title: Myelomeningocele information on the internet is accessible and of variable quality, and requires a high reading level.
abstract: OBJECTIVE
  We assessed the accessibility, readability and quality of myelomeningocele information on the Internet.
  
  
  METHODS
  We entered the term "spina bifida" into the Google, Yahoo! and Microsoft Network search engines, and stored the first 100 links from each Web site. A total of 164 unique Web sites remained for analysis, of which 159 were classified as relevant. Relevant Web sites were considered to have relevant content if more than 50% of the text was directly relevant to the disease, and to have relevant educational content if more than 50% of the text was aimed at relaying educational information. Readability was assessed using the Flesch-Kincaid Grade Level scale. The quality of the 159 Web sites with relevant content was assessed using American Public Health Association Criteria for Assessing Health Information on the Internet. Six criteria were assessed, namely credibility, content, links, design, interactivity and caveats. Web sites were analyzed by 2 separate medical doctors, with each reviewer blinded to the findings of the other. A weighted kappa statistic was used to calculate interrater reliability.
  
  
  RESULTS
  Of 159 relevant sites 146 (91.8%) had relevant content and 122 (76.7%) had relevant educational content. The average Flesch-Kincaid reading level was 10.9 (range 6 to 12). Quality was assessed on a 3-point scale, with 1 denoting poor quality, 2 fair and 3 good. Average scores were 1.92 for credibility, 1.88 for content, 2.29 for links, 2.53 for design, 1.99 for interactivity and 2.90 for caveats. The weighted kappa statistic for interrater reliability was 0.83.
  
  
  CONCLUSIONS
  Myelomeningocele information on the Internet is relatively accessible, requires a high reading level for comprehension and is of variable quality.
authors.affiliation: Department of Urology, Division of Pediatric Urology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Bergman
authors.forename: Ramdev
authors.initials: R
authors.lastname: Konijeti
authors.forename: Steven E
authors.initials: SE
authors.lastname: Lerman
mesh_terms: D022126:Access to Information; D032882:Comprehension; D006801:Humans; D033181:Information Dissemination; D020407:Internet; D008591:Meningomyelocele; D010353:Patient Education as Topic; D011786:Quality Control