Assessment of the Quality, Content, and Readability of Freely Available Online Information for Patients Regarding Diabetic Retinopathy

Importance Diabetic retinopathy is a global leading cause of blindness. Patients increasingly use the internet to search for health-related information that may affect medical decision-making, but to date, no standard exists across published websites. Objective To assess the quality, content, and readability of information found online for diabetic retinopathy. Design and Setting This cross-sectional study analyzed 11 medical sites with information on diabetic retinopathy. Twenty-six questions were composed to include information most relevant to patients, and each website was independently evaluated by 1 vitreoretinal surgeon and 2 vitreoretinal fellows. Readability was analyzed using an online readability tool. TheJAMAbenchmarks were used to evaluate the quality of each site. Data were collected from December 2018 to January 2019 and analyzed in February 2019. Main Outcomes and Measures A 26-question survey,JAMAbenchmarks, Flesch reading ease score, Flesch-Kincaid grade level, Gunning Fog Index, Coleman Liau Index, and Simple Measure of Gobbledygook Index. Results The mean (SD) questionnaire score for all websites was 55.76 (13.38) (95% CI, 47.85-63.67) of 104 possible points. There was a difference between the content quality of the websites (H = 25.811,P = .004). The mean (SD) reading grade for all websites was 11.30 (1.79; 95% CI, 10.24-12.36). No correlation was found between content accuracy and the mean reading grade (r = 0.445,P = .17) or Google rank (r = −0.260,P = .43). No website achieved the full 4JAMAbenchmarks, and only 1 website achieved 3 of the 4JAMAbenchmarks. No correlation was found between the accuracy of the content of the website andJAMAbenchmarks (r = 0.422,P = .20). The interobserver reproducibility was similar among the 3 observers (r = 0.87 between observers 1 and 2,r = 0.83 between observers 1 and 3, andr = 0.84 between observers 2 and 3,P  Conclusions and Relevance These findings suggest that freely available information online about diabetic retinopathy varies by source but is generally of low quality. The material presented seems difficult to interpret and exceeds the recommended reading level for health information. Most websites reviewed did not provide sufficient information using the grading scheme used to support the patient in making medical decisions.