Nguyen Antoinette T, Li Rena A, Galiano Robert D
Department of Plastic Surgery, University of Rochester School of Medicine and Dentistry, Rochester, NY 14620, United States.
Department of Plastic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, United States.
J Sex Med. 2025 May 10;22(5):951-960. doi: 10.1093/jsxmed/qdaf075.
Gender-affirming surgeries significantly improve the well-being of transgender and gender-diverse individuals. However, patients often rely on online patient education materials (OPEMs) to navigate surgical options, making readability, quality, and accessibility critical factors in informed decision-making.
The objective of this study is to evaluate the readability, quality, and accessibility of online patient education materials related to gender-affirming surgeries.
This systematic review analyzed nine studies evaluating 898 OPEMs related to gender-affirming surgeries and transgender voice care. Readability was assessed using Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG), and Flesch Reading Ease Score (FRES), while quality was evaluated using DISCERN and the Patient Education Materials Assessment Tool. A meta-analysis synthesized readability scores, and qualitative trends were examined to assess readability-quality trade-offs.
OPEMs consistently exceeded the recommended 6th-grade reading level, with a pooled FKGL mean of 12.49 (95% CI: 12.41-12.57), indicating high school to university-level complexity. SMOG scores averaged 11.89 (95% CI: 11.79-11.99), suggesting materials required at least some college education. FRES scores (mean: 37.49, 95% CI: 37.17-37.80) classified most materials as "difficult" to "very difficult" to read. Healthcare-affiliated websites had significantly higher FKGL scores than non-healthcare sources (P < 0.01). DISCERN scores were highly variable, with 68.33% of facial feminization materials rated poor or very poor. Physician-created TikTok content scored higher in reliability (P < 0.001) but had lower engagement than non-physician videos. Spanish-language materials were slightly more readable (SMOG 11.7 vs. 14.2 in English) but less available.
Most OPEMs for gender-affirming care fail to meet health literacy guidelines, limiting accessibility. To improve patient comprehension, materials should be simplified without sacrificing accuracy, incorporate multimedia tools, and undergo usability testing. Standardized, trans-affirming, and linguistically inclusive resources are essential for equitable access and informed decision-making.
性别确认手术能显著改善跨性别者和性别多样化者的幸福感。然而，患者通常依靠在线患者教育材料（OPEMs）来了解手术选择，这使得可读性、质量和可获取性成为明智决策的关键因素。
本研究的目的是评估与性别确认手术相关的在线患者教育材料的可读性、质量和可获取性。
本系统评价分析了9项研究，这些研究评估了898份与性别确认手术和跨性别者嗓音护理相关的OPEMs。使用弗莱什-金凯德年级水平（FKGL）、简单费解度测量法（SMOG）和弗莱什阅读易度得分（FRES）评估可读性，同时使用DISCERN和患者教育材料评估工具评估质量。进行荟萃分析以综合可读性得分，并检查定性趋势以评估可读性与质量之间的权衡。
OPEMs始终超过推荐的6年级阅读水平，汇总的FKGL平均值为12.49（95%CI：12.41 - 12.57），表明具有高中到大学水平的复杂性。SMOG得分平均为11.89（95%CI：11.79 - 11.99），表明材料至少需要一些大学教育水平才能理解。FRES得分（平均值：37.49，95%CI：37.17 - 37.80）将大多数材料归类为“难”到“非常难”阅读。与医疗保健相关的网站的FKGL得分显著高于非医疗保健来源（P < 0.01）。DISCERN得分差异很大，68.33%的面部女性化材料被评为差或非常差。医生创建的TikTok内容在可靠性方面得分更高（P < 0.001），但参与度低于非医生视频。西班牙语材料的可读性略高（SMOG为11.7，而英语为14.2），但数量较少。
大多数用于性别确认护理的OPEMs不符合健康素养指南，限制了可获取性。为了提高患者的理解能力，材料应在不牺牲准确性的情况下进行简化，纳入多媒体工具，并进行可用性测试。标准化、支持跨性别者且语言包容的资源对于公平获取信息和明智决策至关重要。
