PC2053: Can Spanish Speaking Patients Use Google with Fair and Equitable Results? A International Quality Analysis of Online Resources for Developmental Dysplasia of the Hip in Spanish and English

Background: Over 80% of parents research their child’s orthopaedic diagnosis online, but available information sources are generally of poor quality, and high-quality resources tend to be written above the recommended 6th grade reading level. No comparable data exists regarding the quality and accuracy of health information available online for Spanish-speaking patients, both in the United States (US) and internationally. Therefore, we sought to compare the quality, accuracy and readability of search engine results for developmental dysplasia of the hip (DDH) in English and Spanish.

Methods: A Google search of DDH was performed in English and Spanish in the US and a comparable Spanish-speaking nation in socioeconomic and education levels (Colombia). All websites relating to DDH in children and adolescents from the first three pages of search results were included. Websites were categorized by type (academic, commercial, personal). Quality was assessed utilizing a previously validated method of quantifying inclusion of information deemed significant by POSNA and AAOS guidelines. Accuracy was scored on the validity of information provided. Readability was analyzed using the Flesch-Kincaid score for English or its Spanish equivalent. Each site was reviewed separately by two native speakers of English or Spanish.

Results: Twenty English and 46 Spanish websites were included (21 from the US; 25 from Colombia). The average English website was written at a 10th grade reading level. The Fernandez Huerta reading score was 62.5 and 62.4 (p=0.99) for US Spanish and Colombian websites, respectively. A score of >70 is considered acceptable for adults; lower scores indicate higher complexity. English websites were significantly higher in quality than both US Spanish websites (CI 3.18-8.84, p< 0.001) and all Spanish websites (CI 4.89-9.23, p< 0.001). There was no difference in quality between US Spanish and Colombian websites (CI -0.94-4.85, p= 0.17). English websites had higher accuracy scores compared to both US Spanish websites (OR 8.2, p= 0.014) and all Spanish websites (OR 11.9, p= 0.0042). There was no difference in accuracy between US Spanish and Colombian websites (OR 0.99, p=0.99).

Conclusion: Spanish language websites for DDH in the US and Colombia were of lower quality and accuracy compared to US English websites. Websites in both languages and countries were written at higher reading levels than recommended. This study highlights the need for creating high-quality online resources for families of children with pediatric orthopaedic diagnoses, most presciently for Spanish-speaking patients. Providing comprehensible healthcare resources should be incorporated into practice, and these resources should be made accessible globally.