Assessing websites and low health literacy

Simple review guidelines

Patient education managers faithfully assess written materials to make sure they are appropriate for people with low health literacy or poor reading skills. They must be just as diligent when selecting websites for educational purposes, says Abigail Jones, MLIS, MA, consumer health librarian at the Library for Health Information in the Atrium at The Ohio State University Medical Center in Columbus.

"It is important to be able to evaluate websites and know where to direct people for good, easy-to-read information, so they have the opportunity to have the best information available to them," says Jones.

As a consumer health librarian, Jones has become skilled at selecting websites that provide appropriate information for patients and families who may not read well or are unfamiliar with medical terminology or certain diseases and health issues.

The first step in evaluating a website is the assessment of the general cyber information to determine if it will be a valuable health resource for consumers, Jones explains. Determine if the information is current by looking for a notation of the last update. If it is a website with lots of pages and documents, look to see if each is dated and when updates occur.

Another important aspect, according to Jones, is the source for the information. Often, there is an "about us" tab or link that tells the user the author of the material or website sponsor. It's important to ask what makes the source an expert and, if he or she has credentials, what those are, says Jones.

Also important is objectivity or absence of bias. Determine if the website has a board or oversight group in addition to the authors or editors of the material, Jones advises. She adds, "Is there information on the website about the review policy or editorial policy?"

Sometimes the organization sponsoring the website is enough of an authority that people would know everything on the site is authoritative and has been written by experts, says Jones. This is the case with MedlinePlus, a consumer health website from the National Library of Medicine and National Institutes of Health.

"They have an extremely rigorous review policy, and the site is supported by those two governmental review bodies. It is the gold standard of consumer health information," says Jones.

The information should not be opinion, but evidence-based. Determine if medical research or medical practice supports the material offered on the site, advises Jones.

It's also a good idea to recommend only those websites that are without advertising, because a consumer may assume the advertising is part of the authentic, objective, health information, says Jones.

Good teaching resource

Once it is determined that the website has current, medically sound information, it is time to assess whether it is a good teaching resource. Many of the rules for plain language or clear communication that apply to written copy also apply to the website text.

The format of the text is important as well. This would include such matters as white space, font style, and font size.

With technological advances, websites can be tailored for specific audiences. MedlinePlus created a site for older adults who may have poor eyesight, called Readers can enlarge the text, choose to have the information read out loud, or increase the contrast so the text is easier to read. (See more easy-to-read websites recommended by Jones on pp. 126.)

"That is an excellent example of making sure that — physically — the website is easy to see," says Jones.

Low literacy websites can incorporate many features that make it easier for consumers to grasp the information. Designers can include online tutorials or tests. Short films or slide shows can be incorporated into the text to increase understanding. Jones says often these clips can be downloaded to review later, and the information can be printed out for future reference. Illustrations within the text, such as photos or line drawings, are also helpful, she adds.

"I think a variety of vehicles are important for delivering the same message in health information, because we have a wide range of reading abilities that can come through our doors at a consumer health library," says Jones.

In addition to looking at the information, it is a good idea to look at how easy it is to navigate a website. If it is a directory-style website where people point and click to access information, categories need to be obvious. Often the alphabet is used to access information, with the letter "D" uncovering topics such as diabetes, for example. If a website has a search engine, it must be quick and extremely intuitive in recognizing natural language, says Jones.

The health consumer library at The Ohio State University Medical Center uses a lot of consumer health subscription databases, because they are current, says Jones. However, there are many specialized, free websites consumers are encouraged to use.

"People assume they will be able to get health information from websites, and they also assume they are the best navigators. Often, people do not realize the depth and extensive scope of health information that is out there, so they overlook sites that are available," says Jones.

Therefore, one of the services of the consumer health library is to act as a human search engine for patients and family members directing them to websites that are reliable, objective, and written in lay language, says Jones.


• Abigail Jones, MLIS, MA, Consumer Health Librarian, Library for Health Information in the Atrium, John A. Prior Health Sciences Library, The Ohio State University Medical Center, Box 154 University Hospital, 410 W. 10th Ave., Columbus, OH 43210. Telephone: (614) 293-3707. E-mail:

(Editor's Note: Jones says patients and families will sometimes state they are not good readers. If they do not provide this information, she provides at least three items of information on the same topic at different reading levels. For example, one would be easy-to-read at a grammar school reading level, the second a high school reading level, and the third a longer, encyclopedia-style article.)