Hostname: page-component-cd9895bd7-gbm5v Total loading time: 0 Render date: 2024-12-25T07:15:07.730Z Has data issue: false hasContentIssue false

The quality, understandability, readability, and popularity of online educational materials for heart murmur

Published online by Cambridge University Press:  26 December 2019

Derya Arslan*
Affiliation:
Department of Pediatric Cardiology, Konya Training and Research Hospital, University of Health Sciences, Konya, Turkey
Mahmut Sami Tutar
Affiliation:
Department of Anesthesiology and Reanimation Clinic, Konya Numune Hospital, Konya, Turkey
Betul Kozanhan
Affiliation:
Department of Anesthesiology and Reanimation Clinic, Konya Education and Research Hospital, University of Health Science, Konya, Turkey
Zafer Bagci
Affiliation:
Department of Pediatrics, University of Health Sciences, Konya Training and Research Hospital, Konya, Turkey
*
Author for correspondence: Derya Arslan, MD, Department of Pediatric Cardiology, Konya Training and Research Hospital, University of Health Sciences, Konya42075, Turkey. Tel: 00. 90. 332. 2415000; Fax: 00. 90. 332. 323 6723; E-mail: [email protected]

Abstract

Objective:

Murmurs are abnormal audible heart sounds produced by turbulent blood flow. Therefore, murmurs in a child may be a source of anxiety for family members. Families often use online materials to explore possible reasons for these murmurs, given the accessibility of information on the Internet. In this study, we evaluated the quality, understandability, readability, and popularity of online materials about heart murmur.

Methods:

An Internet search was performed for “heart murmur” using the Google search engine. The global quality score (on a scale of 1 to 5, corresponding to poor to excellent quality) and Health on the Net code were used to measure the quality of information presented. The understandability of the web pages identified was measured using the Patient Education Materials Assessment Tool (score range from 0 to 100%, scores below 70% reflect poor performance). The readability of each web pages was assessed using four validated indices: the Flesch Reading Ease Score, the Flesch–Kincaid Grade Level, the Gunning Frequency of Gobbledygook, and the Simple Measure of Gobbledygook. The ALEXA traffic tool was used to reference domains’ popularity and visibility.

Results:

We identified 230 English-language patient educational materials that discussed heart murmur. After exclusion, a total of 86 web pages were evaluated for this study. The average global quality score was 4.34 (SD = 0.71; range from 3 to 5) indicating that the quality of information of most websites was good. Only 14 (16.3%) websites had Health on the Net certification. The mean understandability score for all Internet-based patient educational materials was 74.6% (SD = 12.8%; range from 31.2 to 93.7%). A score suggesting these Internet-based patient educational materials were “easy to understand”. The mean readability levels of all patient educational materials were higher than the recommended sixth-grade reading level, according to all indices applied. This means that the level of readability is difficult. The average grade level for all web pages was 10.4 ± 1.65 (range from 7.53 to 14.13). The Flesch–Kincaid Grade level was 10 ± 1.81, the Gunning Frequency of Gobbledygook level was 12.1 ± 1.85, and the Simple Measure of Gobbledygook level was 9.1 ± 1.38. The average Flesch Reading Ease Score was 55 ± 9.1 (range from 32.4 to 72.9).

Conclusion:

We demonstrated that web pages describing heart murmurs were understandable and high quality. However, the readability level of the websites was above the recommended sixth-grade reading level. Readability of written materials from online sources need to be improved. However, care must be taken to ensure that the information of web pages is of a high quality and understandable.

Type
Original Article
Copyright
© Cambridge University Press 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Frank, JE, Jacobe, KM.Evaluation and management of heart murmurs in children. Am Fam Physician 2011; 84: 793800.Google ScholarPubMed
Etoom, Y, Ratnapalan, S.Evaluation of children with heart murmurs. Clin Pediatr (Phila) 2014; 53: 111117.CrossRefGoogle ScholarPubMed
Mesropyan, L, Sanil, Y.Innocent heart murmurs from the perspective of the pediatrician. Pediatr Ann 2016; 45: 306309.CrossRefGoogle ScholarPubMed
McCrindle, BW, Shaffer, KM, Kan, JS, Zahka, KG, Rowe, SA, Kidd, L.Factors prompting referral for cardiology evaluation of heart murmurs in children. Arch Pediatr Adolesc Med 1995; 149: 12771279.CrossRefGoogle ScholarPubMed
Storino, A, Castillo-Angeles, M, Watkins, AA, et al.Assessing the accuracy and readability of online health information for patients with pancreatic cancer. JAMA Surg 2016; 15: 831837.CrossRefGoogle Scholar
De Oliveira, GS Jr, Jung, M, Mccaffery, KJ, McCarthy, RJ, Wolf, MS.Readability evaluation of Internet-based patient education materials related to the anesthesiology field. J Clin Anesth 2015; 27: 401405.CrossRefGoogle ScholarPubMed
Shukla, P, Sanghvi, SP, Lelkes, VM, Kumar, A, Contractor, S.Readability assessment of internet-based patient education materials related to uterine artery embolization. J Vasc Interv Radiol 2013; 24: 469474.CrossRefGoogle ScholarPubMed
AlKhalili, R, Shukla, PA, Patel, RH, Sanghvi, S, Hubbi, B.Readability assessment of internet-based patient education materials related to mammography for breast cancer screening. Acad Radiol 2015; 22: 290295.10.1016/j.acra.2014.10.009CrossRefGoogle ScholarPubMed
Shoemaker, SJ, Wolf, MS, Brach, C.Development of the patient education materials assessment tool (PEMAT): a new measure of understandability and actionability for print and audiovisual patient information. Patient Educ Couns 2014; 96: 395403.10.1016/j.pec.2014.05.027CrossRefGoogle ScholarPubMed
McClure, E, Ng, J, Vitzthum, K, Rudd, R.A mismatch between patient education materials about sickle cell disease and the literacy level of their intended audience. Prev Chronic Dis 2016; 13: 64.CrossRefGoogle ScholarPubMed
Schreuders, EH, Grobbee, EJ, Kuipers, EJ, Spaander, MC, Veldhuyzen van Zanten, SJ.Variable Quality and readability of patient-oriented websites on colorectal cancer screening. Clin Gastroenterol Hepatol 2017; 15: 7985.CrossRefGoogle ScholarPubMed
Boyer, C, Dolamic, L.Automated detection of HONcode website conformity compared to manual detection: an evaluation. J Med Internet Res 2015; 17: 135.CrossRefGoogle ScholarPubMed
Azer, SA, AlOlayan, TI, AlGhamdi, MA, AlSanea, MA.Inflammatory bowel disease: an evaluation of health information on the internet. World J Gastroenterol 2017; 23: 16761696.CrossRefGoogle ScholarPubMed
ALEXA traffic tool. Retrieved November 09, 2018 from https://www.alexa.com/siteinfo [WebCite Cache ID 732VtUJY8].Google Scholar
Hargrave, DR, Hargrave, UA, Bouffet, E.Quality of health information on the Internet in pediatric neuro-oncology. Neuro Oncol 2006; 8: 175182.10.1215/15228517-2005-008CrossRefGoogle ScholarPubMed
Priyanka, P, Hadi, YB, Reynolds, GJ.Analysis of the patient information quality and readability on Esophagogastroduodenoscopy (EGD) on the internet. Can J Gastroenterol Hepatol 2018; 2018: 2849390.CrossRefGoogle ScholarPubMed
Lawrentschuk, N, Sasges, D, Tasevski, R, Abouassaly, R, Scott, AM, Davis, ID.Oncology health information quality on the Internet: a multilingual evaluation. Ann Surg Oncol 2012; 19: 706713.CrossRefGoogle ScholarPubMed
Dee, EC, Lee, G.Adverse effects of radiotherapy and chemotherapy for common malignancies: what is the quality of information patients are finding online? J Cancer Educ 2019 Sep 2. doi: 10.1007/s13187-019-01614-2.CrossRefGoogle Scholar
Patel, SK, Gordon, EJ, Wong, CA, Grobman, WA, Goucher, H, Toledo, P.Readability content, and quality assessment of web-based patient education materials addressing neuraxial labor analgesia. Anesth Analg 2015; 121: 12951300.CrossRefGoogle ScholarPubMed
Hansberry, DR, Agarwal, N, John, ES, et al.Evaluation of internet-based patient education materials from internal medicine subspecialty organizations: will patients understand them? Intern Emerg Med 2017; 12: 535543.CrossRefGoogle Scholar
Ballonoff Suleiman, A, Lin, JS, Constantine, NA.Readability of educational materials to support parent sexual communication with their children and adolescents. J Health Commun 2016; 21: 534543.CrossRefGoogle ScholarPubMed
Patel, CR, Sanghvi, S, Cherla, DV, Baredes, S, Eloy, JA.Readability assessment of internet-based patient education materials related to parathyroid surgery. Ann Otol Rhinol Laryngol 2015; 124: 523527.CrossRefGoogle ScholarPubMed
Walsh, TM, Volsko, TA.Readability assessment of internet-based consumer health information. Respir Care 2008; 53: 13101315.Google ScholarPubMed
Doruk, C, Enver, N, Çaytemel, B, Azezli, E, Başaran, B.Readability, Understandability, and quality of online education materials for vocal fold nodules. J Voice 2018; 1997: 30319–9.Google Scholar
Sabharwal, S, Badarudeen, S, Unes Kunju, S.Readability of online patient education materials from the AAOS web site. Clin Orthop Relat Res 2008; 466: 12451250.CrossRefGoogle ScholarPubMed
Ayyaswami, V, Padmanabhan, D, Patel, M, et al.A readability analysis of online cardiovascular disease-related health education materials. Health Lit Res Pract 2019; 3: 7480.Google ScholarPubMed
Balakrishnan, V, Chandy, Z, Hseih, A, Bui, TL, Verma, SP. Readability and understandability of online vocal cord paralysis materials. Otolaryngol Head Neck Surg 2016; 154: 460464.CrossRefGoogle ScholarPubMed
Berland, GK, Elliott, MN, Morales, LS, et al.Health information on the Internet: accessibility, quality, and readability in English and Spanish. JAMA 2001; 285: 26122621.CrossRefGoogle ScholarPubMed