A growing number of patients use online patient decision aids (PtDAs) due to their easy accessibility. To serve their purpose of assisting patients in shared decision making, PtDAs should meet the NIH recommendation that readability of all patient educational materials be no greater than a 6th grade reading level. However, PtDAs that are found on the Internet are not regulated and vary in their readability and quality. The aim of this study is to determine the readability and quality of online PtDAs for benign urologic conditions including pelvic organ prolapse, urinary incontinence, overactive bladder, and benign prostate hyperplasia.

The four urologic conditions were entered into the Google search engine, and the first two pages of the search results were used for the study. Thirty-one PtDAs met the inclusion criteria of being patient-oriented and being informative about the condition and treatment options without having misleading claims about any services or products. The PtDAs were analyzed using five readability assessment tools: Coleman Liau Index (CLI), Flesch-Kincaid (FKI), Automated Readability Index (ARI), Simple Measure of Gobbledygook (SMOG), and Gunning Fog Index (GFI). An average of the five scores were taken for each PtDA to calculate the percentage of PtDAs meeting the readability requirements. In addition, the validated DISCERN instrument, a health-information specific tool assessing reliability, dependability and trustworthiness, was used to judge the overall quality of the PtDAs.

The average readability score of all thirty-one PtDAs was 11.58 grade level with a standard deviation of 1.98. None met the NIH recommendation of being at or below the sixth grade level, but four were at or below the eighth grade level, the average reading level of Americans. The average DISCERN score was 46.8 with a standard deviation of 8.6, which is classed as ‘fair.’ While 39% were classed as ‘good,’ none was classed as ‘excellent.’

The result of this study indicates that on average, the PtDAs are written at five grade levels above the recommended reading levels and three grade levels above the reading level of an average American. This is particularly concerning given the elderly population possess a lower literacy level, yet a higher risk for the four urologic conditions examined in the study. In addition, the average DISCERN score was 46.8, which is classed as ‘fair’. Given that the score ranges from 16 to 75 points, with the range 64 to 75 points classed as ‘excellent,’ the PtDAs have room for improvement in terms of overall quality.

None of the online PtDAs met the recommended readability guidelines, and on average, they were of moderate quality. Such shortcomings limit the overall utility of the PtDAs. Continued efforts are needed to improve the readability and the quality of online PtDAs.