New research published in Ophthalmology evaluated the web accessibility and readability of patient-oriented educational websites on cataract surgery.
Give me some background first.
Since 2003, both the American Medical Association (AMA) and the National Institutes of Health (NIH) have recommended that educational materials for patients be written at a 6th-grade reading level.
This is particularly important as the average reading level in the US currently stands at an 8th-grade level.
Talk about the study.
In this cross-sectional electronic survey, researchers from The Wilmer Eye Institute at Johns Hopkins University performed an incognito search for “cataract surgery” on a popular search engine and included the top 100 patient-oriented cataract surgery websites.
These websites were organized into three authorship categories, including:
- Institutional
- Academic centers, medical societies, and governmental websites
- Private practice
- For-profit medical organizations that provide patient care
- Medical organization
- Independent health information service websites, health magazines, insurance companies, and pharmaceutical or medical device companies
Tell me more.
Each website was analyzed for readability using four standardized reading grade-level formulas.
Accessibility was measured through four key parameters:
- Multilingual availability
- Accessibility menu availability
- Complementary educational video availability
- Conformity and adherence to the Web Content Accessibility Guidelines (WCAG) 2.0
What were the primary outcome measures of the study?
The main outcome measures for each website was:
- Average reading grade level
- Number of accessibility violations
- Availability of the four accessibility parameters mentioned above
- Violation of the perceivable, operable, understandable, and robust (POUR) principles, according to WCAG 2.0
What is WCAG 2.0?
WCAG 2.0 outlines a broad range of recommendations for making web content more accessible to people with disabilities, including:
- Blindness and low vision
- Deafness and hearing loss
- Learning disabilities
- Cognitive limitations
- Limited movement
- Speech disabilities
- Photosensitivity
- Combinations of these conditions
Findings?
Of the 100 total sites, 32, 55, and 13 were affiliated with institutions, private practice, and other medical organizations, respectively.
The overall mean reading grade of all the sites was 11.8±1.6, and higher reading levels were reported in private practice websites (12.1) compared to institutions and medical organizations combined (11.4, P=0.03).
What about accessibility measures?
Of note, fewer private practice websites had multiple language options in comparison to institutional and medical organization websites combined (5.5% vs. 20.0%, P=0.03).
However, more private practice websites had accessibility menus (27.3%) compared to institutions and medical organizations combined (8.9%, P=0.038).
Anything else?
The overall mean number of WCAG 2.0 POUR principle violations was 17.1±23.1, with no significant difference between categories.
Interestingly, 85% of websites violated the perceivable principle, which outlines that information and user interface elements may benefit from being presented in a way that all users can recognize and understand.
Expert opinion?
The study authors noted that these problems could harm patients by causing medical misinformation, hesitancy or outright refusal of surgery, increased frustration, and reduced satisfaction with surgical outcomes.
“Cataract surgery can be made more equitable and understandable within the general population by providing usable online information to prospective recipients,” they added.
Take home.
These findings suggest that current patient-oriented online information about cataract surgery may not be at the appropriate reading level for the general public.
As such, online resources on cataract surgery might consider aiming to improve readability and accessibility—potentially using guidelines such as WCAG 2.0 when creating these sites.