Stroke education materials on the world wide web: an evaluation of their quality and suitability.(Grand Rounds)

Web-based information is a valuable resource for people affected by stroke, however its accuracy and quality have been questioned. In this study, 30 stroke education websites were reviewed using accountability, readability, and reliability measures. Fifteen consumers and 11 health professionals evaluated six sites in terms of their design, content, and ease of use. The websites mostly met accountability criteria, but their reliability scores were low and their readability was high. Consumers' opinions were consistently higher than health professionals', but scores indicated their preferences for particular websites, especially in terms of design. The importance of considering consumers' preferences when designing and recommending websites is highlighted. Key words: cerebral vascular accident, client education, Internet, stroke, World Wide Web

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Web-based stroke education resources are potentially enormously beneficial for people with stroke, particularly those living in the community, because of their ease of access. The degree to which stroke education websites conform to established guidelines is unknown. The quality and readability of the information available on these websites are also yet to be analyzed. (1) No previous research has examined whether people who have had a stroke, or their carers or family, access the Internet. Although stroke clients' opinions of written health information have been examined, (2) their opinion of web-based materials and whether they would use this source of information is unknown.

Web-Based Health Information

It is estimated that over 70,000 health-related websites exist. (3) Internet access at home and in public facilities such as libraries (4) provides unprecedented opportunity for consumers seeking health information. (5) The Internet has enormous potential for educating people who have experienced stroke and their carers and family A study examining knowledge and perception of stroke revealed that both clients and caters wanted more information about the causes of stroke, treatment methods, and risk of recurrence. (2) The provision of information about stroke is an important role of health professionals, (6) and the Internet has been identified as a key service delivery resource. (7) Numerous factors such as anxiety, physical discomfort, limited privacy, and time constraints impede a client's ability to learn in a health care setting. (8) The Internet provides the opportunity for consumers to access information at a time when they are ready to learn. (9)

Problems with Web-Based Information

Information on the Internet can be incomplete, misleading, and inaccurate. (10) Consumers seeking health information on the Internet can be especially vulnerable to information inaccuracies because they lack skills to evaluate the information. (11) The absence of restrictions on publication of material on the Internet has led to a proliferation of information that may or may not be beneficial. (10) Much of this information is designed to promote financial benefit or political views. (12) Unlike printed material, information published on the Internet is not subject to standards designed to judge the quality of content or to discern evidence from opinion. (12)

Evaluation of Websites

Various guidelines for the evaluation of web-based health materials have been published, but there is not one widely accepted approach in place. (13) Kim et al. (5) reviewed 29 published rating tools and identified several key criteria for the evaluation of websites (see Table 1). Self-policing approaches, such as that established by Health on the Net (HON), enable websites to exhibit the HON code if they conform with a set of principles similar to those identified by Kim and colleagues. (5) Industry groups have also been formulating guidelines in an attempt to promote self-regulation. (10) A study conducted by Griffiths and Christensen examined the quality of web-based information on the treatment of depression. (12) This study used the accountability criteria established by Silberg and colleagues (disclosure of authorship, ownership, and currency of information) (10) and showed that many websites failed to conform to these standards. It also identified that although these factors are important in the evaluation of websites, they are no guarantee of website quality. (10)

Evidence-Based Information

Current client education materials, not just those available on the World Wide Web, can omit relevant data, fail to give a balanced view of the effectiveness of different treatments, and ignore uncertainties. (14) Evaluation of website material needs to go beyond mere accountability to assess the content of the website. The determination of whether the information provided in a website equates with current evidence-based practice involves comparison with accepted guidelines. (15) In a study that evaluated the reliability of health information advice for the management of fever in children, only a few websites were found to provide complete and accurate information regarding this condition. (1)

Readability of Web-Based Information

For health education material to be effective, it needs to be accurate and comprehensible to the consumer. Graber et al. (16) randomly selected 50 samples of client education material from the World Wide Web and analyzed their readability An average reading level of 10th grade 2 months was found. Previous studies have shown that this reading level is not comprehensible to the majority of clients; their recommendation is a reading level of 6th to 7th grade as appropriate. (17-19) Readability levels are particularly pertinent when examining stroke education sites. Stroke can affect people of all ages, but the majority of people affected by stroke are older, and poorer literacy skills have been linked to older age. (20) Neurological deficits that result from stroke, such as aphasia and hemianopia, can also have an impact on an individual's ability to read.

Aims of the Study

No previous research has examined whether people who have had a stroke and their caters and families access web-based stroke education resources. Health care professionals play an important role in recommending high quality websites to consumers. (21) A critical evaluation of the reliability and comprehensibility of information contained on websites is required to do this effectively. The opinions of stroke clients have not been examined to determine how effective they find these resources to be and whether they would use the information to manage their condition.

The aims of this study were to:

1. Analyze the accountability, reliability, and readability of stroke websites.

2. Examine the perceptions of people who have experienced stroke, carers, and health care professionals about web-based stroke education materials. This will encompass the following steps: determine the current use of stroke websites by people who have had a stroke and their carers; determine if differences exist between the perceptions of this group and those of health professionals about the design and aesthetics, ease of use, and content of sites; and ascertain the opinions of stroke health professionals about the accuracy of the content of these websites

Method

Participants

Two convenient groups of participants were recruited. Ethical clearance was obtained from a university ethics committee, and approval to contact potential participants was obtained from a community support …