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Category: Comprehensive Websites

Tips for Reviewing a Website’s Usability

By Nathan Blake |2/15/17

Following up on our previous blog post, this week we will explore how usability reviewers analyze health websites while also providing some tips for becoming a more informed web user.

HealthWeb Navigator’s content reviews and usability reviews are distinct but complementary. Whereas a content review analyzes what information is provided (its accuracy, completeness, currency, depth, etc.), user-experience reviews are focused on how information is provided; that is, whether or not the presentation and organization of material, in your opinion, is easy to use and navigate, visually appealing, readable, widely understandable, speedy, and geared toward its audience appropriately.

Reviewers should always include direct evidence from the website to support any judgment made about a website’s usability.

Below you will find some specific tips for using your web experience as you review a health website’s usability. Due to time and space constraints, you won’t be able to touch on each one of these aspects in your review, but we hope that they can guide you to think more critically about a website so as to be a stronger resource for consumers.

Evaluating a Website’s Usability

A usability expert for HealthWeb Navigator should be prepared to:

Scan the pageReviews of usability should take visual appeal into account. Design is often unconsciously linked to credibility, and though a website’s credibility doesn’t necessarily hinge on its appearance, it does play a part. Let your eyes wander around the page; where’s the first place you look? What does your instinct prompt you to click on first? Do advertisement obstruct navigation, or is the focus directed toward content? Is the content well-organized? Do the colors or font make it difficult to read the type? How about pop-ups? Answering these questions will train your eye to slow down and analyze what it’s seeing. They will also help you determine whether or not the website is effectively designed, allowing you to articulate what could be done to create a more pleasant user-experience.

TIPPut down in writing or speak aloud your initial impressions about the layout of the page and what you think of the colors, graphics, photos, etc. Is it on par with other websites, or is it better or worse than you expected? What can the website do to catch the reader’s eye, and where does it excel at grabbing your attention?

Take the wheel. Think of each website as a vehicle for disseminating information. Each has a different design, yet there are widely shared features such as navigational schemes, search options, editorial disclaimers, etc. Some websites have site-wide search bars, while others only allow users to click links when searching for material. Usability reviewers should try to understand how the site functions and whether or not it’s easy to “drive,” testing out its various components before casting judgment. Is the website easy to use, and can you find what you are looking for? What’s the loading speed of individual pages? Are there any dead links? Can you get around the website intuitively, or does it have you spinning in circles?

TIP: An easy way to focus on a website’s functionality is to disregard the actual content on the page. Play with the website and test out as many of its features as you can, which often helps reviewers discover user-experience issues. It can also be helpful to search for a specific topic that falls under the website’s scope, testing out the various organizational schemes to determine if the site is user-friendly.

Identify the audience(s) and purpose. All texts presume an audience and a purpose, and it is the job of the reviewer to understand those potential audiences and purposes implied by a given web resource. Start with the idea that all writers, consciously or unconsciously, have an ideal audience in mind when they write, and with that knowledge they determine the shape, form, and scope of the ensuing content. The important concept to understand is that readers and listeners will vary in how much they know about the health information being offered, and websites will vary in what they want to accomplish. Some websites listed on HealthWeb Navigator have very little interest in providing medical content. Some are strictly focused on providing social media capabilities, others act as advocates on behalf of patients, and others simply list resources. Identifying these varying purposes can help you understand if the website successfully meets its goals or not.

TIP: Approach each website as an educator: If you had to give the website a grade, from A to F, what grade would you give it and why? What audiences does the website exclude and how? Is material offered in multiple languages, and it is accessible for people with disabilities? What’s the site’s purpose; is it to inform or persuade, describe or convince, define or influence, review or argue, notify or recommend, instruct or change, advise or advocate, illustrate or support?

Paraphrase information. A paraphrase is a restatement of an idea into your own words. Part of a usability reviewer’s duties involves assessing a site’s understandability, how easy it is to read and follow. One quick way to determine whether or not a website is easy to read is to try and summarize material after reading. Imagine teaching the content to someone else. Can you articulate the material’s substance, or are you floundering for meaning? If you find it easy to paraphrase a website’s content, especially as a layperson, then chances are the site is written clearly. If not, try to hone in on what makes the website difficult to understand and mention that in your review.

TIP: Think about how to articulate information in your own words. Of course some of the more clinical concepts will be difficult to summarize without using the resource’s exact language, but you should at least understand the gist of what is being said. Read over a page, look away from the website, and then write down or speak aloud the essential meaning. If you find this difficult, then the website may have a readability issue.

We hope that these tips and reminders will help you better assess a website’s value and give you a peek behind the scenes of our usability review process. Check back to our previous blog post that focuses on how our volunteers conduct content reviews.

Finally, if you are a web user and are interested in a becoming a usability reviewer for HealthWeb Navigator, please visit the following link to sign up as a volunteer: Becoming a Usability Reviewer.

Tips for Reviewing a Health Website’s Content

By Nathan Blake |2/1/17

It is estimated that 40% of the global population uses the internet every day, including over 88% of the U.S. population. As healthcare costs continue to rise, more and more patients turn to the web for health information to learn about diseases and conditions, insurance costs, patient advocacy, and more.

But how can you be sure that the information you find online is credible, up-to-date, and easy to understand?

HealthWeb Navigator is a free online service that helps consumers make sense of the internet’s rapidly expanding collection of health-related websites. Our team continuously publishes reviews of online health resources. The idea is that these reviews will allow consumers to take control over their own health care by guiding them toward only those websites that are accurate, clear, and user-friendly.

Our credibility rests on the expertise of our volunteers, whom we group into two categories: content reviewers and usability reviewers. Medical authorities are tasked with evaluating a health website’s content, while our usability reviewers come from all walks of life and are responsible for reviewing a website’s user experience.

Whereas a usability review analyzes how information is provided (its organization, visual design, user-friendliness, speed, etc.), reviews of content are focused on what information is provided and whether or not that information can be trusted to be accurate, complete, up-to-date, and sufficiently explored.

Below you will find some tips that our health authorities keep in mind when judging a website. We hope that consumers can incorporate these tips into their web-browsing routine, helping them distinguish a reliable web resource from a misleading one.

Evaluating a Website’s Content

A content expert for HealthWeb Navigator should be prepared to:

Look for gaps. If you’re a mental health professional reviewing a website focused on teen mental health, and you notice that the website does not include information about self-harm, then clearly there is a gap in the site’s scope. Consulting a website’s site-map can give you an aerial view of what can or can’t be found on the site. Use your review to make note of any noticeable gaps you find. This is equally true for websites that feature a doctor/provider-finder tool; if, when searching a familiar ZIP code, you see that a specific doctor/provider is missing, then that too is appropriate to mention in your review in regards to completeness.

TIP: Gaps in content are often found simply by browsing a website, keeping an eye out for information that could be present but is in fact missing. You might also consult a site-map when available, allowing you to get a quick idea of those topics the website covers without having to browse every single page. A litmus test for a site’s content might be: On content alone, would you recommend this website to a patient? If “yes,” give examples of what you liked. If “no,” explain what is missing and why it concerns you.

Test the depths. Some websites cover the breadth of a particular subject, including numerous topics and subtopics for consumers to explore. But how useful is the breadth of a site’s material if individual articles are too shallow to gain anything substantive? Use your knowledge to determine if a website’s materials are sufficiently examined in enough depth to provide consumers with quality information. Some websites sacrifice depth for breadth, others go very deep into a limited amount of subjects, while still others manage to strike a balance between the two.

TIP: The key to fairly judging a site’s depth is using your medical expertise to determine whether or not the page with less detail offers enough information to be of use to the public. It may be shallow, but sometimes shallow is all that is necessary, depending on the topic. Consequently, too much depth can overwhelm some readers, especially if the tone is clinical in nature.

Verify the research. Suppose the website you’re reviewing makes a variety of claims but does not provide research or evidence to support those claims—would you trust that website more so than an organization that includes direct links to outside sources? Or what if the site in question relies on misleading or downright false information to prove its points? In both cases, it is the job of the content reviewer to look for and judge the research (or lack thereof) being used by a website to determine whether or not it is credible and accurate. Follow up on any research you see linked on a page, and make note if you see either a lack of verifiable research or an abundance of biased materials.

TIP: Always look for evidence. Remember that good science relies on data and statistics, although even the most objective data can be influenced by bias. Keep the phrase “prove it” in mind, then assess the quality of that proof. Websites that lack research or only reference internal research should be analyzed with caution.

Check the dates. Imagine how you would go about reviewing a website on heart surgery that cited research from 1983. Would you trust that the research holds up after all these years? Or what if a website publishes material on a rapidly-evolving subject like the Affordable Care Act, yet the material has not been reviewed or updated since 2012? Look for dates of both publication and revision to determine if the website is maintaining its currency; the same goes with any outside research or support a site relies upon.

TIP: When you’re looking for evidence, take publication and revision dates of individual articles into account. Usually these dates are found at the top or bottom of web pages. Using your expertise, you can determine whether or not the website maintains currency in a rapidly changing medical landscape.

Know Who’s Who. Everyone approaches the world with particular biases, and it’s important to recognize that occasionally these viewpoints are not necessarily rooted in observable fact. When it comes to website content, always look for names to which information can be attributed including parent and affiliate organizations, leadership, sponsors, advisors, editorial boards, writers, etc. Approach it from the angle of expertise: Would you be more willing to accept an article’s claims if they were written by a layperson or a trained medical authority? If information is generated by laypeople, then there should be some form of expert oversight to maintain quality.

TIP: If individual authors cannot be attributed, do some digging on the website to find out who is responsible for writing and editing content. If you can’t find this information, then that is an appropriate issue to raise in your review.

Follow the Money. Have you heard the phrase “follow the money”? A good tool for assessing the influence of bias and allegiance starts with recognizing the power of financial transaction—determining who’s being paid and who’s providing the money. Look for any products being sold and ask yourself if the website is unduly advertising those products over established medical knowledge (that is, a “cure all”). What organization or sponsors support the website? Who is responsible for generating content, and can you see any financial incentive for what content is generated and what stance the content promotes? You can learn more about how to find out who sponsors a website HERE.

TIP: If you don’t recognize the organization providing the information, some cursory digging can reveal who finances the operation. Most websites you encounter through HealthWeb Navigator will provide this information in an “About Us” or related section. You can also dig deeper into a charity or nonprofit by looking up their listing on Charity Navigator.

We hope that these tips and reminders will help you better assess a website’s value and give you a peek behind the scenes of our content review process. Stay tuned for our next blog post, which will focus on how our volunteers conduct usability reviews.

Finally, if you have medical training of any kind and are interested in a becoming a content reviewer for HealthWeb Navigator, please visit the following link to sign up as a volunteer: Becoming a Medical Reviewer.

What Does Medical Science Say About Fish Oil Supplements?

By Nathan Blake |11/23/16

A recent survey of over 11,000 consumers revealed that fish oil is currently the second most popular nutritional supplement on the American market today, with annual spending exceeding $1.2 billion for over-the-counter fish oil pills and related supplements.

Fish oil has long been touted for its supposedly positive effects on a variety of bodily functions including lowering blood pressure, triglycerides, and cholesterol levels; preventing heart disease; inhibiting the formation of cancer cells; combatting depression and mood disorders; reversing the effects of macular degeneration; and countless others.

But what does medical science have to say about these claims? Is fish oil the cure-all it’s advertised to be, or would consumers be better off spending their money elsewhere?

Fish Oil’s (Not So) Secret Ingredient

Fish oil capsules contain concentrated amounts of omega-3 polyunsaturated fatty acids. Omega-3 fatty acids are necessary for human health, playing a crucial role in brain health and the regulation of inflammatory responses. There are three main types of omega-3 fatty acids, two of which can be found in fish oil capsules.

Eicosapentaenoic acid (EPA) is absorbed into the body by eating oily, coldwater fish like salmon, menhaden, sardines, mackerel, albacore tuna, halibut, and herring. EPA is also found in edible strains of seaweed as well as human breast milk.

Docosahexaenoic acid (DHA) is an important structural component of the human brain and is essential for its proper functioning. It also plays a primary role in maintaining the health of the eye, cerebral cortex, skin, sperm, and testicles. The human body can produce a small amount of DHA on its own, but like EPA, we get the majority of our DHA from cold-water ocean foods. DHA can also be found in organ meat, poultry, and egg yolks, though in small amounts.

Cardiovascular Health

The positive effects of fish oil on the human cardiovascular system have well been established, but that’s not to say no controversy exists. After evaluating the potential benefits of fish oil supplements for patients with multiple pre-existing cardiovascular disease factors, scientists concluded that DHA and EPA had neither a positive nor a negative effect on cardiovascular health. However, an early meta-analysis of fish oil studies revealed a possible correlation between fish oil supplementation and lower blood pressure. Further, scientific data indicates that fish oil consumption can reduce the risk of coronary heart disease, decrease mild hypertension, and prevent certain cardiac arrhythmias. Other studies show that fish oil capsules can be effective in the prevention of primary and secondary cardiovascular disease. In multiple clinical trials, fish oil supplements have been linked to the suppression of major coronary events. The most conclusive benefit of fish oil supplements seems to be that fish oil capsules are effective in lowering triglycerides in the blood. One study found that a prescription dose of EPA + DHA (2x the normal amount) lowered patients’ triglycerides by 27%.

Mood Disorders

Fish oil is not considered to be an effective replacement for mental health treatments, but when used in conjunction with other therapies, fish oil seems to provide beneficial effects to patients diagnosed with borderline personality disorder, unresponsive depression, and schizophrenia. EPA in particular has been studied for its possible use in regulating mood disorders, and researchers found that EPA-heavy omega-3 supplements appear to be effective against primary depression when used alongside prescription medications and other treatment. There is some evidence, however, that fish oil supplementation does not improve mood when tested against a placebo.

Alzheimer’s Disease

In a double-blind study spanning 26 weeks, researchers found that neither high nor low doses of fish oil had an observable effect on cognitive performance in patients age 65 and older. A much longer study, however, found that fish oil intake is associated with lower rates of Alzheimer’s disease. That being said, in a study of 174 Alzheimer’s patients, fish oil supplementation was not shown to reduce cognitive decline in patients with mild or moderate Alzheimer’s disease, though some positive effects were shown in a small group of patients with very mild Alzheimer’s. Other trials confirmed these finding that omega-3 supplementation is beneficial only for patients with mild cognitive impairment. While it’s still too early to make firm recommendations regarding the potential benefits of fish oil intake, daily DHA supplementation in excess of 180 mg is associated with a 50% decrease in dementia risk.

Eye Health

Regular consumption of EPA and DHA fatty acids significantly reduces the risk of developing age-related macular degeneration in women. Other findings suggest that increased omega-3 intake via fish oil capsules can prevent age-related macular degeneration in all subjects, sometimes by an estimated 22%. While the precise role of omega-3 fatty acids in eye health is unclear, there is some evidence that suggests DHA supplements can prevent cell damage and eye stroke injury in the retina.

Inflammation

A study of 250 patients with neck or back pain revealed that fish oil supplements are an equally effective but safer treatment for reducing arthritic pain compared to NSAIDs like ibuprofen and aspirin. Some studies suggest that EPA, independent from DHA, is a potential therapeutic treatment for arthritis-related inflammation in mice, and that EPA has a stronger anti-inflammatory effect than DHA. While another study’s findings suggest that fish oil supplements are not as effective in reducing chronic low-grade inflammation in obese men compared to weight reduction, multiple studies seem to suggest that omega-3 fatty acid supplements can decrease inflammation in patients, particularly those diagnosed with rheumatoid arthritis or ulcerative colitis.

Cancer

Some evidence points to the benefit of fish oil’s anti-inflammatory effects on reducing the overall number of cancer cells in the colon. Another investigation found that EPA + DHA are good candidates for primary and secondary breast cancer prevention due to their abilities to reduce inflammation. Strangely enough, one recent study has shown a correlation between elevated levels of omega-3 fatty acids and an increased risk for developing aggressive prostate cancer; men with the highest DHA levels were 2.5x more likely to develop high-risk prostate cancer, though similar studies proved inconclusive. Further, other studies revealed opposite findings, that fish oils are actually helpful in reducing the risk of prostate cancer in healthy individuals, as well as preventing colorectal and breast cancer formation.

The Last Word

Ultimately, the health benefits of fish oil supplements are still unclear. Studies surrounding omega-3 supplements, as we have seen, are conflicting at best, contradictory at worst. That being said, multiple organizations agree that the potential benefits of fish oil capsules outweigh the potential risks for generally healthy people, though more evidence is needed before making a definitive claim.

Continue taking fish oil capsules if they have been prescribed to you by a physician. If you are planning to begin a fish oil regimen, consult with your primary care physician beforehand to make sure you are healthy enough and that they will benefit you. General consumers should be aware that while many of the findings referenced above are interesting, it’s entirely possible you may not be receiving the benefits you’ve been paying for.

What Do You Know About Diabetes?

By Nathan Blake |11/9/16

November is designated National Diabetes Awareness Month.

In 2012, over 9% of the American population—roughly 29 million people—had some form of diabetes. Worse, one in four people with diabetes do not know they have the disease. With over 1.5 million new cases of diabetes being diagnosed every year, this disease is quickly becoming one of the nation’s fastest growing and most serious epidemics. In fact, diabetes was the seventh leading cause of death among Americans in 2010. That number, if current trends continue, is sure to rise.

What is Diabetes?

Diabetes is a group of health conditions that makes it difficult for the human body to properly control the level of sugar in the blood. When we eat, our bodies convert food into sugars, one of which is called glucose, which our cells rely on as a main source of energy to carry out the basic bodily functions of our muscles, brain, heart, liver, and more.

Because of the importance of glucose in everyday health, there are very intricate biological processes at play to regulate glucose in the blood. These processes ensure that our glucose level does not rise above or fall below a healthy range.

The Importance of Insulin

The cells in our body cannot use glucose directly and must rely on a hormone called insulin. After eating, insulin is released into the bloodstream by the pancreas. Insulin attaches to cells and prompts them to absorb glucose from the bloodstream. The cells then turn the glucose into energy.

When there is an overabundance of sugar in the blood—for instance, after a big meal—insulin stores this excess glucose in the liver to be used later when blood sugar levels drop, such as during the period between meals or while exercising. Normally, glucose is kept under tight control by the pancreas which uses insulin to regulate the blood levels. Diabetes occurs when this regulation system fails to control the levels of glucose.

Types of Diabetes

Type 1 diabetes (formerly called “juvenile-onset diabetes”) occurs when the body cannot create its own insulin. This is because the body’s immune system has destroyed the insulin–producing “beta cells” in the pancreas. Without insulin, glucose cannot enter cells. The cells must then use other inefficient sources of energy while glucose levels rise. This metabolic imbalance can be life–threatening. To prevent this problem, patients with Type 1 diabetes must receive insulin injections daily in order to regulate their blood sugar levels.

Type 2 diabetes (formerly called “adult-onset diabetes”) occurs when the body continues to create insulin but the cells have a sluggish response to its effects. The result of this “insulin resistance” is elevated levels of glucose in the bloodstream. Over time, the high glucose level can also affect the pancreas and reduce its production of insulin.

Gestational diabetes, occurring in roughly 4% of pregnancies, results from hormonal changes during pregnancy that inhibit insulin’s ability to regulate glucose levels.

Risk Factors

While the risk factors for developing type 1 diabetes are still being studied, research shows that having a family member with diabetes can increase your risk for developing the disease. Type 1 diabetes occurs most commonly in children and young adults, accounting for roughly 5% of all people diagnosed with diabetes.

More is known about what causes type 2 diabetes, as it is the disease’s most common form. Several risk factors include a family history of diabetes, being overweight, not getting enough regular physical activity, an unhealthy diet, high blood pressure, and increasing age.

Pregnant women at risk for developing gestational diabetes include those over the age of 25, people with a family history of diabetes, and women who are overweight. For reasons that are not fully understood, gestational diabetes occurs more frequently among black, Hispanic, Asian, and Native American populations.

Treatment

Many diabetics require treatment with insulin or other medications that help control glucose. Equally important are lifestyle habits that can be helpful in preventing diabetic complications. Diabetes can be managed by taking the following precautions:

• Eat meals balanced in starches, fruits and vegetables, proteins, and fats.

• Make physical activity a daily routine.

• Monitor blood sugar levels to be sure they are under control.

• Manage blood cholesterol and lipid levels by eating healthy and taking prescribed medications as recommended by a healthcare provider.

• Control blood pressure to a healthy range (below 130/80).

Prevention

Type 1 diabetes cannot be prevented, although many studies have shown that patients can take a few simple steps to drastically reduce their risk for developing type 2 diabetes.

The Diabetes Prevention Program was a federally-funded project that monitored over 3,000 individuals who were at risk for type 2 diabetes. Researchers discovered that adults at risk for the disease were able to reduce their susceptibility by half by following two practices: healthy eating and regular exercise.

Adhering to a low-calorie, low-fat diet and getting at least 30 minutes of physical activity for five days a week were shown to be effective markers for lowering the risk for diabetes.

To learn more about diabetes diagnosis, treatment, and prevention, visit the National Institute of Diabetes and Digestive and Kidney Diseases, supported in part by the National Institutes of Health.

The “Conversation Project” – Planning for the Future

By Mark A. Kelley, MD |07/15/16

Most of us make future plans about careers, finances, retirement etc.   However, few of us plan for the end of our lives.

Medical science has made great strides in treating complex diseases like cancer, heart failure and diabetes. Nonetheless, for these chronic diseases, complete cures remain the exception, rather than the rule.

If you have helped someone with life-threatening disease, you know the stress involved. As the disease progresses and end of life is near, many difficult issues arise: Is a cure still possible?   Will more treatment be helpful?   Will the treatment be worth the result? Will the end come soon?

As an intensive care physician, I have seen patients and their families grapple with these dilemmas in “crisis mode”. This happens when a gravely ill patient’s wishes at the end of life were never discussed. Now, with very little background information, the family and physicians must make some decisions to guide the patient through life-threatening challenges.

The Conversation Project” is addressing this problem. The objective is to facilitate discussion about patient’s goals well before any crisis. The conversation between the patient and his/her family and physician assures that everyone involved knows the patients’ desires.

The Conversation Project describes research showing that patients want this discussion but need help.

1. 90% of people think that talking about end of life care with their loved ones is important—only 27% do.

2. 82% say it is important to put their wishes in writing but only 23 % have done so.

3. If seriously ill, 80% of people would discuss end of life care with their doctor, but only 7% actually do.

The “Conversation Project” has developed tools to facilitate communication about end of life care. Personally, I have found their approach helpful with both my patients and my family.   The best time to begin the conversation is when there is no pressure for an immediate decision.   Ideally, the patient feels well, and family members and physicians can participate.

The most important part of this conversation is for informed patients to set their objectives for the end of life. Patient preferences vary and can even change depending on circumstances. For example, one third of adults would continue treatment even if their disease were incurable. However, other factors can change that decision.   Over 52% of patients with incurable disease would stop treatment if they must depend on a family member for care.

In a third example, some patients would prefer to stop treatment but continue anyway. They do not want their loved ones to remember them as “giving up”.   I have found that this dilemma can often be solved by a candid discussion with the patient, physician and family members together. In this session, the doctor discusses the medical facts, and the patient describes his/he true feelings and desires. With everyone hearing the same important information, the family usually rallies in support of the patient’s decisions.

These circumstances can differ and the details are very personal. However, there is only one “best” outcome: that each patient communicates their plans and desires for the end of life.   That important action assures that the patient’s wishes are fulfilled and greatly reduces emotional stress for all.

Have you and your family had “The Conversation”?   Check out the Project website (http://theconversationproject.org) for some valuable tips.

 

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