1. Mikki Meadows-Oliver, PhD, MPH, RN Nancy Cantey Banasiak, MSN, PNP-BC ACCURACY AND READABILITY OF ASTHMA WEBSITES

2. PRESENTER DISCLOSURES The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: Neither presenter has any disclosures

3. PURPOSE OF THE STUDY The purpose of the current descriptive study was to assess the accuracy of health information on the Internet regarding asthma using the 8 core educational concepts developed by the NHLBI (2007) on sponsored and unsponsored Internet sites. A secondary aim was to assess readability information on the Internet sites that contained accurate information on all 8 core educational NHLBI concepts

4. ASTHMA Asthma is a chronic illness that requires continuous supervision by parents as well as ongoing communication between parents and their children around treatment management. Because of shorter appointments, parents spend less time in the health care providers office Many have questions that arise after the visit.

5. HEALTH INFORMATION & THE INTERNET Parents may turn to the Internet, a 24 hour source of information. Helps parents to obtain immediate answers Helps to reinforce learning

6. HEALTH INFORMATION & THE INTERNET (FOX & JONES, 2009) 61% of internet users search for health information. Population referred to as e-patients Most e-patients access user generated health information

7. HEALTH INFORMATION & THE INTERNET Researchers have begun to assess the quality and accuracy of pediatric health information on the internet. Most research indicates that information presented is inaccurate or incomplete Readability levels have also been found to be high for the average consumer.

8. ACCURACY OF ASTHMA INFORMATION Croft & Peterson (2002) examined 90 asthma websites. Average asthma website contained 4.9 of the 8 core NHLBI asthma educational concepts Oermann & colleagues (2003) found that only 30/70 (42.9%) contained information on all 8 core educational aspects Park and colleagues (2004) examined 32 Korean Internet websites. The mean number of educational concepts was 2.7/8

9. READABILITY NATIONAL PATIENT SAFETY FOUNDATION (2006) Average reading level in the U.S. is 8th grade, and 20 percent read at the 5th grade level or below. 40 % of seniors read at or below the 5th grade level 50 % of African Americans and Hispanics read at or below the 5th grade reading level Most health-related material is written at the 10th grade reading level or higher (Institute of Medicine)

10. READABILITY OF ASTHMA INFORMATION Forbis & Aligne (2002) found that written asthma management plans presented in National guidelines were written at an 8.1 grade reading level. Wallace & colleagues (2006) examined the readability characteristics of consumer medication information for asthma inhalation devices and found that the materials were written at an 8.2 grade reading level. Smith and colleagues (1998) evaluated the readability of asthma information pamphlets and found that the pamphlets were written at an average reading grade level of 8.7.

11. METHODS 16 English language search engines searched Key word: asthma Inclusion criteria: US websites; Written in English

12. METHODS First 10 unsponsored and first 10 sponsored websites selected Total of 320 sites initially After discarding duplicates, final sample 68 websites 36 unsponsored websites 32 sponsored websites

13. Pathophysiology of asthma Knowledge of triggers Avoidance of triggers Knowledge of controller medications Knowledge of rescue medications Administration of medication Self-assessment Asthma action plan 8 CORE EDUCATIONAL NHLBI CONCEPTS

14. RESULTS 6/68 (8.8%) websites provided accurate information on all 8 NHLBI core educational concepts Unsponsored: 4/36 (11.11%) and Sponsored: 2/32 (6.25%) provided accurate information on all 8 NHLBI criteria Sponsored sites no more likely that unsponsored sites to contain accurate information on all 8 NHLBI criteria ( X 2 [1, N=68], p = 0.82)

15. UNSPONSORED WEBSITES www.asthma.about.com/mbody (HON certified) www.asthma.about.com/mbody www.nhlbi.nih.gov/health/dci/Diseases/Asthma/A sthma_WhatIs.html (available in Spanish) www.nhlbi.nih.gov/health/dci/Diseases/Asthma/A sthma_WhatIs.html www.aafa.org (available in Spanish) www.aafa.org www.aaaai.org (available in Spanish) www.aaaai.org

16. UNSPONSORED WEBSITES Most common on the pathophysiology of asthma (47%) Least common--administration of medication and asthma action plans

17. SPONSORED WEBSITES www.everydaykidz.com www.asthma.nationaljewish.org (available in Spanish) www.asthma.nationaljewish.org

18. SPONSORED WEBSITES 47% had NO information on any of the core educational concepts 25% had information on pathophysiology and triggers Least common—medication administration

19. READABILITY Flesch Reading Ease Range 46.6-63.5 Mean=54.33 Flesch Grade Level Range 8.0-10.3 Mean=9.73

20. DISCUSSION Majority of websites did not contain comprehensive, accurate information regarding asthma Concepts such as medication administration were the least discussed Readability was high for the average consumer

21. DISCUSSION Variability in the quality of information of the websites Internet provides great opportunities for health care education Internet also carries the risk of inaccurate/outdated information

22. LIMITATIONS Cross sectional design Small number of websites included Comprehension was not tested directly

23. IMPLICATIONS As nurses, we can provide information re: previously assessed websites for patients Educate ourselves to, in turn, educate families Written patient education materials listing the accurate websites can be provided to reinforce verbal teaching by nurses in a variety of setting Access to accurate information may enable greater self and family management

24. QUESTIONS ????????