Supplementary Material for: Assessments of the quality, understandability and actionability of Arabic web-based content on oral cancer and precancerous disorders

Introduction
Empowering high-risk individuals to oral cancer and potentially cancerous disorders with written health information is needed for early detection of mucosal changes and self-care. This infodemiological study aimed to assess the web-based and Arabic content related to these disorders when quickly searching the internet.

Methods
The top 20 websites yielded from each of the 7 searches were initially screened for eligibility (oral cancer, leukoplakia, erythroplakia, oral submucous fibrosis, oral lichen planus, oral lichenoid lesions, and oral graft-versus-host disease). These related to search terms written for health care consumers were assessed for website characteristics, quality criteria (4 JAMA benchmarks [authorship, attribution, disclosure, and currency] and Health on the Net seal) and understandability and actionability (Patient Education Materials Assessment Tool). The latter was scored from 0 to 100% based on meeting the criteria. Data representation and analysis were performed using Microsoft Excel and IBM SPSS.

Results
Of the screened 140 websites, 70 (50%) were included in the analysis for all search terms, with oral cancer and lichen planus yielding the most relevant websites (19 and 17, respectively). Commercial and non-for-profit organisations created 50% of the analysed websites. The analysed content was mainly presented as medical facts (71%), often without presenting audiovisual aids (61%). The average JAMA benchmarks achieved per website was 2.5 out of 4, of which ‘disclosure’ and ‘attribution’ were often missing in more than 70% of these websites. Content related to oral cancer and leukoplakia considerably obtained higher average quality benchmarks than other disorders. Acceptable levels for understandability and actionability (≥70%) were found in 52% and 15% of all materials.

Discussion/Conclusion
Patients with these oral disorders seeking web-based information before or after healthcare visits are unlikely to find sufficient and reliable content they can understand and act upon accordingly. Thus, healthcare stakeholders may consider creating and integrating reliable information resources within the health services to support the patients' informed decision-making on their care plans and to maintain value-based healthcare services in line with Saudi Arabia's healthcare transformation vision for 2030.