Toward Universal Precautions: Tracking Quality of Health Websites at a National Level

Background:  Healthy People 2020 is a comprehensive national plan that communicates a vision for improving health by setting measurable objectives and assessing progress throughout the decade. This initiative is composed of 1,200 objectives across 42 topic areas, including Health Communication and Health Information Technology (HC/HIT). The HC/HIT topic area consists of 24 objectives with the overall goal of using health communication strategies and health information technology to improve population health outcomes and health care quality. 

Program background: Health-related websites provide easy access to information and tools to help the public find ways to stay healthy or manage disease. However, with the wealth of health information on the Internet, it is critical for users to determine whether the information provided is reliable. In 2012-13, the HC/HIT workgroup updated data for HC/HIT Objective 8.1, which focuses on assessing information reliability for health-related websites. Additionally, the workgroup established a baseline for HC/HIT Objective 8.2, which focuses on the proportion of health-related websites that follow established usability principles. Both of these objectives demonstrate the importance of providing quality health-related websites to the public.

Evaluation Methods and Results: Ninety-four of the most visited health-related websites were analyzed for each objective. For HC/HIT-8.1, the following elements were analyzed to determine the website’s overall information reliability: website sponsor identity, purpose, health content authorship, privacy policies, means for obtaining user feedback, and health content updating. Results showed that 47.9% of websites sampled met 3 or more criteria for Objective 8.1. The two most frequently met criteria were User Feedback (outlining specific mechanisms for user feedback about the website) and Privacy (describing a privacy policy and explaining how user’s personal information is protected).

The HC/HIT workgroup also developed an assessment tool for HC/HIT-8.2 based on recommendations from usability experts, key publications on website usability, and elements from the Association of American Retired Persons’ Audience-Centered Heuristics: Older Adults. The assessment tool consisted of 19 composites across 59 usability criteria. Composites were grouped into three categories: 1. Site Design (design/graphical elements, multimedia, interaction); 2. Information Architecture (navigation, search functionality, content organization); and 3. Content Design (plain language, accessibility). For Objective 8.2, a benchmark was identified as the proportion of health-related websites that met 15 to 19 of the composites. 45.7% of websites met this usability benchmark. 

Conclusions: Encouraging transparency and usability principles in website design and maintenance is an important step in meeting the health literacy needs of users. Data trends show that while progress is being made, more than half of the most popular health-related websites still lack important disclosure elements related to information reliability. 

Implications for research and/or practice: Both objectives will continue to be tracked over the course of the decade as part of Healthy People 2020, elevating the issue of quality health-related websites as one of national importance. Web developers, content managers, and health communicators are called upon to improve health information reliability and follow established usability principles in designing and disseminating online health information.