Concussion information online: evaluation of information quality, content and readability of concussion-related websites
Ahmed OH., Sullivan SJ., Schneiders AG., McCrory RP. British Journal of Sports Medicine, 2012;46: 675-683.
A lot of people are using the internet to gather health information; however, not all websites are up to date with the latest accurate information. Despite the increased attention on concussion the quality of information online regarding concussions is unclear. Therefore, the purpose of this study was to evaluate concussion websites for information quality, content and readability. The website search included 6 Google searches (taking the top 10 sites on each), concussion expert suggested websites (e.g., Mayo Clinic), websites hosted by international sporting federation (e.g., FIFA), and an industry sampling (e.g., ImPACT). Forty-three websites were included in this study. Information quality was assessed by the inclusion of the HONcode logo on the website. A concussion expert research team created a new 11-item concussion information checklist (CONcheck) to evaluate information content. The checklist, based on information in the 2008 Concussion in Sport Statement, included information regarding the mechanism, signs and symptoms, where to go for medical counsel, and return-to-play measures. Readability was assessed using the Flesch-Kincaide Grade Level (FKGL) and Flesch Reading Ease (FRES). The current study found that 30% (13/43) of websites had the Honcode logo. There were no difference between the HONcode and non HONcode websites and their CONcheck, FKGL, or FRES scores. Six websites achieved the maximum CONcheck score (20 points) and 7 websites scored the lowest score (0 points). Seventeen websites gave 1 to 5 pieces of inaccurate information (e.g., You are allowed to return to play if symptoms resolve in 15 minutes). Over 70% of the websites accurately reported that loss of consciousness is NOT an essential factor for diagnosis of a concussion and an individual with concussion may have one or more of the following symptoms, physical signs, impaired brain function or abnormal behavior. Six out of 11 CONcheck items were commonly inaccurate, incomplete, or missing on more than 50% of the websites. The readability scores indicated that many sites were written for readers at a high school reading level or higher (FRES ranged from 16.3 to 77.4 and FKGL ranged from 6 to 17.8).
People may be supplementing traditional face-to-face discussions and pamphlets with websites that provide concussion information and advice. However, many websites’ are not up to date, and may contain numerous inaccuracies. This study indicated that the HONcode should not be the only quality check of a website. The HONcode is not an award system to rate the quality of information, which may have been the reason that there were no differences in content and readability between sites with and without the HONcode. In contrast to the HONcode, the CONcheck instrument was created specifically to evaluate the content of concussion websites and the authors found that many of the problems were with the return-to-play guidelines and when to seek medical attention. This is particularly troubling since seeking medical counsel following a concussion is an essential aspect of the concussion management protocol. It is important to note that the CONcheck may require further validation to confirm that the instrument is not missing information and reproducible among multiple users. Beyond inaccuracies and missing information, the readability data suggested that the existing concussion information may be worded in a manner where the majority of the general population would not be able to comprehend and utilize the information. This study demonstrated that the overall quality of concussion websites is highly varied, and that steps need to be taken to ensure that the information is distributed in a manner that will ensure accuracy and readability. Do you use websites to gather concussion information? What websites do you use?
Written by: Jane McDevitt MS, ATC, CSCS
Reviewed by: Jeffrey Driban
Ahmed OH, Sullivan SJ, Schneiders AG, & McCrory PR (2012). Concussion information online: evaluation of information quality, content and readability of concussion-related websites. British journal of sports medicine, 46 (9), 675-83 PMID: 21504964