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Patient educational resources on heart failure (HF) medications may improve patient understanding, which is critical for informed decision-making and patient self-efficacy. The purpose of our study was to evaluate the quality and readability of written HF medication educational resources available online.
Methods and Results
Two investigators searched Google, Yahoo and Bing for written patient educational resources that addressed at least one HF medication using search queries that emulate realistic searches of people looking for health information. Search queries included: (1) “heart failure medication patient information”; (2) “heart failure medications patient information”; (3) “heart failure medication patient handout”; (4) “heart failure medications patient handout”; (5) “heart failure drugs patient information”; and (6) “heart failure drugs patient handout”. Educational quality was assessed using the Ensuring Quality Information for Patients (EQIP) tool (range 0 [worst] to 100 [best]). Secondary outcomes included readability and usability of the resources as decision aids, as people typically use information found on the internet to make health decisions. Readability was assessed using the Flesch-Kincaid Grade Level and decision aid quality was assessed using the modified International Patient Decision Aids Standard (mIPDAS) tool (range 1 [worst] to 6 [best]). Resource eligibility criteria included: (1) written resources directed at patients; (2) written in English; (3) ≥10 sentences about HF medications to ensure inclusion of resources with substantive content on medications; (4) free to access (no registration or payment required); (5) described ≥1 different HF medication treatment option (i.e., individual medication or drug class); and (6) provided medication information specific to their use in HF. From 693 identified webpages, 39 HF medication educational resources met eligibility criteria. Among included resources, the median EQIP score was 61 (interquartile range [IQR] 54-68), with 2 (5%) rated as high quality (score ≥75). Accordingly, the median Flesch-Kincaid Grade Level was 8 (IQR 8-12), with four (10%) resources meeting the recommended 6th grade reading level. The median overall mIPDAS score was 1.4 (IQR 1.3-1.7), with similarly low scores in all sub-domains. The single resource self-classified as a decision aid had an overall mIPDAS score of 4.4.
Most HF medication educational resources available online are of acceptable educational quality, but could readily be improved. Most resources were beyond the recommended reading grade level for educational resources, limiting their utility for people with low literacy. Only one formal decision aid was identified, while other educational resources lacked the necessary information to serve as decision aids.