A critical assessment of online patient education materials for gender-affirming surgery: a systematic review and meta-analysis

Abstract

Introduction

Gender-affirming surgeries significantly improve the well-being of transgender and gender-diverse individuals. However, patients often rely on online patient education materials (OPEMs) to navigate surgical options, making readability, quality, and accessibility critical factors in informed decision-making.

Objective

The objective of this study is to evaluate the readability, quality, and accessibility of online patient education materials related to gender-affirming surgeries.

Methods

This systematic review analyzed nine studies evaluating 898 OPEMs related to gender-affirming surgeries and transgender voice care. Readability was assessed using Flesch–Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG), and Flesch Reading Ease Score (FRES), while quality was evaluated using DISCERN and the Patient Education Materials Assessment Tool. A meta-analysis synthesized readability scores, and qualitative trends were examined to assess readability-quality trade-offs.

Results

OPEMs consistently exceeded the recommended 6th-grade reading level, with a pooled FKGL mean of 12.49 (95% CI: 12.41–12.57), indicating high school to university-level complexity. SMOG scores averaged 11.89 (95% CI: 11.79–11.99), suggesting materials required at least some college education. FRES scores (mean: 37.49, 95% CI: 37.17–37.80) classified most materials as “difficult” to “very difficult” to read. Healthcare-affiliated websites had significantly higher FKGL scores than non-healthcare sources (P < 0.01). DISCERN scores were highly variable, with 68.33% of facial feminization materials rated poor or very poor. Physician-created TikTok content scored higher in reliability (P < 0.001) but had lower engagement than non-physician videos. Spanish-language materials were slightly more readable (SMOG 11.7 vs. 14.2 in English) but less available.

Conclusions

Most OPEMs for gender-affirming care fail to meet health literacy guidelines, limiting accessibility. To improve patient comprehension, materials should be simplified without sacrificing accuracy, incorporate multimedia tools, and undergo usability testing. Standardized, trans-affirming, and linguistically inclusive resources are essential for equitable access and informed decision-making.

patient education materials, gender-affirming surgery, readability, online health information, systematic review