Developing and Evaluating Online Education to Improve Older Adults Health Information - 2011

Summary: As an increasing number of Americans, including seniors, are turning to the Internet for information about health care, the ability to identify accurate, high-quality health Web sites can be difficult. There is little data about older consumers' awareness of the varying quality of health care information on the Internet, and whether or not seniors are able to distinguish between high- and lowquality Web-based health information.

The goal of this project is to develop and evaluate the first theory-based online health educational program for people aged 55 and older. The program aims to improve older adults' ability to identify high-quality health Web sites and to promote self-efficacy for communicating with physicians.

The project conducted focus groups to identify older adults' preferences for online learning about health topics to inform the design of an interactive online educational program. The use of this program will be compared to a program of educational materials, developed by the National Library of Medicine (NLM), that are not interactive and not geared specifically to older adults. Interviews with users of each of the two programs will document differences in participants' knowledge and skill in identifying trustworthy health Web sites and in communicating with physicians. The project will result in a theory-based educational program developed with the cooperation and advice of older health consumers.

Specific Aims:

• Convene focus groups to identify older adults' preferences for online learning about health. (Achieved)
• Develop an interactive online educational program to teach older adults to improve their knowledge and skills in identifying high-quality health Web sites and enhance their ability to efficaciously communicate with their physicians. (Achieved)
• Pilot test the feasibility of the program. (Ongoing)
• Evaluate the outcomes of the new program compared to an alternative. (Upcoming)

2011 Activities: The project team conducted patient focus groups to identify older adults' online learning preferences. Participants were recruited by a community partner through flyers, newsletters, articles in the local newspaper, and mailings. The focus groups were conducted in a flexible semi-structured format to allow participants to bring up topics that matter to them, to build conversation from what other group members discussed, and to allow the moderator to probe for deeper insight into discussions. Questions focused on Web sites used for health searches, topics of interest, ways to inform older people about the proposed program, the role of friends and families in guiding health information Web searches, and how to evaluate the accuracy of Web-based health information.

Based on the results of the focus groups, the project team developed the content for the Web-based educational program. The goal of the Web site is to present interactive, high-quality information without over simplifying the material or making it overly technical. Two surveys are being created to assess the end-users' perceptions and experiences with the program as compared to the current standard, a noninteractive presentation developed by the NLM.

As last self-reported in the AHRQ Research Reporting System, project progress and activities are on track and project budget spending is on target.

Preliminary Impact and Findings: The preliminary findings from the focus groups indicated that the majority of participants use Google as an initial portal for health information. Several participants, upon recommendations from their providers, use sites associated with well-known medical institutions. There was general agreement that participants had no systematic method or criteria for evaluating health information, aside from cross-checking multiple Web sites. Participants agreed that a list of highquality sites and criteria for evaluating information would be very useful. The overwhelming amount of information on the Web was reported to be a major barrier to effective use. There was near-uniform agreement that an education tool with trial exercises would be beneficial.

The project team compared the findings from patients 55 to 65 years old with patients 65 to 75 years old. The younger group of patients was more interested in a multimedia approach to disseminate health information, an evaluation or feedback component, and supplemental information such as links from the Web site to other resources. Many participants from the younger age group noted that the current Web sites are static and therefore not very engaging. As a result, Dr. Fink has incorporated a more interactive approach to content presentation. Participants from both age groups, regardless of age and education level, were not good at identifying high-quality health information on the Web.

Target Population: Adults, Elderly*

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to improve health care decisionmaking through the use of integrated data and knowledge management.

Business Goal: Knowledge Creation

* This target population is one of AHRQ's priority populations.