Readability, Content, Quality, and Accuracy Assessment of Internet-based Patient Education Materials Relating to Labor Analgesia

I t has been reported that > 90% of pregnant women in the United States and Western Europe conduct internet searches for health information related to pregnancy. However, 66% of these women believed that information they obtained from a Web site may have been inaccurate or misleading; this potentially wrong content caused them worry about their pregnancy and/or delivery. With pregnancy information widely available online, it is important for health care professionals to monitor the quality and accuracy of the information their patients are receiving from internet sources. In this study, the investigators compared patient education materials (PEMs) provided by national and international medical societies to PEMs found via a Google search, assessing the readability, content, quality, and accuracy of the information. The study authors performed an internet search on Google using the terms “labor epidural” and “labor pain relief. ” Information from non-medical societyWeb sites that were geared to the general public, not health care professionals, was utilized for analysis. Only the first 10 results of the search were included in the study because it has previously been found that >90% of traffic generated from an internet search comes from those first 10 results. The information obtained from these 10Web sites was compared to PEMs obtained from North America and United Kingdom-based medical society Web sites for anesthesiology, obstetrics, and primary care. A total of 13 medical society Web sites were included in the study. The content being analyzed was blinded by removing Web site URLs, Web site names, and authors of the content. The content, readability, accuracy, and quality of all Web site materials were independently evaluated by 2 attending obstetric anesthesiologists and 2 obstetric anesthesiology fellows. Readability was determined by using 5 readability scoring systems that are based on such factors as length of sentences, syllables per word, and difficulty of the words used. Accuracy was calculated as the proportion of correct statements divided by all statements in a PEM. The quality of materials was assessed using the validated Patient Education Materials Assessment Tool for Print (PEMAT), which rates both the understandability of the content as well as the actionability. Actionability is defined as the material providing at least one action identified by the reader as something they can do. In terms of content, the most commonly mentioned topics among both the medical society and general public Web site PEMswere epidural benefits, effects on labor and delivery, procedure definitions, alternative analgesic techniques, and postdural puncture headache. For both the medical society and public PEMs, the mean readability scores based on all scoring systems were at or above an eighth grade reading level, with an eighth grade or lower level often recommended for PEMs. Of note, the medical society materials were found to be at a lower reading level than those from the general public sites. PEMs from the medical societies were significantly more accurate than the PEMs from nonsociety Web site (94.6% vs. 75.8%, P<0.001) In addition, the society Web sites received higher PEMAT scores for understandability although actionability scores were low for both groups of Web sites. The investigators concluded that medical society Web sites provided PEMs with better accuracy and quality of information than PEMs obtained from the most searched Web sites via Google. However, even the PEMs from professional organizations had room for improvement in terms of their readability. They recommended that all Web sites providing patient information regarding labor analgesia should improve their content. They emphasized that health care providers should encourage their patients to utilize society Web sites for obtaining their labor analgesia information since accurate, easy-to-comprehend information provided by qualified professionals should ideally result in more realistic labor expectations and overall higher maternal satisfaction.