Tele-education about cleft lip and palate: development of an educational website about cleft lip and palate

MPP was responsible for structuring of the work, outlining the study, collecting, tabulating, analyzing and interpreting the data, writing and revising the article and consenting to the final version for publication; MGGR was responsible for structuring the work, collecting, tabulating, analyzing and interpreting the data, writing, revising the article and consenting to the final version for publication; RGM was responsible for structuring the website, analyzing and interpreting the data, writing, revising the article and consenting to the final version for publication; TPS was responsible for structuring the website, analyzing and interpreting the data, writing, revising the article and consenting to the final version for publication; CCC was responsible for structuring the website, analyzing and interpreting the data, writing, revising the article and consenting to the final version for publication.

Corresponding author:Melissa Picinato-Pirola. E-mail: melissapicinato@unb.br

Evaluator	Experience with CLP in years
Evaluator 1	26
Evaluator 2	36
Evaluator 3	13
Evaluator 4	8
Evaluator 5	30
Evaluator 6	14
Evaluator 7	16
Evaluator 8	10
Evaluator 9	18
Evaluator 10	18
AVERAGE TOTAL	18.9

Items Evaluated	Agree (%)	Disagree (%)	Accomplishments
Appearance of the Website	8 (80%)	2 (20%)	-University logo added to show the university and department responsible for the study.
Definition of CLP	8 (80%)	2 (20%)	- The form of presentation was changed to emphasize that CLP is a congenital alteration that mostly affects the face.
Etiology /causes	7 (70%)	3 (30%)	-Changed to emphasize that CLP does not have a defined cause, occurring because of multiple reasons.
Types of CLP	6 (60%)	4 (40%)	- Captions added to the images of the different types of CLP, as well as the description of bifid uvula, muscle diastasis and bone notch on the hard palate;
			- An image was removed that made it difficult to visualize the submucosal fissure;
			- Added the hidden submucosal fissure.
Primary Surgeries#	5 (45.5%)	6 (54.5%)	- The title of the topic was changed from “Corrections” to “Treatments”;
			- The specific period for carrying out surgery was removed;
			-emphasis that the type of surgery will depend on the protocol used.
Incidences^# # Evaluators sometimes responded by agreeing, sometimes disagreeing on the same item	8 (72.7%)	3 (27.3%)	-It was emphasized that the incidences presented only applied to the Brazilian population and not worldwide.
Diagnosis	6 (60%)	4 (40%)	- Added that diagnosis by ultrasound will be carried out during the prenatal period;
			- Added diagnosis after birth of various types of CLP.

Professionals involved in treatment	7 (70%)	3 (30%)	- Changed: the treatment that may be carried out by a multidisciplinary and / or interdisciplinary team;
Professionals involved in treatment	7 (70%)	3 (30%)	- Emphasis of the performance of the speech therapist, orthodontist and plastic surgeon who will work with the patient from the beginning of the treatment.
Birth^* * There were no changes	9 (90%)	1 (10%)	- No changes.
Feeding	5 (50%)	5 (50%)	Was changed in relation to:
			- Types of feeding: dependent on the type of CLP;
			- Eating methods: if utensils are used and /or food routes that are safest for the child;
			- Added that a multidisciplinary team will assist in this process.
Oral Hygiene#	7 (58.3%)	5 (41.7%)	- Added nasal hygiene;
Oral Hygiene#	7 (58.3%)	5 (41.7%)	- Added an illustrative video on how to perform oronasal hygiene.
Hearing	5 (50%)	5 (50%)	-The presentation of the information was changed;
			- Modified to a structure in the form of topics;
			- Emphasized that the auditory alterations can occur in the fissures that affect the palate;
			- Added images to help visualize the auditory system.
Speech	5 (50%)	5 (50%)	- Changes in the way the information is presented;
Speech	5 (50%)	5 (50%)	- Modified to a structure in the form of topics.

Number of questions before changes	Number of questions after adjustments	Agree (%)	Disagree (%)	Changes
1*	-	9 (90%)	1 (10%)	- Question was changed to a general question of the participants, as it was intended to identify whether the CLP content had been taught during the graduation period.
2	1	8 (80%)	2 (20%)	- The question and answer options were changed. Previously, we attempted to identify which was the best definition of CLP for health professionals and students, however, after the changes, the objective was only to identify their opinions on CLP, having as options: disability, syndrome, malformation and I don't know.
3	2	7 (70%)	2 (20%)	- The answer options were changed, specifying the alternatives regarding the incidence of CLP.
4	3	7 (70%)	3 (30%)	- The question was rephrased. Previously, we tried to identify the knowledge of the evaluated individuals regarding the cause of CLP. After the modifications, we considered what they believed to be the cause of the CLP.
5	4	7 (70%)	3 (30%)	- The question and answer options were changed. The question in the new version aims to identify the public's knowledge about which stage of the gestational period CLP occurs and the alternatives were changed to weeks of life.
6	-	5 (50%)	5 (50%)	- The question was excluded.
7	5	8 (80%)	2 (20%)	- The question and answer options were changed. Initially, it was sought to identify the different types of CLP, however, due to the various forms of existing classifications, it was decided to verify which name the participants knew for CLP.
8	6	5 (50%)	5 (50%)	- The question was rephrased. In the initial questionnaire, we tried to learn which exam/procedure the diagnosis of CLP was carried out. After the suggestions, the question was split into two parts, one in relation to the possibility of the diagnosis being made in the prenatal period and the other question, related to the way the diagnosis of cleft palate is performed after birth.
8	7	5 (50%)	5 (50%)	- The response options were changed.
9	8	8 (80%)	2 (20%)	- The number of the question was modified, being added to the statement about the existence of restrictions of the type of delivery for children with isolated CLP, since previously it was only aimed at children with cleft in general.
10 and 10.1^* * No changes	9 and 9.1	9 (90%)	1 (10%)	- The number of questions was modified.
11	10	3 (30%)	7 (70%)	- The question and answer options were changed. Previously, it aimed to identify specifically, when primary surgery could be performed (cheiloplasty and palatoplasty). After the changes, we tried to identify, in general, up to what age surgery can be performed.
12	11	3 (30%)	7 (70%)	- The question and answer options were changed. Initially, the objective was to determine which feeding method is preferable to use with babies with CLP. Subsequently, it was modified to identify whether the participants are aware of whether a baby with CLP can be breastfed.
13	12	6 (60%)	4 (40%)	- The question was changed in an attempt to measure the indication of the use of a probe in babies with CLP.
14	13	7 (70%)	3 (30%)	- The question was rephrased, specifying whether babies with cleft palate are more likely to develop hearing disorders.
15	14	7 (70%)	3 (30%)	- A question was added to ascertain the knowledge of the target audience about the speech of children with CLP after primary surgery, as well as about the need for speech therapy for speech disorders.
15	15	7 (70%)	3 (30%)
16^# # Evaluator didn’t answer	16	8 (88.9%)	1 (11.1%)	- The question was changed and sought to identify whether oral/nasal hygiene should be performed for individuals with CLP.
Extra Question	17	-	-	- Question added based on suggestions: “Did you consider the orientation program relevant?”

[1] Legend: CLP = cleft lip and palate

Tele-education about cleft lip and palate: development of an educational website about cleft lip and palate

ABSTRACT