Introduction:

Hispanic women pursue breast augmentation surgery more than any other minority group.1 Additionally, breast implant removals increased by 34.4% in 2019 and by 8% in 2020, perhaps due to rising concerns for breast implant-associated anaplastic large cell lymphoma.2 However, this trend may not be reflected in all racial segments. Patient education materials (PEMs) with advanced readability can limit Hispanic patients’ health literacy and understanding of treatment plans, increasing barriers to breast implant removal and worsening health outcomes. When compared to non-Hispanic Whites, Hispanics attain less highschool and college education, have less household income, and face higher poverty rates.3 These factors negatively influence health literacy. Despite the National Institutes of Health recommending PEMs be written at the 6th-7th grade readability level, online PEMs are often difficult to read. This study assessed and compared the readability of Spanish and English online breast implant removal PEMs.


Methods:

The English and Spanish terms “breast implant removal” and “extracción de implantes mamarios” were queried on Google and the first fifty Uniform Resource Locators (URLs) for each search term were selected. Included resources were non-video, free articles. Each URL was categorized into private business (private clinics, independent practice), institutional (governmental agencies, medical schools/teaching hospitals, medical sources), and academic (journal article, book chapter) groups. To ensure analyses provided useful insights into resources used by patients rather than surgeons, academic articles were regarded as a separate entity and analyzed independently. Readability scores were generated using the Simple Measure of Gobbledygook (SMOG) and the Spanish SMOG scales.


Results:

PEMs published by private businesses comprised the majority (> 60%) of both English and Spanish articles. Overall, online breast implant removal PEMs surpassed recommended reading levels in both English (x̄ = 12.2, highschool senior) and Spanish (x̄ = 11.0, high school junior). Among PEMs in the private business category, those written in English were more difficult to read than Spanish (p < 0.00001). As a whole, English PEMs were similarly more difficult to read than Spanish PEMs (p < 0.00001, excluding academic). There were no significant differences in readability when comparing English and Spanish institutional PEMs, English private business and English institutional PEMs, or Spanish private business and Spanish institutional PEMs.


Conclusion:

Our findings show that the readability of English and Spanish materials for breast implant removal exceeds recommended levels. This discrepancy may have ramifications for certain groups as breast implant removal is a procedure that can have significant cosmetic and psychological impacts.4 It is vital that these patients are provided with educational material appropriate to their literacy level in order for them to understand the procedure, its implications, and indications. Additionally, the significant proportion of PEMs authored by private businesses may be concerning due to an inherent self-serving bias. Online information for breast implant removals should be revised and/or standardized materials should be created by healthcare providers and national organizations in order to more fully educate the public and prospective patients prior to intervention.

Are Difficult to Read Patient Education Materials Problematic? A Readability Assessment of Online Patient Education Resources Related to Breast Implant Removal and Breast Implant Illness.

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