Male infertility websites: what are our patients reading?

Abstract

People ages 20-45 years (reproductive age) have been shown to use the Internet as a source of health information more frequently than their older counterparts. We sought to evaluate the quality and readability of highly visible websites on male infertility. Structured website review. Using Google, the first 60 relevant websites from the search “male infertility” were classified by source and analyzed. Content was evaluated by 4 blinded reviewers. We chose Google because it is the most widely used search engine, comprising 74.5% of Internet searches. Website quality of information was evaluated using the DISCERN score (assesses the quality of written information on treatment choices for a health problem), JAMA benchmark criteria (uses four core standards to evaluate web sites: authorship, attribution, disclosure, currency), and Health on the Net code (HONcode) accreditation status (assesses the reliability and credibility of online information). Readability was assessed using the Dale-Chall and Flesh Reading Ease indexes. Websites were classified as: 43% hospital based, 12% fertility clinic based, 5% other clinic based, 33% society/association based, and 7% government based. The mean total DISCERN score was 44 ± 12 (maximum score 80). 75% (45/60) of websites had clear aims or achieved their aims (scores of 4 or 5 [good]), but only 15% (9/60) described areas of clinical uncertainty. 25% (15/60) described the benefits of treatments, but only 5% (3/60) described the risks of treatments. 72% (43/60) provided unbiased information. 68% (41/60) websites made it clear that there was more than one possible treatment choice. 27% (16/60) of websites encouraged shared decision making. Overall, 60% (36/60) of websites were “poor quality” (score 1-2-3) on the final question of the DISCERN instrument. Only 4/60 (6.7%) websites met all four JAMA benchmark criteria. The mean Dale-Chall score was 9.53 +/- 1.30, indicating a college or graduate degree level of readability. The mean Flesh Reading Ease index was 34.01 +/- 16.26, indicating a graduate degree level of readability. 20% (12/60) of websites were HONcode certified. Websites on “male infertility” are of low quality, and only 6.7% met JAMA benchmark criteria. Minimal information on treatments was present, with only 25% of websites describing treatment benefits, but only 5% describing treatment risks. Only 15% of websites described areas of clinical uncertainty. Despite that these websites were written at a college to graduate degree level of reading, only 27% encouraged shared decision making. Reassuringly, most of these websites were hospital based, and 72% provided unbiased information. Patients should be cautioned that incomplete and potentially biased information on male infertility is prevalent online.