Online Patient Health Resources in Nonmelanoma Skin Cancer: An Assessment of Readability, Quality, and Comprehensiveness

Abstract

Background: Nonmelanoma skin cancer (NMSC), the most prevalent skin cancer, affects over 3 million in the United States annually. Although most patients search for health information on the internet, the readability and quality of NMSC online resources is unknown.
 Objective: We examine the readability, quality, and comprehensiveness of content in NMSC websites.
 Methods: Top 50 Google search results for “nonmelanoma skin cancer”, “basal cell skin cancer”, and “squamous cell skin cancer” were evaluated. Advertisements, blogs, scientific articles, and non-comprehensive, professional, and irrelevant sites were excluded. Six readability scales assessed readability. JAMA Benchmark and Discern Instrument assessed quality. Content was evaluated for comprehensiveness. Pearson’s correlation examined the relationship between readability and quality.
 Results: Seventy-nine websites met inclusion criteria. Average readability level was 11th grade (range 6.8-17.9). No websites met the full criteria of JAMA Benchmark. Only 16.4% had “good”/“excellent” quality per Discern Instrument. Quality and readability scores were not correlated. Most websites discussed risk factors (87.3%), prevention (73.4%), and surgical (87.3%) and nonsurgical (82.3%) treatments. 50.6% included skin cancer images, of which only 17.5% were of skin of color patients.
 Conclusion: Online NMSC resources need improved readability, quality, and diversity in their representation of skin types.