Consumer health information provided by library and hospital Websites in the South Central Region

INTRODUCTION

Consumers are using the Internet more frequently to locate health information. According to the Pew Internet & American Life Project report from July 2003, “80% of adult Internet users, or about ninety-three million Americans, have searched for at least one of sixteen major health topics online” [1]. This number represents an increase of 18% over the results from a similar survey reported in May 2002 [2].

Through an examination of Websites, the authors of this brief communication studied if, and how effectively, selected hospitals and libraries are meeting consumer health information needs and expectations.

METHODOLOGY

Hospital and library Websites were chosen to determine the availability, type, and quality of health information. Forty-nine Websites in the five-state area (Arkansas, Louisiana, Oklahoma, New Mexico, and Texas) comprising the South Central Chapter Region of the Medical Library Association (MLA) were analyzed. The forty-nine Websites represented resource and access libraries, state libraries, and hospitals (Figure 1). The authors consulted the Website of the National Network of Libraries of Medicine, South Central Region, and selected the sixteen resource libraries and the three access libraries.† This group of libraries was selected based on the assumption that they would be leaders, setting the standard for developing portions of their Websites devoted to consumer health. The hospital Websites were selected based on bed size as provided in the 2002–03 American Hospital Association Guide to the Health Care Field. The authors thought that hospitals with the largest number of beds would have the financial resources, technological support, and corporate missions to develop Websites with consumer health information. The five largest hospitals were selected in each state, with the exception of Texas. In that state, the first four of the largest eight were Department of Veterans Affairs (VA) hospitals. The authors selected the largest VA hospital, assuming that it would be representative of the other three, and then added the next four largest non-VA hospitals. Other libraries and smaller hospitals do have quality sites, and these may have been omitted based on the selection criteria.

Figure 1.

Analyzed Websites

The next step was to determine the factors to examine on each Website. Varied resources were consulted in the process [3–5]. Microsoft Excel spreadsheets were devised incorporating the forty-nine Websites and the following factors to study: presence of designated section for consumer health, accessibility of information, source of funding for online resources, presence of MLA's “Top Ten” resources, site index, search feature, disclaimer, and endorsement of information quality.

The analysis was conducted during the first two months of 2003. The authors worked together to evaluate each Website. This approach provided opportunities to discuss differences in opinions and to arrive at a consensus. In this way, objectivity and consistency in observations were increased, particularly for factors of a qualitative nature. At the completion of the analysis, the authors tabulated the results using basic statistical methods.

RESULTS AND DISCUSSION

Thirty-four of the examined Websites have a designated section for consumer health information. Additionally, four library sites provided some consumer health information, and eleven did not provide any (Figure 2).

Figure 2.

Provision of consumer health information

Accessibility of information was another factor examined on each Website. The authors considered the ease of use of each site, simplicity of design, satisfaction with using the site, and efficiency in maneuvering around the site. Twenty-nine of forty-nine sites (59%) provided easily accessible information. Twenty sites (41%) were more difficult to use in locating consumer health information (Figure 3).

Figure 3.

Accessibility of information

A trend was noted by the authors among the hospital Websites. Library Websites were characterized by a format of listing free sites using a very plain layout lacking graphics. This practice differentiated significantly from hospital sites, which were frequently noted for their professionally packaged formats. Among the hospital Websites, thirteen of twenty-five (52%) used fee-based, commercially prepared resources. The most popular were HealthVision and Cerner Multum. Others included Animated Health Library, healthwise, HealthGate, My MD.com, ehc.com, and Adam. Health sciences libraries and state libraries did not incorporate those types of resources in their sites. In the hospital environment, Websites are often part of the overall marketing effort and receive emphasis and funding. Packaging of the content with appropriate graphics appeals to the consumer and can be used skillfully for directing users to resources and services. Library communities frequently do not have the same level of financial support for Websites and do not employ full-time Web developers. Their sites usually put more emphasis on content than graphics.

Surprisingly, MLA's “Top Ten” most useful Websites [6] were not widely incorporated. Only one Website out of the forty-nine examined incorporated all ten. The most frequently used were MEDLINEplus, healthfinder, and the Centers for Disease Control (Figure 4). Lack of inclusion of the “Top Ten” by developers of hospital and library Websites may be due to a lack of awareness of this highly selective but reputable list, especially among hospital Website coordinators. In the library communities, Web developers used these sites sparingly. Academic libraries, in particular, do not have core missions to provide an abundance of consumer health sites. This overall lack of inclusion of the “Top Ten” would indicate that MLA needs to publicize this resource even more aggressively.

Figure 4.

Frequency of use of the “Top Ten” consumer health sites recommended by MLA

The presence of several special features was noted on the forty-nine Websites.

• 38% of sites had a site index

• 69% of sites had a search feature

• 68% had a disclaimer regarding responsibility for providing accurate information

The site index and the search feature were selected as factors, because they are effective tools used to navigate within sites and locate content. Many sites now include disclaimers, because it is considered good practice. The authors were interested in seeing how pervasive this element was among the forty-nine sites.

Another factor noted on sites was the presence or absence of approval or endorsement of information quality by agencies such as URAC and Hi-Ethics. Developers of Websites often claim to be mindful of emphasizing quality. The authors were interested in how many Websites actually made the effort to obtain endorsements by established agencies. Quality indicators were found only sporadically.

Finally, among the forty-nine sites examined were six that incorporated sites funded by the National Library of Medicine and other organizations. These were the following:

• Arkansas HealthLINK‡

• Health e-Links§

• Oklahoma's Comprehensive HIV/AIDS Information Network (CHAIN)**

• The Oklahoma Health Connection††

• Consumer Health Information Project (CHIP)‡‡

• Houston Healthways§§

CONCLUSIONS

Despite the differing missions between hospital and library Websites, the majority sought to provide basic consumer health information that was reliable and of high quality. Providing such information on the Websites is a natural expansion of the libraries' and hospitals' services to patients and consumers.

Technology changed the delivery of information and information-seeking behaviors. For many, the Internet became the first and most important source of information. Sciamanna and his coauthors emphasize the importance of identifying the opportunity gap (the difference between what people are doing and what people are interested in doing on the Internet) when developing or expanding health-related activities for consumers and patients [7]. Some of the most significant desired activities identified by their research were related to health care quality, such as determining if consumers' health care providers are using appropriate treatment protocols, how their quality of care compares to other providers, or what questions to ask a provider. One readily available method to help provide such resources would be to include sites for medical licensing boards, accreditation boards, and evidence-based clinical practice guidelines.

Regional variations in Internet use must be considered as well. These disparities reflect differences in education and income levels. According to a recent Pew Internet & American Life Project report from August 2003, the states with the highest Internet access in the South Central Region are as follows: Texas and New Mexico with 60% access, Oklahoma follows with 55%, and last are Louisiana and Arkansas with 48% [8].

As libraries and hospitals continue to improve designing Websites for those who use them, “it is important to highlight that 24% of Americans live lives far removed from the online world” [9]. Therefore, it is important to keep in mind consumer health information needs of those who do not have access to the Internet and address those needs as well.