Assessing the Readability of Online Patient Education Resources Related to Neophallus Reconstruction

A critical assessment of online patient education materials for gender-affirming surgery: a systematic review and meta-analysis

INTRODUCTION

Gender-affirming surgeries significantly improve the well-being of transgender and gender-diverse individuals. However, patients often rely on online patient education materials (OPEMs) to navigate surgical options, making readability, quality, and accessibility critical factors in informed decision-making.

OBJECTIVE

The objective of this study is to evaluate the readability, quality, and accessibility of online patient education materials related to gender-affirming surgeries.

METHODS

This systematic review analyzed nine studies evaluating 898 OPEMs related to gender-affirming surgeries and transgender voice care. Readability was assessed using Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG), and Flesch Reading Ease Score (FRES), while quality was evaluated using DISCERN and the Patient Education Materials Assessment Tool. A meta-analysis synthesized readability scores, and qualitative trends were examined to assess readability-quality trade-offs.

RESULTS

OPEMs consistently exceeded the recommended 6th-grade reading level, with a pooled FKGL mean of 12.49 (95% CI: 12.41-12.57), indicating high school to university-level complexity. SMOG scores averaged 11.89 (95% CI: 11.79-11.99), suggesting materials required at least some college education. FRES scores (mean: 37.49, 95% CI: 37.17-37.80) classified most materials as "difficult" to "very difficult" to read. Healthcare-affiliated websites had significantly higher FKGL scores than non-healthcare sources (P < 0.01). DISCERN scores were highly variable, with 68.33% of facial feminization materials rated poor or very poor. Physician-created TikTok content scored higher in reliability (P < 0.001) but had lower engagement than non-physician videos. Spanish-language materials were slightly more readable (SMOG 11.7 vs. 14.2 in English) but less available.

CONCLUSIONS

Most OPEMs for gender-affirming care fail to meet health literacy guidelines, limiting accessibility. To improve patient comprehension, materials should be simplified without sacrificing accuracy, incorporate multimedia tools, and undergo usability testing. Standardized, trans-affirming, and linguistically inclusive resources are essential for equitable access and informed decision-making.

Reading Between the Tabloids: An Objective Analysis of the Quality and Readability of Patient Encountered Online Material for Face Transplantation

Face transplantation is a highly sensationalized procedure in the media. The purpose of this study is to assess the content and readability of online materials that prospective patients/public encounter regarding face transplantation. A search for face transplantation was performed on Google. Sites were categorized under 3 groups: established face transplant programs, informational third-party sources (eg, Wikipedia), and news article/tabloid sites. Each site was assessed for readability using 6 different readability metrics, while quality was assessed utilizing JAMA benchmark criteria and DISCERN instrument. One-way ANOVA with post hoc Tukey's multiple comparisons test was used for analysis. News sources were significantly easier to read than face transplant program sites (10.4 grade reading level vs. 12.4). For the JAMA benchmark, face transplant programs demonstrated the lowest average score relative to third-party sites, and news sources (2.05 vs. 2.91 vs. 3.67, respectively; P <0.001), but had significantly greater DISCERN scores than news sources (53.50 vs. 45.83, P =0.019). News sources were significantly more accessible, readable, and offered greater transparency of authorship compared with reputable sources, despite their lack of expertise on face transplantation. Face transplant programs should update their websites to ensure readability and accessibility of the information provided to the public.

Assessing the Readability of Online English and Spanish Resources for Polydactyly and Syndactyly

INTRODUCTION

Online patient education materials (PEMs) that are difficult to read disproportionately affect patients with low health literacy and educational attainment. Patients may not be fully informed or empowered to engage meaningfully with providers and advocate for their goals. We aim to assess the readability of online PEMs regarding polydactyly and syndactyly.

METHODS

Google was used to query "polydactyly" and "syndactyly" in English and Spanish. The first 50 results were categorized into institutional (government, medical school, teaching hospital), noninstitutional (private practice, blog), and academic (journal articles, book chapters). Readability scores were generated using the Simple Measure of Gobbledygook and Spanish Simple Measure of Gobbledygook scales.

RESULTS

All polydactyly PEMs and >95% of syndactyly PEMs exceeded the National Institutes of Health recommended 6th-grade reading level. Altogether, English PEMs had an average reading level of a university freshman and Spanish PEMs had an average reading level of nearly a high school sophomore. For both diagnoses, English PEMs were harder to read than Spanish PEMs overall and when compared across the 3 categories between the 2 languages. Generally, noninstitutional PEMs were more difficult to read than their institutional counterparts.

CONCLUSIONS

To improve patient education, health literacy, and language equity, online resources for polydactyly and syndactyly should be written at the 6th-grade level. Currently, these PEMs are too advanced, which can make accessing, understanding, and pursuing healthcare decisions more challenging. Understanding health conditions and information is crucial to empower patients, regardless of literacy.

Patient education and surgical decision-making in genital gender-affirming surgery

PURPOSE OF REVIEW

An update on the latest advances in surgical decision-making for genital gender-affirming surgery (GGAS), with an emphasis on patient education from three perspectives: surgeon-team perspectives, patient perspectives, and educational resources available to the public on social media.

RECENT FINDINGS

Transgender, nonbinary, and other culturally specific gender identities (TGNB) patients overwhelmingly desire an active role in the decision-making process. New developments in patient-engagement strategies help mitigate the harm of historical gatekeeping practices by centering the needs and experiences of TGNB patients to create a prioritized research agenda for GGAS effectiveness. Patient educational resources play an integral role in navigating the complexity of GGAS-surgical options, informing patients of the technical and logistical knowledge required for GGAS surgical decision-making. Peer support experiences are a critical facilitator for patient surgical decision-making, both for informed decision-making and for psychosocial support.

SUMMARY

Several developments have been made in examining shared-decision making, educational resources from the perspectives of both the surgical team and patients, and the role of social media in GGAS. Surgeons must continue to initiate robust conversations of patient goals, GGAS surgical options, the possible risk and benefit profiles of each option, and aftercare requirements, all while prioritizing patient-engagement strategies.

Evaluating the web as a source of information for patients with chest wall deformities: insights into engagement and disparities

BACKGROUND

Recent data highlight the internet's pivotal role as the primary information source for patients. In this study, we emulate a patient's/caregiver's quest for online information concerning chest deformities and assess the quality of available information.

METHODS

We conducted an internet search using combination of the terms "pectus excavatum," "pectus excavatum surgery," "funnel chest," "pectus excavatum repair" and identified the first 100 relevant websites from the three most popular search engines: Google, Yahoo, and Bing. These websites were evaluated using the modified Ensuring Quality Information for Patients (EQIP) instrument.

RESULTS

Of the 300 websites generated, 140 (46.7%) were included in our evaluation after elimination of duplicates, non-English websites, and those targeting medical professionals. The EQIP scores in the final sample ranged from 8 to 32/36, with a median score of 22. Most of the evaluated websites (32.8%) originated from hospitals, yet none met all 36 EQIP criteria.

DISCUSSION

None of the evaluated websites pertaining to pectus excavatum achieved a flawless "content quality" score. The diverse array of websites potentially complicates patients' efforts to navigate toward high-quality resources. Barriers in accessing high-quality online patient information may contribute to disparities in referral, patient engagement, treatment satisfaction, and overall quality of life.

LEVEL OF EVIDENCE

IV.