Quality Assurance Assessments of the 50 U.S. State's Bioterrorism and Public Health Preparedness Websites

The Internet has become an important consumer education tool for those seeking to gather important information about contagious disease, and disaster preparedness. Despite the proliferation of educational websites, concerns remain within the field of consumer health informatics regarding the quality of Internet-based health information. This study used an instrument developed by Godin (2005; 2008) that assessed quality of the 50 U.S. state websites on bioterrorism and public health preparedness. Two raters, with acceptable Kappa inter-rater reliability coefficients found the following: 1) Only 57% of the sites provided information on the professional credentials of the website authors; 2) None of the websites reviewed indicated that the educational material was "peer reviewed" by appropriate parties for accuracy; 3) Only 4% of the sites provided references to support narrative; 4) About 16% of the websites indicated a date of most recent update; 5) Only 8% of the websites indicated how they were financially supported; 6) Another 8% provided a disclaimer statement indicating the purpose of the website; 7) Very few of the websites (18%) allowed for user interaction (i.e., question/answer scenarios); however, only 2% (one site) informed the user that information obtained in these interactions would be confidential, or that privacy would be maintained; 8) None of the websites used any form of behavior change theories; and 9) Average readability index was measured at 14.0 grade level (most Americans read at the 5th-7th grade). The study also assessed whether “cookies” were placed on the hard drive of the web-visitor. Cookies being placed on hard drives pose significant confidentiality issues, especially if consumers access these websites at their places of employment. Results of this study are discussed within the context of efforts being made within federal public health organizations (i.e., NIH; FDA) to oversee and regulate websites that originate within the US.