Accuracy and Readability of Asthma Websites

1. Accuracy and Readability of Asthma Websites Mikki Meadows-Oliver, PhD, MPH, RN Nancy CanteyBanasiak, MSN, PNP-BC

2. Presenter Disclosures • The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: • Neither presenter has any disclosures

3. Purpose of the Study • The purpose of the current descriptive study was to assess the accuracy of health information on the Internet regarding asthma using the 8 core educational concepts developed by the NHLBI (2007) on sponsored and unsponsored Internet sites. • A secondary aim was to assess readability information on the Internet sites that contained accurate information on all 8 core educational NHLBI concepts

4. Asthma • Asthma is a chronic illness that requires continuous supervision by parents as well as ongoing communication between parents and their children around treatment management. • Because of shorter appointments, parents spend less time in the health care providers office • Many have questions that arise after the visit.

5. Health Information & the Internet • Parents may turn to the Internet, a 24 hour source of information. • Helps parents to obtain immediate answers • Helps to reinforce learning

6. Health Information & the Internet (Fox & Jones, 2009) • 61% of internet users search for health information. • Population referred to as e-patients • Most e-patients access user generated health information

7. Health Information & the Internet • Researchers have begun to assess the quality and accuracy of pediatric health information on the internet. • Most research indicates that information presented is inaccurate or incomplete • Readability levels have also been found to be high for the average consumer.

8. Accuracy of Asthma Information • Croft &Peterson (2002) examined 90 asthma websites. Average asthma website contained 4.9 of the 8 core NHLBI asthma educational concepts • Oermann &colleagues (2003) found that only 30/70 (42.9%) contained information on all 8 core educational aspects • Park and colleagues (2004) examined 32 Korean Internet websites. The mean number of educational concepts was 2.7/8

9. ReadabilityNational Patient Safety Foundation (2006) • Average reading level in the U.S. is 8th grade, and 20 percent read at the 5th grade level or below. • 40 % of seniors read at or below the 5th grade level • 50 % of African Americans and Hispanics read at or below the 5th grade reading level • Most health-related material is written at the 10th grade reading level or higher (Institute of Medicine)

10. Readability of Asthma Information • Forbis & Aligne (2002) found that written asthma management plans presented in National guidelines were written at an 8.1 grade reading level. • Wallace & colleagues (2006) examined the readability characteristics of consumer medication information for asthma inhalation devices and found that the materials were written at an 8.2 grade reading level. • Smith and colleagues (1998) evaluated the readability of asthma information pamphlets and found that the pamphlets were written at an average reading grade level of 8.7.

11. Methods • 16 English language search engines searched • Key word: asthma • Inclusion criteria: US websites; Written in English

12. Methods • First 10 unsponsored and first 10 sponsored websites selected • Total of 320 sites initially • After discarding duplicates, final sample 68 websites • 36 unsponsored websites • 32 sponsored websites

13. 8 Core Educational NHLBI concepts • Knowledge of rescue medications • Administration of medication • Self-assessment • Asthma action plan • Pathophysiology of asthma • Knowledge of triggers • Avoidance of triggers • Knowledge of controller medications

14. Results • 6/68 (8.8%) websites provided accurate information on all 8 NHLBI core educational concepts • Unsponsored: 4/36 (11.11%) and Sponsored: 2/32 (6.25%) provided accurate information on all 8 NHLBI criteria • Sponsored sites no more likely that unsponsored sites to contain accurate information on all 8 NHLBI criteria (X2[1, N=68], p = 0.82)

15. Unsponsored Websites • www.asthma.about.com/mbody (HON certified) • www.nhlbi.nih.gov/health/dci/Diseases/Asthma/Asthma_WhatIs .html (available in Spanish) • www.aafa.org (available in Spanish) • www.aaaai.org (available in Spanish)

16. Unsponsored Websites • Most common on the pathophysiology of asthma (47%) • Least common--administration of medication and asthma action plans

17. Sponsored Websites • www.everydaykidz.com • www.asthma.nationaljewish.org (available in Spanish)

18. Sponsored Websites • 47% had NO information on any of the core educational concepts • 25% had information on pathophysiology and triggers • Least common—medication administration

19. Readability • FleschReading Ease • Range 46.6-63.5 • Mean=54.33 • Flesch Grade Level • Range 8.0-10.3 • Mean=9.73

20. Discussion • Majority of websites did not contain comprehensive, accurate information regarding asthma • Concepts such as medication administration were the least discussed • Readability was high for the average consumer

21. Discussion • Variability in the quality of information of the websites • Internet provides great opportunities for health care education • Internet also carries the risk of inaccurate/outdated information

22. Limitations • Cross sectional design • Small number of websites included • Comprehension was not tested directly

23. Implications • As nurses, we can provide information re: previously assessed websites for patients • Educate ourselves to, in turn, educate families • Written patient education materials listing the accurate websites can be provided to reinforce verbal teaching by nurses in a variety of setting • Access to accurate information may enable greater self and family management

24. QUESTIONS ????????