Background Adults with low literacy may encounter informational obstacles on the Internet when searching for health information, in part because most health Web sites require at least a high-school reading proficiency for optimal access.Objective The purpose of this study was to 1) determine how low-literacy adults independently access and evaluate health information on the Internet, 2) identify challenges and areas of proficiency in the Internet-searching skills of low-literacy adults.Methods Subjects (n=8) were enrolled in a reading assistance program at Bidwell Training Center in Pittsburgh, PA, and read at a 3rd to 8th grade level. Subjects conducted self-directed Internet searches for designated health topics while utilizing a think-aloud protocol. Subjects' keystrokes and comments were recorded using Camtasia Studio screen-capture software. The search terms used to find health information, the amount of time spent on each Web site, the number of Web sites accessed, the reading level of Web sites accessed, and the responses of subjects to questionnaires were assessed.Results Subjects collectively answered 8 out of 24 questions correctly. Seven out of 8 subjects selected "sponsored sites"-paid Web advertisements-over search engine-generated links when answering health questions. On average, subjects accessed health Web sites written at or above a 10th grade reading level. Standard methodologies used for measuring health literacy and for promoting subjects to verbalize responses to Web-site form and content had limited utility in this population.Conclusion This study demonstrates that Web health information requires a reading level that prohibits optimal access by some low-literacy adults. These results highlight the low-literacy adult population as a potential audience for Web health information, and indicate some areas of difficulty that these individuals face when using the Internet and health Web sites to find information on specific health topics.

Background-The usability of dental computer-based patient record (CPR) systems has not been studied, despite early evidence that poor usability is a problem for dental CPR system users at multiple levels.

Data regarding the prevalence of violence among subjects recruited for nonviolent control groups in five studies are presented. These studies examined subjects recruited using a variety of methods, including couples seeking marital therapy and couples recruited from newspaper advertisements. Across the studies, it appears that up to onethird of maritally nondistressed couples and one-half of maritally distressed couples report that husband violence has occurred in their relationship. The implications of these data for the recruitment of control groups in future studies of marital violence are discussed, and questions regarding the ease of recruiting nonviolent couples for control groups are raised.

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Background: Data analysis in community health assessment (CHA) involves the collection, integration, and analysis of large numerical and spatial data sets in order to identify health priorities. Geographic Information Systems (GIS) enable for management and analysis using spatial data, but have limitations in performing analysis of numerical data because of its traditional database architecture.

6145 Background: The timely identification of available clinical trials by an oncologist for a patient represents a critical initial step in the research process. The challenges in supporting this step are threefold: (1) Large cancer centers may have more than 200 active clinical trials; (2) The accrual status of any particular clinical trial can change frequently; (3) Oncologists have limited time in their schedule to seek out clinical trial information. We hypothesized that delivering up-to-date clinical trial information directly to a handheld device would address the combination of these three challenges, and we utilized an iterative design process to refine the format and organization of this information. Methods: Web pages containing clinical trial information and optimized for a handheld display were created using an existing database and standard web development software. AvantGo software was utilized for transferring these web pages to handheld devices upon synchronization. Feedback on the initial design was obtained from four oncologists based in our community network locations. Two subsequent designs were developed based on both this feedback and encountered technical constraints. Results: Four major design changes emerged during our iterative design process. These changes included: (1) The organization of trial information based on network location; (2) The improvement of trial disease categories; (3) The shortening of trial titles; and (4) The inclusion of descriptive trial summaries for all trials. Conclusions: A demonstration of the handheld clinical trial information that is available to over 60 oncologists in our extended network will be provided. The merits of this approach as well as the lessons learned from our design process should be considered by other cancer centers seeking new methods for the distribution of clinical trial information. No significant financial relationships to disclose.