Analysis of a Webpage of the Kidney Failure
Internet has grown rapidly into an immense information source. Internet resources can be used as a patient education tool and they offer the opportunities for personal interaction. Instead of following health advice and instructions passively, internet tools allow people to maintain their physical well-being actively by providing updated health information, user friendly activities, and support groups (Rankin et al., 2005).
64% of the 113 million internet users in America have searched for medical information. (as cited in Rankin et al., 2005). Many health professionals concern that the internet resources can be potentially negative by spreading misinformation (as cited in Rankin et al., 2005). However, only scant research supports this concern, and other research shows that the overall accuracy of the health information on internet is good (as cited in Rankin et al., 2005).
This paper is to analyze MedlinePlus, one of the patient education websites, using Fry Readability Formula, SAM (Suitability Assessment of Materials), and the guidelines that Rankin, Stallings and London (2005) suggest. MedlinePlus contains countless pages of health information including diseases, interactive health tutorials, games, medical dictionary, and videos. Therefore, analyzing one of the vast amounts of pages will have limitation to generalize the whole website. This analysis can be considered as an example. Because I work in the renal unit, and most of my patients experience chronic kidney failure, I chose the page of the chronic kidney disease. The URL is as following; http://www.nlm.nih.gov/medlineplus/ency/article/000471.htm
It will be discussed in the three criteria; qualitative criteria, quantitative criteria, and technical and design characteristics.
Discussion
Qualitative Criteria
On the internet, there are vast amount the web pages that provide health information. Rankin, Stallings and London (2005) state that ‘the most important factor in evaluating the quality of the information on the Internet is determining the credibility of sources of medical information’ (p. 280). The website MedlinePlus (www.medlineplus.gov) is produced by the National Library of Medicine for patients, their families and friends (MedlinePlus, 2012). According to Rankin, Stallings and London (2005), ‘a quality website displays the name and biographical information of all authors’ (p.280), and this webpage shows all the authors with their biographical information. The relationship between the authors and the organization is not explained, but at the end of the page, it clearly states that the quality and accountability of the information is verified by the independent audit institute. Moreover, reliable references to source data are provided, and it is recently updated as it indicates update date as 9/21/2011.
The accuracy of the information on the site can be confirmed by its replication in other resources, and clear distinctions between clinical evidence and personal testimonials (Rankin et al., 2005). The MedlinePlus is proud to present the evidence that its information is used in the scholarly and professional articles and how the site is used by librarians, consumers, and professionals (MedlinePlus, 2012).
The site also provides a disclaimer that 'the information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions’ (MedlinePlus, 2012)
MedlinePlus is the National Institutes of Health's Web site produced by the National Library of Medicine. Because it is not the profit pursuing commercial organization, the contents are expected to be free from bias compared to those sponsored by commercial organizations.
Overall, the MedlinePlus offers the qualified and credible health or medical information.
Quantitative Criteria
Use of computer and internet for patients is a critical issue because they can misunderstand the information, or they may use the medical information instead of consulting with physicians. It could result in negative effect to maintain physical health.
Nearly half of all 90 million American adults have problems understanding and using health information, and there is a higher percentage of hospitalizations and use of emergency departments among patients with deficits in health literacy (Wojciechowski & Cichowski, 2007). Health literacy is defined as the ability to which individuals are capable of obtaining, processing, and understanding basic information and needs to make appropriate decisions about their health.
Readability can be assessed using the Fry Readability Formula (Rankin et al., 2005, p.248). In this paper, the webpage of the chronic kidney failure is used. As this page is short, three samples from different parts are tested. The result of the three 100 word samples according to the Fry Readability Formula is as following; Number of Sentences Number of Syllables
1st 100 words 7.6 153
2nd 100 words 7.7 161
3rd 100 words 10.5 165
Totals 25.8 479
Divide Totals by 3 8.6 159

Referring to the Fry graph (Figure 9.2), the readability level of this page is at the 9th – grade level. SAM (Suitability Assessment of Materials) shows that 9th- grade level and above is not suitable for patient comprehension. Superior is the 5th- grade level or lower, and 6th-, 7th-, 8th – grade level is adequate (Rankin et al., 2005, p.241). However, the website offers other tools, such as animations and videos of the patients or physicians to boost readers’ understanding.
Technical and Design Characteristics Links should support the viewpoint of the original site (Rankin et al., 2005, p.281). This webpage contains many links that lead readers into the related contents. For example, if a reader does not understand one of the symptoms 'high potassium level', the reader can simply click the word, and it leads to the page explaining it in detail within the MedlinePlus website. It explains causes, symptoms, tests, and treatment including what kind of food they need to avoid.
The overall design cannot be overlooked because ‘design and layout of the site affect the ability to access the content (Rankin et al., 2005, p. 281)’. Graphics, illustrations, and text need to be organized in balance for readers not to be distracted from the purpose, and to easily search for further information. This site has many links, and readers can easily go back to the previous page. Moreover, all the pages for the diseases have the same layout; general definition, causes, symptoms, exams/tests, treatment, support groups, prognosis, possible complications, prevention, and alternative names. Each topic and subtitles are colored with blue, and adequate white space is used with bullets. On the right side of the page, it has related diseases, and images. As listed above, the page is logically structured for the patients to expect the flow of information. The bad point is that the images on the page are only the general kidney anatomy with the blood and urine flow. It could be difficult for readers to relate the images to the contents, and the images do not explain the mechanism of the disease. Nevertheless, on other pages of the website, readers can search for animations well explaining the process of the disease, or use interactive tool such as quiz and games.
The website contains search engine and site map so that the readers can browse any specific information. It also provides FAQs, Contact Us, link to support groups as well as other language service to increase interactivity. In addition, it offers mobile version, email update service, and follow up service on Twitter.
Conclusion
The patient education from the medical professionals, such as doctors and patient educators can be very limited. On the other hand, obtaining medical information is getting easier especially through the internet, and accessing to many resources help people to actively maintain their health. In this age of the information overflow online, it is concerned with the quality of the patient education materials, the credibility of the providers, and their interactivity with the readers. In this paper, one of the web pages, Chronic Kidney Failure, in the patient education website, MedlinePlus, is analyzed.
In conclusion, the MedlinePlus is well designed with competent contents. Although the readibility shows the 9th-grade level with only a few images of anatomy, which can be difficult for many readers, the site offers abundant related pages with useful tools and activities that promote readers’ understanding, and help readers be more actively involved.

References
MedlinePlus. (2012. April 18). About MedlinePlus. Retrieved from http://www.nlm.nih.gov/medlineplus/aboutmedlineplus.html MedlinePlus. (2012. April 18). Bibliography. Retrieved from http://www.nlm.nih.gov/medlineplus/bibliography.html#PatientEducation MedlinePlus. (2012. June 28). Chronic Kidney Disease. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/000471.htm Rankin, S. H., Stallings, K. D., & London, F. (2005). Patient education in health and illness (5th ed.). New York: Lippincott.
Wojciechowski E. & Cichowski K. (2007) A Case Review: Designing a New Patient Education
System. The Internet Journal of Advanced Nursing Practice. Volume 8 Number 2. DOI:
10.5580/14d4. Retrieved from http://www.ispub.com/journal/the-internet-journal-of-advanced-nursing-practice/volume-8-number-2/a-case-review-designing-a-new-patient-education-system.html