Quality and Readability of Online Health Information on Hallux Valgus

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: Hallux valgus, also known as a bunion, is a deformity resulting in a bony prominence on the medial side of the metatarsophalangeal joint, affecting nearly one third of adults in the United States. Patients often report pain, swelling, and lack of mobility around the affected joint, leading to difficulty in walking and wearing shoes. As with most common medical conditions, patients with bunions are encouraged to seek additional information from online sources. To date, no study has analyzed the quality of online health resources for this condition and how readable they are for the general population. The purpose of our study was to evaluate the quality and readability of online sources pertaining to hallux valgus. Methods: Google and Bing were searched using “hallux valgus” and “bunion” in incognito mode with location settings off. Two co-investigators independently scored each website using the DISCERN questionnaire and Flesch-Kincaid readability scores, with discrepancies resolved by a third investigator. DISCERN, a validated tool, assesses consumer health information quality across 16 questions, each scored from 1 (No) to 5 (Yes), with the final question rating overall publication quality. Readability was evaluated using the Flesch-Kincaid Grade Level, which estimates the U.S. grade level required for comprehension, and the Reading Ease score (0-100), where higher scores indicate easier readability. A one-way ANOVA compared DISCERN and readability scores across three website categories: Academic/Research, Health Institutions, and Other. Correlation coefficients were calculated to assess relationships between DISCERN scores and readability metrics. Results: Among 38 websites, Academic/Research sites had the highest DISCERN score (52.09) vs. Health Institutions (39.53; p=0.0312). Health Institution websites scored lowest on clarity of sources (1.53 vs. 3.42; p=0.0081) and date of information (1.67 vs. 3.67; p=0.0063). Academic/Research sites had the highest clarity on treatment benefits (4.09 vs. 2.8; p=0.0087) and overall quality (3.36 vs. 2.92; p=0.0128). Average readability was 9.25th grade, with Health Institutions having the lowest grade level (7.75 vs. 10.6; p=0.0096) and highest Reading Ease (60.93 vs. 44.39; p=0.0203). DISCERN correlated with Grade Level (r=0.5) and Reading Ease (r=-0.51), showing that higher-quality information was harder to read for the general population. Conclusion: Online health information on hallux valgus varies in quality and readability, with higher-quality content often being more difficult to read for the general population. Academic/Research websites provide the most reliable information but require a higher reading level, while Health Institution websites are more accessible but lack transparency in source citation and information currency. The inverse relationship between quality and readability suggests a trade-off that may hinder patient comprehension. These findings emphasize the need for improved online health materials that balance accuracy with accessibility to better support patient education and informed decision-making.