Self-presentation on the web: U.s. agencies serving abused and assaulted women

Background. Internet technologies are an essential platform for public health. They are particularly useful for reaching people with stigmatized health conditions because of the anonymity allowed. This study examined the content and usability of websites of agencies serving women victims of violence. Methods. We entered into a search engine the names of a systematic 10% sample of 3,774 agencies listed in the National Directory of Domestic Violence Programs or the Directory of Sexual Assault Centers in the United States. Focusing on function, emphasis, and usability, we analyzed screenshots of the 261 resulting homepages and the readability of 193 home- and first-level pages. Agreement between raters averaged 98%. Results. Victims (94%) and donors (68%) were the primary intended audiences. About one-half of the webpages used social media and one-third provided cues to action. All but one homepage displayed information in English; 23% had a Spanish-language version and only 4% had a translation button to enable users to view the page in any language supported by the translation engine. Almost all (96.4%) were rated “fairly difficult” to “very confusing” to read, and 81.4% required more than a 9th grade education to understand. Conclusions. The service and marketing functions of homepages were met fairly well by the agency homepages but usability (particularly, readability and offering a mobile version) and efforts to increase user safety could be improved. The one-third of agencies lacking a website will not reach the substantial portion of the population that uses the Internet to find health and other resources.