Literacy Analysis of Spanish Online Resources for Breast Reconstruction

Background: Health literacy studies indicate that literacy skills are linked to access to information and health outcomes, potentially contributing to health disparities. In the United States, minority and immigrant populations are more likely to have lower literacy skills than are other population groups. The aim of this study is to evaluate web-based health information prepared in Spanish for Hispanic women considering breast reconstruction surgery. Methods: A search for the term reconstruction de seno (translation: breast reconstruction) was conducted using Google. The 10 most easily accessible institutional/academic websites and media/private web sites were identified. Each web site was assessed for readability, understandability/actionability, suitability, cultural sensitivity, numeracy, and for website content organization and navigation. Two independent raters evaluated understandability/actionability, suitability, and cultural sensitivity. Results: Readability analysis revealed higher than recommended scores (above ninth grade) for institutional/academic and media/private websites with no significant difference. When comparing institutional/academic and media/private websites, scores were adequate with no differences for understandability (50.6% and 47.1%, respectively; P = 0.53), suitability (50.2% vs 49.7%, respectively; P = 0.92), and cultural sensitivity (P = 0.31), whereas actionability scores were low at 18% and 14%, respectively (P = 0.67). In terms of numeracy analysis, most websites were in the less complex area of the hierarchy matrix. Conclusions: Available breast reconstruction online resources for the Spanish-speaking population are rated too high for readability. Suitability, understandability, and cultural sensitivity scores are adequate; however, actionability scores are low, indicating potential areas for improvement. These findings demonstrate an opportunity to correct disparities in the literature on breast reconstruction for the Spanish-speaking population.