The Readability, Actionability, and Accessibility of Hemorrhoid-Focused Online Patient Education Materials: Are We Adequately Addressing Patient Concerns?

Abstract

Background: Hemorrhoidal disease is highly prevalent in the United States and frequently queried online. Unfortunately, health education webpages often lack reliable information.

Objective: To evaluate whether online hemorrhoid education materials in English and Spanish meet national recommendations for readability, actionability, and accessibility, and provide critical clinical guidance on when to seek medical care.

Design: Using three search engines (Bing, Google, Yahoo), we selected the top 30 results for formal medical and colloquial English and Spanish search terms regarding hemorrhoids. We assessed readability using validated scoring systems for readability in English and Spanish to report median reading levels and assessed Health Literacy Performance on a six-point checklist in three categories: accessibility, actionability, and critical clinical guidance.

Settings: University of California Los Angeles.

Main outcome measures: Readability and health literacy performance.

Results: After removing duplicates, 90-95 webpages generated from formal English, Spanish, and colloquial English terms remained. There was minimal overlap of results from the formal and colloquial English searches. Median reading levels were first-year university for formal and colloquial English webpages, and eleventh grade for Spanish webpages. 43.2%, 48.4%, and 18.2% of formal English, Spanish, and colloquial English websites, respectively, had minimal Health Literacy Performance. Health Literacy Performance criteria that were met least often were printability and providing specific, actionable goals for patients to implement.

Limitations: Our study represents searches completed at one point in time utilizing specific terms. Colloquial search terms were generated via survey with convenience sampling and may not be representative of all possible searches used by patients seeking information on hemorrhoidal disease.

Conclusions: Most English and Spanish hemorrhoid-focused webpages failed to provide appropriate patient education, as they exceeded the recommended sixth-grade reading level, lacked actionable recommendations, were not accessible, and failed to provide critical clinical guidance. Online resources are essential for patients of all health literacy levels; improvement is critical to reduce healthcare disparities. See Video Abstract.