Quality and Readability Assessment of Arabic Online Content for Developmental Dysplasia of The Hip: A Cross-Sectional Survey

Quality and Readability Assessment of Arabic Online Content for Developmental Dysplasia of The Hip: A Cross-Sectional Survey | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Quality and Readability Assessment of Arabic Online Content for Developmental Dysplasia of The Hip: A Cross-Sectional Survey Abdullah Addar, Nizar Algarni, Saad AlAngari This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4950291/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract · Background: The suitability of online health information is assessed through the quality of information and readability of the public. Developmental dysplasia of the hip (DDH) is the most common paediatric hip disorder and one in which improved health literacy through patient education material (PEM) can impact outcomes directly. Assessing Arabic online content about DDH can help improve literacy for Arabic-speaking parents and patients. · Methods: A cross-sectional survey of web pages with PEM on DDH written in Arabic, inclusion criteria were: online PEM regarding DDH, written in Arabic, and provided with free access. Quality assessment was performed using the DISCERN tool. Readability assessment was performed with the Flesch-Kincaid (FK) score, the Simple Measure of Gobbledygook (SMOG), and the Flesch-Reading Ease score (FRE). The search was done on January 2024. · Results: Fifty-eight web pages were included in the final analysis. The quality of information was moderate to low, with a mean DISCERN score of 35.15 (SD=7.94). Readability was acceptable, with the mean Flesch-Kincaid grade level at 6.78 (SD=6.67, 0.64-30.82). The mean SMOG score was 3.56 (SD=1.18, 3-8.84). Moreover, the Flesch readability ease score (FRE) averaged 85.96 (SD=17.25, 32.15-110.72). · Conclusions: Arabic online PEM on DDH is of moderate to low quality, despite acceptable readability. Official organizations are encouraged to publish a higher volume of PEM that satisfies quality and readability standards. Hip dislocation Health promotion Consumer Health Information Health Literacy Patient Medical Knowledge Information Sources Figures Figure 1 Introduction: The demand for online health information is increasing worldwide [1]. In the Arab world, access to the internet is around 90%, and a large portion of this access is used to obtain healthcare-related information [2]. In Saudi Arabia, around 60% use the internet to search for healthcare-related information. Patient-targeted content is impactful in providing healthcare information, increasing health literacy, improving quality-of-life scores and lowering the cost burden on healthcare systems and admission [3]. In the United States, around 61% of patients sought online medical information, mainly relating to a symptom or diagnosis, and 80% of information obtained started through a search engine. The information obtained resulted in an actionable change in patients, where 60% adjusted their decision-making about treatment, and around 50% asked a doctor new question [1]. Assessment of online patient education material (PEM) can be performed in multiple domains, but two primary domains are quality of written health content and readability; other domains, such as popularity, accessibility, and actionability, are built upon the former two. Developmental dysplasia of the hip (DDH) is the most common paediatric hip disorder, and it presents a unique condition in which early detection and treatment can result in less invasive and generally more successful treatment [4]. In Arab countries, the incidence of DDH ranges from 3.1–46/1000 [5]. The Arabic translation for DDH is confusing, which is attributed to the complexities of both the Arabic language and the evolution in understanding the disorder itself. The presence of high-quality and readable information online may increase health literacy for DDH and possibly result in less parental apprehension and more compliance with treatment. Quality and readability for orthopaedic PEM in English are well studied. Most studies were done on official healthcare websites of hospitals or orthopaedic organizations, where readability was difficult for the general population [6–8]. Regarding English online content for DDH and paediatric orthopaedic disorders, it was found that most online content is complex for the general public to understand [9, 10]. Arabic healthcare readability studies are less than their English counterparts; however, studies exist that evaluate online content and written patient information (i.e. leaflets). Online content studies have been conducted to assess for breast cancer [11], vitiligo [12], COVID-19 [13], and dental diseases [14]. All the studies demonstrated an overall poor quality of information, readability was mostly easy, but some were difficult. For written patient information such as medication leaflets, quality assessment is not typically done as institutions or professionals prepare most, but for readability, two studies demonstrated overall difficult readability for the general population [15–17]. Regarding Orthopaedics and DDH specifically, there are no current Arabic readability and quality assessment studies for online content to our knowledge. An issue with Arabic readability studies is the lack of an Arabic-specific readability tool that is easily accessible [18]. Arabic healthcare organizations do not advocate for a certain readability level based on the general population's needs. The American Medical Association recommends a target goal for English readability that PEM should not exceed the 6th grade [3]. This study assesses the quality of online healthcare information regarding DDH and the Arabic readability of those web pages. Methods: This cross-sectional study utilized two search engines (Google and Bing). The aim is to capture and assess Arabic web pages that provide information regarding DDH. We entered the following search terms "خلع الورك الولادي OR خلع الورك التطوري OR خلع الورك أطفال" in each search engine after resetting the caches and cookies. The search was done at King Saud University from January 16 to 23rd, 2024. The inclusion criteria were online patient education material (PEM) regarding developmental dysplasia of the hip, written in Arabic, and provided with free access. Exclusion criteria were duplicated material, video-only content, and articles unrelated to patient education (such as research papers, advertisements, and others). Social media content was excluded, as many had copyright infringement for material, and the information was scattered and not placed on a single webpage. The search results are summarized in Fig. 1 . The initial 200 web pages were screened; this involved the web pages in the 1st ten consecutive pages of search results for both search engines. We then applied our inclusion and exclusion criteria to select the final web pages for the study. An important note is that our initial intended search strategy was to involve only official webpages from Arabic Middle-East and North Africa (MENA) hospitals, universities and scientific organizations; unfortunately, there were only a handful of results making this strategy impractical. The primary research outcome measured was the quality of online health information about DDH in Arabic, as well as the readability of the content. Quality of patient education material was done with the DISCERN tool [19]. The DISCERN tool is a series of 16 questions initially developed for online consumer health information assessment in English but has been validated for Arabic in multiple studies [5, 14]. The DISCERN tool assesses three main elements of patient online content: reliability, quality and overall suitability. A score ≥ 65 indicates high-quality information, 33–64 indicates moderate quality and 16–32 is low quality. Readability assessment utilized three different scoring methods: the Flesch-Kincaid (FK) score, the Simple Measure of Gobbledygook (SMOG), and the Flesch-Reading Ease score (FRE). An important note to mention is that Arabic-specific readability tools are being developed; however, most are not easily accessible and have many shortcomings that are constantly being mended. The selected readability tools in this study allow the assessment of simple and language-independent features, in addition to being validated by prior Arabic readability studies. The text from the web pages was uploaded onto a readability tool ( http://www.online-utility.org/english/readability_test_and_improve.jsp ), where the analysis was conducted. Other webpage features were also recorded, including the host country, domain extension, publisher type, and the presence of supplementary images or illustrations and or video content. The collected data comprises means, ranges, standard deviations for continuous variables, and number count and percentage for categorical data. Results: A total of 58 websites were included in the final analysis. The two most common online publishers were commercial websites and periodical media articles, including newspapers and magazines (n = 20, 34.48%). Hospital websites have the lowest presence (n = 4, 6.9%). The most common hosting domain was (.com) (n = 41, 70.69%) Table 1 . Arab countries provided most of the published content (n = 46, 79.3%), and Saudi Arabia was the leading country with registered websites (n = 14, 24.13%); this was followed by Jordan (n = 10, 17.24%). For non-Arab countries, Turkey was the most common country with registered sites (n = 6, 10.34%), followed by the United States (n = 4, 6.89%). Each country had a distinct pattern of online publishers; Saudi Arabian web pages mainly were periodical media (n = 8), whereas Jordanian web pages were primarily commercial websites (n = 6). Turkish web pages mainly were hospital or healthcare provider affiliated (n = 5, 83.3%) Table 1 . The mean DISCERN score reflecting the quality of published information is 35.15 (SD = 7.94); this reflects an overall moderate quality of published information regarding DDH in Arabic. Most published content was of moderate quality (n = 38, 65.5%), and none was high-quality. The least scoring categories within the DISCERN score were (support for shared decision-making, how treatment choices affect the quality of life, and additional resources). Images to illustrate various aspects of DDH, from ultrasounds to physical examinations and treatments, were only present in a third of the websites (n = 20, 34.48%), and only two websites had videos to supplement written content Table 2 . The mean Flesch-Kincaid grade level was 6.78 (SD = 6.67, 0.64–30.82), indicating that most of the content is easy to understand. The most challenging web page was by a hospital in Saudi Arabia. The mean SMOG score was 3.56 (SD = 1.18, 3-8.84). Ease of readability was measured using the Flesch readability ease score (FRE), which averaged 85.96 (SD = 17.25, 32.15-110.72); the same hospital web page in Saudi Arabia had the most challenging readability Table 3 . Discussion: Arabic online content on DDH has moderate quality as assessed by the DISCERN tool score of 35.15 (SD = 7.94). Despite the modest quality, readability for Arabic DDH content is acceptable at the 6th -7th grade level (FK = 6.78). These findings present a barrier to health literacy for a common condition such as DDH. Health literacy is a group of skills to obtain, understand and deploy health information to benefit patients, and was found to be one of the strongest predictors of health status [20]. Hence, improving health literacy should be a target for orthopaedic organizations, healthcare systems and surgeons. The selection of DDH to study quality and readability was made as it is a common condition in the Arab world with a reported incidence that ranges from 3.1–46/1000 [5]. Developmental dysplasia of the hip is also a condition in which patients lack health literacy; this is manifested by the persistence of specific behaviours that are detrimental to DDH, such as swaddling. Additionally, we find that when patients arrive at a specialized orthopaedic clinic, there is mostly no prior understanding of the condition with undue apprehension from the parents. As a condition, it is also unique in that earlier detection results in a less invasive treatment and is generally more successful. Our results correspond to other Arabic language healthcare quality and readability studies, whereby the published online content is primarily of lower quality, despite acceptable readability levels [5, 11–14]. A key finding was the limited number of official web pages on DDH from hospitals and orthopaedic organizations in the Arab world. We found that only 19% of webpages were from hospitals or physicians, and none were affiliated with a government, university or large healthcare group; this contrasts with the United States, where 84% of the top 50 hospitals provided online content for DDH [21]. Most web pages providing Arabic DDH information are commercial and have the highest-ranking web pages. Non-Arab countries hosting Arabic DDH webpages accounted for 21%; most were official organizations such as the Mayo Clinic and the International Hip Dysplasia Institute (IHDI); however, some were for private healthcare providers. This reflects a genuine demand for online content for Arabic-speaking patients in Arabic and non-Arabic countries (or healthcare service provision for their patients). A significant mention is that Non-Arab web pages might provide incomplete PEM in Arabic; we noted an example from the IHDI, where only three out of five total brochures were available in Arabic. Similarly, in the United States, only 36% of the top 50 hospitals provided information for DDH in Spanish, as opposed to 84% providing information in English [22]; these findings demonstrate a barrier to healthcare information accessibility to non-English speaking patients. A comprehensive study on English DDH online content was performed to assess readability and quality in terms of parental understanding and actionability. Readability was poor and found to be at a senior high school level (FK score 12.54), above the recommended elementary school level (FK score < 6). Understandability and actionability were also found to be poor [9]. In Australasia, a similar study found that readability was acceptable in only 10% of web pages pertaining to Australasia [10]. Another element to consider is the search term used to get information on DDH, as it was found that the search term used affected the results and the quality of information, where "developmental dysplasia of the hip" yielded better results than "congenital hip dislocation" or "hip dysplasia in children" [23]. The term for DDH in Arabic is also varied, and we found six different variations; therefore, a unified term is suggested to facilitate patient understanding. The DISCERN tool was selected as it is comprehensive and validated for various conditions and languages, including Arabic, it is not specific to paediatric orthopaedic disorders, and hence certain nuances essential to achieve health literacy can be missed. Nevertheless, it is valuable in providing a general overview. The readability assessment tools used are not Arabic language specific, although they have been validated for Arabic. Once Arabic readability tools are widely available and validated, their use in future studies will add to Arabic healthcare readability literature. Conclusion: Most of the online Arabic content on DDH is of moderate to low quality, albeit acceptable readability. There is an evident lack of institutional webpages regarding this common condition, and hence healthcare authorities and organizations need to publish higher quality content that is readable, accessible and encourages action. Abbreviations DDH Developmental dysplasia of the hip PEM Patient Education Material FK Flesch-Kincaid SMOG Simple Measure of Gobbledygook FRE Flesch-Reading Ease score Declarations Ethics approval and consent to participate: This article does not contain any studies with human participants or animals performed by any of the authors. Consent for Publication: Not Applicable Competing interest: The authors have no conflicts of interest to declare that are relevant to the content of this article. Funding: This work was supported by the College of Medicine Research Center (CMRC), Deanship of Scientific Research, King Saud University, Saudi Arabia. Author Contribution Abdullah Addar conceived and designed the study, and conducted research. Saad AlAngari provided research materials, and collected and organized data. Nizar Algarni performed the formal analysis, reviewed, and edited the manuscript. All authors have critically reviewed and approved the final draft and are responsible for the content and similarity index of the manuscript. Acknowledgement Thanks for support from the College of Medicine Research Center, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia Data Availability Data appendix is provided within the supplementary files. 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Tables Table 1 Webpage Characteristics, n = 58 Country Publisher Type Domain Saudi Arabia (n = 14, 24.13%) Commercial Website (n = 20, 34.48%) .com (n = 41, 70.69%) Jordan (n = 10, 17.24%) Periodical Media (n = 20, 34.48%) .org (n = 5, 8.62%) Turkey (n = 6, 10.34%) Non-profit Organization (n = 7, 12.07%) .net (n = 5, 8.62%) United Arab Emirates, Syria, and Egypt (n = 5, 8.62%)* Healthcare Provider (n = 7, 12.07%) .ae (n = 3, 5.17%) United States, Kuwait (n = 4, 6.89%)* Hospital Website (n = 4, 6.9%) .me (n = 2, 3.45%) United Kingdom, Italy, Lebanon, Algeria, and N/A (n = 1, 1.72%)* .sy (n = 1, 1.72%) .info (n = 1, 1.72%) * Count stated is for each country separately Table 2 Quality of Healthcare Information, n = 58 DISCERN Score Count, % High (> 65) n = 0, 0% Moderate (33–64) n = 38, 65.52% Low (16–32) n = 20, 34.48% Image or illustration presence Yes n = 20, 34.48% No n = 38, 65.52% Video content presence Yes n = 2, 3.45% No n = 56, 96.55% Table 3 Readability scores for the 58 webpages Flesch Kincaid Grade SMOG** Flesch Reading Ease Mean 6.784736019 3.568004712 85.96588409 SD 6.671030655 1.181406669 17.25875285 Range 0.64–30.82 3-8.44 32.15-110.72 < 7 score n = 30, 51.72% n = 57, 98.27% *NA ≥ 7 score n = 28, 48.27% n = 1, 1.72% *NA ≥ 80 score *NA *NA n = 45, 77.58% < 80 score *NA *NA n = 13, 22.41% *NA not applicable. **Simple Measure of Gobbledygook Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4950291","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":354426694,"identity":"7061863c-d0a3-4c00-aaf4-d2a8cf00f39f","order_by":0,"name":"Abdullah Addar","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzUlEQVRIiWNgGAWjYHACAwkGBhsDMJOHBC1ppGs5TIIW/vbDG2/83HPeWH5GAuODt20M9vwNBLRInEkrtux5dtvM4EYCs+HcNobEGQcIWXMgx0yC58BtGwOJBDZp3jaGBAZCWuTPvzGT/HPgnA3QYey/gVrs5QlpMbiRYybNc+CAGcONBDZmoBbGDYS0GN54VmwtcyDZ2ODMw2bJOeckEjcS0iJ3PnnjzTcH7Azntycf/PCmzMZejpAWJMDYACQkiFc/CkbBKBgFowA3AAB7ZkBySrkBAgAAAABJRU5ErkJggg==","orcid":"","institution":"Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia","correspondingAuthor":true,"prefix":"","firstName":"Abdullah","middleName":"","lastName":"Addar","suffix":""},{"id":354426695,"identity":"591c72cb-ed05-40d0-9324-b7aa6a435cb5","order_by":1,"name":"Nizar Algarni","email":"","orcid":"","institution":"Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia","correspondingAuthor":false,"prefix":"","firstName":"Nizar","middleName":"","lastName":"Algarni","suffix":""},{"id":354426696,"identity":"db0873b3-c800-4745-9893-9a6dce59c94a","order_by":2,"name":"Saad AlAngari","email":"","orcid":"","institution":"College of Medicine, King Saud University, Riyadh, Saudi Arabia","correspondingAuthor":false,"prefix":"","firstName":"Saad","middleName":"","lastName":"AlAngari","suffix":""}],"badges":[],"createdAt":"2024-08-21 09:15:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4950291/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4950291/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":66667413,"identity":"1ffb8418-8ab9-4c59-b895-8d9f30fc0ff7","added_by":"auto","created_at":"2024-10-15 09:49:49","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":30747,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart demonstrating the web page selection process\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4950291/v1/9d831bd09d0060ff10837f56.jpg"},{"id":68242523,"identity":"ccfc0487-d6c9-464d-84fd-68272d33edbf","added_by":"auto","created_at":"2024-11-05 08:25:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":960847,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4950291/v1/9d7a8e2c-b3e4-41d9-96de-0c028a02f963.pdf"},{"id":66667414,"identity":"86ec5a48-3051-4c3e-94ad-93d8b43630f8","added_by":"auto","created_at":"2024-10-15 09:49:49","extension":"docx","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":19051,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix.docx","url":"https://assets-eu.researchsquare.com/files/rs-4950291/v1/47365a43f6674c43b7478b4a.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Quality and Readability Assessment of Arabic Online Content for Developmental Dysplasia of The Hip: A Cross-Sectional Survey","fulltext":[{"header":"Introduction:","content":"\u003cp\u003eThe demand for online health information is increasing worldwide [1]. In the Arab world, access to the internet is around 90%, and a large portion of this access is used to obtain healthcare-related information [2]. In Saudi Arabia, around 60% use the internet to search for healthcare-related information. Patient-targeted content is impactful in providing healthcare information, increasing health literacy, improving quality-of-life scores and lowering the cost burden on healthcare systems and admission [3]. In the United States, around 61% of patients sought online medical information, mainly relating to a symptom or diagnosis, and 80% of information obtained started through a search engine. The information obtained resulted in an actionable change in patients, where 60% adjusted their decision-making about treatment, and around 50% asked a doctor new question [1]. Assessment of online patient education material (PEM) can be performed in multiple domains, but two primary domains are quality of written health content and readability; other domains, such as popularity, accessibility, and actionability, are built upon the former two.\u003c/p\u003e \u003cp\u003eDevelopmental dysplasia of the hip (DDH) is the most common paediatric hip disorder, and it presents a unique condition in which early detection and treatment can result in less invasive and generally more successful treatment [4]. In Arab countries, the incidence of DDH ranges from 3.1–46/1000 [5]. The Arabic translation for DDH is confusing, which is attributed to the complexities of both the Arabic language and the evolution in understanding the disorder itself. The presence of high-quality and readable information online may increase health literacy for DDH and possibly result in less parental apprehension and more compliance with treatment.\u003c/p\u003e \u003cp\u003eQuality and readability for orthopaedic PEM in English are well studied. Most studies were done on official healthcare websites of hospitals or orthopaedic organizations, where readability was difficult for the general population [6–8]. Regarding English online content for DDH and paediatric orthopaedic disorders, it was found that most online content is complex for the general public to understand [9, 10].\u003c/p\u003e \u003cp\u003eArabic healthcare readability studies are less than their English counterparts; however, studies exist that evaluate online content and written patient information (i.e. leaflets). Online content studies have been conducted to assess for breast cancer [11], vitiligo [12], COVID-19 [13], and dental diseases [14]. All the studies demonstrated an overall poor quality of information, readability was mostly easy, but some were difficult. For written patient information such as medication leaflets, quality assessment is not typically done as institutions or professionals prepare most, but for readability, two studies demonstrated overall difficult readability for the general population [15–17].\u003c/p\u003e \u003cp\u003eRegarding Orthopaedics and DDH specifically, there are no current Arabic readability and quality assessment studies for online content to our knowledge. An issue with Arabic readability studies is the lack of an Arabic-specific readability tool that is easily accessible [18]. Arabic healthcare organizations do not advocate for a certain readability level based on the general population's needs. The American Medical Association recommends a target goal for English readability that PEM should not exceed the 6th grade [3].\u003c/p\u003e \u003cp\u003eThis study assesses the quality of online healthcare information regarding DDH and the Arabic readability of those web pages.\u003c/p\u003e "},{"header":"Methods:","content":"\u003cp\u003eThis cross-sectional study utilized two search engines (Google and Bing). The aim is to capture and assess Arabic web pages that provide information regarding DDH. We entered the following search terms \"خلع الورك الولادي OR خلع الورك التطوري OR خلع الورك أطفال\" in each search engine after resetting the caches and cookies. The search was done at King Saud University from January 16 to 23rd, 2024. The inclusion criteria were online patient education material (PEM) regarding developmental dysplasia of the hip, written in Arabic, and provided with free access. Exclusion criteria were duplicated material, video-only content, and articles unrelated to patient education (such as research papers, advertisements, and others). Social media content was excluded, as many had copyright infringement for material, and the information was scattered and not placed on a single webpage. The search results are summarized in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003cp\u003eThe initial 200 web pages were screened; this involved the web pages in the 1st ten consecutive pages of search results for both search engines. We then applied our inclusion and exclusion criteria to select the final web pages for the study.\u003c/p\u003e\u003cp\u003eAn important note is that our initial intended search strategy was to involve only official webpages from Arabic Middle-East and North Africa (MENA) hospitals, universities and scientific organizations; unfortunately, there were only a handful of results making this strategy impractical.\u003c/p\u003e\u003cp\u003eThe primary research outcome measured was the quality of online health information about DDH in Arabic, as well as the readability of the content. Quality of patient education material was done with the DISCERN tool [19]. The DISCERN tool is a series of 16 questions initially developed for online consumer health information assessment in English but has been validated for Arabic in multiple studies [5, 14]. The DISCERN tool assesses three main elements of patient online content: reliability, quality and overall suitability. A score ≥ 65 indicates high-quality information, 33–64 indicates moderate quality and 16–32 is low quality.\u003c/p\u003e\u003cp\u003eReadability assessment utilized three different scoring methods: the Flesch-Kincaid (FK) score, the Simple Measure of Gobbledygook (SMOG), and the Flesch-Reading Ease score (FRE). An important note to mention is that Arabic-specific readability tools are being developed; however, most are not easily accessible and have many shortcomings that are constantly being mended. The selected readability tools in this study allow the assessment of simple and language-independent features, in addition to being validated by prior Arabic readability studies. The text from the web pages was uploaded onto a readability tool (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.online-utility.org/english/readability_test_and_improve.jsp\u003c/span\u003e\u003cspan address=\"http://www.online-utility.org/english/readability_test_and_improve.jsp\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e), where the analysis was conducted.\u003c/p\u003e\u003cp\u003eOther webpage features were also recorded, including the host country, domain extension, publisher type, and the presence of supplementary images or illustrations and or video content.\u003c/p\u003e\u003cp\u003eThe collected data comprises means, ranges, standard deviations for continuous variables, and number count and percentage for categorical data.\u003c/p\u003e"},{"header":"Results:","content":"\u003cp\u003eA total of 58 websites were included in the final analysis. The two most common online publishers were commercial websites and periodical media articles, including newspapers and magazines (n\u0026thinsp;=\u0026thinsp;20, 34.48%). Hospital websites have the lowest presence (n\u0026thinsp;=\u0026thinsp;4, 6.9%). The most common hosting domain was (.com) (n\u0026thinsp;=\u0026thinsp;41, 70.69%) Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Arab countries provided most of the published content (n\u0026thinsp;=\u0026thinsp;46, 79.3%), and Saudi Arabia was the leading country with registered websites (n\u0026thinsp;=\u0026thinsp;14, 24.13%); this was followed by Jordan (n\u0026thinsp;=\u0026thinsp;10, 17.24%). For non-Arab countries, Turkey was the most common country with registered sites (n\u0026thinsp;=\u0026thinsp;6, 10.34%), followed by the United States (n\u0026thinsp;=\u0026thinsp;4, 6.89%). Each country had a distinct pattern of online publishers; Saudi Arabian web pages mainly were periodical media (n\u0026thinsp;=\u0026thinsp;8), whereas Jordanian web pages were primarily commercial websites (n\u0026thinsp;=\u0026thinsp;6). Turkish web pages mainly were hospital or healthcare provider affiliated (n\u0026thinsp;=\u0026thinsp;5, 83.3%) Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eThe mean DISCERN score reflecting the quality of published information is 35.15 (SD\u0026thinsp;=\u0026thinsp;7.94); this reflects an overall moderate quality of published information regarding DDH in Arabic. Most published content was of moderate quality (n\u0026thinsp;=\u0026thinsp;38, 65.5%), and none was high-quality. The least scoring categories within the DISCERN score were (support for shared decision-making, how treatment choices affect the quality of life, and additional resources). Images to illustrate various aspects of DDH, from ultrasounds to physical examinations and treatments, were only present in a third of the websites (n\u0026thinsp;=\u0026thinsp;20, 34.48%), and only two websites had videos to supplement written content Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eThe mean Flesch-Kincaid grade level was 6.78 (SD\u0026thinsp;=\u0026thinsp;6.67, 0.64\u0026ndash;30.82), indicating that most of the content is easy to understand. The most challenging web page was by a hospital in Saudi Arabia. The mean SMOG score was 3.56 (SD\u0026thinsp;=\u0026thinsp;1.18, 3-8.84). Ease of readability was measured using the Flesch readability ease score (FRE), which averaged 85.96 (SD\u0026thinsp;=\u0026thinsp;17.25, 32.15-110.72); the same hospital web page in Saudi Arabia had the most challenging readability Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e"},{"header":"Discussion:","content":"\u003cp\u003eArabic online content on DDH has moderate quality as assessed by the DISCERN tool score of 35.15 (SD\u0026thinsp;=\u0026thinsp;7.94). Despite the modest quality, readability for Arabic DDH content is acceptable at the 6th -7th grade level (FK\u0026thinsp;=\u0026thinsp;6.78). These findings present a barrier to health literacy for a common condition such as DDH. Health literacy is a group of skills to obtain, understand and deploy health information to benefit patients, and was found to be one of the strongest predictors of health status [20]. Hence, improving health literacy should be a target for orthopaedic organizations, healthcare systems and surgeons.\u003c/p\u003e \u003cp\u003eThe selection of DDH to study quality and readability was made as it is a common condition in the Arab world with a reported incidence that ranges from 3.1\u0026ndash;46/1000 [5]. Developmental dysplasia of the hip is also a condition in which patients lack health literacy; this is manifested by the persistence of specific behaviours that are detrimental to DDH, such as swaddling. Additionally, we find that when patients arrive at a specialized orthopaedic clinic, there is mostly no prior understanding of the condition with undue apprehension from the parents. As a condition, it is also unique in that earlier detection results in a less invasive treatment and is generally more successful.\u003c/p\u003e \u003cp\u003eOur results correspond to other Arabic language healthcare quality and readability studies, whereby the published online content is primarily of lower quality, despite acceptable readability levels [5, 11\u0026ndash;14].\u003c/p\u003e \u003cp\u003eA key finding was the limited number of official web pages on DDH from hospitals and orthopaedic organizations in the Arab world. We found that only 19% of webpages were from hospitals or physicians, and none were affiliated with a government, university or large healthcare group; this contrasts with the United States, where 84% of the top 50 hospitals provided online content for DDH [21]. Most web pages providing Arabic DDH information are commercial and have the highest-ranking web pages.\u003c/p\u003e \u003cp\u003eNon-Arab countries hosting Arabic DDH webpages accounted for 21%; most were official organizations such as the Mayo Clinic and the International Hip Dysplasia Institute (IHDI); however, some were for private healthcare providers. This reflects a genuine demand for online content for Arabic-speaking patients in Arabic and non-Arabic countries (or healthcare service provision for their patients). A significant mention is that Non-Arab web pages might provide incomplete PEM in Arabic; we noted an example from the IHDI, where only three out of five total brochures were available in Arabic. Similarly, in the United States, only 36% of the top 50 hospitals provided information for DDH in Spanish, as opposed to 84% providing information in English [22]; these findings demonstrate a barrier to healthcare information accessibility to non-English speaking patients.\u003c/p\u003e \u003cp\u003eA comprehensive study on English DDH online content was performed to assess readability and quality in terms of parental understanding and actionability. Readability was poor and found to be at a senior high school level (FK score 12.54), above the recommended elementary school level (FK score\u0026thinsp;\u0026lt;\u0026thinsp;6). Understandability and actionability were also found to be poor [9]. In Australasia, a similar study found that readability was acceptable in only 10% of web pages pertaining to Australasia [10].\u003c/p\u003e \u003cp\u003eAnother element to consider is the search term used to get information on DDH, as it was found that the search term used affected the results and the quality of information, where \"developmental dysplasia of the hip\" yielded better results than \"congenital hip dislocation\" or \"hip dysplasia in children\" [23]. The term for DDH in Arabic is also varied, and we found six different variations; therefore, a unified term is suggested to facilitate patient understanding.\u003c/p\u003e \u003cp\u003eThe DISCERN tool was selected as it is comprehensive and validated for various conditions and languages, including Arabic, it is not specific to paediatric orthopaedic disorders, and hence certain nuances essential to achieve health literacy can be missed. Nevertheless, it is valuable in providing a general overview.\u003c/p\u003e \u003cp\u003eThe readability assessment tools used are not Arabic language specific, although they have been validated for Arabic. Once Arabic readability tools are widely available and validated, their use in future studies will add to Arabic healthcare readability literature.\u003c/p\u003e"},{"header":"Conclusion:","content":"\u003cp\u003eMost of the online Arabic content on DDH is of moderate to low quality, albeit acceptable readability. There is an evident lack of institutional webpages regarding this common condition, and hence healthcare authorities and organizations need to publish higher quality content that is readable, accessible and encourages action.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDDH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDevelopmental dysplasia of the hip\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePEM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePatient Education Material\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eFK\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFlesch-Kincaid\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSMOG\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSimple Measure of Gobbledygook\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eFRE\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFlesch-Reading Ease score\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eEthics approval and consent to participate:\u003c/h2\u003e \u003cp\u003eThis article does not contain any studies with human participants or animals performed by any of the authors.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for Publication:\u003c/strong\u003e \u003cp\u003eNot Applicable\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCompeting interest:\u003c/strong\u003e \u003cp\u003eThe authors have no conflicts of interest to declare that are relevant to the content of this article.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eThis work was supported by the College of Medicine Research Center (CMRC), Deanship of Scientific Research, King Saud University, Saudi Arabia.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAbdullah Addar conceived and designed the study, and conducted research. Saad AlAngari provided research materials, and collected and organized data. Nizar Algarni performed the formal analysis, reviewed, and edited the manuscript. All authors have critically reviewed and approved the final draft and are responsible for the content and similarity index of the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThanks for support from the College of Medicine Research Center, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData appendix is provided within the supplementary files.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003e Algabbani AM, Alzahrani SA, Almomen SM, Hafiz RA: \u003cb\u003eReadability of information imprinted in patient information leaflets (PILs) in Saudi Arabia: The case of antihypertensive medications\u003c/b\u003e. \u003cem\u003eExplor Res Clin Soc Pharm\u003c/em\u003e 2022, \u003cb\u003e8\u003c/b\u003e:100179.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e \u003cb\u003eHealth literacy: report of the Council on Scientific Affairs. 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Halboub E, Al-Ak'hali MS, Al-Mekhlafi HM, Alhajj MN: \u003cb\u003eQuality and readability of web-based Arabic health information on COVID-19: an infodemiological study\u003c/b\u003e. \u003cem\u003eBMC Public Health\u003c/em\u003e 2021, \u003cb\u003e21\u003c/b\u003e(1):151.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e Conger HK, Weinstein S, Gao B, Gulbrandsen T, Shamrock A, Skalitzky MK, Holt J: \u003cb\u003eDevelopmental Dysplasia of the Hip: Quantifying if Patients Read, Understand, and Act on Online Resources?\u003c/b\u003e \u003cem\u003ePediatrics\u003c/em\u003e 2021, \u003cb\u003e147\u003c/b\u003e(3_MeetingAbstract):830\u0026ndash;832.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e Jasem Z, AlMeraj Z, Alhuwail D: \u003cb\u003eEvaluating breast cancer websites targeting Arabic speakers: empirical investigation of popularity, availability, accessibility, readability, and quality\u003c/b\u003e. \u003cem\u003eBMC Med Inform Decis Mak\u003c/em\u003e 2022, \u003cb\u003e22\u003c/b\u003e(1):126.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e Mendoza L, Mitchell S, Swarup I: \u003cb\u003eSpanish Language Resources for Patients with Developmental Dysplasia of the Hip\u003c/b\u003e. \u003cem\u003eJournal of the Pediatric Orthopaedic Society of North America\u003c/em\u003e 2022, \u003cb\u003e4\u003c/b\u003e(4):472.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eWebpage Characteristics, n\u0026thinsp;=\u0026thinsp;58\u003c/div\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr style=\"height: 13px;\"\u003e\n \u003cth style=\"height: 13px;\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eCountry\u003c/div\u003e\n \u003c/th\u003e\n \u003cth style=\"height: 13px;\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003ePublisher Type\u003c/div\u003e\n \u003c/th\u003e\n \u003cth style=\"height: 13px;\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eDomain\u003c/div\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr style=\"height: 13px;\"\u003e\n \u003ctd style=\"height: 13px;\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eSaudi Arabia (n\u0026thinsp;=\u0026thinsp;14, 24.13%)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 13px;\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eCommercial Website (n\u0026thinsp;=\u0026thinsp;20, 34.48%)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 13px;\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e.com (n\u0026thinsp;=\u0026thinsp;41, 70.69%)\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style=\"height: 13px;\"\u003e\n \u003ctd style=\"height: 13px;\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eJordan (n\u0026thinsp;=\u0026thinsp;10, 17.24%)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 13px;\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003ePeriodical Media (n\u0026thinsp;=\u0026thinsp;20, 34.48%)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 13px;\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e.org (n\u0026thinsp;=\u0026thinsp;5, 8.62%)\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style=\"height: 13px;\"\u003e\n \u003ctd style=\"height: 13px;\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eTurkey (n\u0026thinsp;=\u0026thinsp;6, 10.34%)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 13px;\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eNon-profit Organization (n\u0026thinsp;=\u0026thinsp;7, 12.07%)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 13px;\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e.net (n\u0026thinsp;=\u0026thinsp;5, 8.62%)\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style=\"height: 13px;\"\u003e\n \u003ctd style=\"height: 13px;\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eUnited Arab Emirates, Syria, and Egypt (n\u0026thinsp;=\u0026thinsp;5, 8.62%)*\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 13px;\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eHealthcare Provider (n\u0026thinsp;=\u0026thinsp;7, 12.07%)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 13px;\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e.ae (n\u0026thinsp;=\u0026thinsp;3, 5.17%)\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style=\"height: 13.6042px;\"\u003e\n \u003ctd style=\"height: 13.6042px;\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eUnited States, Kuwait (n\u0026thinsp;=\u0026thinsp;4, 6.89%)*\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 13.6042px;\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eHospital Website (n\u0026thinsp;=\u0026thinsp;4, 6.9%)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 13.6042px;\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e.me (n\u0026thinsp;=\u0026thinsp;2, 3.45%)\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style=\"height: 13px;\"\u003e\n \u003ctd style=\"height: 13px;\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eUnited Kingdom, Italy, Lebanon, Algeria, and N/A (n\u0026thinsp;=\u0026thinsp;1, 1.72%)*\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 13px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd style=\"height: 13px;\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e.sy (n\u0026thinsp;=\u0026thinsp;1, 1.72%)\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style=\"height: 13px;\"\u003e\n \u003ctd style=\"height: 13px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd style=\"height: 13px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd style=\"height: 13px;\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e.info (n\u0026thinsp;=\u0026thinsp;1, 1.72%)\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style=\"height: 13px;\"\u003e\n \u003ctd style=\"height: 13px;\" colspan=\"3\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e* Count stated is for each country separately\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eQuality of Healthcare Information, n\u0026thinsp;=\u0026thinsp;58\u003c/div\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth colspan=\"2\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eDISCERN Score\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eCount, %\u003c/div\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eHigh (\u0026gt;\u0026thinsp;65)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003en\u0026thinsp;=\u0026thinsp;0, 0%\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eModerate (33\u0026ndash;64)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003en\u0026thinsp;=\u0026thinsp;38, 65.52%\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eLow (16\u0026ndash;32)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003en\u0026thinsp;=\u0026thinsp;20, 34.48%\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eImage or illustration presence\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eYes\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003en\u0026thinsp;=\u0026thinsp;20, 34.48%\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eNo\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003en\u0026thinsp;=\u0026thinsp;38, 65.52%\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eVideo content presence\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eYes\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003en\u0026thinsp;=\u0026thinsp;2, 3.45%\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eNo\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003en\u0026thinsp;=\u0026thinsp;56, 96.55%\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eReadability scores for the 58 webpages\u003c/div\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eFlesch Kincaid Grade\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eSMOG**\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eFlesch Reading Ease\u003c/div\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eMean\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e6.784736019\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3.568004712\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e85.96588409\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eSD\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e6.671030655\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.181406669\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e17.25875285\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eRange\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.64\u0026ndash;30.82\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3-8.44\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e32.15-110.72\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026thinsp;7 score\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003en\u0026thinsp;=\u0026thinsp;30, 51.72%\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003en\u0026thinsp;=\u0026thinsp;57, 98.27%\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e*NA\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u0026ge;\u0026thinsp;7 score\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003en\u0026thinsp;=\u0026thinsp;28, 48.27%\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003en\u0026thinsp;=\u0026thinsp;1, 1.72%\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e*NA\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u0026ge;\u0026thinsp;80 score\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e*NA\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e*NA\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003en\u0026thinsp;=\u0026thinsp;45, 77.58%\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026thinsp;80 score\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e*NA\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e*NA\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003en\u0026thinsp;=\u0026thinsp;13, 22.41%\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e*NA not applicable. **Simple Measure of Gobbledygook\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Hip dislocation, Health promotion, Consumer Health Information, Health Literacy, Patient Medical Knowledge, Information Sources","lastPublishedDoi":"10.21203/rs.3.rs-4950291/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4950291/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003e· Background:\u003c/strong\u003e The suitability of online health information is assessed through the quality of information and readability of the public. Developmental dysplasia of the hip (DDH) is the most common paediatric hip disorder and one in which improved health literacy through patient education material (PEM) can impact outcomes directly. Assessing Arabic online content about DDH can help improve literacy for Arabic-speaking parents and patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e· Methods:\u003c/strong\u003e A cross-sectional survey of web pages with PEM on DDH written in Arabic, inclusion criteria were: online PEM regarding DDH, written in Arabic, and provided with free access. Quality assessment was performed using the DISCERN tool. Readability assessment was performed with the Flesch-Kincaid (FK) score, the Simple Measure of Gobbledygook (SMOG), and the Flesch-Reading Ease score (FRE). The search was done on January 2024.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e· Results:\u003c/strong\u003e Fifty-eight web pages were included in the final analysis. The quality of information was moderate to low, with a mean DISCERN score of 35.15 (SD=7.94). Readability was acceptable, with the mean Flesch-Kincaid grade level at 6.78 (SD=6.67, 0.64-30.82). The mean SMOG score was 3.56 (SD=1.18, 3-8.84). Moreover, the Flesch readability ease score (FRE) averaged 85.96 (SD=17.25, 32.15-110.72).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e· Conclusions:\u003c/strong\u003e Arabic online PEM on DDH is of moderate to low quality, despite acceptable readability. Official organizations are encouraged to publish a higher volume of PEM that satisfies quality and readability standards.\u003c/p\u003e","manuscriptTitle":"Quality and Readability Assessment of Arabic Online Content for Developmental Dysplasia of The Hip: A Cross-Sectional Survey","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-15 09:49:45","doi":"10.21203/rs.3.rs-4950291/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"530437a6-3aee-4203-93ac-6bb3f5c80ba6","owner":[],"postedDate":"October 15th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-11-05T08:24:18+00:00","versionOfRecord":[],"versionCreatedAt":"2024-10-15 09:49:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4950291","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4950291","identity":"rs-4950291","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}