Background/Purpose:

OA is the most common cause of disability in people >65 years old.

Most patients in the USA use the internet for healthcare information. The quality and readability of this is variable. Guidelines state health information for the general public should be at a 7– 8^th grade reading level.

Health on the Net Foundation Code of Conduct (HONcode) is a well-known quality label for medical and health websites. The DISCERN instrument and JAMA Benchmark criteria are standardized validated tools to assess healthcare information quality. In 2003, online OA information was graded as “poor” by DISCERN. This study reviews the quality and readability of current online OA information.

Methods:

We searched the term “osteoarthritis” on the three most popular (>99%) search engines in the USA (Google, Bing and Yahoo). Research has shown patients are unlikely to search beyond 25 pages. Thus, the 25 most-viewed websites, excluding paid adds, on each search engine were included.

Age of content, content producer, author characteristics and HONcode status were noted. Website quality was evaluated using DISCERN and JAMA criteria. Readability was measured using three validated scoring systems: Flesch Reading Ease Score, Flesch-Kincaid Grade Level and Gunning-Fog Index.

Mean website age, JAMA benchmark criteria and DISCERN score for each website were reviewed with one-way analysis of variance (ANOVA). Analysis was performed by Prism 7 (GraphPad Software). Significance was set at p <0.05.

Results:

Of 75 articles, 38 met exclusion criteria. 31 were duplicate websites;3 non-text pages;2 paywall protected websites; 2 inaccessible for geographic reasons. 37 websites were suitable for analysis.

For 23 websites, author/reviewers were not reported. Reported authors/reviewers were doctors (n=8), other health professionals (n=3), non-specified medical staff (n=1) or non-medical author (n=2). Website characteristics are shown in Table 1.

One website met all four JAMA Criteria. Mean DISCERN quality of information for OA websites was “fair”.

There was a significant difference in quality between author types (ANOVA r²=0.24, p=0.028). Non-doctor health professional authors scoring the highest and non-medical authors scoring the lowest. HONCode endorsed websites (n=16) were of a statistically significantly higher quality.

Readability varied by assessment tool from 8^th to 12^th grade level.

Conclusion:

Quality of online health information for OA is “fair”, an improvement from 2003. Readability was equal to or more difficult than recommendations. HONcode certification was indicative of higher quality, but not readability.

Summary of Results

All results are mean values

JAMA=Journal of the American Medical Association HONcode=Health On the Net certification NGO=Non-governmental organisation FRES=Flesch Reading Ease Score FKGL=Flesch-Kincaid Grade Level GFI=Gunning-Fog Index