Assessing the Quality, Reliability, and Readability of Online Information on Dry Eye Disease

Abstract

Purpose: The purpose of this study was to assess the quality, reliability, readability, and technical quality of web sites relating to dry eye disease.

Methods: A cross-sectional study was conducted that evaluated the first 75 web sites on a Google Search by using the keyword "dry eyes." Each web site was evaluated by 2 independent reviewers using the DISCERN, HONcode, and JAMA criteria to assess quality and reliability. Interrater reliability was also analyzed. Readability was assessed using the Flesch-Kincaid readability tests and the Gunning fog, Simple Measure of Gobbledygook, Coleman-Liau, and automated readability indices. Technical quality was determined by the presence of 10 specific features. Web sites were further categorized into institutional (academic centers, medical associations, and government institutions) and private (private practices) categories.

Results: There was no significant difference in scoring observed between the 2 reviewers. The overall mean DISCERN score ± standard error (SE) was 3.2 ± 0.1, the mean HONcode score (±SE) was 9.3 ± 0.3, and the mean JAMA score (±SE) was 1.9 ± 0.1. Institutional web sites had a higher DISCERN score (3.4 ± 0.1 vs. 3.1 ± 0.1; P < 0.05) and HONcode score (10.3 ± 0.5 vs. 8.8 ± 0.4; P < 0.05) than private sites. Technical quality was higher in institutional web sites compared with private web sites ( P < 0.05). Readability was poor among all web sites, with most web sites not achieving below a ninth grade reading level.

Conclusions: Quality, reliability, and readability scores were low for most web sites. Although institutional web sites achieved higher scores than private web sites, revision is warranted to improve their overall quality of information and readability profile.

FIGURE 1.

Readability of all 75 web sites was assessed using the Flesch–Kincaid reading ease (A), Flesch–Kincaid grade level (B), Gunning fog score (C), SMOG index (D), Coleman–Liau index (E), and automated readability index (F). The red line represents the cutoff score or grade level that is acceptable for an American adult. For the Flesch–Kincaid reading ease score, everything to the right of the red line is considered acceptable. For the remaining 5 metrics, everything to the left of the red line is considered a reading level of the average American adult.

FIGURE 2.

Technical quality of all institutional (white bars) and private web sites (black bars) are presented. Institutional web sites had a higher technical quality overall when compared with private web sites. This includes a higher percentage of web sites with “no ads in the text” or web sites that “load in 3 seconds.” Both institutional and private web sites had a low percentage of web sites that were up to date or that had a link to a blog. *P < 0.05 versus private web sites.