Quality and Readability of Hearing Aid-Related Websites in English and Spanish.

Objective:  To determine the readability and quality of both English and Spanish Web sites for the topic of hearing aids.

Study design:  Cross-sectional Web site analysis.

Setting:  Various online search engines.

Methods:  The term "hearing aid" was queried across four popular search engines. The first resulted 75 English Web sites and first resulted 75 Spanish Web sites were extracted for data collection. Web sites that met the inclusion criteria were stratified by the presence of a Health on the Net Code (HONCode) certificate. Articles were then compiled to be independently reviewed by experts on hearing aids, using the DISCERN criteria, which allowed assessment of the quality of the Web sites. Readability was assessed by calculating the Flesch Reading Ease Score in English and the Fernandez Huerta Formula in Spanish. Readability and quality were both analyzed, comparing scores to their respective language and cross-comparing.

Results:  There were 37 English Web sites and 30 Spanish Web sites that met inclusion criteria. When analyzing readability, English Web sites were determined to be significantly more difficult to read (average = 55.37, standard deviation [SD] = 7.73, 95% confidence interval [CI] = 52.9-57.9) than the Spanish Web site counterparts (average = 58.64, SD = 5.26, 95% CI = 56.8-60.5, p = 0.035). For quality, Spanish Web sites (average = 38, SD = 9.7, 95% CI = 34.5-41.5) were determined to be of significantly higher quality than English Web sites (average = 32.16, SD = 10.60, 95% CI = 29.7-34.6). Additionally, there was a significant difference between the non-HONCode English Web sites versus the non-HONCode Spanish Web sites (p = 0.0081), signifying that Spanish non-HONCode certified Web sites were less reliable than non-HONCode certified English Web sites.

Discussion:  The present study highlights the importance and necessity of providing quality, readable materials to patients seeking information regarding hearing aids. This study shows that both English and Spanish Web sites are written at a level that is much higher than the American Medical Association (AMA)-recommended sixth-grade reading level, and no Web site included in this study fell at or below the AMA-recommended sixth-grade reading level. English and Spanish Web sites also lacked consistency and quality, as evidenced by their wide variability in DISCERN scores. Specifically, Hispanic patients are more likely to suffer long-term consequences of their health care due to low levels of health literacy. It is important to bridge this gap by providing adequate reading materials. It is especially important to provide evidence-based claims that are directly supported by experts in the field.