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State Health Department Web Sites Inaccessible to Many

doi: 10.1097/01.COT.0000295292.12890.87
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While state health department Web sites have become more user-friendly in recent years, too many remain inaccessible to certain populations, according to a study published in Journal of Health Care for the Poor and Underserved (2006;17:652–666).

“People in particular need of up-to-date and accurate health care information appear least able to share in the benefits of online government resources,” wrote Darrell M. West, PhD, Director of the Taubman Center for Public Policy at Brown University, and Edward Alan Miller, PhD, MPA, Assistant Professor of Public Policy, Political Science, and Community Health at Brown.

The study examined public health department Web sites maintained by the 50 US state governments, analyzing content for different dimensions of accessibility and privacy.

Readability levels and disability access were evaluated between 2003 and 2005, and non-English accessibility and the presence of privacy and security statements were examined between 2000 and 2005.

Using the Flesch-Kincaid test to determine readability, the researchers reported that only 20% of state health department Web sites were written at an eighth-grade level in 2005, although half of Americans read at that level. Most sites—62%—were written at a 12th-grade level that year.

State health department Web sites showed improvement in disability access and access for those with limited English proficiency, but there are still gaps, according to the study.

Usability software was used to determine if the sites were accessible to the disabled. In 2005, 42% were accessible, compared with 40% in 2004 and 30% in 2003.

In 2003, 32% of state health Web sites had medical information in languages other than English. This number increased to 44% in 2004 but dropped to 34% in 2005.

If the same standards applied to state health departments as apply to federal elections and education for ensuring access for those with limited English proficiency, many states would not meet them, the authors said.

There have been major improvements in state health department Web sites providing privacy and security policies since 2000, due in part to the implementation of Title II of the Health Insurance Portability and Accountability Act (HIPAA) of 1996, the researchers noted.

“In 2000, only 8% of state health department Web sites had an online privacy policy, and only 4% had a security policy. However, by 2005, these numbers had grown to 86% for privacy policies and 62% for security policies.”

State sites varied in accessibility, privacy, and security. Web sites from Southern states were the most readable and most likely to provide adequate access to those with disabilities, while Western states were the least.

State sites from Southern and Western states were the most likely to provide non-English materials. Midwestern states were the most likely to have privacy and security policies, while Southern states were the least.

© 2006 Lippincott Williams & Wilkins, Inc.
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