Evaluating online patient education materials for liver cirrhosis

Background & aims: Liver cirrhosis affects 4.5 million adults in the United States (US). As more patients educate themselves online, we evaluated the accessibility, quality, understandability, accuracy, readability, and comprehensiveness (AQUA-RC) of online patient education materials for cirrhosis. Methods: Cross-sectional analysis using Google^® and YouTube^® on a cleared internet browser from 12 cities across the US. The authors independently reviewed the top 25 search results from each platform using search terms “liver cirrhosis” and “cirrhosis”. Accessibility was evaluated from twelve cities in six regions across the US. We evaluated resource quality using the DISCERN score, understandability using the PEMAT score, readability using the Flesch-Kinkaid score, and accuracy/comprehensiveness using a list of author-generated criteria. AQUA-RC was compared between 1) academic websites (AW) vs. non-academic websites (NAW), and 2) websites vs. YouTube^® videos. Results: 28 websites and 25 videos were included. Accessibility was equal across all regions. Websites had higher average quality scores than videos, although this was not statistically significant (p = 0.84). Websites were more understandable than videos (p < 0.00001). Both websites and videos were 100% accurate. Readability for websites was higher than recommended standards. Websites were more comprehensive than videos (p = 0.02). Conclusion: Online patient education materials for cirrhosis in the US are equally accessible, but readability and understandability are too complex. Websites are of greater quality, accuracy, and comprehensiveness than YouTube videos, which are often narrowly focused and targeted at the medical community rather than patients. Further efforts should be made to improve online patient education and expand content across platforms.