title: Assessment of online patient materials for breast reconstruction.
abstract: BACKGROUND
  Limited health literacy affects nearly half of American adults and adversely affects patient participation, satisfaction, health care costs, and overall outcomes. As patients increasingly search the Internet for health information, accessibility of online material is critical. Previous studies examining this topic have focused on the readability of these materials. This study evaluates online breast reconstruction resources with regard to reading level, however, adds new metrics to assess degree of complexity, and suitability for the intended audience.
  
  
  METHODS
  The 10 most popular patient Web sites for "breast reconstruction" were identified using the largest Internet search engine. The content of each site was assessed for readability using the simple measure of gobbledygook analysis, complexity using the PMOSE/iKIRSCH formula, and suitability using the suitability assessment of materials instrument. Resulting scores were analyzed overall and by Web site.
  
  
  RESULTS
  Readability analysis revealed an overall average grade level of 13.4 (range 10.7-15.8). All sites exceeded the recommended sixth grade level. Complexity evaluation revealed a mean PMOSE/iKIRSCH score of 6.3, consistent with "low" complexity and requiring an 8th-12th grade education; individual sites ranged from "very low" to "high" complexity. Suitability assessment overall produced a mean 41.2% score, interpreted as "adequate" for the intended patient audience. Five of the 10 sites were found to be "not suitable" when examined individually; the remaining five were "adequate."
  
  
  CONCLUSIONS
  Available online patient material for breast reconstruction is often too difficult for many patients to understand based on readability, complexity, and suitability metrics. Comprehensive assessment is needed to design appropriate patient material and minimize disparities related to limited health literacy.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Christina R
authors.initials: CR
authors.lastname: Vargas
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Neelesh A
authors.initials: NA
authors.lastname: Kantak
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Danielle J
authors.initials: DJ
authors.lastname: Chuang
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Pieter G
authors.initials: PG
authors.lastname: Koolen
authors.affiliation: 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.
authors.forename: Bernard T
authors.initials: BT
authors.lastname: Lee
mesh_terms: D032882:Comprehension; D054626:Consumer Health Information; D005260:Female; D057220:Health Literacy; D006801:Humans; D020407:Internet; D016462:Mammaplasty
keywords: Breast reconstruction; Complexity; Online material; Readability; Suitability