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Readability assessment of online patient health material specific to voiding dysfunction
Juhi Mohile, Undergraduate Student (BS)1, Gunjan Agrawal, MBBS, MPH2, Neha R. Malhotra, MD3, Kathleen M. Kan, MD4.
1University of California, Irvine, Irvine, CA, USA, 2Stanford University, Palo Alto, CA, USA, 3Mount Sinai Health System, New York City, CA, USA, 4Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, USA.

BACKGROUND: Bedwetting (nocturnal enuresis) is a common childhood disease affecting up to 15% of young children in the United States. Oftentimes, families may turn to free online resources for health education and treatment options. We aim to determine the readability and quality of online health information related to the treatment of voiding dysfunction. We hypothesize that the readability level of currently available online health information is higher than the National Institute of Health (NIH) recommended standard of 6th grade reading level.
METHODS: The search terms "Bedwetting" and "Wetting the Bed" were queried in search engines Google, Bing, and Yahoo. The first 30 results from each search engine were captured for each search term. Exclusion criteria consisted of articles that were irrelevant, storefront-based, duplicates, and those without treatment options. Each article was further categorized as an institutional, commercial, charitable organization, or personal website. Three focused readability tools- Gunning Fog (GF), Simple Measure of Gobbledygook (SMOG), and Flesch-Kincaid (FK)- were used to calculate readability scores. An overall readability consensus was also calculated, which corresponded to the grade reading level. Quality was assessed by two independent pediatric urologists using a validated DISCERN instrument. Outdated treatment strategies were noted. All analysis was conducted on R studio (v2022.02.1).
RESULTS: Of the 180 websites, the 53 websites that qualified were reviewed for readability and DISCERN scores. 56.6% of the articles were categorized as institutional articles, 9.4% as commercial, 20.8% as charitable, and 13.2% as personal. Overall mean readability score was 9.3 (2.1) with GF = 11.6 (2.5), SMOG = 8.7 (1.8), and FK = 9.2 (2.2). The individual scores correspond to an adjusted grade level of 11th-12th, 10th-11th, and 9th grade, respectively. There was no statistically significant difference in readability scores (p > 0.05) across website categories. 18 articles were considered to be of "good quality," 26 of "fair quality," and nine of "poor quality" according to the DISCERN scoring. There was no statistically significant difference in quality across website categories. Six articles included the outdated treatment option of intranasal DDAVP.
CONCLUSIONS: Online health information on voiding dysfunction is published at a higher grade reading level than recommended by the NIH, indicating that it is difficult to read. Web resources represent an easily accessible source of health education for voiding dysfunction, however the readability and quality of content need to be improved.


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