Study Details Low Quality, Difficult-to-Read Online Educational Materials Related to Anemia

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A new analysis of Google search results provides perspective into the readability and quality of educational materials available online related to iron deficiency anemia.

New research is providing insight into what investigators consider a need for reform in the online medical education material related to iron deficiency anemia.

An analysis of more than 100 Google search results, data from the study details significant gaps in the readability and quality of information about iron deficiency anemia readily available to patients online.

“Our findings emphasize the gaps in readability and quality of online information about [iron deficiency anemia] and demonstrate the importance of incorporating readability and quality considerations for online health information,” wrote investigators.1 “A particularly significant finding of our paper is the lack of consideration of readability and quality within Google rankings. The first page of Google results represents the web pages most encountered and used by patients, and these should therefore be of the highest quality and readability in comparison to later web pages.”

According to the US Centers for Disease Control and Prevention, iron deficiency anemia is responsible for more than 2 million visits to clinicians offices and nearly 6000 annual deaths.2 Recognizing the threat to public health posed by iron deficiency anemia and the value of patient education, a team led by Gregory Cooper, MD, of University Hospitals, launched the current study with the intent evaluating the quality and readability of online health information related to iron deficiency anemia on the internet. To do so, investigators designed their study as an assessment of online web pages returned when performing a search for the term “iron deficiency anemia”.1

For the purpose of analysis, each webpage was assessed for typology, readability, the Journal of the American Medical Association (JAMA) score, the DISCERN score, and the Health on the Net Foundation certification (HONcode). Of note, readability was assessed using the Flesh-Kincaid grade level (FKGL) and the Simple Measure of Gobbledygook (SMOG). From their search, investigators identified 200 web pages for possible inclusion in the current study.1

Of these 200 web pages, 112 were deemed eligible for inclusion. Investigators pointed out 88 were excluded due to them requiring a subscription, having no information about iron deficiency anemia, being in a language other than English, having duplicates, and requiring more than 3 clicks to access relevant information. Of the 112 websites included in the study, the typologies were as follows:1

  • 34.8% were nonprofit websites
  • 14.3% were scientific journals
  • 13.4% were health portals
  • 10.7% were commercial websites
  • Remaining 26.8% were classified as professional, government, other, and news websites.

Initial analysis indicated the overall mean scores among the 112 webpages included in the analysis for the readability indices FKGL and SMOG were 8.77 (Standard Deviation [SD], 2.49) (95% Confidence Interval [CI], 8.31-9.23) and 7.69 (SD, 2.05) (95% CI, 7.31-8.07), respectively. Investigators pointed out the mean DISCERN score was 3.51 (SD, 0.83) and the mean JAMA score was 2.56 (SD, 1.07) for JAMA, with 51 considered as high quality, which was defined as a JAMA score greater than 3.1

When limiting their analyses to results from the first Google page, investigators found DISCERN scores (4.33 vs. 3.43; (P=.001) were significantly greater than webpages on later pages, but there were no significant differences observed for JAMA scores (P=.40), FKGL (P=.99), or SMOG (P=.91). When stratifying webpages by those considered high quality and others, results indicated significant differences for both the FKGL (10.03 vs. 7.72; P=.000002) and SMOG (8.61 vs. 6.93 (P=.00005), but no significant difference in DISCERN scores (4.12 vs. 3.01).1

“The quality of online health information is critical to promoting access and health literacy among patients. Previous studies have documented the lack of quality of online health information and its consequences, such as misinformation, misleading information, and delayed diagnosis,” investigators added.1


  1. Kulhari S, Ahn AB, Xu J, Rhee J, Cooper G. Online Patient Education Materials on Iron Deficiency Anemia Are Too Difficult to Read and Low Quality: A Readability and Quality Analysis. Cureus. 2023;15(10):e46902. Published 2023 Oct 12. doi:10.7759/cureus.46902
  2. FastStats - anemia. Centers for Disease Control and Prevention. September 13, 2023. Accessed November 27, 2023.