State Health Department Web Sites Remain Unavailable to Many

Newswise — State health department Web sites have become more user-friendly over the past five years, but too many sites are still hard to read, only available in English and inaccessible to people with disabilities, a new report concludes.

"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," say researchers Darrell West, Ph.D., and Edward Alan Miller, Ph.D., of Brown University.

Their study appears in the latest issue of the Journal of Health Care for the Poor and Underserved.

Although half of Americans read at an eighth-grade level, only 20 percent of state health department Web sites were written at that level in 2005, the researchers found. Most were written at a 10th- or 11th-grade level.

"If official health Web sites are written at too high a level for visitors to comprehend, the technology revolution will not reach its full potential as a public health information tool," West said.

In 2005, only 42 percent of the state sites had standard features such as larger font options and audio tags to make them fully accessible to people with physical impairments.

Advocacy groups say these features are mandated by federal laws such as the Americans with Disabilities Act of 1990, although Bambang Parmanto, Ph.D., a University of Pittsburgh researcher who has studied Web accessibility, said, "it is not clear if such provisions apply to the Web sites managed by states."

Parmanto said the laws have kept federal government health Web sites accessible even as they expand their features. "Our thought before we saw the results of our research was that government Web sites tend to be accessible, but at the expense of attractiveness. We thought that for the sake of accessibility, they would not use the technologies that make them attractive to users without disabilities. It turns out this was not the case."

Only 34 percent of state sites had medical information available in a language other than English in 2005, according to West and Miller, who say such numbers would not be acceptable under federal election and education statutes.

"Our results indicate that if standards such as these were applied to state health departments, many states would not meet them," West says.

Privacy and security policies among state sites have improved dramatically since 2000, due in part to the 1996 federal health privacy act known as HIPAA, the researchers say. In 2000, only 8 percent of state health department Web sites had an online privacy policy. In 2005, 86 percent of sites had a privacy policy.

West and Miller say that state sites vary in their accessibility and privacy policies. For instance, Web sites from Southern states are the most readable and most likely to provide adequate access to those with disabilities, while sites from Western states are most likely to provide non-English materials.

"In short, it matters where one lives for access to e-health. There was no single region that was strong on all areas of accessibility, privacy and security," West said.

Journal of Health Care for the Poor and Underserved: Contact Editor Virginia M. Brennan at (615) 327-6819 or [email protected]. Online, visit http://www.press.jhu.edu/journals/journal_of_health_care_for_the_poor_and_underserved/

West DM, Miller EA. The digital divide in public e-health: barriers to accessibility and privacy in state health department websites. Journal of Health Care for the Poor and Underserved, 17, 652"666, 2006.