Readability, complexity, and suitability of online resources for mastectomy and lumpectomy

Bao Ngoc N Tran; Mansher Singh; Dhruv Singhal; Rima Rudd; Bernard T Lee

doi:10.1016/j.jss.2017.01.012

Readability, complexity, and suitability of online resources for mastectomy and lumpectomy

J Surg Res. 2017 May 15:212:214-221. doi: 10.1016/j.jss.2017.01.012. Epub 2017 Jan 28.

Authors

Bao Ngoc N Tran¹, Mansher Singh¹, Dhruv Singhal¹, Rima Rudd², Bernard T Lee³

Affiliations

¹ Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
² Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
³ Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. Electronic address: blee3@bidmc.harvard.edu.

PMID: 28550909
DOI: 10.1016/j.jss.2017.01.012

Abstract

Background: Nearly half of American adults have low or marginal health literacy. This negatively affects patients' participation, decision-making, satisfaction, and overall outcomes especially when there is a mismatch between information provided and the skills of the intended audience. Recommendations that patient information be written below the sixth grade level have been made for over three decades. This study compares online resources for mastectomy versus lumpectomy using expanded metrics including readability level, complexity, and density of data and overall suitability for public consumption.

Methods: The 10 highest ranked Web sites for mastectomy and lumpectomy were identified using the largest Internet engine (Google). Each Web site was assessed for readability (Simple Measure of Gobbledygook), complexity (PMOSE/iKIRSCH), and suitability (Suitability Assessment of Materials). Scores were analyzed by each Web site and overall.

Results: Readability analysis showed a significant reading grade level difference between mastectomy and lumpectomy online information (15.4 and 13.9, P = 0.04, respectively). Complexity analysis via PMOSE/iKIRSCH revealed a mean score of 6.5 for mastectomy materials corresponding to "low" complexity and eighth to 12^th grade education. Lumpectomy literature had a lower PMOSE/iKIRSCH score of 5.8 corresponding to a "very low" complexity and fourth to eighth grade education (P = 0.05). Suitability assessment showed mean values of 41% and 46% (P = 0.83) labeled as the lowest level of "adequacy" for mastectomy and lumpectomy materials, respectively. Inter-rater reliability was high for both complexity and suitability analysis.

Conclusions: Online resources for the surgical treatment of breast cancer are above the recommended reading grade level. The suitability level is barely adequate indicating a need for revision. Online resources for mastectomy have a higher reading grade level than do materials for lumpectomy and tend to be more complex.

Keywords: Complexity; Health literacy; Lumpectomy; Mastectomy; Readability; Suitability.

Publication types

Comparative Study
Evaluation Study

MeSH terms

Adult
Breast Neoplasms / surgery*
Comprehension
Consumer Health Information / standards
Consumer Health Information / statistics & numerical data*
Female
Health Literacy
Humans
Internet*
Mastectomy* / methods