Cultural Insensitivity Pervasive in Spanish Online Cosmetic Surgery Resources: A Call to Action

Abstract

Background: Hispanics are the second largest demographic that underwent cosmetic surgery in 2017. The popularity of cosmetic surgeries among this group has increased significantly within the past decade and is projected to continue rising. Patient-directed websites that provide educational materials addressing these procedures should include information that is accurate, comprehensible, and sensitive to the demographic's diverse cultural and ethnic needs. Online health resources have been shown to vary significantly in their quality and reliability. This can be inimical for patients, as misinformation has been associated with poor health outcomes. The aim of this study is to evaluate online Spanish patient-directed materials for the top 5 cosmetic surgeries performed in 2017 using validated metrics.

Methods: The top 5 cosmetic surgeries performed in 2017 according to the American Society of Plastic Surgeons were identified, and a Google search was performed using the following terms: "breast augmentation," "liposuction," "rhinoplasty," "blepharoplasty," and "abdominoplasty." The top 10 websites providing relevant information in Spanish were identified for each procedure. Fifty unique web links were analyzed by 2 independent bilingual raters using the Cultural Sensitivity Assessment Tool, and mean reading grade level was determined. Interrater reliability was computed using a Cohen κ.

Results: Online information in Spanish was difficult to encounter, with an average of 130 websites evaluated to identify 10 websites for each surgery. The mean reading grade level of all evaluated pages was 10.19, appropriate for a high school sophomore. There were no statistically significant differences between cosmetic surgery procedures (P = 0.69). The mean cultural sensitivity score was 2.20 (2.08-2.38). No subgroup met the threshold score for acceptable cultural sensitivity of >2.5.

Conclusion: This study demonstrates that US websites do not offer appropriate-level Spanish materials for patients seeking information on cosmetic surgeries. Websites providing information in Spanish were often inaccurate automatic translations and further compromised reader understanding. In our search, we frequently encountered organizational statements expressing a commitment to diversity. Increased awareness and development of more culturally appropriate materials is paramount to effectively communicate with patients and begin to close the gap in cultural disparities in health literacy.