Information underload

Hospitals are increasingly relying on their websites to prepare patients for their stay. Some are doing a better job than others, impacting patient outcomes — especially in infection control.

Hospitals have long understood the need to provide information to patients to prepare them for attending the hospital. Going into hospital can be a stressful time and it is recognised that this stress can be reduced by familiarising patients with the processes. Traditionally this has focused on informing patients about what to do prior to admission, about what to bring to the hospital and about what happens during their stay.

Influencing patient behaviour

More recently, information about engaging patients in infection prevention strategies has also been included on websites, brochures and booklets. This is important as studies have identified that the provision of information on healthcare associated infections (HCAIs) can positively influence the patients’ engagement in infection control strategies¹. Patients who receive information on HCAIs demonstrate better understanding about the pathogens, risks etc and are more actively engaged in infection control and prevention measures compared to those who had not received any information².

But how are our hospitals informing and/or engaging with patients around infection prevention and control? As a first step to answering this question, we explored the information being provided on the websites of hospitals in NSW. We acknowledge that hospitals use multiple approaches (posters, brochures, verbal messages etc) to deliver information to patients, but we also know that nowadays many people, especially those with low health literacy scores, will not only seek out information on websites but trust the content provided. Therefore, information provided to patients electronically may play a key role in engaging future patients and their family/friends before they even set foot on-site.

Examining quality of content

Our paper, published in BMC Infectious Diseases, examined online information targeted at patients on HCAIs and infection prevention and compared it using the Suitability Assessment of Material (SAM) and Simple Measure of Gobbledygook (SMOG) readability formulas for suitability, readability and accessibility³. We focused on public tertiary referral hospitals (with >200 beds) in Sydney. Thirty-six webpages were identified as being relevant and containing information about HCAIs or infection prevention.

Based on the SAM/SMOG scores, only three webpages were found to be ‘superior’. Many of the webpages scored poorly in content, literacy, graphics, learning stimulation and cultural appropriateness. In comparison, most of the webpages scored well in the layout and typography. The majority (97%) of the materials were written at a level higher than the recommended reading grade level.

In most cases, there was little in the way of headings/subheadings so searching for the information on HCAIs and infection control required multiple clicks (‘death by scrolling’) through other pages/sites. Information provided in an obscure way could be a barrier for people, especially those with reading and IT difficulties. Lastly, very few of the sites utilised any cues for action; therefore, the website scored low regarding their potential to motivate people.

Websites often use imagery with Caucasian doctors and patients. Image credit: ©stock.adobe.com/au/FotolEdhar

Addressing cultural differences

Aside from the difficulties in actually locating the material, we found that most sites scored low in terms of cultural appropriateness. Given the mix of ethnic backgrounds of not only the patients attending hospitals in NSW but also the staff members working there, it was concerning to see that most pictures were of Caucasian doctors, nurses and patients. It was perhaps not too surprising to find that none of the material had been translated into other languages. As a simple first step to rectify this issue and engage people from culturally and linguistically diverse backgrounds, I would suggest ban the ‘stock’ photo and use real photos of the people walking in the doors of your hospitals. Hospitals should also consider the option of having resources available in the languages that represent the patients group frequenting the healthcare setting.

Improve websites to improve outcomes

Unless we start to make changes to the content, literacy demands and graphics of the hospital websites, patients seeking to engage with the system prior to admission will find the information overwhelming and its usability low. It is also unlikely that patients will go elsewhere to find information and therefore we have potentially lost a key opportunity to talk to them about the benefits of hand hygiene or about their role in reducing infections in hospitals. Further work is needed to address the appropriateness of hospital websites as platforms for promotion of infection prevention strategies and the receptiveness of patients towards receiving information in this format.

References

1. Schwappach DL: Review: engaging patients as vigilant partners in safety: a systematic review. Med Care Res Rev 2010; 67:119-48.
2. Gould DJ, Drey NS, Millar M, Wilks M, Chamney M: Patients and the public: knowledge, sources of information and perceptions about healthcare-associated infection. J Hosp Infect 2009; 72:1-8.
3. Doak CC, Doak LG, Root JH: Teaching patients with low literacy skills. Am J Nurs 1996; 96:16.

*Dr Holly Seale is Senior Lecturer and Ji Park a Masters student at the School of Public Health and Community Medicine, University of NSW

Top image: Hospital website imagery should reflect Australia's diversity. Image credit: ©stock.adobe.com/au/digitalskillet1