title: A Qualitative and Quantitative Comparative Analysis of Commercial and Independent Online Information for Hip Surgery: A Bias in Online Information Targeting Patients?
abstract: Direct to consumer (DTC) advertising, targeting the public over the physician, is an increasingly pervasive presence in medical clinics. It is trending toward a format of online interaction rather than that of traditional print and television advertising.
  
  
  
  We analyze patient-focused Web pages from the top 5 companies supplying prostheses for total hip arthroplasties, comparing them to the top 10 independent medical websites. Quantitative comparison is performed using the Journal of American Medical Association benchmark and DISCERN criteria, and for comparative readability, we use the Flesch-Kincaid grade level, the Flesch reading ease, and the Gunning fog index. Content is analyzed for information on type of surgery and surgical approach.
  
  
  
  There is a statistically significant difference between the independent and DTC websites in both the mean DISCERN score (independent 74.6, standard deviation [SD] = 4.77; DTC 32.2, SD = 10.28; P = .0022) and the mean Journal of American Medical Association score (Independent 3.45, SD = 0.49; DTC 1.9, SD = 0.74; P = .004). The difference between the readability scores is not statistically significantly. The commercial content is found to be heavily biased in favor of the direct anterior approach and minimally invasive surgical techniques.
  
  
  
  We demonstrate that the quality of information on commercial websites is inferior to that of the independent sites. The advocacy of surgical approaches by industry to the patient group is a concern. This study underlines the importance of future regulation of commercial patient education Web pages.
authors.affiliation: Department of Orthopaedic Surgery, Cappagh National Orthopaedic Hospital, Dublin, Ireland.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Kelly
authors.affiliation: Department of Orthopaedic Surgery, Cappagh National Orthopaedic Hospital, Dublin, Ireland.
authors.forename: Iain H
authors.initials: IH
authors.lastname: Feeley
authors.affiliation: Department of Orthopaedic Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: John M
authors.initials: JM
authors.lastname: O'Byrne
mesh_terms: D019644:Arthroplasty, Replacement, Hip; D015982:Bias; D032882:Comprehension; D000067088:Direct-to-Consumer Advertising; D006622:Hip Prosthesis; D006801:Humans; D020407:Internet; D011932:Reading
keywords: direct to consumer; hip arthroplasty; internet; marketing; online advertising; patient information