An evaluation of the readability and visual appearance of online patient resources for fibroadenoma

Abstract

Introduction Fibroadenomas are benign lesions found in the breast tissue. Widespread access to and use of the internet has resulted in more individuals using online resources to better understand health conditions, their prognosis and treatment. The aim of this study was to investigate the readability and visual appearance of online patient resources for fibroadenoma. Methods We searched GoogleTM, BingTM and YahooTM on 6 July 2022 using the search terms “fibroadenoma”, “breast lumps”, “non-cancerous breast lumps”, “benign breast lumps” and “benign breast lesions” to identify the top ten websites that appeared on each of the search engines. We excluded advertised websites, links to individual pdf documents and links to blogs/chats. We compiled a complete list of websites identified using the three search engines and the search terms and analysed the content. We only selected pages that were relevant to fibroadenoma. We excluded pages which only contained contact details and no narrative information relating to the condition. We did not assess information where links were directed to alternative websites. We undertook a qualitative visual assessment of each of the websites using a framework of pre-determined key criteria based on the Centers for Medicare and Medicaid Services toolkit. This involved assessing characteristics such as overall design, page layout, font size and colour. Each criterion was scored as: +1- criterion achieved; -1- criterion not achieved; and 0- no evidence, unclear or not applicable (maximum total score 43). We then assessed the readability of each website to determine the UK and US reading age using five different readability tests: Flesch Kincaid, Gunning Fog, Coleman Liau, SMOG, and the Automated Readability Index. We compared the readability scores to determine if there were any significant differences across the websites identified. We also generated scores for the Flesh Reading Ease as well as information about sentence structure (number of syllables per sentence and proportion of words with a high number of syllables) and proportion of people the text was readable to. Results We identified 39 websites for readability and visual assessment. The visual assessment scores for the 39 websites identified ranged from -19 to 31 points out of a possible score of 43. The median readability score for the identified websites was 8.58 (age 14–15), with a range of 6.69–12.22 (age 12–13 to university level). There was a statistically significant difference between the readability scores obtained across websites (p<0.001). Almost half of the websites (18/39; 46.2%) were classified as very difficult by the Flesch Reading Ease score, with only 13/39 (33.33%) classified as being fairly easy or plain English. Conclusion We found wide differences in the general appearance, layout and focus of the fibroadenoma websites identified. The readability of most of the websites was also much higher than the recommended level for the public to understand. Fibroadenoma website information needs to be simplified to reduce the use of jargon and specificity to the condition for individuals to better comprehend it. In addition, their visual appearance could be improved by changing the layout and including images and diagrams.

Study to evaluate the readability and visual appearance of online resources for blunt chest trauma: an evaluation of online resources using mixed methods

“…Our findings concur with previous research assessing readability of online resources for other health conditions, such as phenylketonuria, fibroadenoma, otolaryngology and parathyroidectomy, which all identified that readability levels were too high 11–14. This suggests that readability issues are common in online health resources, which could be a reason for up to 61% of UK adults not routinely understanding health information 8…”

“…We used five different readability formulae to give a wide evaluation of each website. There is currently no consensus regarding which readability formula is the most appropriate for assessing patient materials and it is, therefore, recommended that more than one formula is used to assess such materials23 Each formula assesses the text in a different way and includes items such as words, characters and syllables 12. Employing a range of scores, therefore, improves the validity of the results 23.…”

“…We compared readability scores with the cumulative score from the visual assessment to determine if there was any correlation between readability and visual appearance, using non-parametric Spearman correlation. A p<0.05 was regarded as being statistically significant 36…”

“…Previous studies have found that online resources for healthcare are at a high readability level and are of poor quality,11–15 showing that they contain medical terminology and are not visually appealing. For BCT, a study assessing the readability of a trauma surgery website found that the readability level was too high, and therefore, difficult to comprehend 16…”

Profile of Fibroadenoma Mammae Patients at MRCCC Siloam Semanggi Hospital 2019-2020

“…Although the exact cause of FAM is unknown, several factors have been identified as a cause of FAM disorders, such as family genetics, age, hormones, radiation exposure, and contraceptive use [6,7]. FAM cases are increasing yearly, accompanied by concerns about lumps around the breast, often misinterpreted as malignancy.…”