Johnson Anna Rose, Doval Andres F, Egeler Sabine A, Lin Samuel J, Lee Bernard T, Singhal Dhruv
From the Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA.
Ann Plast Surg. 2019 Mar;82(3):255-261. doi: 10.1097/SAP.0000000000001762.
Breast cancer is a leading cause of death in US Hispanic females. This demographic is more likely to present with later-stage disease and require more extensive surgical treatment, including axillary lymph node dissection, which increases risk of lymphedema. The Spanish-speaking Hispanic population has a lower health literacy level and requires materials contoured to their unique needs. The aim of this study was to evaluate online Spanish lymphedema resources.
A web search using the Spanish term "linfedema" was performed, and the top 10 websites were identified. Each was analyzed using validated metrics to assess readability, understandability, actionability, and cultural sensitivity using the SOL (Simplified Measure of Gobbledygook, Spanish), Patient Education and Materials Assessment for Understandability and Actionability (Patient Education and Assessment Tool), and Cultural Sensitivity and Assessment Tool (CSAT), respectively. Online materials were assessed by 2 independent evaluators, and interrater reliability was determined.
Online lymphedema material in Spanish had a mean reading grade level of 9.8 (SOL). Average understandability and actionability scores were low at 52% and 36%, respectively. The mean CSAT was 2.27, below the recommended value of 2.5. Cohen κ for interrater reliability was greater than 0.81 for the Patient Education and Assessment Tool and CSAT, suggesting excellent agreement between raters.
Available online Spanish lymphedema resources are written at an elevated reading level and are inappropriate for a population with lower health literacy levels. As patients continue to use the internet as their primary source for health information, health care entities must improve the quality of provided Spanish resources in order to optimize patient comprehension.
乳腺癌是美国西班牙裔女性死亡的主要原因。这一人群更有可能出现晚期疾病，需要更广泛的手术治疗，包括腋窝淋巴结清扫术，这会增加淋巴水肿的风险。讲西班牙语的西班牙裔人群健康素养水平较低，需要符合其独特需求的资料。本研究的目的是评估在线西班牙语淋巴水肿资源。
使用西班牙语术语“linfedema”进行网络搜索，确定排名前十的网站。分别使用经过验证的指标（即使用SOL（西班牙语简化行话度量）、患者教育与可理解性及可操作性材料评估工具（患者教育与评估工具）和文化敏感性与评估工具（CSAT））对每个网站进行分析，以评估其可读性、可理解性、可操作性和文化敏感性。在线资料由两名独立评估人员进行评估，并确定评分者间信度。
西班牙语在线淋巴水肿资料的平均阅读年级水平为9.8（SOL）。平均可理解性和可操作性得分较低，分别为52%和36%。平均CSAT为2.27，低于推荐值2.5。患者教育与评估工具和CSAT的评分者间信度的Cohen κ大于0.81，表明评分者之间具有高度一致性。
现有的在线西班牙语淋巴水肿资源的写作水平较高，并不适用于健康素养水平较低的人群。由于患者继续将互联网作为其健康信息的主要来源，医疗保健机构必须提高所提供西班牙语资源的质量，以优化患者的理解。
