A Comprehensive Assessment of the Difficulty Level and Cultural Sensitivity of Online Cancer Prevention Resources for Older Minority Men

INTRODUCTION Older men are at increased risk for prostate cancer. As seniors turn to the Internet for cancer information, it is important that the resources they locate about lifestyle behaviors and screening are culturally appropriate and easy to understand. This study was a comprehensive analysis of prostate cancer risk as portrayed on the Internet with assessment of content readability and cultural sensitivity. METHODS We selected Web sites about prostate cancer risk and prevention by comparing common sites across three top-rated search engines (Google, Yahoo!, and MSN). A total of 70 Web sites on prostate cancer containing a Web page on risk factors or prevention or both for racial and ethnic populations were included. We assessed readability of one page per Web site using Simple Measure of Gobbledygook (SMOG), Flesch-Kincaid (FK), and Flesch Reading Ease (FRE) measures. Cultural sensitivity of the Web page was evaluated using the Cultural Sensitivity Assessment Tool (CSAT) and questions from a cultural sensitivity checklist. RESULTS Mean readability of Web pages was Grade 12.90 (high school graduate level) using SMOG and Grade 11.20 according to FK. Mean FRE was 45.04 (fairly difficult to read). The mean CSAT score was 2.78 and classified as culturally sensitive. Of the 36 Web pages considered culturally sensitive (CSAT >2.50), 75% did not portray images of representative racial or ethnic individuals as intended readers or as being at high risk for prostate cancer. Older adults and seniors were identified as intended readers on 73% of Web pages. CONCLUSION Online cancer resources are targeting appropriate age groups (high-risk older adults). However, the pages required fairly high-level reading skills and had limited cultural sensitivity. These factors make the pages unsuitable for diverse Internet users.