The accessibility, readability, and quality of online resources for gender affirming surgery

Christina R Vargas; Joseph A Ricci; Michelle Lee; Adam M Tobias; Daniel A Medalie; Bernard T Lee

doi:10.1016/j.jss.2017.05.026

The accessibility, readability, and quality of online resources for gender affirming surgery

J Surg Res. 2017 Sep:217:198-206. doi: 10.1016/j.jss.2017.05.026. Epub 2017 May 11.

Authors

Christina R Vargas¹, Joseph A Ricci², Michelle Lee², Adam M Tobias², Daniel A Medalie³, Bernard T Lee⁴

Affiliations

¹ Department of Plastic Surgery, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio.
² Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
³ Division of Plastic and Reconstructive Surgery, Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio.
⁴ Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. Electronic address: btlee@bidmc.harvard.edu.

PMID: 28587891
DOI: 10.1016/j.jss.2017.05.026

Abstract

Background: 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. This study simulates a patient search for online educational material about gender affirming surgery and evaluates the accessibility, readability, and quality of the information.

Methods: An Internet search for the term "transgender surgery" was performed, and the first 10 relevant hits were identified. Readability was assessed using 10 established tests: Coleman-Liau, Flesch-Kincaid, FORCAST, Fry, Gunning Fog, New Dale-Chall, New Fog Count, Raygor Estimate, Simple Measure of Gobbledygook, and Flesch Reading Ease. Quality was assessed using Journal of the American Medical Association criteria and the DISCERN instrument.

Results: Review of 69 results was required to identify 10 sites with relevant patient information. There were 97 articles collected; overall mean reading level was 14.7. Individual Web site reading levels ranged from 12.0 to 17.5. All articles and Web sites exceeded the recommended sixth grade level. Quality ranged from 0 to 4 (Journal of the American Medical Association) and 35 to 79 (DISCERN) across Web sites.

Conclusions: Web sites 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 Web site quality was noted, and this may further complicate successful navigation. Barriers in access to appropriately written patient information on the Internet may contribute to disparities in referral, involvement, satisfaction, and outcomes.

Keywords: Health literacy; Readability; Reconstructive surgery; Transgender surgery.

MeSH terms

Access to Information
Comprehension
Female
Humans
Internet / statistics & numerical data*
Male
Sex Reassignment Surgery*