The Accessibility, Readability, and Quality of Online Resources for Gender Affirming Surgery

• Published in: The Journal of surgical research 2017-09, Vol.217, p.198-206
• Main Authors: Vargas, Christina R., MD, Ricci, Joseph A., MD, Lee, Michelle, MD, Tobias, Adam M., MD, Medalie, Daniel A., MD, Lee, Bernard T., MD, MBA, MPH
• Format: Article
• Language: English
• Subjects: Access to Information; Comprehension; Female; Health literacy; Humans; Internet - statistics & numerical data; Male; Readability; Reconstructive surgery; Sex Reassignment Surgery; Surgery; Transgender surgery
• ISSN: 0022-4804; 1095-8673
• 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 ten relevant hits were identified. Readability was assessed using ten established tests: Coleman-Liau, Flesch-Kincaid, FORCAST, Fry, Gunning Fog, New Dale-Chall, New Fog Count, Raygor Estimate, SMOG, and Flesch Reading Ease. Quality was assessed using JAMA 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 website reading levels ranged from 12.0 to 17.5. All articles and websites exceeded the recommended 6th grade level. Quality ranged from 0-4 (JAMA) and 35-79 (DISCERN) across websites. Conclusions Websites 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 website 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.