Quality and readability of websites for patient information on tonsillectomy and sleep apnea

Abstract

Objectives

Tonsillectomy is a common treatment for obstructive sleep apnea (OSA). The Internet allows patients direct access to medical information. Since information on the Internet is largely unregulated, quality and readability are variable. This study evaluates the quality and readability of the most likely visited websites presenting information on sleep apnea and tonsillectomy.

Methods

The three most popular search engines (Google, Bing, Yahoo) were queried with the phrase “sleep apnea AND tonsillectomy.” The DISCERN instrument was used to assess quality of information. Readability was evaluated using the Flesch-Kincaid Reading Grade Level (FKGL) and Flesch Reading Ease Score (FRES).

Results

Out of the maximum of 80, the average DISCERN quality score for the websites was 55.1 (SD- 12.3, Median- 60.5). The mean score for FRES was 42.3 (SD- 15.9, Median- 45.5), which falls in the range defined as difficult. No website was above the optimal score of 65. The mean score for the FKGL was US grade-level of 10.7 (SD- 1.6, Median- 11.6). Only 4(27%) websites were in the optimal range of 6–8. There was very weak correlation between FRES and DISCERN (r = 0.07) and FKGL and DISCERN (r = 0.21).

Conclusions

Tonsillectomy is one of the most common surgeries in the US. However, the internet information readily available to patients varies in quality. Additionally, much of the information is above the recommended grade level for comprehension by the public. By being aware of what information patients are reading online, physicians can better explain treatments and address misunderstandings. Physicians may consider using similar methods to test the readability for their own resources for patient education.

Introduction

Sleep apnea exists on the spectrum of sleep-disordered breathing and is defined by pauses in breathing, apneas, and periods of decreased airflow, or hypopneas. In obstructive sleep apnea (OSA), respiratory effort is present, but decreased or absent airflow results from upper airway collapse [1]. OSA occurs in up to 3% of pediatric patients and is most commonly caused by adenotonsillar hypertrophy [2]. Tonsillectomy is one of the mostly commonly performed procedures on children and may often been offered to OSA patients with enlarged tonsils [3]. Patients and their parents may elect to proceed with tonsillectomy, pursue medical management, or forgo treatment entirely.

The advent of the Internet has changed the way patients evaluate treatment options. The Internet allows patients to access medical information directly without having to consult a medical professional. As a result, by the time patients reach a medical provider, they may already have decided on a treatment plan or may have more sophisticated management questions [4]. Since information on the Internet is largely unregulated, the quality of the information is variable. Review of websites with accurate medical information can aid patients in making decisions. However, websites with false, misleading, or biased data can compromise patients' ability to make sound medical decisions [5].

Furthermore, website readability is a concern; Internet sources must be at a level that can be easily understood by the patients consuming them. The American Medical Association [6] and the National Institution of Health [7] recommend that medical information be equal or less than 6th grade reading level.

The readability and quality of medical information available on the Internet related to the topics of glue ear, aural atresia, tympanostomy tubes, and vascular anomalies has been assessed [8], [9], [10], [11], but no similar review has been conducted for the topic of tonsillectomy and sleep. The purpose of this study is to evaluate the quality and readability of the most popular websites presenting information on sleep apnea and tonsillectomy.