Patient Education in the Digital Age: Assessing the Readability, Quality, and Actionability of Keloid Information Online (Preprint)

<sec> <title>BACKGROUND</title> Keloids are chronic fibroproliferative scars that can impair function, cause disfigurement, and affect quality of life. Online patient education materials (PEMs) represent a major source of health information, but their readability, quality, and actionability remain underexplored. </sec> <sec> <title>OBJECTIVE</title> To evaluate the readability, quality, and actionability of publicly available online PEMs addressing keloid treatment, and to assess differences based on authorship (physician vs non-physician) and source type (academic vs commercial). </sec> <sec> <title>METHODS</title> A Google search (January 28, 2025) using the term “keloids” identified the first 30 websites. After applying exclusion criteria, 24 PEMs were analyzed. Readability was assessed using Flesch-Kincaid Grade Level and Flesch Reading Ease. Quality was evaluated using the DISCERN instrument and JAMA benchmarks. Understandability and actionability were measured using the Patient Education Materials Assessment Tool (PEMAT). Interrater reliability was assessed with intraclass correlation coefficients (ICCs). Comparative analyses used independent samples t-tests and Mann–Whitney U tests. </sec> <sec> <title>RESULTS</title> Of 24 PEMs, 11 were authored by physicians, 11 by non-physicians, and 2 with unclear authorship; 13 were academic and 11 commercial. Readability exceeded AMA/NIH recommendations, averaging the 7th–8th grade level. PEMAT scores revealed limited understandability and actionability. DISCERN scores indicated “poor” to “fair” quality, and JAMA benchmarks reflected moderate limitations in transparency. No statistically significant differences were observed between physician- vs non-physician–authored materials or academic vs commercial sources. </sec> <sec> <title>CONCLUSIONS</title> Online PEMs about keloids often fall short of recommended readability, quality, and actionability standards, regardless of authorship or source. Improving accessibility and clarity of PEMs is critical to support informed decision-making, enhance health equity, and empower patients. </sec>