Quality and Accessibility of Online Patient Resources for Obstetric Anal Sphincter Injury

Objectives: Prior studies investigating health information quality on the internet, particularly on pelvic floor disorders, have found low quality information. No study has evaluated the health information available regarding obstetric anal sphincter injury (OASI). The aim of this study was to assess the quality and accessibility of information on the internet for patients regarding OASI.

Methods: This cross-sectional study analyzed online OASI health information through a Google search of the following medical and lay terms: “obstetric anal sphincter injury”, “anal sphincter injury”, “perineal laceration”, “vaginal tear”, “perineal tear”, “3rd degree tear”, “third degree tear”, “4th degree tear”, “fourth degree tear”. To account for Google Personalized Search, searches were carried out in 3 geographic locations (Midwest, South and Northeast) and computer search histories and cookies were cleared.

The top twenty websites listed for each term were ranked by the number of geographic locations a site appeared, analyzed, and scored. Quality of information was evaluated using DISCERN score and the Journal of the American Medical Association (JAMA) benchmark criteria. A subset of websites were scored by two reviewers, with the remainder of the scores performed by a single reviewer. Interrater reliability was determined between the reviewers using Cohen κ test. Reading level was determined using the Flesch-Kincaid readability test. DISCERN scores and JAMA criteria of the terms were compared. Mean DISCERN scores were compared using Kruskal-Wallis test.

Results: 111 unique websites were identified. 46.8% (n=52) were directed towards medical professionals, with 34.2% (n=38) being links to research publications. 24.3% (n=27) were patient-facing from health organizations, most of which were from the United Kingdom National Health Service. 9% (n=10) were websites for law firms or selling products and services.

DISCERN scores ranged from 16 to 77. 18% of websites met all 4 JAMA benchmark criteria. The average reading level was 9 for lay terms, and 15 for medical terms. 10.8% (n=12) of websites were not fully accessible without subscriptions to journals or databases, and all these websites were found with the highest reading level terms, “obstetrical anal sphincter injury“ and ”anal sphincter injury”.

Conclusions: OASI health information on the internet is of high quality, but primarily intended for medical professionals. Using terms like "anal sphincter injury" required a 15th-grade reading level. While terms such as “3rd degree tear” and “4th degree tear” resulted in the most patient-facing information, this was associated with a 9th-grade reading level. When discussing OASI with patients, we recommend using distinct terms relating to their injury and directing them to preferred websites that are patient-facing. This study highlights the paucity of broadly-accessible patient-facing OASI educational resources on the internet.