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Expanding the Reach and Impact of
Consumer e-Health Tools

June 2006

Office of Disease Prevention and Health Promotion logo

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Appendix 3. Chapter 3 Literature Review Summary (Part 8)

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Table Reference Number/Authors/
Text Section
Sample Health Topic Area/
Locus of Use/
Description of the Tool Overview Measures Outcomes
Content Analyses
83. Cheh, JA, Ribisl KM, Wildemuth, BM. An assessment of the quality and usability of smoking cessation information on the Internet. Health Promotion Practice 2003;4(3):278-87. [Appropriateness] NA Smoking cessation: lab computer with Internet Smoking cessation Web sites Reviewed 30 Web sites identified from online and print resources Informational content, accessibility and usability, source credibility, currency of information Majority of sites contained information content congruent with published smoking cessation guidelines. 93.3% of sites written above a fifth-grade Flesch-Kincaid reading level; 9 sites contained >50 pages of content; 16 had site map or search mechanism; 63.3% were created by organizations with authors having health credentials; 3 sites supported claims with reference to scientific research; 5 sites displayed when their content was last updated.
84. Evers KE, Prochaska JM, Prochaska JO, Driskell M, Cummin CO, Velicer WF. Strengths and weaknesses of health behavior change programs on the Internet. Journal of Health Psychology 2003;8:63-70. [Appropriateness] NA Health information: lab computer with Internet 37 public Web sites on health behavior change for disease prevention and management 273 Web sites addressing 7 targeted problem areas (tobacco use, physical activity, alcohol, diet, diabetes, depression, and pediatric asthma) were identified and screened according to quality criteria that would determine whether the sites had the minimum criteria for having the potential to change behavior. 15% (42) of the programs met 4 of 5 of the criteria, and these sites underwent a full review. The five “A’s” for effective health behavior change treatment on the Internet (advise, assess, assist, anticipatory guidance, and arrange followup), use of behavior change theory, single vs. multiple behaviors, interactivity, security, privacy and confidentiality, accountability, evaluation Found that the types of assessments varied across types of programs; 81% of programs gave a rationale for the assessment; 84% of the programs provided feedback that followed appropriately from the assessment, although only five used individualized, tailored feedback; 73% offered some form of anticipatory guidance to prevent relapse; 11% specified when a user should come back, and 22% used e-mail reminders to keep in contact; 29% explicitly stated use of a theoretical model; 78% were part of a site addressing multiple risk behaviors. Interactive features included assessments (100%), chat room (49%), bulletin boards or discussion lists (73%), ask-the-expert (49%), behavior tracking tool (49%), e-mail reminders or newsletters (70%). 76% required registration with a password to access all of site. 92% posted a privacy policy statement. 100% had some form of contact, either e-mail or phone. None of the sites included information about evaluation for effectiveness.
85. Fahey D, Weinberg J. LASIK complications and the Internet: is the public being misled? Journal of Medical Internet Research 2003;5:e2. [Appropriateness] NA LASIK surgery: lab computer with Internet Web sites about LASIK surgery Content analysis of 21 Web sites related to LASIK surgery Authorship (recognized authority, credentials, contact information), content (details of complications, easy to understand, ease of locating complications, accuracy of references, currency, balanced information), and technical quality (quality of page layout, ease of identifying site’s header and footer). 17/21 sites were commercial; 5/21 (24%) had no information on complications. Of the 16 sites that had information on complications: the author of the information was clearly identified in 5 (31%), the content was referenced in 2 (12.5%), and evidence of the information having been updated was seen in 2 (12.5%).
86. Finn J. An exploration of helping processes in an online self-help group focusing on issues of disability. Health and Social Work 1999;24:220-31. [Acceptability] NA Social support: lab computer with Internet An online group whose purpose was to allow discussion and support between individuals coping with physical or mental limitations Analyzed 3 months of messages from an online support group Types of posts Messages focused on health and disability-related information (38.2% of posts), emotional and interpersonal issues related to disability (28.4%), empowerment of members through legal and political means (11.2%), plus more than 1/10 messages devoted to social interchange unrelated to issues of health or disability.
87. Madan AK, Frantzides CT, Pesce CE. The quality of information about laparoscopic bariatric surgery on the Internet. Surgical Endoscopy 2003;17:685-7. [Appropriateness] NA Bariatric surgery: lab computer with Internet Web sites about laparoscopic bariatric surgery Evaluation of 119 Internet sites found via 6 search engines and 2 metasearch engines. The first 20 “hits” for each separate search engine were included in the study. Educational information on laparoscopic obesity surgery, discussion of at least one procedure related to the surgery, procedure details, discussion of other procedures, discussion of risks, including death, and discussion of this surgery as an option for obesity surgery. Sites were also evaluated for inclusion of misleading or biased information. A total of 602 hits found with search engines. Of these, only 119 unique sites. Of these, 63/119 had educational information about bariatric surgery, 56 discussed laparoscopic surgery as an option, 33 gave details of the procedure, 30 discussed accurate weight loss results, 26 discussed death as a complication, 18 contained biased or misleading information. Only 89 of the original 602 hits led to sites that discussed this type of surgery, procedure details, and complications in an unbiased manner.
88. McTavish FM, Pingree S, Hawkins R, Gustafson D. Cultural differences in use of an electronic discussion group. Journal of Health Psychology 2003;8:105-17. [Overview, Applicability] 113 women who received the Comprehensive Health Enhancement Support System (CHESS) and who had participated in the discussion group; 86 white, 23 African American, 2 Native American, 2 Asian Cancer: lab computer with Internet CHESS breast cancer module: study focused on use of the Women’s Only Discussion Group, which only allowed access to women with breast cancer. Messages from the discussion group were randomly selected for analysis. Use of discussion group, message content Women of color used the discussion group significantly less than Caucasian women. Most of their use was in the first 3 months, while the Caucasian women’s use of the discussion group declined much more gradually. Women of color wrote a greater proportion of messages specific to breast cancer and its treatment, and fewer dealing with daily life than Caucasian women. The groups did not differ in self-disclosure, but Caucasian women were more likely to offer support to other women. Message focus changed over time. Caucasian women wrote more about daily life than breast cancer as time went on. Women of color initially wrote more about breast cancer, and then overall usage dropped off significantly.
89. Mendelson C. Gentle hugs: Internet listservs as sources of support for women with lupus. Advances in Nursing Science 2003;26:299-306. [Acceptability] NA Lupus: lab computer with Internet Three online listservs for women with lupus Three online listservs for women with lupus were identified. Content analysis of posting was completed. Types of posts Themes emerged: exchanging information and advice, living with illness, life goes on/friendly banter; life in cyberspace (introduction of self to list/welcome from member), support.
90. Oermann M, Lowery N, Thornley J. Evaluation of Web sites on management of pain in children. Pain Management Nursing 2003;4:99-105. [Appropriateness] NA Pain management: lab computer with Internet Web sites about pain management 40 Web sites identified from Google and MSN were rated for quality using the Health Information Technology Institute (HITI) criteria (credibility, content, disclosure, links, design, interactivity, and caveats). Quality, readability 9/40 sites met all of the HITI criteria and were at an appropriate reading level for most users. The mean reading grade level of all sites was 10.8—too high for many consumers.
91. Seidman J, Steinwachs D, Rubin H. Design and testing of a tool for evaluating the quality of diabetes consumer-information Web sites. Journal of Medical Internet Research 2003;5:e30. [Appropriateness] NA Diabetes: lab computer with Internet Web sites about diabetes Researchers developed a tool, based on the American Diabetes Association’s Clinical Practice Recommendations, that would allow evaluation of the quality of diabetes-related Web sites. Then they assessed 90 diabetes-related Web sites using the tool. Quality Found wide variation in the quality of consumer diabetes information on the Internet. Average score of 50% suggests substantial level of inaccurate and missing information.

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