From a Literature Review to a Conceptual Framework for Health Sector Websites’ Assessment
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paper_title: A quality evaluation methodology for health-related websites based on a 2-tuple fuzzy linguistic approach

paper_content:

Nowadays, the patients and physicians use the health-related websites as an important information source and, therefore, it is critical the quality evaluation of health- related websites. The quality assessment of health-related websites becomes especially relevant because their use imply the existence of a wide range of threats which can affect people’s health. Additionally, website quality evaluation can also contribute to maximize the exploitation of invested resources by organizations in the development of user-perceived quality websites. But there is not yet a clear and unambiguous definition of the concept of website quality and the debate about quality evaluation on the Web remains open. In this paper, we present a qualitative and user-oriented methodology for assessing quality of health-related websites based on a 2-tuple fuzzy linguistic approach. To identify the quality criteria set, a qualitative research has been carried out using the focus groups technique. The measurement method generates linguistic quality assessments considering the visitors’ judgements with respect to those quality criteria. The combination of the linguistic judgements is implemented without a loss of information by applying a 2-tuple linguistic weighted average operator. This methodology means an improvement on quality evaluation of health websites through the commitment to put users first.
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paper_title: Hospital Website Rankings in the United States: Expanding Benchmarks and Standards for Effective Consumer Engagement

paper_content:

Background: Passage of the Patient Protection and Affordable Care Act (ACA) increased the roles hospitals and health systems play in care delivery and led to a wave of consolidation of medical groups and hospitals. As such, the traditional patient interaction with an independent medical provider is becoming far less common, replaced by frequent interactions with integrated medical groups and health systems. It is thus increasingly important for these organizations to have an effective social media presence. Moreover, in the age of the informed consumer, patients desire a readily accessible, electronic interface to initiate contact, making a well-designed website and social media strategy critical features of the modern health care organization. Objective: The purpose of this study was to assess the Web presence of hospitals and their health systems on five dimensions: accessibility, content, marketing, technology, and usability. In addition, an overall ranking was calculated to identify the top 100 hospital and health system websites. Methods: A total of 2407 unique Web domains covering 2785 hospital facilities or their parent organizations were identified and matched against the 2009 American Hospital Association (AHA) Annual Survey. This is a four-fold improvement in prior research and represents what the authors believe to be a census assessment of the online presence of US hospitals and their health systems. Each of the five dimensions was investigated with an automated content analysis using a suite of tools. Scores on the dimensions are reported on a range from 0 to 10, with a higher score on any given dimension representing better comparative performance. Rankings on each dimension and an average ranking are provided for the top 100 hospitals. Results: The mean score on the usability dimension, meant to rate overall website quality, was 5.16 (SD 1.43), with the highest score of 8 shared by only 5 hospitals. Mean scores on other dimensions were between 4.43 (SD 2.19) and 6.49 (SD 0.96). Based on these scores, rank order calculations for the top 100 websites are presented. Additionally, a link to raw data, including AHA ID, is provided to enable researchers and practitioners the ability to further explore relationships to other dynamics in health care. Conclusions: This census assessment of US hospitals and their health systems provides a clear indication of the state of the sector. While stakeholder engagement is core to most discussions of the role that hospitals must play in relation to communities, management of an online presence has not been recognized as a core competency fundamental to care delivery. Yet, social media management and network engagement are skills that exist at the confluence of marketing and technical prowess. This paper presents performance guidelines evaluated against best-demonstrated practice or independent standards to facilitate improvement of the sector’s use of websites and social media.
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paper_title: The Triple Aim: Care, Health, And Cost

paper_content:

Improving the U.S. health care system requires simultaneous pursuit of three aims: improving the experience of care, improving the health of populations, and reducing per capita costs of health care. Preconditions for this include the enrollment of an identified population, a commitment to universality for its members, and the existence of an organization (an "integrator") that accepts responsibility for all three aims for that population. The integrator's role includes at least five components: partnership with individuals and families, redesign of primary care, population health management, financial management, and macro system integration.
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paper_title: Emergence of a new consumer health informatics framework: introducing the healthcare organization.

paper_content:

Healthcare consumers are increasingly seeking reliable forms of health information on the Internet that can be used to support health related decision-making. Frameworks that have been developed and tested in the field of health informatics have attempted to describe the effects of the Internet upon the health care consumer and physician relationship. More recently, health care organizations are responding by providing information such as hospital wait lists or strategies for self-managing disease, and this information is being provided on organizational web-sites. The authors of this paper propose that current conceptualizations of the relationship between the Internet, physicians and patients are limited from a consumer informatics perspective and may need to be extended to include healthcare organizations.
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paper_title: The Triple Aim: Care, Health, And Cost

paper_content:

Improving the U.S. health care system requires simultaneous pursuit of three aims: improving the experience of care, improving the health of populations, and reducing per capita costs of health care. Preconditions for this include the enrollment of an identified population, a commitment to universality for its members, and the existence of an organization (an "integrator") that accepts responsibility for all three aims for that population. The integrator's role includes at least five components: partnership with individuals and families, redesign of primary care, population health management, financial management, and macro system integration.
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paper_title: The Quality and Characteristics of Leading General Hospitals’ Websites in China

paper_content:

This paper focuses on the evaluation of quality of hospital websites in China. Leading general hospitals' websites in China are increasingly used by the public, but research on the quality of these websites in China is few and far between. In this article, we conducted a cross-sectional descriptive infodemiology study to assess the quality and to describe the characteristics of these websites. Using a pre-defined objective criterion based on content, function, design, and management & usage, two well-trained reviewers independently reviewed and analyzed websites of 23 nationally prominent leading general hospitals of China from April to June 2009. Hospital election is on the basis of the best Chinese hospitals published by official and non-official sources combined with experts' experiences and the research purpose. Results show that websites of most hospitals showed a good performance in website content, showed a normal performance in website function and design, but showed a bad performance in website management & usage. As the public increasingly looks to hospital websites for information and services, leading general hospitals in China need to keep up with increasingly high standards and demands of health-care consumers.
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paper_title: Evaluation of Norwegian cancer hospitals' Web sites and explorative survey among cancer patients on their use of the Internet

paper_content:

BACKGROUND ::: Hospital homepages should provide comprehensive information on the hospital's services, such as departments and treatments available, prices, waiting time, leisure facilities, and other information important for patients and their relatives. Norway, with its population of approximately 4.3 million, ranks among the top countries globally for its ability to absorb and use technology. It is unclear to what degree Norwegian hospitals and patients use the Internet for information about health services. ::: ::: ::: OBJECTIVES ::: This study was undertaken to evaluate the quality of the biggest Norwegian cancer hospitals Web sites and to gather some preliminary data on patients use of the Internet. ::: ::: ::: METHODS ::: In January 2001, we analyzed Web sites of 5 of the 7 biggest Norwegian hospitals treating cancer patients using a scoring system. The scoring instrument was based on recommendations developed by the Norwegian Central Information Service for Web sites and reflects the scope and depth of service information offered on hospital Web pages. In addition, 31 cancer patients visiting one hospital-based medical oncologist were surveyed about their use of the Internet. ::: ::: ::: RESULTS ::: Of the 7 hospitals, 5 had a Web site. The Web sites differed markedly in quality. Types of information included - and number of Web sites that included each type of information - were, for example: search option, 1; interpreter service, 2; date of last update, 2; postal address, phone number, and e-mail service, 3; information in English, 2. None of the Web sites included information on waiting time or prices. Of the 31 patients surveyed, 12 had personal experience using the Internet and 4 had searched for medical information. The Internet users were significantly younger (mean age 47.8 years, range 28.4-66.8 years) than the nonusers (mean age 61.8 years, range 33.1-90.0 years) (P = 0.007). ::: ::: ::: CONCLUSIONS ::: The hospitals Web sites offer cancer patients and relatives useful information, but the Web sites were not impressive.
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paper_title: A quality evaluation methodology for health-related websites based on a 2-tuple fuzzy linguistic approach

paper_content:

Nowadays, the patients and physicians use the health-related websites as an important information source and, therefore, it is critical the quality evaluation of health- related websites. The quality assessment of health-related websites becomes especially relevant because their use imply the existence of a wide range of threats which can affect people’s health. Additionally, website quality evaluation can also contribute to maximize the exploitation of invested resources by organizations in the development of user-perceived quality websites. But there is not yet a clear and unambiguous definition of the concept of website quality and the debate about quality evaluation on the Web remains open. In this paper, we present a qualitative and user-oriented methodology for assessing quality of health-related websites based on a 2-tuple fuzzy linguistic approach. To identify the quality criteria set, a qualitative research has been carried out using the focus groups technique. The measurement method generates linguistic quality assessments considering the visitors’ judgements with respect to those quality criteria. The combination of the linguistic judgements is implemented without a loss of information by applying a 2-tuple linguistic weighted average operator. This methodology means an improvement on quality evaluation of health websites through the commitment to put users first.
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paper_title: A Comparison of Websites from Spanish, American and British Hospitals

paper_content:

Objective: To evaluate and compare the user-orientation of Spanish, American and British hospital websites. Methods: A descriptive study of 32 hospital portals (12 Spanish, 10 American and 10 British) was carried out in which the following were analyzed: website readability according to the Flesch Index, websites accessibility using the Web Accessibility Test, and the quality of information provided using the “e-Information Scale of Health Care Centers”. Results: Fifty percent of the user-oriented information quality attributes are met. Readability indices tend to be below 60 (standard readability), and only 10 of the 32 websites meet the accessibility criteria. Conclusions: Most portals exhibit accessibility problems that favor computer illiteracy. There is a wide variability in terms of website readability and in terms of useroriented content.
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paper_title: An Evaluation and Ranking of Children’s Hospital Websites in the United States

paper_content:

Background: Children’s hospitals are faced with the rising need for technological innovation. Their prospective health care consumers, who increasingly depend on the Web and social media for communication and consumer engagement, drive this need. As patients and family members navigate the Web presence of hospitals, it is important for these specialized organizations to present themselves and their services efficiently. Objective: The purpose of this study was to evaluate the website content of children’s hospitals in order to identify opportunities to improve website design and create benchmarks to judge improvement. Methods: All websites associated with a children’s hospital were identified using a census list of all children’s hospitals in the United States. In March of 2014, each website and its social media were evaluated using a Web crawler that provided a 5-dimensional assessment that included website accessibility, marketing, content, technology, and usability. The 5-dimensional assessment was scored on a scale ranging from 0 to 10 with positive findings rated higher on the scale. Websites were ranked by individual dimensions as well as according to their average ranking across all dimensions. Results: Mean scores of 153 websites ranged from 5.05 to 8.23 across all 5 dimensions. Results revealed that no website scored a perfect 10 on any dimension and that room exists for meaningful improvement. Conclusions: Study findings allow for the establishment of baseline benchmarks for tracking future website and social media improvements and display the need for enhanced Web-based consumer engagement for children’s hospitals. [J Med Internet Res 2016;18(8):e228]
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paper_title: Hospital Website Rankings in the United States: Expanding Benchmarks and Standards for Effective Consumer Engagement

paper_content:

Background: Passage of the Patient Protection and Affordable Care Act (ACA) increased the roles hospitals and health systems play in care delivery and led to a wave of consolidation of medical groups and hospitals. As such, the traditional patient interaction with an independent medical provider is becoming far less common, replaced by frequent interactions with integrated medical groups and health systems. It is thus increasingly important for these organizations to have an effective social media presence. Moreover, in the age of the informed consumer, patients desire a readily accessible, electronic interface to initiate contact, making a well-designed website and social media strategy critical features of the modern health care organization. Objective: The purpose of this study was to assess the Web presence of hospitals and their health systems on five dimensions: accessibility, content, marketing, technology, and usability. In addition, an overall ranking was calculated to identify the top 100 hospital and health system websites. Methods: A total of 2407 unique Web domains covering 2785 hospital facilities or their parent organizations were identified and matched against the 2009 American Hospital Association (AHA) Annual Survey. This is a four-fold improvement in prior research and represents what the authors believe to be a census assessment of the online presence of US hospitals and their health systems. Each of the five dimensions was investigated with an automated content analysis using a suite of tools. Scores on the dimensions are reported on a range from 0 to 10, with a higher score on any given dimension representing better comparative performance. Rankings on each dimension and an average ranking are provided for the top 100 hospitals. Results: The mean score on the usability dimension, meant to rate overall website quality, was 5.16 (SD 1.43), with the highest score of 8 shared by only 5 hospitals. Mean scores on other dimensions were between 4.43 (SD 2.19) and 6.49 (SD 0.96). Based on these scores, rank order calculations for the top 100 websites are presented. Additionally, a link to raw data, including AHA ID, is provided to enable researchers and practitioners the ability to further explore relationships to other dynamics in health care. Conclusions: This census assessment of US hospitals and their health systems provides a clear indication of the state of the sector. While stakeholder engagement is core to most discussions of the role that hospitals must play in relation to communities, management of an online presence has not been recognized as a core competency fundamental to care delivery. Yet, social media management and network engagement are skills that exist at the confluence of marketing and technical prowess. This paper presents performance guidelines evaluated against best-demonstrated practice or independent standards to facilitate improvement of the sector’s use of websites and social media.
---
paper_title: A fuzzy preference-ranking model for a quality evaluation of hospital web sites

paper_content:

This article presents a quality evaluation model for measuring the performance of hospital Web sites. The model is developed on the basis of a conceptual framework, which consists of seven major e-service quality dimensions, including tangibles, reliability, responsiveness, confidence, empathy, quality of information, and integration of communication issues of Web sites. The dimensions and their associated attributes are first obtained from published articles in the health care and information technology literature and then adapted according to the suggestions of related domain experts. Two multicriteria decision-making methods are used in the evaluation procedure. Determined Web site evaluation dimensions and their relevant attributes are weighted using the Analytic Hierarchy Process (AHP) method. Vagueness in some stages of the evaluation required the incorporation of fuzzy numbers in the assessment process. Both fuzzy and crisp data are then synthesized using the fuzzy PROMETHEE (Preference Ranking Organization Method for Enrichment Evaluation) ranking method. The model is applied initially to measure the performance of the Web sites of Turkish hospitals. This study should be of interest to health care and technology practitioners and researchers, as the findings shed light on the further development of performance measurements for hospital Web sites. © 2006 Wiley Periodicals, Inc. Int J Int Syst 21: 1181–1197, 2006.
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paper_title: Quality of websites of obstetrics and gynecology departments: a cross-sectional study

paper_content:

\(\bf Background:\) The internet has become an easily accessible and widely used source of healthcare information. There are, however, no standardized or commonly accepted criteria for the quality of Obstetrics and Gynecology websites. In this study, we aimed to evaluate the quality of websites of Obstetrics and Gynecology departments in German-speaking countries and to compare websites nationally and internationally. ::: ::: \(\bf Methods:\) We scored 672 websites from Germany (n = 566), Austria (n = 57), and Switzerland (n = 49) using the objective criteria: Google search rank (2 items), technical aspects (11 items), navigation (8 items), and content (6 items) for a 26 point score. Scores were compared nationally and inter nationally. Multivariable regression models assessed good quality scores (\(\geq\)50% of maximum) as the dependent variables and country, academic affiliation, being member of a healthcare consortium, confessional affiliation, and content management system (CMS) use as independent variables. ::: ::: \(\bf Results:\) The mean score of websites was 13.8 \(\pm\) 3.3. 4.2% were rated as good (\(\geq\)75% of maximum), 61.8% as fair ((\(\geq\)50% of maximum). German (14.0 \(\pm\) 3.2) and Swiss (13.8 \(\pm\) 4.0) websites scored significantly higher compared to Austrian websites (11.6 \(\pm\) 2.5) (P < 0.001 and P = 0.005, respectively). Within Germany, academic had higher scores than non-academic departments (14.9 \(\pm\) 3.2 vs. 13.7 \(\pm\) 3.1, P < 0.001). Single institutions had higher scores compared to healthcare consortium institutions (14.1 \(\pm\) 3.2 vs. 13.2 \(\pm\) 2.6, P = 0.003). Departments in Northern and Southern states had higher scores compared to Eastern states (14.4 \(\pm\) 3.2 and 14.2 \(\pm\) 3.2 vs. 13.0 \(\pm\) 3.0, P < 0.001). In multivariate regression models, all subscores (all: P < 0.001) independently predicted a website’s reaching a good quality score, with navigation subscore as strongest predictor. Affiliations were predictors for some good individual subscores, but not for others. High content subscore was associated with good Google search rank, technical aspects, and navigation subscores. ::: ::: \(\bf Conclusions:\) The quality of websites of Obstetrics and Gynecology departments varies widely. We found marked differences depending on country, affiliation, and region.
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paper_title: E-health and assurance: curing hospital websites

paper_content:

Hospital websites are becoming an industry standard as patients (consumers) and health professionals use web resources for information, research, and communication. Industry predictions focused on future e-hospitals that would integrate all stakeholders in a seamless network allowing data to be shared. This paper investigates web assurance strategies implemented by hospitals in the design of their websites. The protection of critical infrastructure and information is crucial to the success of the web assurance strategy. The study reviewed a sample of 100 premier hospital websites. Results show little progress in the goal of making the website a fully functional unit of the hospital. Current sites are limited in scope and have become more selective in their provision of information in light of new HIPAA regulations.
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paper_title: Developing and validating a nursing website evaluation questionnaire

paper_content:

Aim. The aim of this paper is to report on the development and validation of an evaluation questionnaire for nursing websites. ::: ::: ::: ::: Background. Increasing numbers of the general public and health care professionals are using the Internet to access health and health care-related information. The quality of such websites, therefore, needs to be evaluated. ::: ::: ::: ::: Methods. A total of 24 websites in the United States and Taiwan, including websites in 13 leading schools and 11 hospitals, were selected as test websites. A total of 120 participants with Master's degrees in either nursing or mechanical engineering were invited to examine the 24 websites using a nursing website evaluation questionnaire. A 32-item questionnaire was developed, covering overall impression, download and switch speed, accessibility and convenience, web page content, service function and compatibility with common browsers. Participants were requested to connect to the specific websites and browse the contents before filling in the questionnaire. The results were arranged into 12 different sequences and prepared on a CD using Macromedia Dreamweaver. Data were analysed using Cronbach's α, Guttman split-half reliability and factor analysis. ::: ::: ::: ::: Findings. Internal consistency was good, with a Cronbach's α of 0·93 in Part I and a KR-20 (Kuder Richardson) of 0·85 in Part II. Four factors given in Part I were identified as content truth, accessibility and convenience, speed and connection, and overall impression. ::: ::: ::: ::: Conclusion. The nursing website evaluation questionnaire had good construct validity and internal consistency.
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paper_title: Italian hospitals on the web: a cross-sectional analysis of official websites

paper_content:

BackgroundAlthough the use of the Internet for health purposes has increased steadily in the last decade, only a few studies have explored the information provided by the websites of health institutions and no studies on the on-line activities of Italian hospitals have been performed to date. The aim of this study was to explore the characteristics of the contents and the user-orientation of Italian hospital websites.MethodsThe cross-sectional analysis considered all the Italian hospitals with a working website between December 2008 and February 2009. The websites were coded using an ad hoc Codebook, comprising eighty-nine items divided into five sections: technical characteristics, hospital information and facilities, medical services, interactive on-line services and external activities. We calculated a website evaluation score, on the basis of the items satisfied, to compare private (PrHs) and public hospitals, the latter divided into ones with their own website (PubHs-1) and ones with a section on the website of their Local Health Authority (PubHs-2). Lastly, a descriptive analysis of each item was carried out.ResultsOut of the 1265 hospitals in Italy, we found that 419 of the 652 public hospitals (64.3%) and 344 of the 613 PrHs (56.1%) had a working website (p = 0.01). The mean website evaluation score was 41.9 for PubHs-1, 21.2 for PubHs-2 and 30.8 for PrHs (p < 0.001).Only 5 hospitals out of 763 (< 1%) provided specific clinical performance indicators, such as the nosocomial infection rate or the surgical mortality rates. Regarding interactive on-line services, although nearly 80% of both public and private hospitals enabled users to communicate on-line, less than 18% allowed the reservation of medical services, and only 8 websites (1%) provided a health-care forum.ConclusionsA high percentage of hospitals did not provide an official website and the majority of the websites found had several limitations. Very few hospitals provided information to increase the credibility of the hospital and user confidence in the institution. This study suggests that Italian hospital websites are more a source of information on admissions and services than a means of communication between user and hospital.
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paper_title: Emergence of a new consumer health informatics framework: introducing the healthcare organization.

paper_content:

Healthcare consumers are increasingly seeking reliable forms of health information on the Internet that can be used to support health related decision-making. Frameworks that have been developed and tested in the field of health informatics have attempted to describe the effects of the Internet upon the health care consumer and physician relationship. More recently, health care organizations are responding by providing information such as hospital wait lists or strategies for self-managing disease, and this information is being provided on organizational web-sites. The authors of this paper propose that current conceptualizations of the relationship between the Internet, physicians and patients are limited from a consumer informatics perspective and may need to be extended to include healthcare organizations.
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paper_title: Quality assessment of the Website for Eating Disorders: a systematic review of a pending challenge

paper_content:

A Systematic review of articles from peer-reviewed journals was conducted, studying the complete texts in all cases. The key words selected were: "Eating Disorders" and "Internet." Descriptive analysis was performed on the variables selected, and Fisher's Exact test was used to analyze the presence of a linear relationship between qualitative variables. Of the 7 studies reviewed, 5 (71.42%) focused on content criteria and 2 (28.57%) examined both documentary and content criteria. Documentary quality was evaluated using two assessment instruments developed by two of the authors, comprising a set of 20 different variables, 5 of which were common to both studies (25% observed percentage agreement). Fisher's Exact test revealed significant differences between the two questionnaires (p = 0.049). Studies assessing Website content used 30 different topics to classify the subject matter, of which 6 were common to 2 studies. Although generic instruments for assessing the quality of Websites devoted to eating disorders were found, no validated questionnaire was found. This research did not locate any checklist or simple tool which could be used by consumers of health information available on the Web.
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paper_title: Evaluation of Greek public hospital websites

paper_content:

Hospital web sites need to operate as effective web resources of information and interactive communication mediums to address the multifaceted requirements of their main stakeholders, (i.e. patients, healthy citizens, healthcare professionals and local communities). In case of public hospitals, web sites should also be considered as a mean to provide governmental electronic services. The main objective of this study is to provide an evaluation framework for hospital web sites. The proposed framework focuses on three main criteria: information, communication and electronic services. A total of 53 Greek hospital web sites within the Public Sector were evaluated based on a 67-item scale. The main findings of the study were the following: (a) the majority of the web sites in the analysis failed to support necessary web-based transactions between the institutions and their stakeholders (b) web sites are lacking important features regarding provision of information and communication practices. Improvements on interaction and information quality are necessary in order for the institutions to provide a viable and useful online environment for patients and citizens.
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paper_title: The unpromising quality and evolution of Spanish public hospital web sites

paper_content:

Purpose – The objective of this paper is twofold: first to determine to what extent Spanish public hospitals are using their web sites to provide useful information to users and to improve hospital‐patient relationships, and second to determine which factors have an influence on web site adoption and level of development over time.Design/methodology/approach – The web sites of public hospitals were searched for and analysed in 2005 and 2008. Their contents and features were scored using an 86‐item checklist. Several hypotheses were proposed regarding the influence of internal and external factors on web site adoption and level of development. Logit and linear regressions were conducted to test the proposed hypotheses.Findings – Half of the Spanish public hospitals do not have a web site. The hospital web sites were acceptable in the information dimension but should improve their interactive features, as well as their navigation and usability. No significant improvements were observed during the period ana...
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paper_title: Evaluation of Norwegian cancer hospitals' Web sites and explorative survey among cancer patients on their use of the Internet

paper_content:

BACKGROUND ::: Hospital homepages should provide comprehensive information on the hospital's services, such as departments and treatments available, prices, waiting time, leisure facilities, and other information important for patients and their relatives. Norway, with its population of approximately 4.3 million, ranks among the top countries globally for its ability to absorb and use technology. It is unclear to what degree Norwegian hospitals and patients use the Internet for information about health services. ::: ::: ::: OBJECTIVES ::: This study was undertaken to evaluate the quality of the biggest Norwegian cancer hospitals Web sites and to gather some preliminary data on patients use of the Internet. ::: ::: ::: METHODS ::: In January 2001, we analyzed Web sites of 5 of the 7 biggest Norwegian hospitals treating cancer patients using a scoring system. The scoring instrument was based on recommendations developed by the Norwegian Central Information Service for Web sites and reflects the scope and depth of service information offered on hospital Web pages. In addition, 31 cancer patients visiting one hospital-based medical oncologist were surveyed about their use of the Internet. ::: ::: ::: RESULTS ::: Of the 7 hospitals, 5 had a Web site. The Web sites differed markedly in quality. Types of information included - and number of Web sites that included each type of information - were, for example: search option, 1; interpreter service, 2; date of last update, 2; postal address, phone number, and e-mail service, 3; information in English, 2. None of the Web sites included information on waiting time or prices. Of the 31 patients surveyed, 12 had personal experience using the Internet and 4 had searched for medical information. The Internet users were significantly younger (mean age 47.8 years, range 28.4-66.8 years) than the nonusers (mean age 61.8 years, range 33.1-90.0 years) (P = 0.007). ::: ::: ::: CONCLUSIONS ::: The hospitals Web sites offer cancer patients and relatives useful information, but the Web sites were not impressive.
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paper_title: An Evaluation and Ranking of Children’s Hospital Websites in the United States

paper_content:

Background: Children’s hospitals are faced with the rising need for technological innovation. Their prospective health care consumers, who increasingly depend on the Web and social media for communication and consumer engagement, drive this need. As patients and family members navigate the Web presence of hospitals, it is important for these specialized organizations to present themselves and their services efficiently. Objective: The purpose of this study was to evaluate the website content of children’s hospitals in order to identify opportunities to improve website design and create benchmarks to judge improvement. Methods: All websites associated with a children’s hospital were identified using a census list of all children’s hospitals in the United States. In March of 2014, each website and its social media were evaluated using a Web crawler that provided a 5-dimensional assessment that included website accessibility, marketing, content, technology, and usability. The 5-dimensional assessment was scored on a scale ranging from 0 to 10 with positive findings rated higher on the scale. Websites were ranked by individual dimensions as well as according to their average ranking across all dimensions. Results: Mean scores of 153 websites ranged from 5.05 to 8.23 across all 5 dimensions. Results revealed that no website scored a perfect 10 on any dimension and that room exists for meaningful improvement. Conclusions: Study findings allow for the establishment of baseline benchmarks for tracking future website and social media improvements and display the need for enhanced Web-based consumer engagement for children’s hospitals. [J Med Internet Res 2016;18(8):e228]
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paper_title: A fuzzy preference-ranking model for a quality evaluation of hospital web sites

paper_content:

This article presents a quality evaluation model for measuring the performance of hospital Web sites. The model is developed on the basis of a conceptual framework, which consists of seven major e-service quality dimensions, including tangibles, reliability, responsiveness, confidence, empathy, quality of information, and integration of communication issues of Web sites. The dimensions and their associated attributes are first obtained from published articles in the health care and information technology literature and then adapted according to the suggestions of related domain experts. Two multicriteria decision-making methods are used in the evaluation procedure. Determined Web site evaluation dimensions and their relevant attributes are weighted using the Analytic Hierarchy Process (AHP) method. Vagueness in some stages of the evaluation required the incorporation of fuzzy numbers in the assessment process. Both fuzzy and crisp data are then synthesized using the fuzzy PROMETHEE (Preference Ranking Organization Method for Enrichment Evaluation) ranking method. The model is applied initially to measure the performance of the Web sites of Turkish hospitals. This study should be of interest to health care and technology practitioners and researchers, as the findings shed light on the further development of performance measurements for hospital Web sites. © 2006 Wiley Periodicals, Inc. Int J Int Syst 21: 1181–1197, 2006.
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paper_title: Quality of websites of obstetrics and gynecology departments: a cross-sectional study

paper_content:

\(\bf Background:\) The internet has become an easily accessible and widely used source of healthcare information. There are, however, no standardized or commonly accepted criteria for the quality of Obstetrics and Gynecology websites. In this study, we aimed to evaluate the quality of websites of Obstetrics and Gynecology departments in German-speaking countries and to compare websites nationally and internationally. ::: ::: \(\bf Methods:\) We scored 672 websites from Germany (n = 566), Austria (n = 57), and Switzerland (n = 49) using the objective criteria: Google search rank (2 items), technical aspects (11 items), navigation (8 items), and content (6 items) for a 26 point score. Scores were compared nationally and inter nationally. Multivariable regression models assessed good quality scores (\(\geq\)50% of maximum) as the dependent variables and country, academic affiliation, being member of a healthcare consortium, confessional affiliation, and content management system (CMS) use as independent variables. ::: ::: \(\bf Results:\) The mean score of websites was 13.8 \(\pm\) 3.3. 4.2% were rated as good (\(\geq\)75% of maximum), 61.8% as fair ((\(\geq\)50% of maximum). German (14.0 \(\pm\) 3.2) and Swiss (13.8 \(\pm\) 4.0) websites scored significantly higher compared to Austrian websites (11.6 \(\pm\) 2.5) (P < 0.001 and P = 0.005, respectively). Within Germany, academic had higher scores than non-academic departments (14.9 \(\pm\) 3.2 vs. 13.7 \(\pm\) 3.1, P < 0.001). Single institutions had higher scores compared to healthcare consortium institutions (14.1 \(\pm\) 3.2 vs. 13.2 \(\pm\) 2.6, P = 0.003). Departments in Northern and Southern states had higher scores compared to Eastern states (14.4 \(\pm\) 3.2 and 14.2 \(\pm\) 3.2 vs. 13.0 \(\pm\) 3.0, P < 0.001). In multivariate regression models, all subscores (all: P < 0.001) independently predicted a website’s reaching a good quality score, with navigation subscore as strongest predictor. Affiliations were predictors for some good individual subscores, but not for others. High content subscore was associated with good Google search rank, technical aspects, and navigation subscores. ::: ::: \(\bf Conclusions:\) The quality of websites of Obstetrics and Gynecology departments varies widely. We found marked differences depending on country, affiliation, and region.
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paper_title: E-health and assurance: curing hospital websites

paper_content:

Hospital websites are becoming an industry standard as patients (consumers) and health professionals use web resources for information, research, and communication. Industry predictions focused on future e-hospitals that would integrate all stakeholders in a seamless network allowing data to be shared. This paper investigates web assurance strategies implemented by hospitals in the design of their websites. The protection of critical infrastructure and information is crucial to the success of the web assurance strategy. The study reviewed a sample of 100 premier hospital websites. Results show little progress in the goal of making the website a fully functional unit of the hospital. Current sites are limited in scope and have become more selective in their provision of information in light of new HIPAA regulations.
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paper_title: Developing and validating a nursing website evaluation questionnaire

paper_content:

Aim. The aim of this paper is to report on the development and validation of an evaluation questionnaire for nursing websites. ::: ::: ::: ::: Background. Increasing numbers of the general public and health care professionals are using the Internet to access health and health care-related information. The quality of such websites, therefore, needs to be evaluated. ::: ::: ::: ::: Methods. A total of 24 websites in the United States and Taiwan, including websites in 13 leading schools and 11 hospitals, were selected as test websites. A total of 120 participants with Master's degrees in either nursing or mechanical engineering were invited to examine the 24 websites using a nursing website evaluation questionnaire. A 32-item questionnaire was developed, covering overall impression, download and switch speed, accessibility and convenience, web page content, service function and compatibility with common browsers. Participants were requested to connect to the specific websites and browse the contents before filling in the questionnaire. The results were arranged into 12 different sequences and prepared on a CD using Macromedia Dreamweaver. Data were analysed using Cronbach's α, Guttman split-half reliability and factor analysis. ::: ::: ::: ::: Findings. Internal consistency was good, with a Cronbach's α of 0·93 in Part I and a KR-20 (Kuder Richardson) of 0·85 in Part II. Four factors given in Part I were identified as content truth, accessibility and convenience, speed and connection, and overall impression. ::: ::: ::: ::: Conclusion. The nursing website evaluation questionnaire had good construct validity and internal consistency.
---
paper_title: Italian hospitals on the web: a cross-sectional analysis of official websites

paper_content:

BackgroundAlthough the use of the Internet for health purposes has increased steadily in the last decade, only a few studies have explored the information provided by the websites of health institutions and no studies on the on-line activities of Italian hospitals have been performed to date. The aim of this study was to explore the characteristics of the contents and the user-orientation of Italian hospital websites.MethodsThe cross-sectional analysis considered all the Italian hospitals with a working website between December 2008 and February 2009. The websites were coded using an ad hoc Codebook, comprising eighty-nine items divided into five sections: technical characteristics, hospital information and facilities, medical services, interactive on-line services and external activities. We calculated a website evaluation score, on the basis of the items satisfied, to compare private (PrHs) and public hospitals, the latter divided into ones with their own website (PubHs-1) and ones with a section on the website of their Local Health Authority (PubHs-2). Lastly, a descriptive analysis of each item was carried out.ResultsOut of the 1265 hospitals in Italy, we found that 419 of the 652 public hospitals (64.3%) and 344 of the 613 PrHs (56.1%) had a working website (p = 0.01). The mean website evaluation score was 41.9 for PubHs-1, 21.2 for PubHs-2 and 30.8 for PrHs (p < 0.001).Only 5 hospitals out of 763 (< 1%) provided specific clinical performance indicators, such as the nosocomial infection rate or the surgical mortality rates. Regarding interactive on-line services, although nearly 80% of both public and private hospitals enabled users to communicate on-line, less than 18% allowed the reservation of medical services, and only 8 websites (1%) provided a health-care forum.ConclusionsA high percentage of hospitals did not provide an official website and the majority of the websites found had several limitations. Very few hospitals provided information to increase the credibility of the hospital and user confidence in the institution. This study suggests that Italian hospital websites are more a source of information on admissions and services than a means of communication between user and hospital.
---
paper_title: Emergence of a new consumer health informatics framework: introducing the healthcare organization.

paper_content:

Healthcare consumers are increasingly seeking reliable forms of health information on the Internet that can be used to support health related decision-making. Frameworks that have been developed and tested in the field of health informatics have attempted to describe the effects of the Internet upon the health care consumer and physician relationship. More recently, health care organizations are responding by providing information such as hospital wait lists or strategies for self-managing disease, and this information is being provided on organizational web-sites. The authors of this paper propose that current conceptualizations of the relationship between the Internet, physicians and patients are limited from a consumer informatics perspective and may need to be extended to include healthcare organizations.
---
paper_title: Quality assessment of the Website for Eating Disorders: a systematic review of a pending challenge

paper_content:

A Systematic review of articles from peer-reviewed journals was conducted, studying the complete texts in all cases. The key words selected were: "Eating Disorders" and "Internet." Descriptive analysis was performed on the variables selected, and Fisher's Exact test was used to analyze the presence of a linear relationship between qualitative variables. Of the 7 studies reviewed, 5 (71.42%) focused on content criteria and 2 (28.57%) examined both documentary and content criteria. Documentary quality was evaluated using two assessment instruments developed by two of the authors, comprising a set of 20 different variables, 5 of which were common to both studies (25% observed percentage agreement). Fisher's Exact test revealed significant differences between the two questionnaires (p = 0.049). Studies assessing Website content used 30 different topics to classify the subject matter, of which 6 were common to 2 studies. Although generic instruments for assessing the quality of Websites devoted to eating disorders were found, no validated questionnaire was found. This research did not locate any checklist or simple tool which could be used by consumers of health information available on the Web.
---
paper_title: Evaluation of Greek public hospital websites

paper_content:

Hospital web sites need to operate as effective web resources of information and interactive communication mediums to address the multifaceted requirements of their main stakeholders, (i.e. patients, healthy citizens, healthcare professionals and local communities). In case of public hospitals, web sites should also be considered as a mean to provide governmental electronic services. The main objective of this study is to provide an evaluation framework for hospital web sites. The proposed framework focuses on three main criteria: information, communication and electronic services. A total of 53 Greek hospital web sites within the Public Sector were evaluated based on a 67-item scale. The main findings of the study were the following: (a) the majority of the web sites in the analysis failed to support necessary web-based transactions between the institutions and their stakeholders (b) web sites are lacking important features regarding provision of information and communication practices. Improvements on interaction and information quality are necessary in order for the institutions to provide a viable and useful online environment for patients and citizens.
---
paper_title: Evaluation of Norwegian cancer hospitals' Web sites and explorative survey among cancer patients on their use of the Internet

paper_content:

BACKGROUND ::: Hospital homepages should provide comprehensive information on the hospital's services, such as departments and treatments available, prices, waiting time, leisure facilities, and other information important for patients and their relatives. Norway, with its population of approximately 4.3 million, ranks among the top countries globally for its ability to absorb and use technology. It is unclear to what degree Norwegian hospitals and patients use the Internet for information about health services. ::: ::: ::: OBJECTIVES ::: This study was undertaken to evaluate the quality of the biggest Norwegian cancer hospitals Web sites and to gather some preliminary data on patients use of the Internet. ::: ::: ::: METHODS ::: In January 2001, we analyzed Web sites of 5 of the 7 biggest Norwegian hospitals treating cancer patients using a scoring system. The scoring instrument was based on recommendations developed by the Norwegian Central Information Service for Web sites and reflects the scope and depth of service information offered on hospital Web pages. In addition, 31 cancer patients visiting one hospital-based medical oncologist were surveyed about their use of the Internet. ::: ::: ::: RESULTS ::: Of the 7 hospitals, 5 had a Web site. The Web sites differed markedly in quality. Types of information included - and number of Web sites that included each type of information - were, for example: search option, 1; interpreter service, 2; date of last update, 2; postal address, phone number, and e-mail service, 3; information in English, 2. None of the Web sites included information on waiting time or prices. Of the 31 patients surveyed, 12 had personal experience using the Internet and 4 had searched for medical information. The Internet users were significantly younger (mean age 47.8 years, range 28.4-66.8 years) than the nonusers (mean age 61.8 years, range 33.1-90.0 years) (P = 0.007). ::: ::: ::: CONCLUSIONS ::: The hospitals Web sites offer cancer patients and relatives useful information, but the Web sites were not impressive.
---
paper_title: A fuzzy preference-ranking model for a quality evaluation of hospital web sites

paper_content:

This article presents a quality evaluation model for measuring the performance of hospital Web sites. The model is developed on the basis of a conceptual framework, which consists of seven major e-service quality dimensions, including tangibles, reliability, responsiveness, confidence, empathy, quality of information, and integration of communication issues of Web sites. The dimensions and their associated attributes are first obtained from published articles in the health care and information technology literature and then adapted according to the suggestions of related domain experts. Two multicriteria decision-making methods are used in the evaluation procedure. Determined Web site evaluation dimensions and their relevant attributes are weighted using the Analytic Hierarchy Process (AHP) method. Vagueness in some stages of the evaluation required the incorporation of fuzzy numbers in the assessment process. Both fuzzy and crisp data are then synthesized using the fuzzy PROMETHEE (Preference Ranking Organization Method for Enrichment Evaluation) ranking method. The model is applied initially to measure the performance of the Web sites of Turkish hospitals. This study should be of interest to health care and technology practitioners and researchers, as the findings shed light on the further development of performance measurements for hospital Web sites. © 2006 Wiley Periodicals, Inc. Int J Int Syst 21: 1181–1197, 2006.
---
paper_title: Quality of websites of obstetrics and gynecology departments: a cross-sectional study

paper_content:

\(\bf Background:\) The internet has become an easily accessible and widely used source of healthcare information. There are, however, no standardized or commonly accepted criteria for the quality of Obstetrics and Gynecology websites. In this study, we aimed to evaluate the quality of websites of Obstetrics and Gynecology departments in German-speaking countries and to compare websites nationally and internationally. ::: ::: \(\bf Methods:\) We scored 672 websites from Germany (n = 566), Austria (n = 57), and Switzerland (n = 49) using the objective criteria: Google search rank (2 items), technical aspects (11 items), navigation (8 items), and content (6 items) for a 26 point score. Scores were compared nationally and inter nationally. Multivariable regression models assessed good quality scores (\(\geq\)50% of maximum) as the dependent variables and country, academic affiliation, being member of a healthcare consortium, confessional affiliation, and content management system (CMS) use as independent variables. ::: ::: \(\bf Results:\) The mean score of websites was 13.8 \(\pm\) 3.3. 4.2% were rated as good (\(\geq\)75% of maximum), 61.8% as fair ((\(\geq\)50% of maximum). German (14.0 \(\pm\) 3.2) and Swiss (13.8 \(\pm\) 4.0) websites scored significantly higher compared to Austrian websites (11.6 \(\pm\) 2.5) (P < 0.001 and P = 0.005, respectively). Within Germany, academic had higher scores than non-academic departments (14.9 \(\pm\) 3.2 vs. 13.7 \(\pm\) 3.1, P < 0.001). Single institutions had higher scores compared to healthcare consortium institutions (14.1 \(\pm\) 3.2 vs. 13.2 \(\pm\) 2.6, P = 0.003). Departments in Northern and Southern states had higher scores compared to Eastern states (14.4 \(\pm\) 3.2 and 14.2 \(\pm\) 3.2 vs. 13.0 \(\pm\) 3.0, P < 0.001). In multivariate regression models, all subscores (all: P < 0.001) independently predicted a website’s reaching a good quality score, with navigation subscore as strongest predictor. Affiliations were predictors for some good individual subscores, but not for others. High content subscore was associated with good Google search rank, technical aspects, and navigation subscores. ::: ::: \(\bf Conclusions:\) The quality of websites of Obstetrics and Gynecology departments varies widely. We found marked differences depending on country, affiliation, and region.
---
paper_title: Evaluation of Norwegian cancer hospitals' Web sites and explorative survey among cancer patients on their use of the Internet

paper_content:

BACKGROUND ::: Hospital homepages should provide comprehensive information on the hospital's services, such as departments and treatments available, prices, waiting time, leisure facilities, and other information important for patients and their relatives. Norway, with its population of approximately 4.3 million, ranks among the top countries globally for its ability to absorb and use technology. It is unclear to what degree Norwegian hospitals and patients use the Internet for information about health services. ::: ::: ::: OBJECTIVES ::: This study was undertaken to evaluate the quality of the biggest Norwegian cancer hospitals Web sites and to gather some preliminary data on patients use of the Internet. ::: ::: ::: METHODS ::: In January 2001, we analyzed Web sites of 5 of the 7 biggest Norwegian hospitals treating cancer patients using a scoring system. The scoring instrument was based on recommendations developed by the Norwegian Central Information Service for Web sites and reflects the scope and depth of service information offered on hospital Web pages. In addition, 31 cancer patients visiting one hospital-based medical oncologist were surveyed about their use of the Internet. ::: ::: ::: RESULTS ::: Of the 7 hospitals, 5 had a Web site. The Web sites differed markedly in quality. Types of information included - and number of Web sites that included each type of information - were, for example: search option, 1; interpreter service, 2; date of last update, 2; postal address, phone number, and e-mail service, 3; information in English, 2. None of the Web sites included information on waiting time or prices. Of the 31 patients surveyed, 12 had personal experience using the Internet and 4 had searched for medical information. The Internet users were significantly younger (mean age 47.8 years, range 28.4-66.8 years) than the nonusers (mean age 61.8 years, range 33.1-90.0 years) (P = 0.007). ::: ::: ::: CONCLUSIONS ::: The hospitals Web sites offer cancer patients and relatives useful information, but the Web sites were not impressive.
---
paper_title: A fuzzy preference-ranking model for a quality evaluation of hospital web sites

paper_content:

This article presents a quality evaluation model for measuring the performance of hospital Web sites. The model is developed on the basis of a conceptual framework, which consists of seven major e-service quality dimensions, including tangibles, reliability, responsiveness, confidence, empathy, quality of information, and integration of communication issues of Web sites. The dimensions and their associated attributes are first obtained from published articles in the health care and information technology literature and then adapted according to the suggestions of related domain experts. Two multicriteria decision-making methods are used in the evaluation procedure. Determined Web site evaluation dimensions and their relevant attributes are weighted using the Analytic Hierarchy Process (AHP) method. Vagueness in some stages of the evaluation required the incorporation of fuzzy numbers in the assessment process. Both fuzzy and crisp data are then synthesized using the fuzzy PROMETHEE (Preference Ranking Organization Method for Enrichment Evaluation) ranking method. The model is applied initially to measure the performance of the Web sites of Turkish hospitals. This study should be of interest to health care and technology practitioners and researchers, as the findings shed light on the further development of performance measurements for hospital Web sites. © 2006 Wiley Periodicals, Inc. Int J Int Syst 21: 1181–1197, 2006.
---
paper_title: Quality of websites of obstetrics and gynecology departments: a cross-sectional study

paper_content:

\(\bf Background:\) The internet has become an easily accessible and widely used source of healthcare information. There are, however, no standardized or commonly accepted criteria for the quality of Obstetrics and Gynecology websites. In this study, we aimed to evaluate the quality of websites of Obstetrics and Gynecology departments in German-speaking countries and to compare websites nationally and internationally. ::: ::: \(\bf Methods:\) We scored 672 websites from Germany (n = 566), Austria (n = 57), and Switzerland (n = 49) using the objective criteria: Google search rank (2 items), technical aspects (11 items), navigation (8 items), and content (6 items) for a 26 point score. Scores were compared nationally and inter nationally. Multivariable regression models assessed good quality scores (\(\geq\)50% of maximum) as the dependent variables and country, academic affiliation, being member of a healthcare consortium, confessional affiliation, and content management system (CMS) use as independent variables. ::: ::: \(\bf Results:\) The mean score of websites was 13.8 \(\pm\) 3.3. 4.2% were rated as good (\(\geq\)75% of maximum), 61.8% as fair ((\(\geq\)50% of maximum). German (14.0 \(\pm\) 3.2) and Swiss (13.8 \(\pm\) 4.0) websites scored significantly higher compared to Austrian websites (11.6 \(\pm\) 2.5) (P < 0.001 and P = 0.005, respectively). Within Germany, academic had higher scores than non-academic departments (14.9 \(\pm\) 3.2 vs. 13.7 \(\pm\) 3.1, P < 0.001). Single institutions had higher scores compared to healthcare consortium institutions (14.1 \(\pm\) 3.2 vs. 13.2 \(\pm\) 2.6, P = 0.003). Departments in Northern and Southern states had higher scores compared to Eastern states (14.4 \(\pm\) 3.2 and 14.2 \(\pm\) 3.2 vs. 13.0 \(\pm\) 3.0, P < 0.001). In multivariate regression models, all subscores (all: P < 0.001) independently predicted a website’s reaching a good quality score, with navigation subscore as strongest predictor. Affiliations were predictors for some good individual subscores, but not for others. High content subscore was associated with good Google search rank, technical aspects, and navigation subscores. ::: ::: \(\bf Conclusions:\) The quality of websites of Obstetrics and Gynecology departments varies widely. We found marked differences depending on country, affiliation, and region.
---
paper_title: E-health and assurance: curing hospital websites

paper_content:

Hospital websites are becoming an industry standard as patients (consumers) and health professionals use web resources for information, research, and communication. Industry predictions focused on future e-hospitals that would integrate all stakeholders in a seamless network allowing data to be shared. This paper investigates web assurance strategies implemented by hospitals in the design of their websites. The protection of critical infrastructure and information is crucial to the success of the web assurance strategy. The study reviewed a sample of 100 premier hospital websites. Results show little progress in the goal of making the website a fully functional unit of the hospital. Current sites are limited in scope and have become more selective in their provision of information in light of new HIPAA regulations.
---
paper_title: Developing and validating a nursing website evaluation questionnaire

paper_content:

Aim. The aim of this paper is to report on the development and validation of an evaluation questionnaire for nursing websites. ::: ::: ::: ::: Background. Increasing numbers of the general public and health care professionals are using the Internet to access health and health care-related information. The quality of such websites, therefore, needs to be evaluated. ::: ::: ::: ::: Methods. A total of 24 websites in the United States and Taiwan, including websites in 13 leading schools and 11 hospitals, were selected as test websites. A total of 120 participants with Master's degrees in either nursing or mechanical engineering were invited to examine the 24 websites using a nursing website evaluation questionnaire. A 32-item questionnaire was developed, covering overall impression, download and switch speed, accessibility and convenience, web page content, service function and compatibility with common browsers. Participants were requested to connect to the specific websites and browse the contents before filling in the questionnaire. The results were arranged into 12 different sequences and prepared on a CD using Macromedia Dreamweaver. Data were analysed using Cronbach's α, Guttman split-half reliability and factor analysis. ::: ::: ::: ::: Findings. Internal consistency was good, with a Cronbach's α of 0·93 in Part I and a KR-20 (Kuder Richardson) of 0·85 in Part II. Four factors given in Part I were identified as content truth, accessibility and convenience, speed and connection, and overall impression. ::: ::: ::: ::: Conclusion. The nursing website evaluation questionnaire had good construct validity and internal consistency.
---
paper_title: Italian hospitals on the web: a cross-sectional analysis of official websites

paper_content:

BackgroundAlthough the use of the Internet for health purposes has increased steadily in the last decade, only a few studies have explored the information provided by the websites of health institutions and no studies on the on-line activities of Italian hospitals have been performed to date. The aim of this study was to explore the characteristics of the contents and the user-orientation of Italian hospital websites.MethodsThe cross-sectional analysis considered all the Italian hospitals with a working website between December 2008 and February 2009. The websites were coded using an ad hoc Codebook, comprising eighty-nine items divided into five sections: technical characteristics, hospital information and facilities, medical services, interactive on-line services and external activities. We calculated a website evaluation score, on the basis of the items satisfied, to compare private (PrHs) and public hospitals, the latter divided into ones with their own website (PubHs-1) and ones with a section on the website of their Local Health Authority (PubHs-2). Lastly, a descriptive analysis of each item was carried out.ResultsOut of the 1265 hospitals in Italy, we found that 419 of the 652 public hospitals (64.3%) and 344 of the 613 PrHs (56.1%) had a working website (p = 0.01). The mean website evaluation score was 41.9 for PubHs-1, 21.2 for PubHs-2 and 30.8 for PrHs (p < 0.001).Only 5 hospitals out of 763 (< 1%) provided specific clinical performance indicators, such as the nosocomial infection rate or the surgical mortality rates. Regarding interactive on-line services, although nearly 80% of both public and private hospitals enabled users to communicate on-line, less than 18% allowed the reservation of medical services, and only 8 websites (1%) provided a health-care forum.ConclusionsA high percentage of hospitals did not provide an official website and the majority of the websites found had several limitations. Very few hospitals provided information to increase the credibility of the hospital and user confidence in the institution. This study suggests that Italian hospital websites are more a source of information on admissions and services than a means of communication between user and hospital.
---
paper_title: Emergence of a new consumer health informatics framework: introducing the healthcare organization.

paper_content:

Healthcare consumers are increasingly seeking reliable forms of health information on the Internet that can be used to support health related decision-making. Frameworks that have been developed and tested in the field of health informatics have attempted to describe the effects of the Internet upon the health care consumer and physician relationship. More recently, health care organizations are responding by providing information such as hospital wait lists or strategies for self-managing disease, and this information is being provided on organizational web-sites. The authors of this paper propose that current conceptualizations of the relationship between the Internet, physicians and patients are limited from a consumer informatics perspective and may need to be extended to include healthcare organizations.
---
paper_title: Quality assessment of the Website for Eating Disorders: a systematic review of a pending challenge

paper_content:

A Systematic review of articles from peer-reviewed journals was conducted, studying the complete texts in all cases. The key words selected were: "Eating Disorders" and "Internet." Descriptive analysis was performed on the variables selected, and Fisher's Exact test was used to analyze the presence of a linear relationship between qualitative variables. Of the 7 studies reviewed, 5 (71.42%) focused on content criteria and 2 (28.57%) examined both documentary and content criteria. Documentary quality was evaluated using two assessment instruments developed by two of the authors, comprising a set of 20 different variables, 5 of which were common to both studies (25% observed percentage agreement). Fisher's Exact test revealed significant differences between the two questionnaires (p = 0.049). Studies assessing Website content used 30 different topics to classify the subject matter, of which 6 were common to 2 studies. Although generic instruments for assessing the quality of Websites devoted to eating disorders were found, no validated questionnaire was found. This research did not locate any checklist or simple tool which could be used by consumers of health information available on the Web.
---
paper_title: Evaluation of Greek public hospital websites

paper_content:

Hospital web sites need to operate as effective web resources of information and interactive communication mediums to address the multifaceted requirements of their main stakeholders, (i.e. patients, healthy citizens, healthcare professionals and local communities). In case of public hospitals, web sites should also be considered as a mean to provide governmental electronic services. The main objective of this study is to provide an evaluation framework for hospital web sites. The proposed framework focuses on three main criteria: information, communication and electronic services. A total of 53 Greek hospital web sites within the Public Sector were evaluated based on a 67-item scale. The main findings of the study were the following: (a) the majority of the web sites in the analysis failed to support necessary web-based transactions between the institutions and their stakeholders (b) web sites are lacking important features regarding provision of information and communication practices. Improvements on interaction and information quality are necessary in order for the institutions to provide a viable and useful online environment for patients and citizens.
---
paper_title: Evaluation of Norwegian cancer hospitals' Web sites and explorative survey among cancer patients on their use of the Internet

paper_content:

BACKGROUND ::: Hospital homepages should provide comprehensive information on the hospital's services, such as departments and treatments available, prices, waiting time, leisure facilities, and other information important for patients and their relatives. Norway, with its population of approximately 4.3 million, ranks among the top countries globally for its ability to absorb and use technology. It is unclear to what degree Norwegian hospitals and patients use the Internet for information about health services. ::: ::: ::: OBJECTIVES ::: This study was undertaken to evaluate the quality of the biggest Norwegian cancer hospitals Web sites and to gather some preliminary data on patients use of the Internet. ::: ::: ::: METHODS ::: In January 2001, we analyzed Web sites of 5 of the 7 biggest Norwegian hospitals treating cancer patients using a scoring system. The scoring instrument was based on recommendations developed by the Norwegian Central Information Service for Web sites and reflects the scope and depth of service information offered on hospital Web pages. In addition, 31 cancer patients visiting one hospital-based medical oncologist were surveyed about their use of the Internet. ::: ::: ::: RESULTS ::: Of the 7 hospitals, 5 had a Web site. The Web sites differed markedly in quality. Types of information included - and number of Web sites that included each type of information - were, for example: search option, 1; interpreter service, 2; date of last update, 2; postal address, phone number, and e-mail service, 3; information in English, 2. None of the Web sites included information on waiting time or prices. Of the 31 patients surveyed, 12 had personal experience using the Internet and 4 had searched for medical information. The Internet users were significantly younger (mean age 47.8 years, range 28.4-66.8 years) than the nonusers (mean age 61.8 years, range 33.1-90.0 years) (P = 0.007). ::: ::: ::: CONCLUSIONS ::: The hospitals Web sites offer cancer patients and relatives useful information, but the Web sites were not impressive.
---
paper_title: E-health and assurance: curing hospital websites

paper_content:

Hospital websites are becoming an industry standard as patients (consumers) and health professionals use web resources for information, research, and communication. Industry predictions focused on future e-hospitals that would integrate all stakeholders in a seamless network allowing data to be shared. This paper investigates web assurance strategies implemented by hospitals in the design of their websites. The protection of critical infrastructure and information is crucial to the success of the web assurance strategy. The study reviewed a sample of 100 premier hospital websites. Results show little progress in the goal of making the website a fully functional unit of the hospital. Current sites are limited in scope and have become more selective in their provision of information in light of new HIPAA regulations.
---
paper_title: Evaluation of Greek public hospital websites

paper_content:

Hospital web sites need to operate as effective web resources of information and interactive communication mediums to address the multifaceted requirements of their main stakeholders, (i.e. patients, healthy citizens, healthcare professionals and local communities). In case of public hospitals, web sites should also be considered as a mean to provide governmental electronic services. The main objective of this study is to provide an evaluation framework for hospital web sites. The proposed framework focuses on three main criteria: information, communication and electronic services. A total of 53 Greek hospital web sites within the Public Sector were evaluated based on a 67-item scale. The main findings of the study were the following: (a) the majority of the web sites in the analysis failed to support necessary web-based transactions between the institutions and their stakeholders (b) web sites are lacking important features regarding provision of information and communication practices. Improvements on interaction and information quality are necessary in order for the institutions to provide a viable and useful online environment for patients and citizens.
---
paper_title: Evaluation of Norwegian cancer hospitals' Web sites and explorative survey among cancer patients on their use of the Internet

paper_content:

BACKGROUND ::: Hospital homepages should provide comprehensive information on the hospital's services, such as departments and treatments available, prices, waiting time, leisure facilities, and other information important for patients and their relatives. Norway, with its population of approximately 4.3 million, ranks among the top countries globally for its ability to absorb and use technology. It is unclear to what degree Norwegian hospitals and patients use the Internet for information about health services. ::: ::: ::: OBJECTIVES ::: This study was undertaken to evaluate the quality of the biggest Norwegian cancer hospitals Web sites and to gather some preliminary data on patients use of the Internet. ::: ::: ::: METHODS ::: In January 2001, we analyzed Web sites of 5 of the 7 biggest Norwegian hospitals treating cancer patients using a scoring system. The scoring instrument was based on recommendations developed by the Norwegian Central Information Service for Web sites and reflects the scope and depth of service information offered on hospital Web pages. In addition, 31 cancer patients visiting one hospital-based medical oncologist were surveyed about their use of the Internet. ::: ::: ::: RESULTS ::: Of the 7 hospitals, 5 had a Web site. The Web sites differed markedly in quality. Types of information included - and number of Web sites that included each type of information - were, for example: search option, 1; interpreter service, 2; date of last update, 2; postal address, phone number, and e-mail service, 3; information in English, 2. None of the Web sites included information on waiting time or prices. Of the 31 patients surveyed, 12 had personal experience using the Internet and 4 had searched for medical information. The Internet users were significantly younger (mean age 47.8 years, range 28.4-66.8 years) than the nonusers (mean age 61.8 years, range 33.1-90.0 years) (P = 0.007). ::: ::: ::: CONCLUSIONS ::: The hospitals Web sites offer cancer patients and relatives useful information, but the Web sites were not impressive.
---
paper_title: Quality of websites of obstetrics and gynecology departments: a cross-sectional study

paper_content:

\(\bf Background:\) The internet has become an easily accessible and widely used source of healthcare information. There are, however, no standardized or commonly accepted criteria for the quality of Obstetrics and Gynecology websites. In this study, we aimed to evaluate the quality of websites of Obstetrics and Gynecology departments in German-speaking countries and to compare websites nationally and internationally. ::: ::: \(\bf Methods:\) We scored 672 websites from Germany (n = 566), Austria (n = 57), and Switzerland (n = 49) using the objective criteria: Google search rank (2 items), technical aspects (11 items), navigation (8 items), and content (6 items) for a 26 point score. Scores were compared nationally and inter nationally. Multivariable regression models assessed good quality scores (\(\geq\)50% of maximum) as the dependent variables and country, academic affiliation, being member of a healthcare consortium, confessional affiliation, and content management system (CMS) use as independent variables. ::: ::: \(\bf Results:\) The mean score of websites was 13.8 \(\pm\) 3.3. 4.2% were rated as good (\(\geq\)75% of maximum), 61.8% as fair ((\(\geq\)50% of maximum). German (14.0 \(\pm\) 3.2) and Swiss (13.8 \(\pm\) 4.0) websites scored significantly higher compared to Austrian websites (11.6 \(\pm\) 2.5) (P < 0.001 and P = 0.005, respectively). Within Germany, academic had higher scores than non-academic departments (14.9 \(\pm\) 3.2 vs. 13.7 \(\pm\) 3.1, P < 0.001). Single institutions had higher scores compared to healthcare consortium institutions (14.1 \(\pm\) 3.2 vs. 13.2 \(\pm\) 2.6, P = 0.003). Departments in Northern and Southern states had higher scores compared to Eastern states (14.4 \(\pm\) 3.2 and 14.2 \(\pm\) 3.2 vs. 13.0 \(\pm\) 3.0, P < 0.001). In multivariate regression models, all subscores (all: P < 0.001) independently predicted a website’s reaching a good quality score, with navigation subscore as strongest predictor. Affiliations were predictors for some good individual subscores, but not for others. High content subscore was associated with good Google search rank, technical aspects, and navigation subscores. ::: ::: \(\bf Conclusions:\) The quality of websites of Obstetrics and Gynecology departments varies widely. We found marked differences depending on country, affiliation, and region.
---
paper_title: E-health and assurance: curing hospital websites

paper_content:

Hospital websites are becoming an industry standard as patients (consumers) and health professionals use web resources for information, research, and communication. Industry predictions focused on future e-hospitals that would integrate all stakeholders in a seamless network allowing data to be shared. This paper investigates web assurance strategies implemented by hospitals in the design of their websites. The protection of critical infrastructure and information is crucial to the success of the web assurance strategy. The study reviewed a sample of 100 premier hospital websites. Results show little progress in the goal of making the website a fully functional unit of the hospital. Current sites are limited in scope and have become more selective in their provision of information in light of new HIPAA regulations.
---
paper_title: Emergence of a new consumer health informatics framework: introducing the healthcare organization.

paper_content:

Healthcare consumers are increasingly seeking reliable forms of health information on the Internet that can be used to support health related decision-making. Frameworks that have been developed and tested in the field of health informatics have attempted to describe the effects of the Internet upon the health care consumer and physician relationship. More recently, health care organizations are responding by providing information such as hospital wait lists or strategies for self-managing disease, and this information is being provided on organizational web-sites. The authors of this paper propose that current conceptualizations of the relationship between the Internet, physicians and patients are limited from a consumer informatics perspective and may need to be extended to include healthcare organizations.
---
paper_title: Emergence of a new consumer health informatics framework: introducing the healthcare organization.

paper_content:

Healthcare consumers are increasingly seeking reliable forms of health information on the Internet that can be used to support health related decision-making. Frameworks that have been developed and tested in the field of health informatics have attempted to describe the effects of the Internet upon the health care consumer and physician relationship. More recently, health care organizations are responding by providing information such as hospital wait lists or strategies for self-managing disease, and this information is being provided on organizational web-sites. The authors of this paper propose that current conceptualizations of the relationship between the Internet, physicians and patients are limited from a consumer informatics perspective and may need to be extended to include healthcare organizations.
---
paper_title: A quality evaluation methodology for health-related websites based on a 2-tuple fuzzy linguistic approach

paper_content:

Nowadays, the patients and physicians use the health-related websites as an important information source and, therefore, it is critical the quality evaluation of health- related websites. The quality assessment of health-related websites becomes especially relevant because their use imply the existence of a wide range of threats which can affect people’s health. Additionally, website quality evaluation can also contribute to maximize the exploitation of invested resources by organizations in the development of user-perceived quality websites. But there is not yet a clear and unambiguous definition of the concept of website quality and the debate about quality evaluation on the Web remains open. In this paper, we present a qualitative and user-oriented methodology for assessing quality of health-related websites based on a 2-tuple fuzzy linguistic approach. To identify the quality criteria set, a qualitative research has been carried out using the focus groups technique. The measurement method generates linguistic quality assessments considering the visitors’ judgements with respect to those quality criteria. The combination of the linguistic judgements is implemented without a loss of information by applying a 2-tuple linguistic weighted average operator. This methodology means an improvement on quality evaluation of health websites through the commitment to put users first.
---
paper_title: Quality of websites of obstetrics and gynecology departments: a cross-sectional study

paper_content:

\(\bf Background:\) The internet has become an easily accessible and widely used source of healthcare information. There are, however, no standardized or commonly accepted criteria for the quality of Obstetrics and Gynecology websites. In this study, we aimed to evaluate the quality of websites of Obstetrics and Gynecology departments in German-speaking countries and to compare websites nationally and internationally. ::: ::: \(\bf Methods:\) We scored 672 websites from Germany (n = 566), Austria (n = 57), and Switzerland (n = 49) using the objective criteria: Google search rank (2 items), technical aspects (11 items), navigation (8 items), and content (6 items) for a 26 point score. Scores were compared nationally and inter nationally. Multivariable regression models assessed good quality scores (\(\geq\)50% of maximum) as the dependent variables and country, academic affiliation, being member of a healthcare consortium, confessional affiliation, and content management system (CMS) use as independent variables. ::: ::: \(\bf Results:\) The mean score of websites was 13.8 \(\pm\) 3.3. 4.2% were rated as good (\(\geq\)75% of maximum), 61.8% as fair ((\(\geq\)50% of maximum). German (14.0 \(\pm\) 3.2) and Swiss (13.8 \(\pm\) 4.0) websites scored significantly higher compared to Austrian websites (11.6 \(\pm\) 2.5) (P < 0.001 and P = 0.005, respectively). Within Germany, academic had higher scores than non-academic departments (14.9 \(\pm\) 3.2 vs. 13.7 \(\pm\) 3.1, P < 0.001). Single institutions had higher scores compared to healthcare consortium institutions (14.1 \(\pm\) 3.2 vs. 13.2 \(\pm\) 2.6, P = 0.003). Departments in Northern and Southern states had higher scores compared to Eastern states (14.4 \(\pm\) 3.2 and 14.2 \(\pm\) 3.2 vs. 13.0 \(\pm\) 3.0, P < 0.001). In multivariate regression models, all subscores (all: P < 0.001) independently predicted a website’s reaching a good quality score, with navigation subscore as strongest predictor. Affiliations were predictors for some good individual subscores, but not for others. High content subscore was associated with good Google search rank, technical aspects, and navigation subscores. ::: ::: \(\bf Conclusions:\) The quality of websites of Obstetrics and Gynecology departments varies widely. We found marked differences depending on country, affiliation, and region.
---
paper_title: E-health and assurance: curing hospital websites

paper_content:

Hospital websites are becoming an industry standard as patients (consumers) and health professionals use web resources for information, research, and communication. Industry predictions focused on future e-hospitals that would integrate all stakeholders in a seamless network allowing data to be shared. This paper investigates web assurance strategies implemented by hospitals in the design of their websites. The protection of critical infrastructure and information is crucial to the success of the web assurance strategy. The study reviewed a sample of 100 premier hospital websites. Results show little progress in the goal of making the website a fully functional unit of the hospital. Current sites are limited in scope and have become more selective in their provision of information in light of new HIPAA regulations.
---
paper_title: Emergence of a new consumer health informatics framework: introducing the healthcare organization.

paper_content:

Healthcare consumers are increasingly seeking reliable forms of health information on the Internet that can be used to support health related decision-making. Frameworks that have been developed and tested in the field of health informatics have attempted to describe the effects of the Internet upon the health care consumer and physician relationship. More recently, health care organizations are responding by providing information such as hospital wait lists or strategies for self-managing disease, and this information is being provided on organizational web-sites. The authors of this paper propose that current conceptualizations of the relationship between the Internet, physicians and patients are limited from a consumer informatics perspective and may need to be extended to include healthcare organizations.
---
paper_title: A quality evaluation methodology for health-related websites based on a 2-tuple fuzzy linguistic approach

paper_content:

Nowadays, the patients and physicians use the health-related websites as an important information source and, therefore, it is critical the quality evaluation of health- related websites. The quality assessment of health-related websites becomes especially relevant because their use imply the existence of a wide range of threats which can affect people’s health. Additionally, website quality evaluation can also contribute to maximize the exploitation of invested resources by organizations in the development of user-perceived quality websites. But there is not yet a clear and unambiguous definition of the concept of website quality and the debate about quality evaluation on the Web remains open. In this paper, we present a qualitative and user-oriented methodology for assessing quality of health-related websites based on a 2-tuple fuzzy linguistic approach. To identify the quality criteria set, a qualitative research has been carried out using the focus groups technique. The measurement method generates linguistic quality assessments considering the visitors’ judgements with respect to those quality criteria. The combination of the linguistic judgements is implemented without a loss of information by applying a 2-tuple linguistic weighted average operator. This methodology means an improvement on quality evaluation of health websites through the commitment to put users first.
---
paper_title: A Comparison of Websites from Spanish, American and British Hospitals

paper_content:

Objective: To evaluate and compare the user-orientation of Spanish, American and British hospital websites. Methods: A descriptive study of 32 hospital portals (12 Spanish, 10 American and 10 British) was carried out in which the following were analyzed: website readability according to the Flesch Index, websites accessibility using the Web Accessibility Test, and the quality of information provided using the “e-Information Scale of Health Care Centers”. Results: Fifty percent of the user-oriented information quality attributes are met. Readability indices tend to be below 60 (standard readability), and only 10 of the 32 websites meet the accessibility criteria. Conclusions: Most portals exhibit accessibility problems that favor computer illiteracy. There is a wide variability in terms of website readability and in terms of useroriented content.
---
paper_title: Hospital Website Rankings in the United States: Expanding Benchmarks and Standards for Effective Consumer Engagement

paper_content:

Background: Passage of the Patient Protection and Affordable Care Act (ACA) increased the roles hospitals and health systems play in care delivery and led to a wave of consolidation of medical groups and hospitals. As such, the traditional patient interaction with an independent medical provider is becoming far less common, replaced by frequent interactions with integrated medical groups and health systems. It is thus increasingly important for these organizations to have an effective social media presence. Moreover, in the age of the informed consumer, patients desire a readily accessible, electronic interface to initiate contact, making a well-designed website and social media strategy critical features of the modern health care organization. Objective: The purpose of this study was to assess the Web presence of hospitals and their health systems on five dimensions: accessibility, content, marketing, technology, and usability. In addition, an overall ranking was calculated to identify the top 100 hospital and health system websites. Methods: A total of 2407 unique Web domains covering 2785 hospital facilities or their parent organizations were identified and matched against the 2009 American Hospital Association (AHA) Annual Survey. This is a four-fold improvement in prior research and represents what the authors believe to be a census assessment of the online presence of US hospitals and their health systems. Each of the five dimensions was investigated with an automated content analysis using a suite of tools. Scores on the dimensions are reported on a range from 0 to 10, with a higher score on any given dimension representing better comparative performance. Rankings on each dimension and an average ranking are provided for the top 100 hospitals. Results: The mean score on the usability dimension, meant to rate overall website quality, was 5.16 (SD 1.43), with the highest score of 8 shared by only 5 hospitals. Mean scores on other dimensions were between 4.43 (SD 2.19) and 6.49 (SD 0.96). Based on these scores, rank order calculations for the top 100 websites are presented. Additionally, a link to raw data, including AHA ID, is provided to enable researchers and practitioners the ability to further explore relationships to other dynamics in health care. Conclusions: This census assessment of US hospitals and their health systems provides a clear indication of the state of the sector. While stakeholder engagement is core to most discussions of the role that hospitals must play in relation to communities, management of an online presence has not been recognized as a core competency fundamental to care delivery. Yet, social media management and network engagement are skills that exist at the confluence of marketing and technical prowess. This paper presents performance guidelines evaluated against best-demonstrated practice or independent standards to facilitate improvement of the sector’s use of websites and social media.
---
paper_title: Quality of websites of obstetrics and gynecology departments: a cross-sectional study

paper_content:

\(\bf Background:\) The internet has become an easily accessible and widely used source of healthcare information. There are, however, no standardized or commonly accepted criteria for the quality of Obstetrics and Gynecology websites. In this study, we aimed to evaluate the quality of websites of Obstetrics and Gynecology departments in German-speaking countries and to compare websites nationally and internationally. ::: ::: \(\bf Methods:\) We scored 672 websites from Germany (n = 566), Austria (n = 57), and Switzerland (n = 49) using the objective criteria: Google search rank (2 items), technical aspects (11 items), navigation (8 items), and content (6 items) for a 26 point score. Scores were compared nationally and inter nationally. Multivariable regression models assessed good quality scores (\(\geq\)50% of maximum) as the dependent variables and country, academic affiliation, being member of a healthcare consortium, confessional affiliation, and content management system (CMS) use as independent variables. ::: ::: \(\bf Results:\) The mean score of websites was 13.8 \(\pm\) 3.3. 4.2% were rated as good (\(\geq\)75% of maximum), 61.8% as fair ((\(\geq\)50% of maximum). German (14.0 \(\pm\) 3.2) and Swiss (13.8 \(\pm\) 4.0) websites scored significantly higher compared to Austrian websites (11.6 \(\pm\) 2.5) (P < 0.001 and P = 0.005, respectively). Within Germany, academic had higher scores than non-academic departments (14.9 \(\pm\) 3.2 vs. 13.7 \(\pm\) 3.1, P < 0.001). Single institutions had higher scores compared to healthcare consortium institutions (14.1 \(\pm\) 3.2 vs. 13.2 \(\pm\) 2.6, P = 0.003). Departments in Northern and Southern states had higher scores compared to Eastern states (14.4 \(\pm\) 3.2 and 14.2 \(\pm\) 3.2 vs. 13.0 \(\pm\) 3.0, P < 0.001). In multivariate regression models, all subscores (all: P < 0.001) independently predicted a website’s reaching a good quality score, with navigation subscore as strongest predictor. Affiliations were predictors for some good individual subscores, but not for others. High content subscore was associated with good Google search rank, technical aspects, and navigation subscores. ::: ::: \(\bf Conclusions:\) The quality of websites of Obstetrics and Gynecology departments varies widely. We found marked differences depending on country, affiliation, and region.
---
paper_title: Developing and validating a nursing website evaluation questionnaire

paper_content:

Aim. The aim of this paper is to report on the development and validation of an evaluation questionnaire for nursing websites. ::: ::: ::: ::: Background. Increasing numbers of the general public and health care professionals are using the Internet to access health and health care-related information. The quality of such websites, therefore, needs to be evaluated. ::: ::: ::: ::: Methods. A total of 24 websites in the United States and Taiwan, including websites in 13 leading schools and 11 hospitals, were selected as test websites. A total of 120 participants with Master's degrees in either nursing or mechanical engineering were invited to examine the 24 websites using a nursing website evaluation questionnaire. A 32-item questionnaire was developed, covering overall impression, download and switch speed, accessibility and convenience, web page content, service function and compatibility with common browsers. Participants were requested to connect to the specific websites and browse the contents before filling in the questionnaire. The results were arranged into 12 different sequences and prepared on a CD using Macromedia Dreamweaver. Data were analysed using Cronbach's α, Guttman split-half reliability and factor analysis. ::: ::: ::: ::: Findings. Internal consistency was good, with a Cronbach's α of 0·93 in Part I and a KR-20 (Kuder Richardson) of 0·85 in Part II. Four factors given in Part I were identified as content truth, accessibility and convenience, speed and connection, and overall impression. ::: ::: ::: ::: Conclusion. The nursing website evaluation questionnaire had good construct validity and internal consistency.
---
paper_title: Emergence of a new consumer health informatics framework: introducing the healthcare organization.

paper_content:

Healthcare consumers are increasingly seeking reliable forms of health information on the Internet that can be used to support health related decision-making. Frameworks that have been developed and tested in the field of health informatics have attempted to describe the effects of the Internet upon the health care consumer and physician relationship. More recently, health care organizations are responding by providing information such as hospital wait lists or strategies for self-managing disease, and this information is being provided on organizational web-sites. The authors of this paper propose that current conceptualizations of the relationship between the Internet, physicians and patients are limited from a consumer informatics perspective and may need to be extended to include healthcare organizations.
---
paper_title: Evaluation of Norwegian cancer hospitals' Web sites and explorative survey among cancer patients on their use of the Internet

paper_content:

BACKGROUND ::: Hospital homepages should provide comprehensive information on the hospital's services, such as departments and treatments available, prices, waiting time, leisure facilities, and other information important for patients and their relatives. Norway, with its population of approximately 4.3 million, ranks among the top countries globally for its ability to absorb and use technology. It is unclear to what degree Norwegian hospitals and patients use the Internet for information about health services. ::: ::: ::: OBJECTIVES ::: This study was undertaken to evaluate the quality of the biggest Norwegian cancer hospitals Web sites and to gather some preliminary data on patients use of the Internet. ::: ::: ::: METHODS ::: In January 2001, we analyzed Web sites of 5 of the 7 biggest Norwegian hospitals treating cancer patients using a scoring system. The scoring instrument was based on recommendations developed by the Norwegian Central Information Service for Web sites and reflects the scope and depth of service information offered on hospital Web pages. In addition, 31 cancer patients visiting one hospital-based medical oncologist were surveyed about their use of the Internet. ::: ::: ::: RESULTS ::: Of the 7 hospitals, 5 had a Web site. The Web sites differed markedly in quality. Types of information included - and number of Web sites that included each type of information - were, for example: search option, 1; interpreter service, 2; date of last update, 2; postal address, phone number, and e-mail service, 3; information in English, 2. None of the Web sites included information on waiting time or prices. Of the 31 patients surveyed, 12 had personal experience using the Internet and 4 had searched for medical information. The Internet users were significantly younger (mean age 47.8 years, range 28.4-66.8 years) than the nonusers (mean age 61.8 years, range 33.1-90.0 years) (P = 0.007). ::: ::: ::: CONCLUSIONS ::: The hospitals Web sites offer cancer patients and relatives useful information, but the Web sites were not impressive.
---
paper_title: A quality evaluation methodology for health-related websites based on a 2-tuple fuzzy linguistic approach

paper_content:

Nowadays, the patients and physicians use the health-related websites as an important information source and, therefore, it is critical the quality evaluation of health- related websites. The quality assessment of health-related websites becomes especially relevant because their use imply the existence of a wide range of threats which can affect people’s health. Additionally, website quality evaluation can also contribute to maximize the exploitation of invested resources by organizations in the development of user-perceived quality websites. But there is not yet a clear and unambiguous definition of the concept of website quality and the debate about quality evaluation on the Web remains open. In this paper, we present a qualitative and user-oriented methodology for assessing quality of health-related websites based on a 2-tuple fuzzy linguistic approach. To identify the quality criteria set, a qualitative research has been carried out using the focus groups technique. The measurement method generates linguistic quality assessments considering the visitors’ judgements with respect to those quality criteria. The combination of the linguistic judgements is implemented without a loss of information by applying a 2-tuple linguistic weighted average operator. This methodology means an improvement on quality evaluation of health websites through the commitment to put users first.
---
paper_title: A Comparison of Websites from Spanish, American and British Hospitals

paper_content:

Objective: To evaluate and compare the user-orientation of Spanish, American and British hospital websites. Methods: A descriptive study of 32 hospital portals (12 Spanish, 10 American and 10 British) was carried out in which the following were analyzed: website readability according to the Flesch Index, websites accessibility using the Web Accessibility Test, and the quality of information provided using the “e-Information Scale of Health Care Centers”. Results: Fifty percent of the user-oriented information quality attributes are met. Readability indices tend to be below 60 (standard readability), and only 10 of the 32 websites meet the accessibility criteria. Conclusions: Most portals exhibit accessibility problems that favor computer illiteracy. There is a wide variability in terms of website readability and in terms of useroriented content.
---
paper_title: Hospital Website Rankings in the United States: Expanding Benchmarks and Standards for Effective Consumer Engagement

paper_content:

Background: Passage of the Patient Protection and Affordable Care Act (ACA) increased the roles hospitals and health systems play in care delivery and led to a wave of consolidation of medical groups and hospitals. As such, the traditional patient interaction with an independent medical provider is becoming far less common, replaced by frequent interactions with integrated medical groups and health systems. It is thus increasingly important for these organizations to have an effective social media presence. Moreover, in the age of the informed consumer, patients desire a readily accessible, electronic interface to initiate contact, making a well-designed website and social media strategy critical features of the modern health care organization. Objective: The purpose of this study was to assess the Web presence of hospitals and their health systems on five dimensions: accessibility, content, marketing, technology, and usability. In addition, an overall ranking was calculated to identify the top 100 hospital and health system websites. Methods: A total of 2407 unique Web domains covering 2785 hospital facilities or their parent organizations were identified and matched against the 2009 American Hospital Association (AHA) Annual Survey. This is a four-fold improvement in prior research and represents what the authors believe to be a census assessment of the online presence of US hospitals and their health systems. Each of the five dimensions was investigated with an automated content analysis using a suite of tools. Scores on the dimensions are reported on a range from 0 to 10, with a higher score on any given dimension representing better comparative performance. Rankings on each dimension and an average ranking are provided for the top 100 hospitals. Results: The mean score on the usability dimension, meant to rate overall website quality, was 5.16 (SD 1.43), with the highest score of 8 shared by only 5 hospitals. Mean scores on other dimensions were between 4.43 (SD 2.19) and 6.49 (SD 0.96). Based on these scores, rank order calculations for the top 100 websites are presented. Additionally, a link to raw data, including AHA ID, is provided to enable researchers and practitioners the ability to further explore relationships to other dynamics in health care. Conclusions: This census assessment of US hospitals and their health systems provides a clear indication of the state of the sector. While stakeholder engagement is core to most discussions of the role that hospitals must play in relation to communities, management of an online presence has not been recognized as a core competency fundamental to care delivery. Yet, social media management and network engagement are skills that exist at the confluence of marketing and technical prowess. This paper presents performance guidelines evaluated against best-demonstrated practice or independent standards to facilitate improvement of the sector’s use of websites and social media.
---
paper_title: A fuzzy preference-ranking model for a quality evaluation of hospital web sites

paper_content:

This article presents a quality evaluation model for measuring the performance of hospital Web sites. The model is developed on the basis of a conceptual framework, which consists of seven major e-service quality dimensions, including tangibles, reliability, responsiveness, confidence, empathy, quality of information, and integration of communication issues of Web sites. The dimensions and their associated attributes are first obtained from published articles in the health care and information technology literature and then adapted according to the suggestions of related domain experts. Two multicriteria decision-making methods are used in the evaluation procedure. Determined Web site evaluation dimensions and their relevant attributes are weighted using the Analytic Hierarchy Process (AHP) method. Vagueness in some stages of the evaluation required the incorporation of fuzzy numbers in the assessment process. Both fuzzy and crisp data are then synthesized using the fuzzy PROMETHEE (Preference Ranking Organization Method for Enrichment Evaluation) ranking method. The model is applied initially to measure the performance of the Web sites of Turkish hospitals. This study should be of interest to health care and technology practitioners and researchers, as the findings shed light on the further development of performance measurements for hospital Web sites. © 2006 Wiley Periodicals, Inc. Int J Int Syst 21: 1181–1197, 2006.
---
paper_title: Quality of websites of obstetrics and gynecology departments: a cross-sectional study

paper_content:

\(\bf Background:\) The internet has become an easily accessible and widely used source of healthcare information. There are, however, no standardized or commonly accepted criteria for the quality of Obstetrics and Gynecology websites. In this study, we aimed to evaluate the quality of websites of Obstetrics and Gynecology departments in German-speaking countries and to compare websites nationally and internationally. ::: ::: \(\bf Methods:\) We scored 672 websites from Germany (n = 566), Austria (n = 57), and Switzerland (n = 49) using the objective criteria: Google search rank (2 items), technical aspects (11 items), navigation (8 items), and content (6 items) for a 26 point score. Scores were compared nationally and inter nationally. Multivariable regression models assessed good quality scores (\(\geq\)50% of maximum) as the dependent variables and country, academic affiliation, being member of a healthcare consortium, confessional affiliation, and content management system (CMS) use as independent variables. ::: ::: \(\bf Results:\) The mean score of websites was 13.8 \(\pm\) 3.3. 4.2% were rated as good (\(\geq\)75% of maximum), 61.8% as fair ((\(\geq\)50% of maximum). German (14.0 \(\pm\) 3.2) and Swiss (13.8 \(\pm\) 4.0) websites scored significantly higher compared to Austrian websites (11.6 \(\pm\) 2.5) (P < 0.001 and P = 0.005, respectively). Within Germany, academic had higher scores than non-academic departments (14.9 \(\pm\) 3.2 vs. 13.7 \(\pm\) 3.1, P < 0.001). Single institutions had higher scores compared to healthcare consortium institutions (14.1 \(\pm\) 3.2 vs. 13.2 \(\pm\) 2.6, P = 0.003). Departments in Northern and Southern states had higher scores compared to Eastern states (14.4 \(\pm\) 3.2 and 14.2 \(\pm\) 3.2 vs. 13.0 \(\pm\) 3.0, P < 0.001). In multivariate regression models, all subscores (all: P < 0.001) independently predicted a website’s reaching a good quality score, with navigation subscore as strongest predictor. Affiliations were predictors for some good individual subscores, but not for others. High content subscore was associated with good Google search rank, technical aspects, and navigation subscores. ::: ::: \(\bf Conclusions:\) The quality of websites of Obstetrics and Gynecology departments varies widely. We found marked differences depending on country, affiliation, and region.
---
paper_title: E-health and assurance: curing hospital websites

paper_content:

Hospital websites are becoming an industry standard as patients (consumers) and health professionals use web resources for information, research, and communication. Industry predictions focused on future e-hospitals that would integrate all stakeholders in a seamless network allowing data to be shared. This paper investigates web assurance strategies implemented by hospitals in the design of their websites. The protection of critical infrastructure and information is crucial to the success of the web assurance strategy. The study reviewed a sample of 100 premier hospital websites. Results show little progress in the goal of making the website a fully functional unit of the hospital. Current sites are limited in scope and have become more selective in their provision of information in light of new HIPAA regulations.
---
paper_title: Emergence of a new consumer health informatics framework: introducing the healthcare organization.

paper_content:

Healthcare consumers are increasingly seeking reliable forms of health information on the Internet that can be used to support health related decision-making. Frameworks that have been developed and tested in the field of health informatics have attempted to describe the effects of the Internet upon the health care consumer and physician relationship. More recently, health care organizations are responding by providing information such as hospital wait lists or strategies for self-managing disease, and this information is being provided on organizational web-sites. The authors of this paper propose that current conceptualizations of the relationship between the Internet, physicians and patients are limited from a consumer informatics perspective and may need to be extended to include healthcare organizations.
---
paper_title: Quality assessment of the Website for Eating Disorders: a systematic review of a pending challenge

paper_content:

A Systematic review of articles from peer-reviewed journals was conducted, studying the complete texts in all cases. The key words selected were: "Eating Disorders" and "Internet." Descriptive analysis was performed on the variables selected, and Fisher's Exact test was used to analyze the presence of a linear relationship between qualitative variables. Of the 7 studies reviewed, 5 (71.42%) focused on content criteria and 2 (28.57%) examined both documentary and content criteria. Documentary quality was evaluated using two assessment instruments developed by two of the authors, comprising a set of 20 different variables, 5 of which were common to both studies (25% observed percentage agreement). Fisher's Exact test revealed significant differences between the two questionnaires (p = 0.049). Studies assessing Website content used 30 different topics to classify the subject matter, of which 6 were common to 2 studies. Although generic instruments for assessing the quality of Websites devoted to eating disorders were found, no validated questionnaire was found. This research did not locate any checklist or simple tool which could be used by consumers of health information available on the Web.
---
paper_title: A quality evaluation methodology for health-related websites based on a 2-tuple fuzzy linguistic approach

paper_content:

Nowadays, the patients and physicians use the health-related websites as an important information source and, therefore, it is critical the quality evaluation of health- related websites. The quality assessment of health-related websites becomes especially relevant because their use imply the existence of a wide range of threats which can affect people’s health. Additionally, website quality evaluation can also contribute to maximize the exploitation of invested resources by organizations in the development of user-perceived quality websites. But there is not yet a clear and unambiguous definition of the concept of website quality and the debate about quality evaluation on the Web remains open. In this paper, we present a qualitative and user-oriented methodology for assessing quality of health-related websites based on a 2-tuple fuzzy linguistic approach. To identify the quality criteria set, a qualitative research has been carried out using the focus groups technique. The measurement method generates linguistic quality assessments considering the visitors’ judgements with respect to those quality criteria. The combination of the linguistic judgements is implemented without a loss of information by applying a 2-tuple linguistic weighted average operator. This methodology means an improvement on quality evaluation of health websites through the commitment to put users first.
---
paper_title: A Comparison of Websites from Spanish, American and British Hospitals

paper_content:

Objective: To evaluate and compare the user-orientation of Spanish, American and British hospital websites. Methods: A descriptive study of 32 hospital portals (12 Spanish, 10 American and 10 British) was carried out in which the following were analyzed: website readability according to the Flesch Index, websites accessibility using the Web Accessibility Test, and the quality of information provided using the “e-Information Scale of Health Care Centers”. Results: Fifty percent of the user-oriented information quality attributes are met. Readability indices tend to be below 60 (standard readability), and only 10 of the 32 websites meet the accessibility criteria. Conclusions: Most portals exhibit accessibility problems that favor computer illiteracy. There is a wide variability in terms of website readability and in terms of useroriented content.
---
paper_title: An Evaluation and Ranking of Children’s Hospital Websites in the United States

paper_content:

Background: Children’s hospitals are faced with the rising need for technological innovation. Their prospective health care consumers, who increasingly depend on the Web and social media for communication and consumer engagement, drive this need. As patients and family members navigate the Web presence of hospitals, it is important for these specialized organizations to present themselves and their services efficiently. Objective: The purpose of this study was to evaluate the website content of children’s hospitals in order to identify opportunities to improve website design and create benchmarks to judge improvement. Methods: All websites associated with a children’s hospital were identified using a census list of all children’s hospitals in the United States. In March of 2014, each website and its social media were evaluated using a Web crawler that provided a 5-dimensional assessment that included website accessibility, marketing, content, technology, and usability. The 5-dimensional assessment was scored on a scale ranging from 0 to 10 with positive findings rated higher on the scale. Websites were ranked by individual dimensions as well as according to their average ranking across all dimensions. Results: Mean scores of 153 websites ranged from 5.05 to 8.23 across all 5 dimensions. Results revealed that no website scored a perfect 10 on any dimension and that room exists for meaningful improvement. Conclusions: Study findings allow for the establishment of baseline benchmarks for tracking future website and social media improvements and display the need for enhanced Web-based consumer engagement for children’s hospitals. [J Med Internet Res 2016;18(8):e228]
---
paper_title: Hospital Website Rankings in the United States: Expanding Benchmarks and Standards for Effective Consumer Engagement

paper_content:

Background: Passage of the Patient Protection and Affordable Care Act (ACA) increased the roles hospitals and health systems play in care delivery and led to a wave of consolidation of medical groups and hospitals. As such, the traditional patient interaction with an independent medical provider is becoming far less common, replaced by frequent interactions with integrated medical groups and health systems. It is thus increasingly important for these organizations to have an effective social media presence. Moreover, in the age of the informed consumer, patients desire a readily accessible, electronic interface to initiate contact, making a well-designed website and social media strategy critical features of the modern health care organization. Objective: The purpose of this study was to assess the Web presence of hospitals and their health systems on five dimensions: accessibility, content, marketing, technology, and usability. In addition, an overall ranking was calculated to identify the top 100 hospital and health system websites. Methods: A total of 2407 unique Web domains covering 2785 hospital facilities or their parent organizations were identified and matched against the 2009 American Hospital Association (AHA) Annual Survey. This is a four-fold improvement in prior research and represents what the authors believe to be a census assessment of the online presence of US hospitals and their health systems. Each of the five dimensions was investigated with an automated content analysis using a suite of tools. Scores on the dimensions are reported on a range from 0 to 10, with a higher score on any given dimension representing better comparative performance. Rankings on each dimension and an average ranking are provided for the top 100 hospitals. Results: The mean score on the usability dimension, meant to rate overall website quality, was 5.16 (SD 1.43), with the highest score of 8 shared by only 5 hospitals. Mean scores on other dimensions were between 4.43 (SD 2.19) and 6.49 (SD 0.96). Based on these scores, rank order calculations for the top 100 websites are presented. Additionally, a link to raw data, including AHA ID, is provided to enable researchers and practitioners the ability to further explore relationships to other dynamics in health care. Conclusions: This census assessment of US hospitals and their health systems provides a clear indication of the state of the sector. While stakeholder engagement is core to most discussions of the role that hospitals must play in relation to communities, management of an online presence has not been recognized as a core competency fundamental to care delivery. Yet, social media management and network engagement are skills that exist at the confluence of marketing and technical prowess. This paper presents performance guidelines evaluated against best-demonstrated practice or independent standards to facilitate improvement of the sector’s use of websites and social media.
---
paper_title: Italian hospitals on the web: a cross-sectional analysis of official websites

paper_content:

BackgroundAlthough the use of the Internet for health purposes has increased steadily in the last decade, only a few studies have explored the information provided by the websites of health institutions and no studies on the on-line activities of Italian hospitals have been performed to date. The aim of this study was to explore the characteristics of the contents and the user-orientation of Italian hospital websites.MethodsThe cross-sectional analysis considered all the Italian hospitals with a working website between December 2008 and February 2009. The websites were coded using an ad hoc Codebook, comprising eighty-nine items divided into five sections: technical characteristics, hospital information and facilities, medical services, interactive on-line services and external activities. We calculated a website evaluation score, on the basis of the items satisfied, to compare private (PrHs) and public hospitals, the latter divided into ones with their own website (PubHs-1) and ones with a section on the website of their Local Health Authority (PubHs-2). Lastly, a descriptive analysis of each item was carried out.ResultsOut of the 1265 hospitals in Italy, we found that 419 of the 652 public hospitals (64.3%) and 344 of the 613 PrHs (56.1%) had a working website (p = 0.01). The mean website evaluation score was 41.9 for PubHs-1, 21.2 for PubHs-2 and 30.8 for PrHs (p < 0.001).Only 5 hospitals out of 763 (< 1%) provided specific clinical performance indicators, such as the nosocomial infection rate or the surgical mortality rates. Regarding interactive on-line services, although nearly 80% of both public and private hospitals enabled users to communicate on-line, less than 18% allowed the reservation of medical services, and only 8 websites (1%) provided a health-care forum.ConclusionsA high percentage of hospitals did not provide an official website and the majority of the websites found had several limitations. Very few hospitals provided information to increase the credibility of the hospital and user confidence in the institution. This study suggests that Italian hospital websites are more a source of information on admissions and services than a means of communication between user and hospital.
---
paper_title: Emergence of a new consumer health informatics framework: introducing the healthcare organization.

paper_content:

Healthcare consumers are increasingly seeking reliable forms of health information on the Internet that can be used to support health related decision-making. Frameworks that have been developed and tested in the field of health informatics have attempted to describe the effects of the Internet upon the health care consumer and physician relationship. More recently, health care organizations are responding by providing information such as hospital wait lists or strategies for self-managing disease, and this information is being provided on organizational web-sites. The authors of this paper propose that current conceptualizations of the relationship between the Internet, physicians and patients are limited from a consumer informatics perspective and may need to be extended to include healthcare organizations.
---
paper_title: Quality assessment of the Website for Eating Disorders: a systematic review of a pending challenge

paper_content:

A Systematic review of articles from peer-reviewed journals was conducted, studying the complete texts in all cases. The key words selected were: "Eating Disorders" and "Internet." Descriptive analysis was performed on the variables selected, and Fisher's Exact test was used to analyze the presence of a linear relationship between qualitative variables. Of the 7 studies reviewed, 5 (71.42%) focused on content criteria and 2 (28.57%) examined both documentary and content criteria. Documentary quality was evaluated using two assessment instruments developed by two of the authors, comprising a set of 20 different variables, 5 of which were common to both studies (25% observed percentage agreement). Fisher's Exact test revealed significant differences between the two questionnaires (p = 0.049). Studies assessing Website content used 30 different topics to classify the subject matter, of which 6 were common to 2 studies. Although generic instruments for assessing the quality of Websites devoted to eating disorders were found, no validated questionnaire was found. This research did not locate any checklist or simple tool which could be used by consumers of health information available on the Web.
---
paper_title: A quality evaluation methodology for health-related websites based on a 2-tuple fuzzy linguistic approach

paper_content:

Nowadays, the patients and physicians use the health-related websites as an important information source and, therefore, it is critical the quality evaluation of health- related websites. The quality assessment of health-related websites becomes especially relevant because their use imply the existence of a wide range of threats which can affect people’s health. Additionally, website quality evaluation can also contribute to maximize the exploitation of invested resources by organizations in the development of user-perceived quality websites. But there is not yet a clear and unambiguous definition of the concept of website quality and the debate about quality evaluation on the Web remains open. In this paper, we present a qualitative and user-oriented methodology for assessing quality of health-related websites based on a 2-tuple fuzzy linguistic approach. To identify the quality criteria set, a qualitative research has been carried out using the focus groups technique. The measurement method generates linguistic quality assessments considering the visitors’ judgements with respect to those quality criteria. The combination of the linguistic judgements is implemented without a loss of information by applying a 2-tuple linguistic weighted average operator. This methodology means an improvement on quality evaluation of health websites through the commitment to put users first.
---
paper_title: Quality assessment of the Website for Eating Disorders: a systematic review of a pending challenge

paper_content:

A Systematic review of articles from peer-reviewed journals was conducted, studying the complete texts in all cases. The key words selected were: "Eating Disorders" and "Internet." Descriptive analysis was performed on the variables selected, and Fisher's Exact test was used to analyze the presence of a linear relationship between qualitative variables. Of the 7 studies reviewed, 5 (71.42%) focused on content criteria and 2 (28.57%) examined both documentary and content criteria. Documentary quality was evaluated using two assessment instruments developed by two of the authors, comprising a set of 20 different variables, 5 of which were common to both studies (25% observed percentage agreement). Fisher's Exact test revealed significant differences between the two questionnaires (p = 0.049). Studies assessing Website content used 30 different topics to classify the subject matter, of which 6 were common to 2 studies. Although generic instruments for assessing the quality of Websites devoted to eating disorders were found, no validated questionnaire was found. This research did not locate any checklist or simple tool which could be used by consumers of health information available on the Web.
---
paper_title: Evaluation of Greek public hospital websites

paper_content:

Hospital web sites need to operate as effective web resources of information and interactive communication mediums to address the multifaceted requirements of their main stakeholders, (i.e. patients, healthy citizens, healthcare professionals and local communities). In case of public hospitals, web sites should also be considered as a mean to provide governmental electronic services. The main objective of this study is to provide an evaluation framework for hospital web sites. The proposed framework focuses on three main criteria: information, communication and electronic services. A total of 53 Greek hospital web sites within the Public Sector were evaluated based on a 67-item scale. The main findings of the study were the following: (a) the majority of the web sites in the analysis failed to support necessary web-based transactions between the institutions and their stakeholders (b) web sites are lacking important features regarding provision of information and communication practices. Improvements on interaction and information quality are necessary in order for the institutions to provide a viable and useful online environment for patients and citizens.
---
paper_title: Evaluation of Norwegian cancer hospitals' Web sites and explorative survey among cancer patients on their use of the Internet

paper_content:

BACKGROUND ::: Hospital homepages should provide comprehensive information on the hospital's services, such as departments and treatments available, prices, waiting time, leisure facilities, and other information important for patients and their relatives. Norway, with its population of approximately 4.3 million, ranks among the top countries globally for its ability to absorb and use technology. It is unclear to what degree Norwegian hospitals and patients use the Internet for information about health services. ::: ::: ::: OBJECTIVES ::: This study was undertaken to evaluate the quality of the biggest Norwegian cancer hospitals Web sites and to gather some preliminary data on patients use of the Internet. ::: ::: ::: METHODS ::: In January 2001, we analyzed Web sites of 5 of the 7 biggest Norwegian hospitals treating cancer patients using a scoring system. The scoring instrument was based on recommendations developed by the Norwegian Central Information Service for Web sites and reflects the scope and depth of service information offered on hospital Web pages. In addition, 31 cancer patients visiting one hospital-based medical oncologist were surveyed about their use of the Internet. ::: ::: ::: RESULTS ::: Of the 7 hospitals, 5 had a Web site. The Web sites differed markedly in quality. Types of information included - and number of Web sites that included each type of information - were, for example: search option, 1; interpreter service, 2; date of last update, 2; postal address, phone number, and e-mail service, 3; information in English, 2. None of the Web sites included information on waiting time or prices. Of the 31 patients surveyed, 12 had personal experience using the Internet and 4 had searched for medical information. The Internet users were significantly younger (mean age 47.8 years, range 28.4-66.8 years) than the nonusers (mean age 61.8 years, range 33.1-90.0 years) (P = 0.007). ::: ::: ::: CONCLUSIONS ::: The hospitals Web sites offer cancer patients and relatives useful information, but the Web sites were not impressive.
---
paper_title: A quality evaluation methodology for health-related websites based on a 2-tuple fuzzy linguistic approach

paper_content:

Nowadays, the patients and physicians use the health-related websites as an important information source and, therefore, it is critical the quality evaluation of health- related websites. The quality assessment of health-related websites becomes especially relevant because their use imply the existence of a wide range of threats which can affect people’s health. Additionally, website quality evaluation can also contribute to maximize the exploitation of invested resources by organizations in the development of user-perceived quality websites. But there is not yet a clear and unambiguous definition of the concept of website quality and the debate about quality evaluation on the Web remains open. In this paper, we present a qualitative and user-oriented methodology for assessing quality of health-related websites based on a 2-tuple fuzzy linguistic approach. To identify the quality criteria set, a qualitative research has been carried out using the focus groups technique. The measurement method generates linguistic quality assessments considering the visitors’ judgements with respect to those quality criteria. The combination of the linguistic judgements is implemented without a loss of information by applying a 2-tuple linguistic weighted average operator. This methodology means an improvement on quality evaluation of health websites through the commitment to put users first.
---
paper_title: Italian hospitals on the web: a cross-sectional analysis of official websites

paper_content:

BackgroundAlthough the use of the Internet for health purposes has increased steadily in the last decade, only a few studies have explored the information provided by the websites of health institutions and no studies on the on-line activities of Italian hospitals have been performed to date. The aim of this study was to explore the characteristics of the contents and the user-orientation of Italian hospital websites.MethodsThe cross-sectional analysis considered all the Italian hospitals with a working website between December 2008 and February 2009. The websites were coded using an ad hoc Codebook, comprising eighty-nine items divided into five sections: technical characteristics, hospital information and facilities, medical services, interactive on-line services and external activities. We calculated a website evaluation score, on the basis of the items satisfied, to compare private (PrHs) and public hospitals, the latter divided into ones with their own website (PubHs-1) and ones with a section on the website of their Local Health Authority (PubHs-2). Lastly, a descriptive analysis of each item was carried out.ResultsOut of the 1265 hospitals in Italy, we found that 419 of the 652 public hospitals (64.3%) and 344 of the 613 PrHs (56.1%) had a working website (p = 0.01). The mean website evaluation score was 41.9 for PubHs-1, 21.2 for PubHs-2 and 30.8 for PrHs (p < 0.001).Only 5 hospitals out of 763 (< 1%) provided specific clinical performance indicators, such as the nosocomial infection rate or the surgical mortality rates. Regarding interactive on-line services, although nearly 80% of both public and private hospitals enabled users to communicate on-line, less than 18% allowed the reservation of medical services, and only 8 websites (1%) provided a health-care forum.ConclusionsA high percentage of hospitals did not provide an official website and the majority of the websites found had several limitations. Very few hospitals provided information to increase the credibility of the hospital and user confidence in the institution. This study suggests that Italian hospital websites are more a source of information on admissions and services than a means of communication between user and hospital.
---
paper_title: Emergence of a new consumer health informatics framework: introducing the healthcare organization.

paper_content:

Healthcare consumers are increasingly seeking reliable forms of health information on the Internet that can be used to support health related decision-making. Frameworks that have been developed and tested in the field of health informatics have attempted to describe the effects of the Internet upon the health care consumer and physician relationship. More recently, health care organizations are responding by providing information such as hospital wait lists or strategies for self-managing disease, and this information is being provided on organizational web-sites. The authors of this paper propose that current conceptualizations of the relationship between the Internet, physicians and patients are limited from a consumer informatics perspective and may need to be extended to include healthcare organizations.
---
paper_title: Quality of websites of obstetrics and gynecology departments: a cross-sectional study

paper_content:

\(\bf Background:\) The internet has become an easily accessible and widely used source of healthcare information. There are, however, no standardized or commonly accepted criteria for the quality of Obstetrics and Gynecology websites. In this study, we aimed to evaluate the quality of websites of Obstetrics and Gynecology departments in German-speaking countries and to compare websites nationally and internationally. ::: ::: \(\bf Methods:\) We scored 672 websites from Germany (n = 566), Austria (n = 57), and Switzerland (n = 49) using the objective criteria: Google search rank (2 items), technical aspects (11 items), navigation (8 items), and content (6 items) for a 26 point score. Scores were compared nationally and inter nationally. Multivariable regression models assessed good quality scores (\(\geq\)50% of maximum) as the dependent variables and country, academic affiliation, being member of a healthcare consortium, confessional affiliation, and content management system (CMS) use as independent variables. ::: ::: \(\bf Results:\) The mean score of websites was 13.8 \(\pm\) 3.3. 4.2% were rated as good (\(\geq\)75% of maximum), 61.8% as fair ((\(\geq\)50% of maximum). German (14.0 \(\pm\) 3.2) and Swiss (13.8 \(\pm\) 4.0) websites scored significantly higher compared to Austrian websites (11.6 \(\pm\) 2.5) (P < 0.001 and P = 0.005, respectively). Within Germany, academic had higher scores than non-academic departments (14.9 \(\pm\) 3.2 vs. 13.7 \(\pm\) 3.1, P < 0.001). Single institutions had higher scores compared to healthcare consortium institutions (14.1 \(\pm\) 3.2 vs. 13.2 \(\pm\) 2.6, P = 0.003). Departments in Northern and Southern states had higher scores compared to Eastern states (14.4 \(\pm\) 3.2 and 14.2 \(\pm\) 3.2 vs. 13.0 \(\pm\) 3.0, P < 0.001). In multivariate regression models, all subscores (all: P < 0.001) independently predicted a website’s reaching a good quality score, with navigation subscore as strongest predictor. Affiliations were predictors for some good individual subscores, but not for others. High content subscore was associated with good Google search rank, technical aspects, and navigation subscores. ::: ::: \(\bf Conclusions:\) The quality of websites of Obstetrics and Gynecology departments varies widely. We found marked differences depending on country, affiliation, and region.
---
paper_title: E-health and assurance: curing hospital websites

paper_content:

Hospital websites are becoming an industry standard as patients (consumers) and health professionals use web resources for information, research, and communication. Industry predictions focused on future e-hospitals that would integrate all stakeholders in a seamless network allowing data to be shared. This paper investigates web assurance strategies implemented by hospitals in the design of their websites. The protection of critical infrastructure and information is crucial to the success of the web assurance strategy. The study reviewed a sample of 100 premier hospital websites. Results show little progress in the goal of making the website a fully functional unit of the hospital. Current sites are limited in scope and have become more selective in their provision of information in light of new HIPAA regulations.
---
paper_title: Evaluation of Greek public hospital websites

paper_content:

Hospital web sites need to operate as effective web resources of information and interactive communication mediums to address the multifaceted requirements of their main stakeholders, (i.e. patients, healthy citizens, healthcare professionals and local communities). In case of public hospitals, web sites should also be considered as a mean to provide governmental electronic services. The main objective of this study is to provide an evaluation framework for hospital web sites. The proposed framework focuses on three main criteria: information, communication and electronic services. A total of 53 Greek hospital web sites within the Public Sector were evaluated based on a 67-item scale. The main findings of the study were the following: (a) the majority of the web sites in the analysis failed to support necessary web-based transactions between the institutions and their stakeholders (b) web sites are lacking important features regarding provision of information and communication practices. Improvements on interaction and information quality are necessary in order for the institutions to provide a viable and useful online environment for patients and citizens.
---
paper_title: A Comparison of Websites from Spanish, American and British Hospitals

paper_content:

Objective: To evaluate and compare the user-orientation of Spanish, American and British hospital websites. Methods: A descriptive study of 32 hospital portals (12 Spanish, 10 American and 10 British) was carried out in which the following were analyzed: website readability according to the Flesch Index, websites accessibility using the Web Accessibility Test, and the quality of information provided using the “e-Information Scale of Health Care Centers”. Results: Fifty percent of the user-oriented information quality attributes are met. Readability indices tend to be below 60 (standard readability), and only 10 of the 32 websites meet the accessibility criteria. Conclusions: Most portals exhibit accessibility problems that favor computer illiteracy. There is a wide variability in terms of website readability and in terms of useroriented content.
---
paper_title: Quality assessment of the Website for Eating Disorders: a systematic review of a pending challenge

paper_content:

A Systematic review of articles from peer-reviewed journals was conducted, studying the complete texts in all cases. The key words selected were: "Eating Disorders" and "Internet." Descriptive analysis was performed on the variables selected, and Fisher's Exact test was used to analyze the presence of a linear relationship between qualitative variables. Of the 7 studies reviewed, 5 (71.42%) focused on content criteria and 2 (28.57%) examined both documentary and content criteria. Documentary quality was evaluated using two assessment instruments developed by two of the authors, comprising a set of 20 different variables, 5 of which were common to both studies (25% observed percentage agreement). Fisher's Exact test revealed significant differences between the two questionnaires (p = 0.049). Studies assessing Website content used 30 different topics to classify the subject matter, of which 6 were common to 2 studies. Although generic instruments for assessing the quality of Websites devoted to eating disorders were found, no validated questionnaire was found. This research did not locate any checklist or simple tool which could be used by consumers of health information available on the Web.
---
paper_title: Evaluation of Greek public hospital websites

paper_content:

Hospital web sites need to operate as effective web resources of information and interactive communication mediums to address the multifaceted requirements of their main stakeholders, (i.e. patients, healthy citizens, healthcare professionals and local communities). In case of public hospitals, web sites should also be considered as a mean to provide governmental electronic services. The main objective of this study is to provide an evaluation framework for hospital web sites. The proposed framework focuses on three main criteria: information, communication and electronic services. A total of 53 Greek hospital web sites within the Public Sector were evaluated based on a 67-item scale. The main findings of the study were the following: (a) the majority of the web sites in the analysis failed to support necessary web-based transactions between the institutions and their stakeholders (b) web sites are lacking important features regarding provision of information and communication practices. Improvements on interaction and information quality are necessary in order for the institutions to provide a viable and useful online environment for patients and citizens.
---
paper_title: Hospital web sites: Promise and progress

paper_content:

Abstract The Internet provides a wide range of technologies that enable hospitals to communicate with their patients, physicians and other important groups. We discuss the promise of many widely used web site features for hospitals. Using a structured audit of 111 hospital web sites, we evaluate the progress being made. We find that most hospitals have mastered the basic “electronic brochure” capabilities. However, less than half of the sites enable visitors to easily search for pertinent information. The progress towards using web sites for appointment scheduling or providing discussion forums about health care is likewise confined to a small group of hospitals.
---
paper_title: Quality of websites in Spanish public hospitals.

paper_content:

The objectives were to assess the quality of websites in Spanish public hospitals by means of a validated system, also including measures of readability and accessibility. A scale was designed and validated to assess the quality (citizen-orientated) of the websites of hospitals. The quality of the of public hospital websites was evaluated by means of the results of the above evaluation scale, analysis of the readability of their contents, and the results of the accessibility test. The validated scale contains 73 elements or attributes. Analysis of the concordance of website evaluations shows average assessment values of between 0.80 and 0.81, which confirms a high degree of agreement among jurors. Twenty per cent of the attributes do not appear on any websites, and 14% are present on all of them. The average mark of the hospitals is 43%. The marks given for readability of tests show that it is satisfactory for 64% hospitals. None of the websites visited fulfilled the requirements necessary to be considered as accessible. The quality of the websites analysed by means of this scale varies from 23% to 62%. Differences in the size or location of the hospitals do not explain this high level of variability. The results suggest that the readability of websites should be improved and that such sites should be accessible to people with disabilities.
---
paper_title: A quality evaluation methodology for health-related websites based on a 2-tuple fuzzy linguistic approach

paper_content:

Nowadays, the patients and physicians use the health-related websites as an important information source and, therefore, it is critical the quality evaluation of health- related websites. The quality assessment of health-related websites becomes especially relevant because their use imply the existence of a wide range of threats which can affect people’s health. Additionally, website quality evaluation can also contribute to maximize the exploitation of invested resources by organizations in the development of user-perceived quality websites. But there is not yet a clear and unambiguous definition of the concept of website quality and the debate about quality evaluation on the Web remains open. In this paper, we present a qualitative and user-oriented methodology for assessing quality of health-related websites based on a 2-tuple fuzzy linguistic approach. To identify the quality criteria set, a qualitative research has been carried out using the focus groups technique. The measurement method generates linguistic quality assessments considering the visitors’ judgements with respect to those quality criteria. The combination of the linguistic judgements is implemented without a loss of information by applying a 2-tuple linguistic weighted average operator. This methodology means an improvement on quality evaluation of health websites through the commitment to put users first.
---
paper_title: Italian hospitals on the web: a cross-sectional analysis of official websites

paper_content:

BackgroundAlthough the use of the Internet for health purposes has increased steadily in the last decade, only a few studies have explored the information provided by the websites of health institutions and no studies on the on-line activities of Italian hospitals have been performed to date. The aim of this study was to explore the characteristics of the contents and the user-orientation of Italian hospital websites.MethodsThe cross-sectional analysis considered all the Italian hospitals with a working website between December 2008 and February 2009. The websites were coded using an ad hoc Codebook, comprising eighty-nine items divided into five sections: technical characteristics, hospital information and facilities, medical services, interactive on-line services and external activities. We calculated a website evaluation score, on the basis of the items satisfied, to compare private (PrHs) and public hospitals, the latter divided into ones with their own website (PubHs-1) and ones with a section on the website of their Local Health Authority (PubHs-2). Lastly, a descriptive analysis of each item was carried out.ResultsOut of the 1265 hospitals in Italy, we found that 419 of the 652 public hospitals (64.3%) and 344 of the 613 PrHs (56.1%) had a working website (p = 0.01). The mean website evaluation score was 41.9 for PubHs-1, 21.2 for PubHs-2 and 30.8 for PrHs (p < 0.001).Only 5 hospitals out of 763 (< 1%) provided specific clinical performance indicators, such as the nosocomial infection rate or the surgical mortality rates. Regarding interactive on-line services, although nearly 80% of both public and private hospitals enabled users to communicate on-line, less than 18% allowed the reservation of medical services, and only 8 websites (1%) provided a health-care forum.ConclusionsA high percentage of hospitals did not provide an official website and the majority of the websites found had several limitations. Very few hospitals provided information to increase the credibility of the hospital and user confidence in the institution. This study suggests that Italian hospital websites are more a source of information on admissions and services than a means of communication between user and hospital.
---
paper_title: Evaluation of Norwegian cancer hospitals' Web sites and explorative survey among cancer patients on their use of the Internet

paper_content:

BACKGROUND ::: Hospital homepages should provide comprehensive information on the hospital's services, such as departments and treatments available, prices, waiting time, leisure facilities, and other information important for patients and their relatives. Norway, with its population of approximately 4.3 million, ranks among the top countries globally for its ability to absorb and use technology. It is unclear to what degree Norwegian hospitals and patients use the Internet for information about health services. ::: ::: ::: OBJECTIVES ::: This study was undertaken to evaluate the quality of the biggest Norwegian cancer hospitals Web sites and to gather some preliminary data on patients use of the Internet. ::: ::: ::: METHODS ::: In January 2001, we analyzed Web sites of 5 of the 7 biggest Norwegian hospitals treating cancer patients using a scoring system. The scoring instrument was based on recommendations developed by the Norwegian Central Information Service for Web sites and reflects the scope and depth of service information offered on hospital Web pages. In addition, 31 cancer patients visiting one hospital-based medical oncologist were surveyed about their use of the Internet. ::: ::: ::: RESULTS ::: Of the 7 hospitals, 5 had a Web site. The Web sites differed markedly in quality. Types of information included - and number of Web sites that included each type of information - were, for example: search option, 1; interpreter service, 2; date of last update, 2; postal address, phone number, and e-mail service, 3; information in English, 2. None of the Web sites included information on waiting time or prices. Of the 31 patients surveyed, 12 had personal experience using the Internet and 4 had searched for medical information. The Internet users were significantly younger (mean age 47.8 years, range 28.4-66.8 years) than the nonusers (mean age 61.8 years, range 33.1-90.0 years) (P = 0.007). ::: ::: ::: CONCLUSIONS ::: The hospitals Web sites offer cancer patients and relatives useful information, but the Web sites were not impressive.
---
paper_title: A quality evaluation methodology for health-related websites based on a 2-tuple fuzzy linguistic approach

paper_content:

Nowadays, the patients and physicians use the health-related websites as an important information source and, therefore, it is critical the quality evaluation of health- related websites. The quality assessment of health-related websites becomes especially relevant because their use imply the existence of a wide range of threats which can affect people’s health. Additionally, website quality evaluation can also contribute to maximize the exploitation of invested resources by organizations in the development of user-perceived quality websites. But there is not yet a clear and unambiguous definition of the concept of website quality and the debate about quality evaluation on the Web remains open. In this paper, we present a qualitative and user-oriented methodology for assessing quality of health-related websites based on a 2-tuple fuzzy linguistic approach. To identify the quality criteria set, a qualitative research has been carried out using the focus groups technique. The measurement method generates linguistic quality assessments considering the visitors’ judgements with respect to those quality criteria. The combination of the linguistic judgements is implemented without a loss of information by applying a 2-tuple linguistic weighted average operator. This methodology means an improvement on quality evaluation of health websites through the commitment to put users first.
---
paper_title: A Comparison of Websites from Spanish, American and British Hospitals

paper_content:

Objective: To evaluate and compare the user-orientation of Spanish, American and British hospital websites. Methods: A descriptive study of 32 hospital portals (12 Spanish, 10 American and 10 British) was carried out in which the following were analyzed: website readability according to the Flesch Index, websites accessibility using the Web Accessibility Test, and the quality of information provided using the “e-Information Scale of Health Care Centers”. Results: Fifty percent of the user-oriented information quality attributes are met. Readability indices tend to be below 60 (standard readability), and only 10 of the 32 websites meet the accessibility criteria. Conclusions: Most portals exhibit accessibility problems that favor computer illiteracy. There is a wide variability in terms of website readability and in terms of useroriented content.
---
paper_title: Quality of websites of obstetrics and gynecology departments: a cross-sectional study

paper_content:

\(\bf Background:\) The internet has become an easily accessible and widely used source of healthcare information. There are, however, no standardized or commonly accepted criteria for the quality of Obstetrics and Gynecology websites. In this study, we aimed to evaluate the quality of websites of Obstetrics and Gynecology departments in German-speaking countries and to compare websites nationally and internationally. ::: ::: \(\bf Methods:\) We scored 672 websites from Germany (n = 566), Austria (n = 57), and Switzerland (n = 49) using the objective criteria: Google search rank (2 items), technical aspects (11 items), navigation (8 items), and content (6 items) for a 26 point score. Scores were compared nationally and inter nationally. Multivariable regression models assessed good quality scores (\(\geq\)50% of maximum) as the dependent variables and country, academic affiliation, being member of a healthcare consortium, confessional affiliation, and content management system (CMS) use as independent variables. ::: ::: \(\bf Results:\) The mean score of websites was 13.8 \(\pm\) 3.3. 4.2% were rated as good (\(\geq\)75% of maximum), 61.8% as fair ((\(\geq\)50% of maximum). German (14.0 \(\pm\) 3.2) and Swiss (13.8 \(\pm\) 4.0) websites scored significantly higher compared to Austrian websites (11.6 \(\pm\) 2.5) (P < 0.001 and P = 0.005, respectively). Within Germany, academic had higher scores than non-academic departments (14.9 \(\pm\) 3.2 vs. 13.7 \(\pm\) 3.1, P < 0.001). Single institutions had higher scores compared to healthcare consortium institutions (14.1 \(\pm\) 3.2 vs. 13.2 \(\pm\) 2.6, P = 0.003). Departments in Northern and Southern states had higher scores compared to Eastern states (14.4 \(\pm\) 3.2 and 14.2 \(\pm\) 3.2 vs. 13.0 \(\pm\) 3.0, P < 0.001). In multivariate regression models, all subscores (all: P < 0.001) independently predicted a website’s reaching a good quality score, with navigation subscore as strongest predictor. Affiliations were predictors for some good individual subscores, but not for others. High content subscore was associated with good Google search rank, technical aspects, and navigation subscores. ::: ::: \(\bf Conclusions:\) The quality of websites of Obstetrics and Gynecology departments varies widely. We found marked differences depending on country, affiliation, and region.
---
paper_title: E-health and assurance: curing hospital websites

paper_content:

Hospital websites are becoming an industry standard as patients (consumers) and health professionals use web resources for information, research, and communication. Industry predictions focused on future e-hospitals that would integrate all stakeholders in a seamless network allowing data to be shared. This paper investigates web assurance strategies implemented by hospitals in the design of their websites. The protection of critical infrastructure and information is crucial to the success of the web assurance strategy. The study reviewed a sample of 100 premier hospital websites. Results show little progress in the goal of making the website a fully functional unit of the hospital. Current sites are limited in scope and have become more selective in their provision of information in light of new HIPAA regulations.
---
paper_title: Quality assessment of the Website for Eating Disorders: a systematic review of a pending challenge

paper_content:

A Systematic review of articles from peer-reviewed journals was conducted, studying the complete texts in all cases. The key words selected were: "Eating Disorders" and "Internet." Descriptive analysis was performed on the variables selected, and Fisher's Exact test was used to analyze the presence of a linear relationship between qualitative variables. Of the 7 studies reviewed, 5 (71.42%) focused on content criteria and 2 (28.57%) examined both documentary and content criteria. Documentary quality was evaluated using two assessment instruments developed by two of the authors, comprising a set of 20 different variables, 5 of which were common to both studies (25% observed percentage agreement). Fisher's Exact test revealed significant differences between the two questionnaires (p = 0.049). Studies assessing Website content used 30 different topics to classify the subject matter, of which 6 were common to 2 studies. Although generic instruments for assessing the quality of Websites devoted to eating disorders were found, no validated questionnaire was found. This research did not locate any checklist or simple tool which could be used by consumers of health information available on the Web.
---
paper_title: Evaluation of Greek public hospital websites

paper_content:

Hospital web sites need to operate as effective web resources of information and interactive communication mediums to address the multifaceted requirements of their main stakeholders, (i.e. patients, healthy citizens, healthcare professionals and local communities). In case of public hospitals, web sites should also be considered as a mean to provide governmental electronic services. The main objective of this study is to provide an evaluation framework for hospital web sites. The proposed framework focuses on three main criteria: information, communication and electronic services. A total of 53 Greek hospital web sites within the Public Sector were evaluated based on a 67-item scale. The main findings of the study were the following: (a) the majority of the web sites in the analysis failed to support necessary web-based transactions between the institutions and their stakeholders (b) web sites are lacking important features regarding provision of information and communication practices. Improvements on interaction and information quality are necessary in order for the institutions to provide a viable and useful online environment for patients and citizens.
---
paper_title: Quality of websites of obstetrics and gynecology departments: a cross-sectional study

paper_content:

\(\bf Background:\) The internet has become an easily accessible and widely used source of healthcare information. There are, however, no standardized or commonly accepted criteria for the quality of Obstetrics and Gynecology websites. In this study, we aimed to evaluate the quality of websites of Obstetrics and Gynecology departments in German-speaking countries and to compare websites nationally and internationally. ::: ::: \(\bf Methods:\) We scored 672 websites from Germany (n = 566), Austria (n = 57), and Switzerland (n = 49) using the objective criteria: Google search rank (2 items), technical aspects (11 items), navigation (8 items), and content (6 items) for a 26 point score. Scores were compared nationally and inter nationally. Multivariable regression models assessed good quality scores (\(\geq\)50% of maximum) as the dependent variables and country, academic affiliation, being member of a healthcare consortium, confessional affiliation, and content management system (CMS) use as independent variables. ::: ::: \(\bf Results:\) The mean score of websites was 13.8 \(\pm\) 3.3. 4.2% were rated as good (\(\geq\)75% of maximum), 61.8% as fair ((\(\geq\)50% of maximum). German (14.0 \(\pm\) 3.2) and Swiss (13.8 \(\pm\) 4.0) websites scored significantly higher compared to Austrian websites (11.6 \(\pm\) 2.5) (P < 0.001 and P = 0.005, respectively). Within Germany, academic had higher scores than non-academic departments (14.9 \(\pm\) 3.2 vs. 13.7 \(\pm\) 3.1, P < 0.001). Single institutions had higher scores compared to healthcare consortium institutions (14.1 \(\pm\) 3.2 vs. 13.2 \(\pm\) 2.6, P = 0.003). Departments in Northern and Southern states had higher scores compared to Eastern states (14.4 \(\pm\) 3.2 and 14.2 \(\pm\) 3.2 vs. 13.0 \(\pm\) 3.0, P < 0.001). In multivariate regression models, all subscores (all: P < 0.001) independently predicted a website’s reaching a good quality score, with navigation subscore as strongest predictor. Affiliations were predictors for some good individual subscores, but not for others. High content subscore was associated with good Google search rank, technical aspects, and navigation subscores. ::: ::: \(\bf Conclusions:\) The quality of websites of Obstetrics and Gynecology departments varies widely. We found marked differences depending on country, affiliation, and region.
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paper_title: Emergence of a new consumer health informatics framework: introducing the healthcare organization.

paper_content:

Healthcare consumers are increasingly seeking reliable forms of health information on the Internet that can be used to support health related decision-making. Frameworks that have been developed and tested in the field of health informatics have attempted to describe the effects of the Internet upon the health care consumer and physician relationship. More recently, health care organizations are responding by providing information such as hospital wait lists or strategies for self-managing disease, and this information is being provided on organizational web-sites. The authors of this paper propose that current conceptualizations of the relationship between the Internet, physicians and patients are limited from a consumer informatics perspective and may need to be extended to include healthcare organizations.
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paper_title: Evaluation of Norwegian cancer hospitals' Web sites and explorative survey among cancer patients on their use of the Internet

paper_content:

BACKGROUND ::: Hospital homepages should provide comprehensive information on the hospital's services, such as departments and treatments available, prices, waiting time, leisure facilities, and other information important for patients and their relatives. Norway, with its population of approximately 4.3 million, ranks among the top countries globally for its ability to absorb and use technology. It is unclear to what degree Norwegian hospitals and patients use the Internet for information about health services. ::: ::: ::: OBJECTIVES ::: This study was undertaken to evaluate the quality of the biggest Norwegian cancer hospitals Web sites and to gather some preliminary data on patients use of the Internet. ::: ::: ::: METHODS ::: In January 2001, we analyzed Web sites of 5 of the 7 biggest Norwegian hospitals treating cancer patients using a scoring system. The scoring instrument was based on recommendations developed by the Norwegian Central Information Service for Web sites and reflects the scope and depth of service information offered on hospital Web pages. In addition, 31 cancer patients visiting one hospital-based medical oncologist were surveyed about their use of the Internet. ::: ::: ::: RESULTS ::: Of the 7 hospitals, 5 had a Web site. The Web sites differed markedly in quality. Types of information included - and number of Web sites that included each type of information - were, for example: search option, 1; interpreter service, 2; date of last update, 2; postal address, phone number, and e-mail service, 3; information in English, 2. None of the Web sites included information on waiting time or prices. Of the 31 patients surveyed, 12 had personal experience using the Internet and 4 had searched for medical information. The Internet users were significantly younger (mean age 47.8 years, range 28.4-66.8 years) than the nonusers (mean age 61.8 years, range 33.1-90.0 years) (P = 0.007). ::: ::: ::: CONCLUSIONS ::: The hospitals Web sites offer cancer patients and relatives useful information, but the Web sites were not impressive.
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paper_title: An Evaluation and Ranking of Children’s Hospital Websites in the United States

paper_content:

Background: Children’s hospitals are faced with the rising need for technological innovation. Their prospective health care consumers, who increasingly depend on the Web and social media for communication and consumer engagement, drive this need. As patients and family members navigate the Web presence of hospitals, it is important for these specialized organizations to present themselves and their services efficiently. Objective: The purpose of this study was to evaluate the website content of children’s hospitals in order to identify opportunities to improve website design and create benchmarks to judge improvement. Methods: All websites associated with a children’s hospital were identified using a census list of all children’s hospitals in the United States. In March of 2014, each website and its social media were evaluated using a Web crawler that provided a 5-dimensional assessment that included website accessibility, marketing, content, technology, and usability. The 5-dimensional assessment was scored on a scale ranging from 0 to 10 with positive findings rated higher on the scale. Websites were ranked by individual dimensions as well as according to their average ranking across all dimensions. Results: Mean scores of 153 websites ranged from 5.05 to 8.23 across all 5 dimensions. Results revealed that no website scored a perfect 10 on any dimension and that room exists for meaningful improvement. Conclusions: Study findings allow for the establishment of baseline benchmarks for tracking future website and social media improvements and display the need for enhanced Web-based consumer engagement for children’s hospitals. [J Med Internet Res 2016;18(8):e228]
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paper_title: Hospital Website Rankings in the United States: Expanding Benchmarks and Standards for Effective Consumer Engagement

paper_content:

Background: Passage of the Patient Protection and Affordable Care Act (ACA) increased the roles hospitals and health systems play in care delivery and led to a wave of consolidation of medical groups and hospitals. As such, the traditional patient interaction with an independent medical provider is becoming far less common, replaced by frequent interactions with integrated medical groups and health systems. It is thus increasingly important for these organizations to have an effective social media presence. Moreover, in the age of the informed consumer, patients desire a readily accessible, electronic interface to initiate contact, making a well-designed website and social media strategy critical features of the modern health care organization. Objective: The purpose of this study was to assess the Web presence of hospitals and their health systems on five dimensions: accessibility, content, marketing, technology, and usability. In addition, an overall ranking was calculated to identify the top 100 hospital and health system websites. Methods: A total of 2407 unique Web domains covering 2785 hospital facilities or their parent organizations were identified and matched against the 2009 American Hospital Association (AHA) Annual Survey. This is a four-fold improvement in prior research and represents what the authors believe to be a census assessment of the online presence of US hospitals and their health systems. Each of the five dimensions was investigated with an automated content analysis using a suite of tools. Scores on the dimensions are reported on a range from 0 to 10, with a higher score on any given dimension representing better comparative performance. Rankings on each dimension and an average ranking are provided for the top 100 hospitals. Results: The mean score on the usability dimension, meant to rate overall website quality, was 5.16 (SD 1.43), with the highest score of 8 shared by only 5 hospitals. Mean scores on other dimensions were between 4.43 (SD 2.19) and 6.49 (SD 0.96). Based on these scores, rank order calculations for the top 100 websites are presented. Additionally, a link to raw data, including AHA ID, is provided to enable researchers and practitioners the ability to further explore relationships to other dynamics in health care. Conclusions: This census assessment of US hospitals and their health systems provides a clear indication of the state of the sector. While stakeholder engagement is core to most discussions of the role that hospitals must play in relation to communities, management of an online presence has not been recognized as a core competency fundamental to care delivery. Yet, social media management and network engagement are skills that exist at the confluence of marketing and technical prowess. This paper presents performance guidelines evaluated against best-demonstrated practice or independent standards to facilitate improvement of the sector’s use of websites and social media.
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paper_title: Quality of websites of obstetrics and gynecology departments: a cross-sectional study

paper_content:

\(\bf Background:\) The internet has become an easily accessible and widely used source of healthcare information. There are, however, no standardized or commonly accepted criteria for the quality of Obstetrics and Gynecology websites. In this study, we aimed to evaluate the quality of websites of Obstetrics and Gynecology departments in German-speaking countries and to compare websites nationally and internationally. ::: ::: \(\bf Methods:\) We scored 672 websites from Germany (n = 566), Austria (n = 57), and Switzerland (n = 49) using the objective criteria: Google search rank (2 items), technical aspects (11 items), navigation (8 items), and content (6 items) for a 26 point score. Scores were compared nationally and inter nationally. Multivariable regression models assessed good quality scores (\(\geq\)50% of maximum) as the dependent variables and country, academic affiliation, being member of a healthcare consortium, confessional affiliation, and content management system (CMS) use as independent variables. ::: ::: \(\bf Results:\) The mean score of websites was 13.8 \(\pm\) 3.3. 4.2% were rated as good (\(\geq\)75% of maximum), 61.8% as fair ((\(\geq\)50% of maximum). German (14.0 \(\pm\) 3.2) and Swiss (13.8 \(\pm\) 4.0) websites scored significantly higher compared to Austrian websites (11.6 \(\pm\) 2.5) (P < 0.001 and P = 0.005, respectively). Within Germany, academic had higher scores than non-academic departments (14.9 \(\pm\) 3.2 vs. 13.7 \(\pm\) 3.1, P < 0.001). Single institutions had higher scores compared to healthcare consortium institutions (14.1 \(\pm\) 3.2 vs. 13.2 \(\pm\) 2.6, P = 0.003). Departments in Northern and Southern states had higher scores compared to Eastern states (14.4 \(\pm\) 3.2 and 14.2 \(\pm\) 3.2 vs. 13.0 \(\pm\) 3.0, P < 0.001). In multivariate regression models, all subscores (all: P < 0.001) independently predicted a website’s reaching a good quality score, with navigation subscore as strongest predictor. Affiliations were predictors for some good individual subscores, but not for others. High content subscore was associated with good Google search rank, technical aspects, and navigation subscores. ::: ::: \(\bf Conclusions:\) The quality of websites of Obstetrics and Gynecology departments varies widely. We found marked differences depending on country, affiliation, and region.
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paper_title: Developing and validating a nursing website evaluation questionnaire

paper_content:

Aim. The aim of this paper is to report on the development and validation of an evaluation questionnaire for nursing websites. ::: ::: ::: ::: Background. Increasing numbers of the general public and health care professionals are using the Internet to access health and health care-related information. The quality of such websites, therefore, needs to be evaluated. ::: ::: ::: ::: Methods. A total of 24 websites in the United States and Taiwan, including websites in 13 leading schools and 11 hospitals, were selected as test websites. A total of 120 participants with Master's degrees in either nursing or mechanical engineering were invited to examine the 24 websites using a nursing website evaluation questionnaire. A 32-item questionnaire was developed, covering overall impression, download and switch speed, accessibility and convenience, web page content, service function and compatibility with common browsers. Participants were requested to connect to the specific websites and browse the contents before filling in the questionnaire. The results were arranged into 12 different sequences and prepared on a CD using Macromedia Dreamweaver. Data were analysed using Cronbach's α, Guttman split-half reliability and factor analysis. ::: ::: ::: ::: Findings. Internal consistency was good, with a Cronbach's α of 0·93 in Part I and a KR-20 (Kuder Richardson) of 0·85 in Part II. Four factors given in Part I were identified as content truth, accessibility and convenience, speed and connection, and overall impression. ::: ::: ::: ::: Conclusion. The nursing website evaluation questionnaire had good construct validity and internal consistency.
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paper_title: Health information in Italian public health websites: moving from inaccessibility to accessibility

paper_content:

Aims: In January 2004, the Italian government passed new legislation designed to give people with disabilities access to online services. Starting from the new legislation requirements, the purpose of this study is to investigate whether Italian Local Health Authorities websites are accessible to users with different abilities. ::: ::: ::: ::: Methods: One hundred and seventy websites were analysed evaluating their compliance to the World Wide Web Consortium (W3C) Priority 1 guidelines via a combination of appropriate accessibility testing methods. This review was carried out twice: the first time it took place between the end of 2003 and May–June 2004. The same survey was repeated again in December 2004, after the issuing of the draft of the Implementation Regulations for The Stanca Law in July 2004. In this second survey, all the websites analysed before were checked again to establish if some measures to make those sites accessible were taken. ::: ::: ::: ::: Results: Seventy-six per cent of the analysed websites fail to satisfy the most basic W3C requirements, but Italian Local Health Authorities websites are likely to present significant improvements to access for some disabled user groups: the number of accessible websites increased consistently between the first and the second review. ::: ::: ::: ::: Conclusions: It seems that awareness of web accessibility issues is increasing among developers of health information websites because of law enforcement. Recommendations for future research and development are offered.
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Title: From a Literature Review to a Conceptual Framework for Health Sector Websites’ Assessment

Section 1: Introduction
Description 1: Introduce the topic, the importance of effective health-sector web portals, and the need for their assessment.

Section 2: Background Information
Description 2: Provide background information on the current state of health-sector website assessments and their importance.

Section 3: Methodology
Description 3: Describe the methodology used in the literature review and the approach to developing the conceptual framework.

Section 4: Material Collection
Description 4: Discuss the databases and criteria used for collecting relevant articles and studies for the review.

Section 5: Content Analysis
Description 5: Explain the systematic check techniques used for analysing the content of the selected articles.

Section 6: Conceptual Framework Synthesis
Description 6: Detail the steps followed to design the assessment framework and propose the main assessment criteria and indicators.

Section 7: Related Works
Description 7: Review existing literature on health-sector website quality assessment, highlighting key studies and their findings.

Section 8: Assessment Framework
Description 8: Present the proposed assessment framework, detailing the four fundamental criteria and associated indicators for evaluating health-sector websites.

Section 9: Conclusions and Future Work
Description 9: Summarize the key findings and contributions of the study, and outline possible future research directions and applications of the proposed framework.