C. R. Vargas1, J. A. Ricci3, M. Lee3, A. M. Tobias3, D. A. Medalie2, B. T. Lee3 1Case Western Reserve University School Of Medicine,Plastic Surgery,Cleveland, OH, USA 2MetroHealth Medical Center,Plastic And Reconstructive Surgery,Cleveland, OH, USA 3Beth Israel Deaconess Medical Center,Plastic And Reconstructive Surgery,Boston, MA, USA
Introduction: The transgender population is disproportionally affected by health disparities related to access to care. In many communities, transgender specialists are geographically distant and locally available medical professionals may be unfamiliar with unique needs of transgender patients. As a result, use of internet resources for information about gender affirming surgery is particularly important. Inadequate functional health literacy has been found to contribute to poorer health status, increased mortality, less awareness of preventative health measures, decreased understanding of personal medical conditions, greater likelihood of hospitalization, higher health care costs, lack of self-empowerment, less participation in decision-making in the course of care, and overall worse health outcomes. Minority populations are known to be particularly at risk for these health disparities. This study aims to simulate a patient search for online educational material about gender affirming surgery and to evaluate the accessibility, readability, and quality of the resulting information.
Methods: An Internet search for the term, “transgender surgery” was performed, and the first ten relevant hits were identified. Readability was assessed using ten established tests: Coleman-Liau, Flesch-Kincaid, FORCAST, Fry, Gunning Fog, New Dale-Chall, New Fog Count, Raygor Estimate, SMOG, and Flesch Reading Ease. Quality was assessed by two independent raters using JAMA criteria and the DISCERN instrument; these indices were plotted graphically for comparison.
Results: Review of 69 search results was required to identify 10 sites with relevant patient information. 97 articles were subsequently collected; overall mean reading level was 14.7. Individual website reading levels ranged from 12.0 to 17.5. All articles and websites exceeded the recommended 6th grade level. Quality ranged from 0-4 (JAMA) and 35-79 (DISCERN) across websites. When DISCERN quality was plotted against FRE readability, a nonlinear relationship was observed (Figure). Peak readability correlated with the middle of the quality index and declined at both extremes. Notably, readability of the highest quality resources was low, suggesting limited utility for average readers.
Conclusion: Websites with relevant patient information about gender affirming surgery were difficult to identify from search results. The content of these sites universally exceeded the recommended reading level. A wide range of website quality was noted and may further complicate successful resource navigation for patients Barriers in access to appropriately written patient information on the internet may contribute to disparities in referral, involvement, satisfaction, and outcomes for transgender patients.
