Disclosure of Loop Electrosurgical Excision Procedure Complications: Qualitative Analysis of Hospital- Affiliated Online Resources in Canada

Abstract

Objective: Determine the current level of knowledge translation presented in hospital-affiliated online resources (HAOR) related to Loop Electrosurgical Excision Procedure (LEEP) and critically evaluate how these resources convey information to patients using validated measures of health literacy.

Methods: Qualitative analysis was conducted to assess HAOR content. Reading level was calculated using the Flesch-Kincaid Grade Level (FKGL), Gunning Fog Index (GFI), and Simple Measure of Gobbledygook (SMOG). Actionability and understandability were measured using the Patient Education Material Assessment Tool for Print (PEMAT-P).

Results: Twenty-four HAORs relating to LEEP were identified on Canadian health care institution websites (n = 167). Bleeding (n=15), discharge (n=14), pain/discomfort (n=14), infections (n=9), and cervical stenosis (n=7) were disclosed as short-term complications. Less frequently disclosed were long-term risks relating to pregnancy (n=5) and fertility (n=1). Complications related to sexual health and well-being were absent. Discrepancies were observed in the disclosure of when updates were performed (n=21) and sourcing details (n=2). The mean readability scores were above the recommended grade-level 5/6 for patient education materials (FKGL: x̄ = 6.64, σ = 1.07; GFI: x̄ = 8.58, σ = 1.50; SMOG: x̄ = 9.92, σ = 0.92). All HAORs scored above the PEMAT-P threshold (≥70%) for good actionability. Few HAORs (n=7) exceeded the threshold (≥70%) for good understandability (x̄ = 68.7%, σ = 11.0).

Conclusions: Inconsistent disclosure of LEEP risks and complications suggests critical elements of knowledge translation are inadequately applied to the curation process of HAORs. Measures of readability, understandability, and actionability indicate poor resource accessibility.

Keywords: electrosurgery; gynecology; qualitative research; women's health.