Accessibility and Decision-Supportive Quality of Benign Breast Disease Articles on Chinese Hospital WeChat Public Accounts: Nationwide Cross-Sectional Study.

Abstract

Background: Shared decision-making (SDM) is critical for managing clinically ambiguous conditions such as benign breast disease (BBD), requiring reliable health information. In China, WeChat public accounts (WPAs) run by hospitals serve as a major health information channel, yet their quality remains unevaluated.

Objective: This study aimed to evaluate the quality of BBD-related articles on hospital WPAs in China.

Methods: Using a multistage stratified random sampling approach, we conducted a nationwide survey examining the quality of articles published from January 2020 to November 2024. The articles were evaluated for accessibility (readability, image quality, and user-friendliness) and SDM readiness (credibility, balance, and decision relevance) using validated instruments and content analysis.

Results: Among 276,617 articles from 158 sampled hospitals, 464 were related to BBD. Accessibility was generally good: 72.4% (336/464) were written at a junior high school reading level. Visual presentation was acceptable, although only 10.2% (42/410) had complete image labeling. The Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P) scores showed moderate understandability (mean 73.6%, SD 17.3%) but limited actionability (mean 50%, SD 23.2%). For SDM readiness, the mean Quality Evaluation Scoring Tool (QUEST) score was 14.9 (SD 4.7) out of 28, with treatment-related articles scoring lower than prevention-related articles (P<.001). In the balance evaluation, using Brief DISCERN, 84.3% (182/216) of articles were below the high-quality threshold, often lacking information on treatment risks and quality-of-life impacts. Decision relevance revealed variability in surgical recommendations, especially regarding excision criteria and pregnancy-related guidance.

Conclusions: WPA articles on BBD showed good accessibility but substantial gaps in SDM support, particularly in information balance and decision relevance. Standardized guidelines and quality improvements are needed to enhance patient-centered online health services.