surgeons

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An evaluation of the readability, quality, and accuracy of health information online regarding the treatment of hypospadias
Theodore Cisu, BS1, Gerald Mingin, MD1, Laurence Baskin, MD2.
1University of Vermont College of Medicine, Burlington, VT, USA, 2University of California, San Francisco, San Francisco, CA, USA.

BACKGROUND:
Hypospadias is one of the most common congenital anomalies, thought to occur in 1 in 150 live male births. Treatment of hypospadias requires surgical repair, usually in childhood. Patients are increasingly using the internet to learn more about their health or that of their children, which can often empower patients to make well-informed healthcare decisions. The average American adult reads at an eighth-grade level, and organizations including the NIH and AMA recommend health information be written at a sixth-grade reading level. This study seeks to evaluate not only the readability, but also the quality and accuracy, of available online health information for the treatment of hypospadias.
METHODS:
The search terms "hypospadias treatment" and "treatment of hypospadias" were queried on three search engines (Google, Bing, Yahoo), from which the top 50 websites on each were analyzed. Paid advertisements, duplicated websites, research and news articles, and sub-pages of similar parent websites were excluded. Each website was classified into one of four categories: institutional, commercial, charitable organization, or personal website (Table 1). The first 30 sentences on each website discussing treatment options were analyzed for readability using the Gunning-Fog scale, SMOG index, and Dale-Chall score, a triad of readability formulas that serve as a proxy for approximating the reading level required to comprehend material. A validated tool, the DISCERN checklist, was used to measure quality of online health information regarding hypospadias treatment. Each 30-sentence block was assessed for accuracy independently by two pediatric urologists on a 1-5 scale, where 1 and 5 correspond with 0% and 100% of the information in the text is accurate, respectively. Each website was also cross-referenced with the Health on the Net (HoN) Foundation for certification of content validity.
RESULTS:
After exclusion criteria were applied, 46 of the 150 search engine results were analyzed for readability, quality, and accuracy. Of these, 11 (23.9%) websites had their content validated by the Health on the Net Foundation, and 5 (6.5%) websites received 100% accuracy ratings. Institutional and charitable websites had the highest mean accuracy scores (3.85 and 3.67, respectively), with institutional websites proving to have significantly more accurate information regarding hypospadias treatment than commercial websites (3.85 and 3.21, respectively; p=0.021). The mean readability scores across all websites were 14.89 (Gunning-Fog), 11.01 (SMOG), and 8.44 (Dale-Chall), which correspond to an 11th-12th grade reading level. Readability and quality scores were not statistically different between website categories (Table 1).
CONCLUSIONS:
Institutional websites tended to contain more accurate information than commercial "dotcom" websites, and only a minority of websites contained 100% accuracy ratings. Regardless of website category, quality of health information was adequate, albeit not superior, across all domains. Interestingly, this study definitively indicates that most of the online health information for hypospadias treatment is written at an 11th-12th grade level across three independent readability parameters, significantly higher than the 8th grade reading level of most Americans.


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