Assessing the information quality and usability of My Health Record within a health literacy framework: What's changed since 2016?

BACKGROUND: This study examined the health literacy demands of My Health Record (MyHR) in the context of preparing for a government-announced opt-out system by repeating two studies of health information and usability conducted in 2016. OBJECTIVE: To examine whether Australia's MyHR meets the information and usability needs of people at risk of low health literacy and changes since 2016. METHOD: Content analysis: Informed by the 2016 methods and findings, measures of information quality, themes and target audiences were recorded and reported for each online consumer-facing health information resource. Heuristic evaluation: An evaluation of the MyHR and supporting information website was conducted using a predetermined checklist of usability criteria. A list of usability violations for both websites was identified. RESULTS: Total number of resources grew from 80 in 2016 to 233 in 2018. There was little change since 2016 to average readability levels, target audiences, presentation style, links between resources and usability of MyHR. Compared to 2016, this study demonstrated increases in resources from non-government organisations; video resources; translated resources; and resources with themes of privacy, security and post-registration use. CONCLUSION: This study identified some improvements in information quality since 2016, but gaps remain in information quality and usability which may negatively impact the ability for people with low health literacy to access and use MyHR. IMPLICATIONS: This study provides a framework for ongoing monitoring and evaluation of the suitability of MyHR for people at risk of low health literacy.

The Reliability and Quality of YouTube Videos as a Source of Public Health Information Regarding COVID-19 Vaccination: Cross-sectional Study.

BACKGROUND: Recent emergency authorization and rollout of COVID-19 vaccines by regulatory bodies has generated global attention. As the most popular video-sharing platform globally, YouTube is a potent medium for the dissemination of key public health information. Understanding the nature of available content regarding COVID-19 vaccination on this widely used platform is of substantial public health interest. OBJECTIVE: This study aimed to evaluate the reliability and quality of information on COVID-19 vaccination in YouTube videos. METHODS: In this cross-sectional study, the phrases "coronavirus vaccine" and "COVID-19 vaccine" were searched on the UK version of YouTube on December 10, 2020. The 200 most viewed videos of each search were extracted and screened for relevance and English language. Video content and characteristics were extracted and independently rated against Health on the Net Foundation Code of Conduct and DISCERN quality criteria for consumer health information by 2 authors. RESULTS: Forty-eight videos, with a combined total view count of 30,100,561, were included in the analysis. Topics addressed comprised the following: vaccine science (n=18, 58%), vaccine trials (n=28, 58%), side effects (n=23, 48%), efficacy (n=17, 35%), and manufacturing (n=8, 17%). Ten (21%) videos encouraged continued public health measures. Only 2 (4.2%) videos made nonfactual claims. The content of 47 (98%) videos was scored to have low (n=27, 56%) or moderate (n=20, 42%) adherence to Health on the Net Foundation Code of Conduct principles. Median overall DISCERN score per channel type ranged from 40.3 (IQR 34.8-47.0) to 64.3 (IQR 58.5-66.3). Educational channels produced by both medical and nonmedical professionals achieved significantly higher DISCERN scores than those of other categories. The highest median DISCERN scores were achieved by educational videos produced by medical professionals (64.3, IQR 58.5-66.3) and the lowest median scores by independent users (18, IQR 18-20). CONCLUSIONS: The overall quality and reliability of information on COVID-19 vaccines on YouTube remains poor. Videos produced by educational channels, especially by medical professionals, were higher in quality and reliability than those produced by other sources, including health-related organizations. Collaboration between health-related organizations and established medical and educational YouTube content producers provides an opportunity for the dissemination of high-quality information on COVID-19 vaccination. Such collaboration holds potential as a rapidly implementable public health intervention aiming to engage a wide audience and increase public vaccination awareness and knowledge.

Hesitancy Toward a COVID-19 Vaccine.

The scientific community has come together in a mass mobilization to combat the public health risks of COVID-19, including efforts to develop a vaccine. However, the success of any vaccine depends on the share of the population that gets vaccinated. We designed a survey experiment in which a nationally representative sample of 3,133 adults in the USA stated their intentions to vaccinate themselves and their children for COVID-19. The factors that we varied across treatments were: the stated severity and infectiousness of COVID-19 and the stated source of the risk information (White House or the Centers for Disease Control). We find that 20% of people in the USA intend to decline the vaccine. We find no statistically significant effect on vaccine intentions from the severity of COVID-19. In contrast, we find that the degree of infectiousness of the coronavirus influences vaccine intentions and that inconsistent risk messages from public health experts and elected officials may reduce vaccine uptake. However, the most important determinants of COVID-19 vaccine hesitancy seem to be distrust of the vaccine safety (including uncertainty due to vaccine novelty), as well as general vaccine avoidance, as implied by not having had a flu shot in the last two years.

An evaluation of the quality of online information on emergency contraception.

OBJECTIVES: The increasing availability of health information online combined with reduced access to health care providers due to the coronavirus pandemic means that more people are using the internet for health information. However, with no standardised regulation of the internet, the population is vulnerable to misinformation regarding important health information. This review aimed to evaluate the quality and readability of the online information available on emergency contraception (EC) options. STUDY DESIGN: In this descriptive study, a Google search was performed using the term 'emergency contraception options' on 13 April 2020 yielding 232 results. Seventy-one results were excluded (34 inaccessible, 37 contained no medical information). The remaining 161 results were categorised by typology and assessed for credibility (JAMA criteria and HONcode), reliability (DISCERN tool) and readability (Flesch-Kincaid Grade Level and Simple Measure of Gobbledygook). RESULTS: Of all webpages evaluated, the most common typology was governmental. Credibility of web pages was poor (average JAMA score of 1.47 out of 4). Only 10.6% of webpages were HONcode certified. The most common DISCERN category was Fair (29.81%), closely followed by Poor (27.95%) reliability. On average, readability levels were above the recommended grade level for health information. The intrauterine device was discussed least frequently (86.96%) of all the EC options. CONCLUSION: Online information was of low credibility, reliability and written above the recommended reading level. Clinicians should be aware of the poor quality of online information on EC options, and actively educate patients on what makes a source credible.

"Ask a Doctor About Coronavirus": How Physicians on Social Media Can Provide Valid Health Information During a Pandemic.

In the wake of the COVID-19 pandemic, the information stream has overflowed with accurate information, misinformation, and constantly changing guidelines. There is a great need for guidance on the identification of trustworthy health information, and official channels are struggling to keep pace with this infodemic. Consequently, a Facebook group was created where volunteer medical physicians would answer laypeople's questions about the 2019 novel coronavirus. There is not much precedence in health care professional-driven Facebook groups, and the framework was thus developed continuously. We ended up with an approach without room for debate, which fostered a sense of calmness, trust, and safety among the questioners. Substantial moderator effort was needed to ensure high quality and consistency through collaboration among the presently >200 physicians participating in this group. At the time of writing, the group provides a much-needed service to >58,000 people in Denmark during this crisis.

Factors Affecting Public Adoption of COVID-19 Prevention and Treatment Information During an Infodemic: Cross-sectional Survey Study.

BACKGROUND: With the spread of COVID-19, an infodemic is also emerging. In public health emergencies, the use of information to enable disease prevention and treatment is incredibly important. Although both the information adoption model (IAM) and health belief model (HBM) have their own merits, they only focus on information or public influence factors, respectively, to explain the public's intention to adopt online prevention and treatment information. OBJECTIVE: The aim of this study was to fill this gap by using a combination of the IAM and the HBM as the framework for exploring the influencing factors and paths in public health events that affect the public's adoption of online health information and health behaviors, focusing on both objective and subjective factors. METHODS: We carried out an online survey to collect responses from participants in China (N=501). Structural equation modeling was used to evaluate items, and confirmatory factor analysis was used to calculate construct reliability and validity. The goodness of fit of the model and mediation effects were analyzed. RESULTS: The overall fitness indices for the model developed in this study indicated an acceptable fit. Adoption intention was predicted by information characteristics (ß=.266, P<.001) and perceived usefulness (ß=.565, P<.001), which jointly explained nearly 67% of the adoption intention variance. Information characteristics (ß=.244, P<.001), perceived drawbacks (ß=-.097, P=.002), perceived benefits (ß=.512, P<.001), and self-efficacy (ß=.141, P<.001) jointly determined perceived usefulness and explained about 81% of the variance of perceived usefulness. However, social influence did not have a statistically significant impact on perceived usefulness, and self-efficacy did not significantly influence adoption intention directly. CONCLUSIONS: By integrating IAM and HBM, this study provided the insight and understanding that perceived usefulness and adoption intention of online health information could be influenced by information characteristics, people's perceptions of information drawbacks and benefits, and self-efficacy. Moreover, people also exhibited proactive behavior rather than reactive behavior to adopt information. Thus, we should consider these factors when helping the informed public obtain useful information via two approaches: one is to improve the quality of government-based and other official information, and the other is to improve the public's capacity to obtain information, in order to promote truth and fight rumors. This will, in turn, contribute to saving lives as the pandemic continues to unfold and run its course.

The Quality of Infectious Disease Hospital Websites in Poland in Light of the COVID-19 Pandemic.

The quality of healthcare service websites gains particular importance in the time of the pandemic, asthe popularity of electronic services grows. This applies to infectious disease hospitals as well, often on the front line of the effort against COVID-19. The paper aims to assess the quality of infectious disease hospital websites in Poland in light of the COVID-19 pandemic. The research covered 91 websites. The first stage was an analysis of selected technical attributes of the websites (including website performance, SEO quality, website availability, and mobile-friendliness) with selected online tools, such as Google PageSpeed Insights, Blink Audit Tool, Backlink Checker, andwebsite accessibility evaluation tool (WAVE). The data were then analyzed with statistical methods. The next step was to analyze the content of the websites. The research has shown that most of the websites were of satisfactory quality, apart from those that were not mobile-ready. The following keywords were found most often on the hospital websites: SARS-CoV-2, COVID-19, smear, specialist care clinic, isolation, telephone consultations, sample collection center, support, coronavirus, recommendations, patient registration, signs of disease. The research suggests that the quality of infectious disease hospital websites in Poland is significantly diversified in search engine optimization, mobile-friendliness, and needs of people at risk of digital exclusion.

Quality and readability of web-based Arabic health information on COVID-19: an infodemiological study.

BACKGROUND: This study sought to assess the quality and readability of web-based Arabic health information on COVID-19. METHODS: Three search engines were searched on 13 April 2020 for specific Arabic terms on COVID-19. The first 100 consecutive websites from each engine were analyzed for eligibility, which resulted in a sample of 36 websites. These websites were subjected to quality assessments using the Journal of the American Medical Association (JAMA) benchmarks tool, the DISCERN tool, and Health on the Net Foundation Code of Conduct (HONcode) certification. The readability of the websites was assessed using an online readability calculator. RESULTS: Among the 36 eligible websites, only one (2.7%) was HONcode certified. No website attained a high score based on the criteria of the DISCERN tool; the mean score of all websites was 31.5 ± 12.55. As regards the JAMA benchmarks results, a mean score of 2.08 ± 1.05 was achieved by the websites; however, only four (11.1%) met all the JAMA criteria. The average grade levels for readability were 7.2 ± 7.5, 3.3 ± 0.6 and 93.5 ± 19.4 for the Flesch Kincaid Grade Level, Simple Measure of Gobbledygook, and Flesch Reading Ease scales, respectively. CONCLUSION: Almost all of the most easily accessible web-based Arabic health information on COVID-19 does not meet recognized quality standards regardless of the level of readability and ability to be understood by the general population of Arabic speakers.

Mental health consequences of COVID-19 media coverage: the need for effective crisis communication practices.

During global pandemics, such as coronavirus disease 2019 (COVID-19), crisis communication is indispensable in dispelling fears, uncertainty, and unifying individuals worldwide in a collective fight against health threats. Inadequate crisis communication can bring dire personal and economic consequences. Mounting research shows that seemingly endless newsfeeds related to COVID-19 infection and death rates could considerably increase the risk of mental health problems. Unfortunately, media reports that include infodemics regarding the influence of COVID-19 on mental health may be a source of the adverse psychological effects on individuals. Owing partially to insufficient crisis communication practices, media and news organizations across the globe have played minimal roles in battling COVID-19 infodemics. Common refrains include raging QAnon conspiracies, a false and misleading "Chinese virus" narrative, and the use of disinfectants to "cure" COVID-19. With the potential to deteriorate mental health, infodemics fueled by a kaleidoscopic range of misinformation can be dangerous. Unfortunately, there is a shortage of research on how to improve crisis communication across media and news organization channels. This paper identifies ways that legacy media reports on COVID-19 and how social media-based infodemics can result in mental health concerns. This paper discusses possible crisis communication solutions that media and news organizations can adopt to mitigate the negative influences of COVID-19 related news on mental health. Emphasizing the need for global media entities to forge a fact-based, person-centered, and collaborative response to COVID-19 reporting, this paper encourages media resources to focus on the core issue of how to slow or stop COVID-19 transmission effectively.

Governmental actions to address COVID-19 misinformation.

Since COVID-19 emerged, a plethora of misinformation has undermined the public's ability to identify reliable sources of accurate information. To identify the range of methods governments used to address COVID-19 misinformation, we conducted a content analysis of international media and evaluated government actions in light of international law, which protects freedom of expression and calls on governments to guarantee this fundamental right even during a pandemic or other emergency. We identified five categories of government activities: (1) disseminating and increasing access to accurate information; (2) restricting access to accurate information; (3) disseminating disinformation, false information, and misinformation; (4) addressing commercial fraud; and (5) criminalizing expression. The goal of addressing COVID-19 misinformation is best served by protecting expression, disseminating factual information, ensuring strong protections for whistleblowers, and supporting an independent media environment. Conversely, governments undermine public health when they create a state of uncertainty and violate human rights.

Demographic Factors Influencing the Impact of Coronavirus-Related Misinformation on WhatsApp: Cross-sectional Questionnaire Study.

BACKGROUND: The risks of misinformation on social networking sites is a global issue, especially in light of the COVID-19 infodemic. WhatsApp is being used as an important source of COVID-19-related information during the current pandemic. Unlike Facebook and Twitter, limited studies have investigated the role of WhatsApp as a source of communication, information, or misinformation during crisis situations. OBJECTIVE: Our study aimed to evaluate the vulnerability of demographic cohorts in a developing country toward COVID-19-related misinformation shared via WhatsApp. We also aimed to identify characteristics of WhatsApp messages associated with increased credibility of misinformation. METHODS: We conducted a web-based questionnaire survey and designed a scoring system based on theories supported by the existing literature. Vulnerability (K) was measured as a ratio of the respondent's score to the maximum score. Respondents were stratified according to age and occupation, and Kmean was calculated and compared among each subgroup using single-factor analysis of variance and Hochberg GT2 tests. The questionnaire evaluated the respondents' opinion of the veracity of coronavirus-related WhatsApp messages. The responses to the false-proven messages were compared using z test between the 2 groups: coronavirus-related WhatsApp messages with an attached link and/or source and those without. RESULTS: We analyzed 1137 responses from WhatsApp users in India. Users aged over 65 years had the highest vulnerability (Kmean=0.38, 95% CI 0.341-0.419) to misinformation. Respondents in the age group 19-25 years had significantly lower vulnerability (Kmean=0.31, 95% CI 0.301-0.319) than those aged over 25 years (P<.05). The vulnerability of users employed in elementary occupations was the highest (Kmean=0.38, 95% CI 0.356-0.404), and it was significantly higher than that of professionals and students (P<.05). Interestingly, the vulnerability of healthcare workers was not significantly different from that of other occupation groups (P>.05). We found that false CRWMs with an attached link and/or source were marked true 6 times more often than false CRWMs without an attached link or source (P<.001). CONCLUSIONS: Our study demonstrates that in a developing country, WhatsApp users aged over 65 years and those involved in elementary occupations were found to be the most vulnerable to false information disseminated via WhatsApp. Health care workers, who are otherwise considered as experts with regard to this global health care crisis, also shared this vulnerability to misinformation with other occupation groups. Our findings also indicated that the presence of an attached link and/or source falsely validating an incorrect message adds significant false credibility, making it appear true. These results indicate an emergent need to address and rectify the current usage patterns of WhatsApp users. This study also provides metrics that can be used by health care organizations and government authorities of developing countries to formulate guidelines to contain the spread of WhatsApp-related misinformation.

Predictors of COVID-19 Information Sources and Their Perceived Accuracy in Nigeria: Online Cross-sectional Study.

BACKGROUND: Effective communication is critical for mitigating the public health risks associated with the COVID-19 pandemic. OBJECTIVE: This study assesses the source(s) of COVID-19 information among people in Nigeria, as well as the predictors and the perceived accuracy of information from these sources. METHODS: We conducted an online survey of consenting adults residing in Nigeria between April and May 2020 during the lockdown and first wave of COVID-19. The major sources of information about COVID-19 were distilled from 7 potential sources (family and friends, places of worship, health care providers, internet, workplace, traditional media, and public posters/banners). An open-ended question was asked to explore how respondents determined accuracy of information. Statistical analysis was conducted using STATA 15.0 software (StataCorp Texas) with significance placed at P<.05. Approval to conduct this study was obtained from the Lagos State University Teaching Hospital Health Research Ethics Committee. RESULTS: A total of 719 respondents completed the survey. Most respondents (n=642, 89.3%) obtained COVID-19-related information from the internet. The majority (n=617, 85.8%) considered their source(s) of information to be accurate, and 32.6% (n=234) depended on only 1 out of the 7 potential sources of COVID-19 information. Respondents earning a monthly income between NGN 70,000-120,000 had lower odds of obtaining COVID-19 information from the internet compared to respondents earning less than NGN 20,000 (odds ratio [OR] 0.49, 95% CI 0.24-0.98). In addition, a significant proportion of respondents sought accurate information from recognized health organizations, such as the Nigeria Centre for Disease Control and the World Health Organization. CONCLUSIONS: The internet was the most common source of COVID-19 information, and the population sampled had a relatively high level of perceived accuracy for the COVID-19 information received. Effective communication requires dissemination of information via credible communication channels, as identified from this study. This can be potentially beneficial for risk communication to control the pandemic.

Information uncertainty: a correlate for acute stress disorder during the COVID-19 outbreak in China.

BACKGROUND: Individuals' stress in responding to the current COVID-19 pandemic may be exacerbated by information uncertainty driven by inconsistent, unverified, and conflicting news from various sources. The current study aims to test if information uncertainty during the COVID-19 outbreak was related to acute stress disorder (ASD) over and above other psychosocial stressors. METHODS: An anonymous online survey was conducted with 7800 college students throughout China from January 31 through February 11, 2020. Existing scales were modified to measure ASD and six potential stressors including information uncertainty during the COVID-19 outbreak. Hierarchical regression analysis was conducted to assess the unique association of information uncertainty with ASD. To minimize the effect of large sample size and also to get a sense of whether the effects of information uncertainty were similar to people at the center of the epidemic, we repeated the hierarchical regression among 10% of the students who were randomly selected from the entire sample ("10% random sample"; n = 780) and 226 students from Hubei Province where the outbreak started. RESULTS: Information uncertainty was highly prevalent among the respondents (64%). It was significantly associated with ASD beyond other key variables and potential stressors across three samples. In the hierarchical regression among the entire sample, demographic variables accounted for 9.4% of the variance in ASD. The other five stressors added 5.1% of the variance. The information uncertainty (ß = .159; p < .001) explained an additional 2.1% of the variance. Likewise, the information uncertainty explained an additional 2.1 and 3.4% of the variance in ASD beyond all other variables among the 10% random sample (ß = .165; p < .001) and the Hubei sample (ß = .196; p < .01), respectively. CONCLUSION: Information uncertainty is a unique correlate of psychological stress during the COVID-19 outbreak. Reducing information uncertainty is essential not only for halting virus transmission but also for mitigating negative impacts of the pandemic on people's psychosocial wellbeing. Transparent, timely, and accurate communication can reduce public confusion, fear, and stress. Capacity building in governments, communities, and media outlets to prevent, reduce and manage information uncertainty should be a critical part of the response to an emerging global health crisis such as the COVID-19 pandemic.

Uncertainty Management and Curve Flattening Behaviors in the Wake of COVID-19's First Wave.

The coronavirus (COVID-19) outbreak poses a substantial threat to public health. Individual efforts to engage in COVID-19 precautionary behaviors are necessary to flatten the pandemic's curve in the waiting period before a vaccine is developed. This study sought to apply the Theory of Motivated Information Management to investigate the relationships among COVID-19 illness uncertainty, information management, and actual precautionary behaviors, both preparatory and preventative. The results of a national opt-in online panel demonstrate that uncertainty discrepancy, anxiety, and information management strategies are key predictors of the adoption of COVID-19 preparation and prevention behaviors. The results further identify diverging associations across age groups with respect to associations between information management and precautionary behaviors. Implications for theory and practice are discussed.

Assessment of the Readability of Online Patient Education Material from Major Geriatric Associations.

BACKGROUND/OBJECTIVES: An increasing number of patients are using the internet to supplement information provided by medical professionals. Online geriatric patient education materials (PEMs) should be written at or below a 6th grade reading level (GRL) that takes into account barriers unique to the geriatric population. The objectives of the study are to assess PEMs of geriatric associations' websites and determine whether they are above the GRL recommended by the Centers for Disease Control and National Institutes of Health. DESIGN: Descriptive and correlational methodology. PEMs from 10 major geriatric associations were assessed for their GRL using 10 scales. Eight of the scales provide a numerical GRL while two of the scales provide a visual representation of the GRLs. Analysis was conducted using Readability Studio 2019.3. SETTING: Analysis was conducted February 2020. PARTICIPANTS: Identified 10 geriatric associations and 884 PEMs. MEASUREMENTS: GRLs were measured by 10 validated readability indices: the Degrees of Reading Power and Grade Equivalent test, Flesch-Kincaid grade level, Simple Measure of Gobbledygook test, Coleman-Liau Index, Gunning Fog Index, New Fog Count, New Dale-Chall readability formula, Ford, Caylor, Sticht scale, Raygor readability estimate graph, and Fry readability graph. RESULTS: The mean of all PEMs using the numerical scales was 11.1 ± 2.4. Ninety-nine percent of PEMs are above the 6th GRL. PEMs ranged from a grade 3.0 to 19.0 reading level. Analysis of variance demonstrated a significant difference between associations (P < .0001), and multiple comparison analysis identified the National Institute on Aging as the content easiest to read (9.5 ± 1.6). CONCLUSION: PEMs from geriatric association websites are written above the recommended 6th GRL. As patients increasingly look toward online supplementary health information during COVID-19, there is an opportunity for improving PEMs to enable greater comprehension by the target population.