A Multimetric Health Literacy Analysis of Online Resources for Nipple Reconstruction

This study aims to evaluate the accessibility of online health resources for nipple reconstruction in English and Spanish to identify areas of improving information access.

A deidentified Google search was conducted using the search phrase "nipple reconstruction" in English and "reconstrucción del pezón" in Spanish. The first ten websites in English and Spanish were included. A quality assessment of these websites was performed using the Patient Education and Materials Assessment Tool, Cultural Sensitivity Assessment Tool, and Simple Measure of Gobbledygook to evaluate understandability and actionability, cultural sensitivity, and readability, respectively. Unpaired t-tests and Chi-square tests were used to analyze differences between the groups.

English sites scored similarly to Spanish sites on understandability (70.1% versus 71.0%, P = 0.82) and actionability (46.3% versus 37.5%, P = 0.27), although actionability scores were below the acceptable threshold (70%) in both groups. English sites were significantly more culturally sensitive than Spanish sites (60% versus 10%, P < 0.001). English sites had a statistically significant higher average reading grade level compared to Spanish sites (12.3 versus 10.4, P = 0.005); however both groups exceeded recommended reading grade levels for online health resources. For websites from the same organization, English websites tended to be difficult to read; however, more culturally sensitive, compared to Spanish ones.

These findings suggest areas of improvement for culturally competent care for reconstruction patients. Improving the readability of online health resources for nipple reconstruction is essential in enabling patients to create informed decisions about their reconstructed breast.