Readability, understandability, actionability and information quality of online patient information on diagnostic imaging during pregnancy and breastfeeding: A cross-sectional study

INTRODUCTION: Patients commonly use online information when considering imaging during pregnancy or breastfeeding. Information that is difficult to read, poorly contextualised or inconsistent may contribute to anxiety, delayed investigation or unnecessary breastfeeding interruption. This study aimed to evaluate the readability, understandability, actionability and information quality of highly ranked online patient information on diagnostic imaging during pregnancy and breastfeeding. METHODS: A cross-sectional Google search was performed on 30 July 2026 using 15 predefined patient-relevant search terms. The first 10 organic results for each term were screened. Duplicate occurrences were removed and 51 unique eligible resources were analysed at resource level. Readability was assessed using Flesch-Kincaid Grade Level (FKGL) as the primary metric, with Flesch Reading Ease (FRE), Simple Measure of Gobbledygook (SMOG), Coleman-Liau Index and Gunning Fog Index as supplementary measures. Understandability and actionability were assessed using the Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P), and information quality using Journal of the American Medical Association (JAMA) benchmarks and DISCERN (quality of written consumer health information on treatment choices). Clinical content was reviewed descriptively using structured domains. RESULTS: Mean FKGL was 8.6 (standard deviation [SD] 1.3); 49/51 resources (96.1%) exceeded the recommended sixth-grade level. Mean PEMAT-P understandability and actionability scores were 78.4% and 72.3%, respectively. Mean JAMA and DISCERN scores were 2.8/4 and 60.2. Inter-rater reliability was excellent for PEMAT-P understandability, PEMAT-P actionability and DISCERN [intraclass correlation coefficient (ICC) (2,1) = 0.982-0.998]. Structured narrative review identified variable risk contextualisation and inconsistencies in contrast-media and breastfeeding advice. CONCLUSION: Highly ranked resources were generally understandable but frequently exceeded recommended reading levels, while transparency, risk contextualisation and practical clinical advice varied. IMPLICATIONS FOR PRACTICE: Radiography services should review online patient information for reading demand, transparency, risk contextualisation and consistency of practical advice, with particular attention to maternal and foetal risk communication, contrast media and breastfeeding.