Consulting Dr. Google: Quality of Online Resources About Tympanostomy Tube Placement

Vandra C. Harris, Anne R. Links, Paul Hong, Jonathan Walsh, Desi P. Schoo, David E Tunkel, Charles Matthew Stewart, Emily Boss

Research output: Contribution to journalArticle

Abstract

Objective: Tympanostomy tube (TT) placement is common in children; however, family-centeredness and utility of online information used for decision making and understanding is unknown. We evaluate the quality of leading Internet resources describing TT placement. Study Design: Cross-sectional descriptive design. Methods: We performed a Google (Menlo Park, CA) search for terms related to TTs. We defined quality using scaled readability measures (Flesch Reading Ease and Flesch-Kincaid Grade-Level), understandability and actionability (Patient Education Materials Assessment Tool), shared decision-making centrality (Center for Medicare and Medicaid Services informed consent guidelines), and clinical practice guideline (CPG) compatibility. Three reviewers coded each measure. Fleiss κ interrater reliability analysis was performed. Results: Ten most frequently encountered websites were analyzed. One of 10 met national health literacy standards (mean 10th-grade level reading, median 9th, range 6-15th). All sites were understandable (mean understandability 81.9%, range 73%-92%). Most had low actionability scores (7 of 10, median 47%, mean 44.6%, range 0-80). Shared decision-making centrality was high (mean 5, range 4-6), but most did not list alternative treatment options. Although CPG compatibility was high (mean 3.4, range 1-4), many websites contained inconsistent recommendations about tube duration, follow-up, and water precautions. There was inter-rater agreement for understandability scoring (κ = 0.20; P = 0.02). Conclusion: Internet resources about TT placement vary in quality pertaining to health literacy, principles of shared decision making, and consistency with practice guidelines. With growing emphasis on patient-/family-centered engagement in healthcare decision making, standardization of content and improved usability of educational materials for common surgical procedures in children such as tympanostomy tube placement should be a public health priority.

Original languageEnglish (US)
JournalLaryngoscope
DOIs
StateAccepted/In press - 2017

Fingerprint

Middle Ear Ventilation
Decision Making
Practice Guidelines
Health Literacy
Internet
Reading
Centers for Medicare and Medicaid Services (U.S.)
Health Priorities
Patient Education
Informed Consent
Public Health
Cross-Sectional Studies
Guidelines
Delivery of Health Care
Water

Keywords

  • Actionability
  • Clinical practice guidelines
  • Health literacy
  • Internet
  • Patient education
  • Patient education materials
  • Patient Education Materials Evaluation Tool (PEMAT)
  • Quality improvement
  • Readability
  • Readability formula
  • Shared decision making
  • Tympanostomy tubes
  • Understandability

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Consulting Dr. Google : Quality of Online Resources About Tympanostomy Tube Placement. / Harris, Vandra C.; Links, Anne R.; Hong, Paul; Walsh, Jonathan; Schoo, Desi P.; Tunkel, David E; Stewart, Charles Matthew; Boss, Emily.

In: Laryngoscope, 2017.

Research output: Contribution to journalArticle

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title = "Consulting Dr. Google: Quality of Online Resources About Tympanostomy Tube Placement",
abstract = "Objective: Tympanostomy tube (TT) placement is common in children; however, family-centeredness and utility of online information used for decision making and understanding is unknown. We evaluate the quality of leading Internet resources describing TT placement. Study Design: Cross-sectional descriptive design. Methods: We performed a Google (Menlo Park, CA) search for terms related to TTs. We defined quality using scaled readability measures (Flesch Reading Ease and Flesch-Kincaid Grade-Level), understandability and actionability (Patient Education Materials Assessment Tool), shared decision-making centrality (Center for Medicare and Medicaid Services informed consent guidelines), and clinical practice guideline (CPG) compatibility. Three reviewers coded each measure. Fleiss κ interrater reliability analysis was performed. Results: Ten most frequently encountered websites were analyzed. One of 10 met national health literacy standards (mean 10th-grade level reading, median 9th, range 6-15th). All sites were understandable (mean understandability 81.9{\%}, range 73{\%}-92{\%}). Most had low actionability scores (7 of 10, median 47{\%}, mean 44.6{\%}, range 0-80). Shared decision-making centrality was high (mean 5, range 4-6), but most did not list alternative treatment options. Although CPG compatibility was high (mean 3.4, range 1-4), many websites contained inconsistent recommendations about tube duration, follow-up, and water precautions. There was inter-rater agreement for understandability scoring (κ = 0.20; P = 0.02). Conclusion: Internet resources about TT placement vary in quality pertaining to health literacy, principles of shared decision making, and consistency with practice guidelines. With growing emphasis on patient-/family-centered engagement in healthcare decision making, standardization of content and improved usability of educational materials for common surgical procedures in children such as tympanostomy tube placement should be a public health priority.",
keywords = "Actionability, Clinical practice guidelines, Health literacy, Internet, Patient education, Patient education materials, Patient Education Materials Evaluation Tool (PEMAT), Quality improvement, Readability, Readability formula, Shared decision making, Tympanostomy tubes, Understandability",
author = "Harris, {Vandra C.} and Links, {Anne R.} and Paul Hong and Jonathan Walsh and Schoo, {Desi P.} and Tunkel, {David E} and Stewart, {Charles Matthew} and Emily Boss",
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AU - Harris, Vandra C.

AU - Links, Anne R.

AU - Hong, Paul

AU - Walsh, Jonathan

AU - Schoo, Desi P.

AU - Tunkel, David E

AU - Stewart, Charles Matthew

AU - Boss, Emily

PY - 2017

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N2 - Objective: Tympanostomy tube (TT) placement is common in children; however, family-centeredness and utility of online information used for decision making and understanding is unknown. We evaluate the quality of leading Internet resources describing TT placement. Study Design: Cross-sectional descriptive design. Methods: We performed a Google (Menlo Park, CA) search for terms related to TTs. We defined quality using scaled readability measures (Flesch Reading Ease and Flesch-Kincaid Grade-Level), understandability and actionability (Patient Education Materials Assessment Tool), shared decision-making centrality (Center for Medicare and Medicaid Services informed consent guidelines), and clinical practice guideline (CPG) compatibility. Three reviewers coded each measure. Fleiss κ interrater reliability analysis was performed. Results: Ten most frequently encountered websites were analyzed. One of 10 met national health literacy standards (mean 10th-grade level reading, median 9th, range 6-15th). All sites were understandable (mean understandability 81.9%, range 73%-92%). Most had low actionability scores (7 of 10, median 47%, mean 44.6%, range 0-80). Shared decision-making centrality was high (mean 5, range 4-6), but most did not list alternative treatment options. Although CPG compatibility was high (mean 3.4, range 1-4), many websites contained inconsistent recommendations about tube duration, follow-up, and water precautions. There was inter-rater agreement for understandability scoring (κ = 0.20; P = 0.02). Conclusion: Internet resources about TT placement vary in quality pertaining to health literacy, principles of shared decision making, and consistency with practice guidelines. With growing emphasis on patient-/family-centered engagement in healthcare decision making, standardization of content and improved usability of educational materials for common surgical procedures in children such as tympanostomy tube placement should be a public health priority.

AB - Objective: Tympanostomy tube (TT) placement is common in children; however, family-centeredness and utility of online information used for decision making and understanding is unknown. We evaluate the quality of leading Internet resources describing TT placement. Study Design: Cross-sectional descriptive design. Methods: We performed a Google (Menlo Park, CA) search for terms related to TTs. We defined quality using scaled readability measures (Flesch Reading Ease and Flesch-Kincaid Grade-Level), understandability and actionability (Patient Education Materials Assessment Tool), shared decision-making centrality (Center for Medicare and Medicaid Services informed consent guidelines), and clinical practice guideline (CPG) compatibility. Three reviewers coded each measure. Fleiss κ interrater reliability analysis was performed. Results: Ten most frequently encountered websites were analyzed. One of 10 met national health literacy standards (mean 10th-grade level reading, median 9th, range 6-15th). All sites were understandable (mean understandability 81.9%, range 73%-92%). Most had low actionability scores (7 of 10, median 47%, mean 44.6%, range 0-80). Shared decision-making centrality was high (mean 5, range 4-6), but most did not list alternative treatment options. Although CPG compatibility was high (mean 3.4, range 1-4), many websites contained inconsistent recommendations about tube duration, follow-up, and water precautions. There was inter-rater agreement for understandability scoring (κ = 0.20; P = 0.02). Conclusion: Internet resources about TT placement vary in quality pertaining to health literacy, principles of shared decision making, and consistency with practice guidelines. With growing emphasis on patient-/family-centered engagement in healthcare decision making, standardization of content and improved usability of educational materials for common surgical procedures in children such as tympanostomy tube placement should be a public health priority.

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KW - Quality improvement

KW - Readability

KW - Readability formula

KW - Shared decision making

KW - Tympanostomy tubes

KW - Understandability

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