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C R O S S S E C T I O N A L A N A LY S I S O F S C O L I O S I S - S P E C I F I C I N F O R M AT I O N O N T H E I N T E R N E T
David Truumees; Ashley Duncan, MBA, RN; Kano Mayer, MD; Devender Singh, PhD; Matthew Geck, MD; Eeric Truumees, MD
ARE PATIENTS BEING MISINFORMED?
Ascension Texas Spine and Scoliosis CenterAustin, Texas United States
DISCLOSURESDavid Truumees: None
Ashley Duncan, MBA, RN: None
Kano Mayer, MD: Indiago (b), Lanai Health Solutions (b), IOPIP (b)
Devender Singh, PhD: None
Matthew Geck, MD: Diffusion (b); Seton Brain and Spine institute, Spine Hope (c), Spine and Scoliosis Research Foundation (c); Genesys (d)
Eeric Truumees, MD: Globus (a); Doctors research group(b); NASS (c); Stryker spine (d); Stryker spine (e)
a.Grants/Research Support
b.Stock/Shareholder
c.Board Membership
d.Royalties
e.Patent
CROSS SECTIONAL ANALYSIS OF SCOLIOSIS-SPECIFIC INFORMATION ON THE INTERNET: ARE PATIENTS BEING MISINFORMED?
PRESENTATION CONTENT
Results
Conclusions
Study Design
Methods
Background
Purpose
CROSS SECTIONAL ANALYSIS OF SCOLIOSIS-SPECIFIC INFORMATION ON THE INTERNET: ARE PATIENTS BEING MISINFORMED?
BACKGROUND
CROSS SECTIONAL ANALYSIS OF SCOLIOSIS-SPECIFIC INFORMATION ON THE INTERNET: ARE PATIENTS BEING MISINFORMED?
• The internet is one of the leading sources patients turn to for health and medical information
• Low-quality information can negatively impact the physician-patient dynamic1
• Previous studies have demonstrated that not only is most of online health information unreliable, it is often presented at a reading level well above the general public standard2,3
• Adolescence is the primary age of scoliosis diagnosis. This current generation has always had technology readily available, and therefore are nine times more likely to seek information on the internet first4
PURPOSEIn our study, we aimed to not only evaluate the accuracy of scoliosis-specific content from the most widely used search engines, but also to assess the readability of the content and the level of distraction caused by the host source. Both critical factors in health care literacy and retention.
CROSS SECTIONAL ANALYSIS OF SCOLIOSIS-SPECIFIC INFORMATION ON THE INTERNET: ARE PATIENTS BEING MISINFORMED?
Accuracy
Low Distraction Readability
STUDY DESIGN: CROSS SECTIONAL ANALYSIS
CROSS SECTIONAL ANALYSIS OF SCOLIOSIS-SPECIFIC INFORMATION ON THE INTERNET: ARE PATIENTS BEING MISINFORMED?
METHODS: Independent searches were conducted across three search engines for the keyword “scoliosis”.
The top 30 sites from each search were then analyzed for the following:
Accuracy
• Authorship• ± HONcode• DISCERN• JAMA• SSQC
Readability
• Flesch Reading Ease
• Flesch-Kincaid reading level
Distraction
• Validated distraction index (number of clicks to read article, ads, pop-ups, cookies, ease of navigation)
RESULTS
CROSS SECTIONAL ANALYSIS OF SCOLIOSIS-SPECIFIC INFORMATION ON THE INTERNET: ARE PATIENTS BEING MISINFORMED?
Search Term“Scoliosis”
Yahoo number of hits-
13,500,000
Google number of hits-
10,700,000
Bingnumber of hits-
13,500,000
Top 30 websites selected
Top 30 websites selected
Top 30 websites selected
48 Excluded sites:
-Duplicate=46-Inaccessible=1-Sites closed=1
42 of 90 unique websites evaluated
RESULTS (CONT’D)
CROSS SECTIONAL ANALYSIS OF SCOLIOSIS-SPECIFIC INFORMATION ON THE INTERNET: ARE PATIENTS BEING MISINFORMED?
Average readability was at a 12th grade reading level
OVERALL
Academic, 31%
Health News Outlet, 29%
Healthcare System, 21%
Unspecified, 19%
WEBSITE CATEGORIES
More than 90% of sites were “mobile friendly”
RESULTS (CONT’D)
CROSS SECTIONAL ANALYSIS OF SCOLIOSIS-SPECIFIC INFORMATION ON THE INTERNET: ARE PATIENTS BEING MISINFORMED?
ACCURACY• ~71% of sites were not HONcode certified• Certified sites were associated with higher DISCERN and JAMA scores• Uncertified sites had higher scoliosis-specific content scores
HEALTH NEWS OUTLETS:
• Health News Outlets had the highest rate of HONcode certification• Highest DISCERN and JAMA scores
ACADEMIC SITES: Highest scoliosis-specific content score (SSQC)
RESULTS (CONT’D)
CROSS SECTIONAL ANALYSIS OF SCOLIOSIS-SPECIFIC INFORMATION ON THE INTERNET: ARE PATIENTS BEING MISINFORMED?
READABILITYHONcode certified sites were associated with better readability (written at lower grade level, higher ease of reading)
Health News Outlets were written on a lower grade level and had highest ease of reading scores
Academic sites were the most difficult to read, being written at over a 12th grade level and a reading ease score of 35.9 ±15.9 (overall average: 11.8 ±0.8 grade level, 40.4 ±3.5 reading ease score), but highest rate of physician authorship
CROSS SECTIONAL ANALYSIS OF SCOLIOSIS-SPECIFIC INFORMATION ON THE INTERNET: ARE PATIENTS BEING MISINFORMED?
RESULTS (CONT’D)
DISTRACTION INDEX
2.1
1
2.1
1
2.1
1
0
0.5
1
1.5
2
2.5
3
Health new
s outlet
Academ
ic
Health new
s outlet
Healthcare system
Health new
s outlet
Unspecified
Mean Distraction Index*
RESULTS (CONT’D)
CROSS SECTIONAL ANALYSIS OF SCOLIOSIS-SPECIFIC INFORMATION ON THE INTERNET: ARE PATIENTS BEING MISINFORMED?
HONcode: Health on the net code; JAMA: Journal of American Medical Association
CONCLUSIONS
Despite an increase in the numbers of sites, the quality and accuracy of the information remains questionable.
CROSS SECTIONAL ANALYSIS OF SCOLIOSIS-SPECIFIC INFORMATION ON THE INTERNET: ARE PATIENTS BEING MISINFORMED?
For the iGeneration and their care-givers, the internet remains the most popular source of health-related and medical information.
As clinicians, we should not only help develop high quality sites with more accurate information, but also direct patients to verifiable sites with regulated information.
REFERENCES
1. Allam A, Schulz PJ, Krauthammer M. Toward automated assessment of health Web page quality using the DISCERN instrument. Journal of the American Medical Informatics Association. May 2016:481-487. doi:10.1093/jamia/ocw140.
2. Daraz L, Morrow AS, Ponce OJ, et al. Readability of Online Health Information: A Meta-Narrative Systematic Review. American Journal of Medical Quality. 2018;33(5):487-492. doi:10.1177/1062860617751639.
3. Daraz L, Morrow AS, Ponce OJ, et al. Can Patients Trust Online Health Information? A Meta-narrative Systematic Review Addressing the Quality of Health Information on the Internet. Journal of General Internal Medicine. 2019;34(9):1884-1891. doi:10.1007/s11606-019-05109-0.
4. Hesse BW, Nelson DE, Kreps GL, et al. Trust and Sources of Health Information. Archives of Internal Medicine. 2005;165(22):2618-2624. doi:10.1001/archinte.165.22.2618.
CROSS SECTIONAL ANALYSIS OF SCOLIOSIS-SPECIFIC INFORMATION ON THE INTERNET: ARE PATIENTS BEING MISINFORMED?
THANK YOU
CROSS SECTIONAL ANALYSIS OF SCOLIOSIS-SPECIFIC INFORMATION ON THE INTERNET: ARE PATIENTS BEING MISINFORMED?
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