To maintain their own health and the health of their families and communities, consumers rely heavily on the health information that is available to them. This information is at the core of the partnerships that patients and their families forge with today?s complex modern health systems. This information may be provided in a variety of forms ? ranging from a discussion between a patient and a health care provider to a health promotion advertisement, a consent form, or one of many other forms of health communication common in our society. Yet millions of Americans cannot understand or act upon this information. To address this problem, the field of health literacy brings together research and practice from diverse fields including education, health services, and social and cultural sciences, and the many organizations whose actions can improve or impede health literacy. Health Literacy: Prescription to End Confusion examines the body of knowledge that applies to the field of health literacy, and recommends actions to promote a health literate society. By examining the extent of limited health literacy and the ways to improve it, we can improve the health of individuals and populations.

Health literacy : a prescription to end confusion

OBJECTIVE: To review the relationship between literacy and health outcomes DATA SOURCES: We searched MEDLINE, Cumulative Index to Nursing and Allied Health (CINAHL), Educational Resources Information Center (ERIC), Public Affairs Information Service (PAIS), Industrial and Labor Relations Review (ILLR), PsychInfo, and Ageline from 1980 to 2003 STUDY SELECTION: We included observational studies that reported original data, measured literacy with any valid instrument, and measured one or more health outcomes Two abstractors reviewed each study for inclusion and resolved disagreements by discussion DATA EXTRACTION: One reviewer abstracted data from each article into an evidence table; the second reviewer checked each entry The whole study team reconciled disagreements about information in evidence tables Both data extractors independently completed an 11-item quality scale for each article; scores were averaged to give a final measure of article quality DATA SYNTHESIS: We reviewed 3,015 titles and abstracts and pulled 684 articles for full review; 73 articles met inclusion criteria and, of those, 44 addressed the questions of this report Patients with low literacy had poorer health outcomes, including knowledge, intermediate disease markers, measures of morbidity, general health status, and use of health resources Patients with low literacy were generally 15 to 3 times more likely to experience a given poor outcome The average quality of the articles was fair to good Most studies were cross-sectional in design; many failed to address adequately confounding and the use of multiple comparisons CONCLUSIONS: Low literacy is associated with several adverse health outcomes Future research, using more rigorous methods, will better define these relationships and guide developers of new interventions

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Literacy and health outcomes

Objectives: To describe techniques for retrieval and appraisal used by consumers when they search for health information on the internet. Design: Qualitative study using focus groups, naturalistic observation of consumers searching the world wide web in a usability laboratory, and in-depth interviews. Participants: A total of 21 users of the internet participated in three focus group sessions. 17 participants were given a series of health questions and observed in a usability laboratory setting while retrieving health information from the web; this was followed by in-depth interviews. Setting: Heidelberg, Germany. Results: Although their search technique was often suboptimal, internet users successfully found health information to answer questions in an average of 5 minutes 42 seconds (median 4 minutes 18 seconds) per question. Participants in focus groups said that when assessing the credibility of a website they primarily looked for the source, a professional design, a scientific or official touch, language, and ease of use. However, in the observational study, no participants checked any “about us” sections of websites, disclaimers, or disclosure statements. In the post-search interviews, it emerged that very few participants had noticed and remembered which websites they had retrieved information from. Conclusions: Further observational studies are needed to design and evaluate educational and technological innovations for guiding consumers to high quality health information on the web. What is already known on this topic Little is known about how consumers retrieve and assess the quality of health information on the internet Qualitative data are needed to design educational and technological innovations to guide consumers to high quality health information What this study adds Users of the internet explore only the first few links on general search engines when seeking health information Consumers say that when assessing the credibility of a site they primarily look for the source, a professional design, and a variety of other criteria In practice, internet users do not check the “about us” sections of websites, try to find out who authors or owners of the site are, or read disclaimers or disclosure statements Very few internet users later remember from which websites they retrieved information or who stood behind the sites

https://www.bmj.com/content/bmj/324/7337/573.full.pdf

How do consumers search for and appraise health information on the world wide web? Qualitative study using focus groups, usability tests, and in-depth interviews

ContextThe quality of consumer health information on the World Wide Web is
an important issue for medicine, but to date no systematic and comprehensive
synthesis of the methods and evidence has been performed.ObjectivesTo establish a methodological framework on how quality on the Web is
evaluated in practice, to determine the heterogeneity of the results and conclusions,
and to compare the methodological rigor of these studies, to determine to
what extent the conclusions depend on the methodology used, and to suggest
future directions for research.Data SourcesWe searched MEDLINE and PREMEDLINE (1966 through September 2001), Science
Citation Index (1997 through September 2001), Social Sciences Citation Index
(1997 through September 2001), Arts and Humanities Citation Index (1997 through
September 2001), LISA (1969 through July 2001), CINAHL (1982 through July
2001), PsychINFO (1988 through September 2001), EMBASE (1988 through June
2001), and SIGLE (1980 through June 2001). We also conducted hand searches,
general Internet searches, and a personal bibliographic database search.Study SelectionWe included published and unpublished empirical studies in any language
in which investigators searched the Web systematically for specific health
information, evaluated the quality of Web sites or pages, and reported quantitative
results. We screened 7830 citations and retrieved 170 potentially eligible
full articles. A total of 79 distinct studies met the inclusion criteria,
evaluating 5941 health Web sites and 1329 Web pages, and reporting 408 evaluation
results for 86 different quality criteria.Data ExtractionTwo reviewers independently extracted study characteristics, medical
domains, search strategies used, methods and criteria of quality assessment,
results (percentage of sites or pages rated as inadequate pertaining to a
quality criterion), and quality and rigor of study methods and reporting.Data SynthesisMost frequently used quality criteria used include accuracy, completeness,
readability, design, disclosures, and references provided. Fifty-five studies
(70%) concluded that quality is a problem on the Web, 17 (22%) remained neutral,
and 7 studies (9%) came to a positive conclusion. Positive studies scored
significantly lower in search (P = .02) and evaluation
(P = .04) methods.ConclusionsDue to differences in study methods and rigor, quality criteria, study
population, and topic chosen, study results and conclusions on health-related
Web sites vary widely. Operational definitions of quality criteria are needed.

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Empirical Studies Assessing the Quality of Health Information for Consumers on the World Wide Web: A Systematic Review

The widespread prevalence and persistence of misinformation in contemporary societies, such as the false belief that there is a link between childhood vaccinations and autism, is a matter of public concern. For example, the myths surrounding vaccinations, which prompted some parents to withhold immunization from their children, have led to a marked increase in vaccine-preventable disease, as well as unnecessary public expenditure on research and public-information campaigns aimed at rectifying the situation.We first examine the mechanisms by which such misinformation is disseminated in society, both inadvertently and purposely. Misinformation can originate from rumors but also from works of fiction, governments and politicians, and vested interests. Moreover, changes in the media landscape, including the arrival of the Internet, have fundamentally influenced the ways in which information is communicated and misinformation is spread.We next move to misinformation at the level of the individual, and review ...

/pdf/misinformation-and-its-correction-continued-influence-and-1r5m0vnn49.pdf

Misinformation and Its Correction: Continued Influence and Successful Debiasing

ContextDespite the substantial amount of health-related information available
on the Internet, little is known about the accessibility, quality, and reading
grade level of that health information.ObjectiveTo evaluate health information on breast cancer, depression, obesity,
and childhood asthma available through English- and Spanish-language search
engines and Web sites.Design and SettingThree unique studies were performed from July 2000 through December
2000. Accessibility of 14 search engines was assessed using a structured search
experiment. Quality of 25 health Web sites and content provided by 1 search
engine was evaluated by 34 physicians using structured implicit review (interrater
reliability >0.90). The reading grade level of text selected for structured
implicit review was established using the Fry Readability Graph method.Main Outcome MeasuresFor the accessibility study, proportion of links leading to relevant
content; for quality, coverage and accuracy of key clinical elements; and
grade level reading formulas.ResultsLess than one quarter of the search engine's first pages of links led
to relevant content (20% of English and 12% of Spanish). On average, 45% of
the clinical elements on English- and 22% on Spanish-language Web sites were
more than minimally covered and completely accurate and 24% of the clinical
elements on English- and 53% on Spanish-language Web sites were not covered
at all. All English and 86% of Spanish Web sites required high school level
or greater reading ability.ConclusionAccessing health information using search engines and simple search
terms is not efficient. Coverage of key information on English- and Spanish-language
Web sites is poor and inconsistent, although the accuracy of the information
provided is generally good. High reading levels are required to comprehend
Web-based health information.

https://jamanetwork.com/journals/jama/articlepdf/193864/joc02274.pdf

Health Information on the Internet: Accessibility, Quality, and Readability in English and Spanish

To the Editor. —Dr Stone and colleagues 1 report findings from their study designed to investigate the natural history and treatment of patients with unstable angina or non—Qwave myocardial infarction (MI). In their conclusions, the investigators suggest that "more aggressive strategies should be directed to those patients with the greatest likelihood of adverse outcomes." Although this conclusion generally makes logical clinical sense (ie, women with angina or MI), the investigators have taken a giant leap in extending this conclusion to elderly patients without further investigation. This study showed that elderly patients received significantly less aggressive medical management, underwent fewer angiographic procedures and revascularizations, and experienced more severe outcomes. It is possible, as the authors suggest, that elderly patients and their families refuse aggressive procedures and therapy or that invasive procedures are offered to the elderly less often because of coexisting morbidities. It seems only logical that, before we can suggest

Jeffrey I. Algazy

Papers

Health Information on the Internet: Accessibility, Quality, and Readability in English and Spanish

Treatment Strategies for Patients With Ischemic Chest Pain