Online patient education in breast reconstruction: A systematic review and meta-analysis of readability, quality, usability, and cultural representation.

Abstract

Online patient education materials (OPEMs) are increasingly relied upon by patients seeking information on breast reconstruction. However, the readability, quality, and cultural inclusivity of these resources remain unclear. Following PRISMA guidelines, a systematic review and meta-analysis of OPEMs related to breast reconstruction was conducted across PubMed, Embase, and Scopus through April 2025. Eligible studies evaluated websites, videos, or AI-generated materials for readability [Flesch-Kincaid Grade Level (FKGL), Flesch Reading Ease Scores (FRES), and SMOG], quality (DISCERN), or usability [Patient Education Materials Assessment Tool (PEMAT)]. Data were pooled using random-effects models. Studies lacking quantitative data were synthesized thematically. Twenty studies encompassing 1634 OPEMs (1038 websites and 596 videos) were included. Meta-analyses revealed that most materials required a high reading level: FKGL mean=12.68, SMOG=12.29, and FRES=42.39, all indicating difficult-to-college-level text. DISCERN quality scores averaged 2.72/5, with wide variability across sources. PEMAT scores indicated suboptimal usability: understandability=61.9% and actionability=21.9%. Thematic analysis highlighted deficiencies in risk disclosure, citation use, language accessibility, and racial/ethnic representation. Non-English materials and social media content were especially limited in cultural sensitivity and depth. OPEMs in breast reconstruction are often inaccessible, incomplete, and insufficiently actionable. Content from academic or institutional sources generally outperforms patient-generated and AI-based materials but still falls short of re--ed standards. There is an urgent need for coordinated evidence-based guidelines to improve digital patient education in reconstructive surgery.