The Study On Application And Usability Of Online Health Information Readability Evaluation Indicator System

Objective To test the reliability and usability of the self-developed online health information readability evaluation tool among nurses,and invite nurses to evaluate the readability of online health information about diabetes by using the tool and propose improvement strategies based on the evaluation results.Methods The research was divided into two phases:Phase One:Test reliability and usability of the OHIRET.According to the first-level indicators in the readability evaluation index system,the evaluation dimensions were set,and the evaluation items were set according to the second-level indicators,and the“Online Health Information Readability Evaluation Questionnaire”（hereinafter referred to as“Readability Evaluation Questionnaire”）and“Online Health Information Readability Evaluation User’s Guide”were prepared,which were collectively referred to as the OHIRET.The“User Guide”included explanations of evaluation items,scoring standards and examples.Four health education web pages for a common disease in the internal,external,gynecological,pediatric and infectious disease departments were selected respectively,and 10 nurses in charge or above were invited to evaluate the web pages,calculated the inter-rater reliability of each item in the tool as Percent raw agreement,Fleiss’Kappa and Gwet’s AC₁,and completed the“Usability Test”after each round of reliability testing.The tool was revised according to each round of results of reliability and suitability tests until the Gwet’s AC₁value of each item in the tool was≥0.70,forming an OHIRET suitable for clinical nurses.Phase Two:Evaluation of the readability online health information about diabetes.Developed a retrieval strategy to screen online health information about diabetes.Eight nurses in charge and above who had been engaged in diabetes health education for more than 5 years were selected and invited them to independently use the revised OHIRET to evaluate 74 diabetes health information web pages.The difficulty coefficient of 74web pages was calculated using Zhang Ningzhi’s readability formula,and the correlation analysis was carried out with the results of nurse readability evaluation.According to the readability evaluation results,eight raters summarized the specific problems,and held a panel meeting with three researchers to form the“Optimization Strategy for Online Health Information Readability about diabetes”.Results Phase one:In this study,an OHIRET suitable for clinical nurses was formed through 3 rounds of reliability tests and usability tests,including 7 evaluation dimensions and 32 evaluation items.The overall Gwet’s AC₁value was 0.82,the Gwet’s AC₁value of all dimensions ranged from 0.76 to 0.90,the Gwet’s AC₁value of all items in the tool ranged from 0.70 to 1,and all of which were up to the standard.The results of the 3 rounds of usability tests showed that all items of the tool had a score of（6.10-7.00）for ease of understanding and（5.90-7.00）for ease of use.The appropriate score for scoring criteria was（6.10±0.74）.The raters considered the tool’s usefulness in“evaluating the readability of online health information”,“writing highly readable online health information”,and“recommending highly readable online health information to readers”was respectively 100%（14/14）),92%（13/14）and 78%（11/14）.At the same time,the scores of they intend to use the online health information readability assessment tool to“evaluate the readability of online health information”,“write highly readable online health information”and“recommend online health information with high ratings for readers”were（6.00±1.56）,（6.00±1.25）,and（5.80±1.48）respectively.Phase two:The correlation coefficient r between the nurse readability evaluation results and Zhang Ningzhi’s readability formula coefficient was-0.67.The readability scores of the 74 online health information web pages about diabetes ranged from（0.25to 0.72）points,with a mean of（0.49±0.16）points.There was no difference in the readability of web pages retrieved by different search engines（F=0.22,P=0.81）.The total score of 15 web pages was above 0.70（good readability）,of which 5 pages were from Baidu,6 pages were from 360,and 4 pages were from Sogou.The scores of the seven dimensions of web pages readability about diabetes from low to high were Dimension 4:“Operability”,Dimension 7:“Visual aid”,Dimension 3:“Content design”,Dimension 1:“Text expression”,Dimension 2:“Numerical application”,Dimension 5:“Organizational layout”and Dimension 6:“Layout design”.Most of the web pages were not vivid and interesting in text presentations,there was no summary review,the behavioral information lacked actionability,the lack of reader interaction,the key content was not prominently marked,and the diet and complications section lacked visual aids,etc.The study analyzed common problems in web pages,and proposed optimization strategies,including:（1）Increasing the information in conversational and comic style,and controlling the length of sentences within 40 characters;（2）Using commonly values and unit information;（3）Adding a summary after each part of the health information topic and providing interactive behavior skills;（4）When introducing behavioral information,explaining the benefits of taking the behavior or the adverse consequences of not taking the behavior;splitting the behavior into achievable,easy-to-understand actions that relate to the reader’s everyday experience;providing tools for behavior implementation to help readers take action;（5）Visual cues highlight the title;using color,underline,bold or box to visually emphasize key information;（6）Adding pictures of plates to the diet section;When introducing information on related complications,using pictures or videos to introduce the causes and clinical manifestations of complications vividly.The picture and video should be next to the relevant text,and briefly summarized by the title;when displaying the food that should be avoided,it can be distinguished by color or symbol（such as√/×）to avoid misunderstanding by readers.Conclusion The revised OHIRET has good reliability and usability among nurses,and nurses have high recognition and willingness to use OHIRET.Clinical nurses with experience in health education can use OHIRET to assess the readability of existing online health information and to screen,revise or develop highly readable online health information to recommend to patients.Clinical nurses found that the readability of online health information about diabetes is poor readability.It is recommended to break down behavioral steps,provide behavioral implementation tools,use comic or question-and-answer style,focus on summary and interaction with readers,and use visual emphasis when necessary.Pictures or videos and other strategies assist to enhance the readability of online health information about diabetes.