Appraisal of international, patient-facing resources on heavy menstrual bleeding

This study aimed to systematically evaluate the quality of widely accessible, English language, patient-facing resources on heavy menstrual bleeding (HMB), identifying strengths, gaps, and opportunities for improvement. Resources were obtained from (1) a systematic Google Trends-informed Google search and (2) submissions from subject matter experts. Eligible resources were independently reviewed and scored using validated tools for credibility (QUEST), aesthetics (modified Abbott's scale), and readability. To evaluate clinical utility, resources were graded using a tool designed by international experts for comprehensiveness and accuracy across six domains. Inter-rater reliability was assessed with the intraclass correlation coefficient (ICC) and Cohen's kappa. Of 353 resources identified, 63 met the inclusion criteria. Mean QUEST score (maximum = 28) was 18.7 ± 5.1, with 4/63 (6%) resources meeting all credibility criteria. Mean aesthetics score (maximum = 7) was 5.3 ± 1.1, with only 15/63 (24%) resources with graphics. Most resources (40/63, 64%) were written at a grade 10-12 reading level. Mean comprehensiveness score (maximum = 6) was 4.6 ± 0.8, with gaps most often observed in advice on when to seek emergency care and information about iron deficiency. Mean accuracy score (maximum = 12) was 8.0 ± 2.3, with only 3/63 (13%) resources containing completely accurate content. There was moderate-to-substantial agreement across reviewers (ICC = 0.60-65 for aesthetics credibility; κ = 0.38-49 for accuracy comprehensiveness). In conclusion, most online resources accessed by patients are moderately credible, difficult to read, and underutilize figures. Content gaps exist mainly related to education on safety and iron deficiency. Very few resources are entirely accurate. We recommend targeted revisions to patient education resources to better inform and empower patients experiencing HMB.