How Readable Is BPH Treatment Information on the Internet? Assessing Barriers to Literacy in Prostate Health

Abstract

Information about benign prostatic hyperplasia (BPH) has become increasingly accessible on the Internet. Though the ability to find such material is encouraging, its readability and impact on informing patient decision making are not known. To evaluate the readability of Internet-based information about BPH in the context of website ownership and Health on the Net certification, three search engines were queried daily for 1 month with BPH-related keywords. Website ownership data and Health on the Net certification status were verified. Three readability analyses were performed: SMOG test, Dale-Chall readability formula, and Fry readability graph. An adjusted SMOG calculation was performed to reduce overestimation from medical jargon. After a total of 270 searches, 52 websites met inclusion criteria. Mean SMOG grade was 10.6 ( SD = 1.4) and 10.2 after adjustment. Mean Dale-Chall score was 9.1 ( SD = 0.6), or Grades 13 to 15. Mean Fry graph coordinates (173 syllables, 5.1 sentences) corresponded to Grade 15. Seven sites (13%) were at or below the average adult reading level based on SMOG; none of the sites qualified based on the other tests. Readability was significantly poorer for academic versus commercial sites and for Health on the Net-certified versus noncertified sites. In conclusion, online information about BPH treatment markedly exceeds the reading comprehension of most U.S. adults. Websites maintained by academic institutions and certified by the Health on the Net standard have more difficult readability. Efforts to improve literacy with respect to urological health should target content readability independent of reliability.

Keywords: Internet; benign prostatic hyperplasia; consumer health information; health literacy; readability.

Figure 1.

PRISMA diagram for sample selection. Note. PRISMA = Preferred Reporting Items for Systematic reviews and Meta-Analysis; BPH = benign prostatic hyperplasia.

Figure 2.

Fry readability graph of websites discussing BPH treatment by site ownership. Note. BPH = benign prostatic hyperplasia. Star represents mean coordinates for all sites. Boxed numbers indicate corresponding reading grade level. Color code: Red, commercial; Green, academic; Purple, private practice; Orange, other.

Figure 3.

Fry readability graph of websites discussing BPH treatment by Health on the Net certification status. Note. BPH = benign prostatic hyperplasia. Star represents mean coordinates for all sites. Boxed numbers indicate corresponding reading grade level. Color code: Blue, certified; Black, not certified.