Rationale and Objectives
Investigators aimed to assess online information describing uterine artery embolization (UAE) to examine the quality and readability of websites patients are accessing.
Materials and Methods
A list of applicable, commonly used searchable terms was generated, including “Uterine Artery Embolization,” “Fibroid Embolization,” “Uterine Fibroid Embolization,” and “Uterine Artery Embolisation.” Each possible term was assessed across the five most-used English language search engines to determine the most commonly used term. The most common term was then investigated across each search engine, with the first 25 pages returned by each engine included for analysis. Duplicate pages, nontext content such as video or audio, and pages behind paywalls were excluded. Pages were analyzed for quality and readability using validated tools including DISCERN score, JAMA Benchmark Criteria, HONcode Certification, Flesch Reading Ease Score, Flesch-Kincaid Grade Level, and Gunning-Fog Index. Secondary features such as age, rank, author, and publisher were recorded.
Results
The most common applicable term was “Uterine Artery Embolization” (492,900 results). Mean DISCERN quality of information provided by UAE websites is “fair”; however, it has declined since comparative 2012 studies. Adherence to JAMA Benchmark Criteria has reduced to 6.7%. UAE website readability remains more difficult than the World Health Organization–recommended 7–8th grade reading levels. HONcode-certified websites (35.6%) demonstrated significantly higher quality than noncertified websites.
Conclusions
Quality of online UAE information remains “fair.” Adherence to JAMA benchmark criteria is poor. Readability is above recommended 7–8th grade levels. HONcode certification was predictive of higher website quality, a useful guide to patients requesting additional information.
Introduction
Uterine artery embolization (UAE) is a widely performed radiological intervention, most commonly for the treatment of symptomatic uterine fibroids. Although patients decide on treatments in consultation with healthcare providers, the majority of patients also use the Internet for healthcare-related information . This information is beyond the control of healthcare providers, and a more in-depth understanding of this information may help healthcare providers make helpful recommendations to patients or alert healthcare providers to low-quality information which may influence patients.
In 2012, studies by Tavare et al. and by Kaicker et al. separately assessed the readability and quality of Internet information regarding UAE (of note the study by Kaicker et al study was performed and e-published in 2012, however written publication occurred in 2013). Although the definition of quality may vary, standardized validated tools (such as the DISCERN instrument) have been developed to quantify the quality of healthcare information. The quality of healthcare information on the World Wide Web is variable. Kaicker et al. found the quality of UAE websites to be “fair.” Furthermore, only 26% of websites met the Journal of American Medical Association (JAMA) benchmarks for quality online information. Guidelines suggest that healthcare information for the general public should be written at a seventh to eighth grade (US) reading level . In 2012, Tavare et al. demonstrated that website information on UAE was written at a college grade reading level (Flesch Reading Ease Score [FRES] of 42) . The studies of Kaicker et al. and Tavare et al. concluded that there were deficiencies in website quality and readability, and called for an increase in high-quality patient-focused information .
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Materials and Methods
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Quality
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Readability
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Statistical Methods
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Results
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TABLE 1
Summary of Results
Producer Age (y) JAMA Benchmark Criteria DISCERN Score HONcode Certification (%) Readability Authorship Attribution Currency Disclosure Readability Treatment Choices Quality Total FRES FKGL GFI All 5.6 24.7 29.3 3 47 24.7 29.3 3 47 35.6 38.7 10 10.6 Journal articles 9.4 100% 100% 100% 100% 31.3 18.4 3.3 52.9 50 35.4 10.6 11.8 Not-for-profit (including governmental and NGOs) 2.5 80% 80% 80% 40%% 26.8 20.6 3.4 50.8 60 42 9.2 11.1 Professional Society 6.9 40% 60% 80% 0% 25.6 20.6 3.4 49.6 20 42.8 9.3 11.3 For-profit company 2.0 66.6% 44.4% 77.7% 11.1% 23.3 18.2 2.8 44.3 55.5 43.5 9.6 11.5 Healthcare providers 5.1 39% 22% 22% 56% 21.7 19.5 2.8 44.1 17 35.7 10.3 9.2
All results are mean value.
FKGL, Flesch-Kincaid Grade Level; FRES, Flesch Reading Ease Score; GFI, Gunning-Fog Index; HONcode, Health On the Net certification; JAMA, Journal of the American Medical Association ; NGO, nongovernmental organization.
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JAMA Benchmark Criteria
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TABLE 2
Compliance with Journal of the American Medical Association (JAMA) Quality Benchmarks
2012 (Kaicker et al.) 2017 (Current Study) Number Percentage Number Percentage Authorship 15 44% 27 60% Attribution 24 71% 23 51% Currency 23 68% 27 60% Disclosure 16 47% 7 16%
Compliance with JAMA Quality Benchmarks in current study, with comparison to Kaicker et al. (2012) .
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DISCERN Score
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TABLE 3
DISCERN Score—Quality of Websites
Percentage Number of Websites Very poor (16–26) 6.7% 3 Poor (27–38) 17.8% 8 Fair (39–50) 42.2% 19 Good (51–62) 22.2% 10 Excellent (>63) 11.1% 5 Total 100% 45
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HONcode Certification
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Readability
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Discussion
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Conclusions
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