Trustworthiness, Readability, and Suitability of Web-Based Information for Stroke Prevention and Self-Management for Korean Americans: Critical Evaluation (Preprint)

Abstract

Background: The websites are common resources of health-information to stroke survivors and caregivers to obtain information and resources for continual management of stroke and the long-term sequels. Korean Americans (KAs) are frequent users of the webbased health information related to stroke management. The high stroke risk factors and mortality in KAs and lack of insurance, thus limited access to long-term care explains KAs' reliance on the web-based information. Quality of information on the websites is often questioned. Objective: This study aimed to provide a systematic evaluation of stroke-related websites regarding (1) trustworthiness (2) readability, and (3) the suitability for stroke prevention and self-management in KAs. Methods: The search terms 'stroke,' 'CVA,' '중풍 [jungpung],' and '뇌졸증[noejoljung]' were used to find stroke-related websites on Google and Yahoo. A total of 156 websites appeared on the 1 st and 2 nd pages. After eliminating duplicates and irrelevant websites (n=116), a total of 42 websites (15 in English and 27 in Korean) were evaluated using the National Library of Medicine's health websites evaluation tool for trustworthiness; SMOG for readability; and Suitability Assessment of Materials (SAM) for suitability. All three instruments used the 3-point Likert scale: superior (=2), adequate (=1), or not suitable (=0). Results: Overall, 26 (61.9%) websites received a rating of "adequate" or above for trustworthiness; however, in currency/timeline, the information on 47.6% hasn't been updated more than a year. In terms of authority, 33% failed to provide the publisher and contact information. Regarding accuracy, 50% of the websites didn't cite sources of health information. The overall readability was not suitable; only two (4.8%) websites were rated 5 th grade or lower reading level. In the suitability evaluation, only one website was rated as "superior," 25 (59.5%) websites were "adequate," and 16 (38.1%) websites were "not suitable." Among the suitability subcategory criteria, many websites were limited in graphical directions, interactive motivations for desired healthy behaviors, and multiplelanguage translations. Conclusion: The existing stroke-related websites in either English or Korean are trustworthy and suitable, yet precise citation of evidence-based information will improve trustworthiness. The high reading level of the information may set a barrier to utilization of web-based health information to KAs with a lower level of education. With the consideration of culturally relevant information in multiple languages, graphical examples, multimedia, and interaction features are the areas for improvement in suitability. The improved features can reduce the reading burden of stroke patients/caregivers and build more confidence or self-efficacy when applying the information for condition management and rehabilitation in daily living. These strategies are especially crucial to KAs, who inevitably seek web-based information to fill the gap between their demand and access to he...