Accessibility and Decision-Supportive Quality of Benign Breast Disease Articles on Chinese Hospital WeChat Public Accounts: Nationwide Cross-Sectional Study

Abstract Background Shared decision-making (SDM) is critical for managing clinically ambiguous conditions such as benign breast disease (BBD), requiring reliable health information. In China, WeChat public accounts (WPAs) run by hospitals serve as a major health information channel, yet their quality remains unevaluated. Objective This study aimed to evaluate the quality of BBD-related articles on hospital WPAs in China. Methods Using a multistage stratified random sampling approach, we conducted a nationwide survey examining the quality of articles published from January 2020 to November 2024. The articles were evaluated for accessibility (readability, image quality, and user-friendliness) and SDM readiness (credibility, balance, and decision relevance) using validated instruments and content analysis. Results Among 276,617 articles from 158 sampled hospitals, 464 were related to BBD. Accessibility was generally good: 72.4% (336/464) were written at a junior high school reading level. Visual presentation was acceptable, although only 10.2% (42/410) had complete image labeling. The Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P) scores showed moderate understandability (mean 73.6%, SD 17.3%) but limited actionability (mean 50%, SD 23.2%). For SDM readiness, the mean Quality Evaluation Scoring Tool (QUEST) score was 14.9 (SD 4.7) out of 28, with treatment-related articles scoring lower than prevention-related articles ( P <.001). In the balance evaluation, using Brief DISCERN, 84.3% (182/216) of articles were below the high-quality threshold, often lacking information on treatment risks and quality-of-life impacts. Decision relevance revealed variability in surgical recommendations, especially regarding excision criteria and pregnancy-related guidance. Conclusions WPA articles on BBD showed good accessibility but substantial gaps in SDM support, particularly in information balance and decision relevance. Standardized guidelines and quality improvements are needed to enhance patient-centered online health services.