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Evaluation of the Quality and Accessibility of Available Websites on Kidney Transplantation

Saeideh Valizadeh-Haghi, Shahabedin Rahmatizadeh




Purpose: (i) to assess the quality of health websites on kidney transplant and (ii) to evaluate the accessibility of these websites and their concordance with the existing guidelines.
Materials and Methods: The terms “kidney transplantation” and “renal transplantation” were searched in the three most popular search engines Google, Yahoo, and Bing. 58 unique websites were eligible for the analysis . The Websites accessibility was evaluated using the AChecker tool. Kruskal–Wallis test was performed to examine any significant difference between accessibility issues across different domains. The eligible websites were screened
for quality based on the HONcode of conducts. Moreover, the daily traffic data of each website was determined by Alexa. The correlation of known accessibility problems with website popularity was examined too.
Result: The main reported known problems belonged to “scripts must have functional text,” “text equivalents,” “accessible forms,” and “text links for server-side image map”. Although the mean accessibility errors in governmental (10.25 ± 7.274) and organizational (12.31 ± 9.469) websites were less than those in the other domains, the differences were not significant (P = 0.60). Findings showed no significant correlation (P > 0.05) between
the extent of known problems (16.50 ± 12.18) and Alexa ranking (253675.07 ± 534690.947). Furthermore, most websites on kidney transplant were not certified by the HONcode.
Conclusion: The health websites designers should be aware of accessibility problems, because there is a growing population of potential users with disabilities. This study indicated the need to ensure the compliance of kidney transplant websites with accessibility guidelines such as Section 508. Furthermore, most surveyed websites were of poor quality and unreliable. Therefore, physicians should warn their patients about unqualified online health information and guide them to websites which are more reliable.


IDI Web Accessibility Checker : Web Accessibility Checker [Internet]. [cited 2017 May 29]. Available from: https://achecker.ca/checker/index.php

Abbasi MA, Chertow GM, Hall YN. End-stage renal disease. BMJ Clin Evid [Internet]. 2010 Jul 19 [cited 2017 Jun 19];2010. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21418665

The United States Renal Data System: Annual Data Report 2016 [Internet]. 2016 [cited 2017 Jun 18]. Available from: https://www.usrds.org/adr.aspx

Garcia GG, Harden P, Chapman J, World Kidney Day Steering Committee 2012 for the WKDSC. The global role of kidney transplantation. Kidney Blood Press Res [Internet]. 2012 [cited 2017 Jun 17];35(5):299–304. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22353691

Laupacis A, Keown P, Pus N, Krueger H, Ferguson B, Wong C, et al. A study of the quality of life and cost-utility of renal transplantation. Kidney Int [Internet]. 1996 Jul [cited 2017 Jun 17];50(1):235–42. Available from: http://www.ncbi.nlm.nih.gov/pubmed/8807593

Humar A, Matas AJ. Surgical Complications After Kidney Transplantation. Semin Dial [Internet]. 2005 Nov 29 [cited 2017 Jun 19];18(6):505–10. Available from: http://doi.wiley.com/10.1111/j.1525-139X.2005.00097.x

Flechner SM. Surgical Complications after Kidney Transplantation. In: Kidney and Pancreas Transplantation [Internet]. Totowa, NJ: Humana Press; 2011 [cited 2017 Jun 24]. p. 281–98. Available from: http://link.springer.com/10.1007/978-1-60761-642-9_15

Moldovan-Johnson M, Martinez L, Lewis N, Freres D, Hornik RC. The Role of Patient Clinician Information Engagement and Information Seeking from Nonmedical Channels in Fruit and Vegetable Intake among Cancer Patients. J Health Commun. 2014;19(12):1359.

Klein B, White A, Kavanagh D, Shandley K, Kay-Lambkin F, Proudfoot J, et al. Content and functionality of alcohol and other drug websites: Results of an online survey. J Med Internet Res. 2010;12(5).

Dearman D, Kellar M, Truong KN. An examination of daily information needs and sharing opportunities. In: Proceedings of the 2008 ACM conference on Computer supported cooperative work. ACM; 2008. p. 679–88.

Hornik R, Parvanta S, Mello S, Freres D, Kelly B, Schwartz JS. Effects of Scanning—Routine Health Information Exposure—on Cancer Screening and Prevention Behaviors in the General Population. J Health Commun. 2013;18(12):1422.

Kim D, Chang H. Key functional characteristics in designing and operating health information websites for user satisfaction: An application of the extended technology acceptance model. Int J Med Inform. 2007;76(11):790–800.

Morahan-Martin JM. How internet users find, evaluate, and use online health information: a cross-cultural review. Cyberpsychol Behav. 2005/01/26. 2004;7(5):497–510.

Moorhead SA, Hazlett DE, Harrison L, Carroll JK, Irwin A, Hoving C. A new dimension of health care: systematic review of the uses, benefits, and limitations of social media for health communication. J Med Internet Res. 2013;15(4):e85.

Andreassen HK, Bujnowska-Fedak MM, Chronaki CE, Dumitru RC, Pudule I, Santana S, et al. European citizens’ use of E-health services: a study of seven countries. BMC Public Health. 2007;7(1):1.

Coulter A, Ellins J, Swain D, Clarke A, Heron P, Rasul F, et al. Assessing the quality of information to support people in making decisions about their health and healthcare. Picker Institute Europe. Citeseer; 2006. 70 p.

Valizadeh-Haghi S, Seifi L. 180:Identifying electronic health literacy level in adult patients: an Iranian experience. BMJ Open [Internet]. 2017 Feb 1;7(Suppl 1). Available from: http://bmjopen.bmj.com/content/7/Suppl_1/bmjopen-2016-015415.180.abstract

Lorence DP, Park H, Fox S. Racial disparities in health information access: resilience of the digital divide. J Med Syst. 2006;30(4):241–9.

Coulter A. Engaging Patients in Healthcare. McGraw-Hill Education (UK); 2011.

Mun YY, Yoon JJ, Davis JM, Lee T. Untangling the antecedents of initial trust in Web-based health information: The roles of argument quality, source expertise, and user perceptions of information quality and risk. Decis Support Syst. 2013;55(1):284–95.

De Boer MJ, Versteegen GJ, van Wijhe M. Patients’ use of the Internet for pain-related medical information. Patient Educ Couns. 2007;68(1):86–97.

Jadad AR, Gagliardi A. Rating health information on the Internet. JAMA J Am Med Assoc. 1998;279(8):611–4.

Jadad AR, Haynes RB, Hunt D, Browman GP. The Internet and evidence-based decision-making: a needed synergy for efficient knowledge management in health care. Can Med Assoc J. 2000;162(3):362–5.

Winker MA, Flanagin A, Chi-Lum B, White J, Andrews K, Kennett RL, et al. Guidelines for medical and health information sites on the internet: Principles governing ama web sites. JAMA [Internet]. 2000;283(12):1600–6. Available from: http://dx.doi.org/10.1001/jama.283.12.1600

Wathen CN, Burkell J. Believe it or not: Factors influencing credibility on the Web. J Am Soc Inf Sci Technol. 2002;53(2):134–44.

Moore D, Ayers S. A review of postnatal mental health websites: help for healthcare professionals and patients. Arch Womens Ment Heal. 2011/11/24. 2011;14(6):443–52.

Patel U, Cobourne MT. Orthodontic extractions and the Internet: Quality of online information available to the public. Am J Orthod Dentofac Orthop [Internet]. 2011;139(2):e103–9. Available from: http://www.sciencedirect.com/science/article/pii/S0889540610008577

Elliott AD, Bartel AF, Simonson D, Roukis TS. Is the internet a reliable source of information for patients seeking total ankle replacement? J Foot Ankle Surg. 2015/03/10. 2015;54(3):378–81.

Grewal P, Alagaratnam S. The quality and readability of colorectal cancer information on the internet. Int J Surg. 2013/03/26. 2013;11(5):410–3.

Haymes AT. The Quality of Rhinoplasty Health Information on the Internet. Ann Plast Surg. 2016/01/14. 2016;76(2):143–9.

Goslin RA, Elhassan HA. Evaluating internet health resources in ear, nose, and throat surgery. Laryngoscope [Internet]. 2013;123(7):1626–31. Available from: http://dx.doi.org/10.1002/lary.23773

Livas C, Delli K, Ren Y. Quality evaluation of the available Internet information regarding pain during orthodontic treatment. Angle Orthod [Internet]. 2013;83(3):500–6. Available from: http://www.angle.org/doi/abs/10.2319/052512-435.1

Ahmed OH, Sullivan SJ, Schneiders AG, McCrory PR. Concussion information online: evaluation of information quality, content and readability of concussion-related websites. Br J Sports Med [Internet]. 2012;46(9):675–83. Available from: http://bjsm.bmj.com/cgi/doi/10.1136/bjsm.2010.081620

Aldairy T, Laverick S, McIntyre GT. Orthognathic surgery: is patient information on the Internet valid? Eur J Orthod. 2012;34(4):466–9.

Hu X, Bell RA, Kravitz RL, Orrange S. The prepared patient: information seeking of online support group members before their medical appointments. J Health Commun. 2012;17(8):960–78.

Harrison S, Barlow J, Williams G. The content and interactivity of health support group websites. Health Educ J [Internet]. 2007;66(4):371–81. Available from: https://login.proxy.bib.uottawa.ca/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=2009935305&site=ehost-live

Chiang MF, Starren J. Evaluation of consumer health website accessibility by users with sensory and physical disabilities. Stud Health Technol Inform [Internet]. 2004 [cited 2017 Aug 13];107(Pt 2):1128–32. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15360988

Harper S, Yesilada Y. Web accessibility: a foundation for research. Harper S, Yesilada Y, editors. Springer Science & Business Media; 2008. 364 p.

McMullan M. Patients using the Internet to obtain health information: How this affects the patient–health professional relationship. Patient Educ Couns. 2006 Oct;63(1–2):24–8.

Cocquebert E, Trentesaux D, Tahon C. WISDOM: A website design method based on reusing design and software solutions. Inf Softw Technol. 2010;52(12):1272–85.

Cebi S. Determining importance degrees of website design parameters based on interactions and types of websites. Decis Support Syst [Internet]. 2013 Jan [cited 2017 Jul 2];54(2):1030–43. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0167923612002916

de Santana VF, de Oliveira R, Almeida LDA, Baranauskas MCC. Web accessibility and people with dyslexia: a survey on techniques and guidelines. In: Proceedings of the International Cross-Disciplinary Conference on Web Accessibility - W4A ’12 [Internet]. New York, New York, USA: ACM Press; 2012 [cited 2017 Jun 18]. p. 1. Available from: http://dl.acm.org/citation.cfm?doid=2207016.2207047

Bernstam E V, Walji MF, Sagaram S, Sagaram D, Johnson CW, Meric‐Bernstam F. Commonly cited website quality criteria are not effective at identifying inaccurate online information about breast cancer. Cancer. 2008;112(6):1206–13.

PURCELL K, BRENNER J;, RAINIE LEE. Search Engine Use 2012 [Internet]. Vol. 2016. Washington, D.C.: Pew Research Center’s Internet & American Life Project; 2012. Available from: http://pewinternet.org/Reports/2012/Search-Engine-Use-2012.aspx

iProspect Blended Search Results Study [Internet]. Vol. 2014. 2008. Available from: http://www.herramientas-seo.com/pdf/estudio-buscadores-iprospect.pdf

Barricelli BR, Sciarelli P, Valtolina S, Rizzi A. Web accessibility legislation in Italy: a survey 10 years after the Stanca Act. Univers Access Inf Soc [Internet]. 2017 Feb 7 [cited 2017 Aug 14];1–12. Available from: http://link.springer.com/10.1007/s10209-017-0526-z

Ivory MY, Hearst MA, Ivory MY, Hearst MA. The state of the art in automating usability evaluation of user interfaces. ACM Comput Surv [Internet]. 2001 Dec 1 [cited 2017 Jun 25];33(4):470–516. Available from: http://portal.acm.org/citation.cfm?doid=503112.503114

Gay G, Li CQ. AChecker: open, interactive, customizable, web accessibility checking. In: Proceedings of the 2010 International Cross Disciplinary Conference on Web Accessibility (W4A) - W4A ’10. New York, New York, USA: ACM Press; 2010. p. 1.

Web Accessibility Evaluation Tools List [Internet]. [cited 2017 Aug 15]. Available from: https://www.w3.org/WAI/ER/tools/

Youngblood NE. Revisiting Alabama state website accessibility. Gov Inf Q. 2014;31(3):476–87.

AkgÜL Y, Vatansever K. Web Accessibility Evaluation of Government Websites for People with Disabilities in Turkey. J Adv Manag Sci. 2016;201–10.

Alahmadi T, Drew S. An evaluation of the accessibility of top-ranking university websites: Accessibility rates from 2005 to 2015. In: There and back: Charting flexible pathways in open, mobile and istance education. Hamilton; 2016. p. 224–33.

The HON Code of Conduct for medical and health Web sites (HONcode) [Internet]. Vol. 2016. Available from: http://www.hon.ch/HONcode/Plugin/Plugins.html

Memon M, Ginsberg L, Simunovic N, Ristevski B, Bhandari M, Kleinlugtenbelt YV. Quality of Web-based Information for the 10 Most Common Fractures. Interact J Med Res [Internet]. 2016 Jun 17 [cited 2017 Feb 22];5(2):e19. Available from: http://www.i-jmr.org/2016/2/e19/

Lee S, Shin JJ, Haro MS, Song SH, Nho SJ. Evaluating the Quality of Internet Information for Femoroacetabular Impingement. Arthrosc J Arthrosc Relat Surg. 2014;30(10):1372–9.

Raj S, Sharma VL, Singh AJ, Goel S. Evaluation of Quality and Readability of Health Information Websites Identified through India’s Major Search Engines. Adv Prev Med. 2016;2016:1–6.

Website Traffic, Statistics and Analytics - Alexa [Internet]. [cited 2017 Aug 20]. Available from: https://www.alexa.com/siteinfo

IDI Web Accessibility Checker : View Guideline [Internet]. [cited 2017 Aug 21]. Available from: https://achecker.ca/guideline/view_guideline.php?id=2

Zeng X, Parmanto B. Web Content Accessibility of Consumer Health Information Web Sites for People with Disabilities: A Cross Sectional Evaluation. J Med Internet Res [Internet]. 2004 Jun 21 [cited 2017 Aug 16];6(2):e19. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15249268

Lazar J, Beere P, Greenidge K-D, Nagappa Y. Web accessibility in the Mid-Atlantic United States: a study of 50 homepages. Univers Access Inf Soc. 2003 Nov 1;2(4):331–41.

Bray M, Pugalee D, Flowers CP, Algozzine B. Accessibility of Middle Schools’ Web Sites for Students with Disabilities. Clear House [Internet]. [cited 2017 Jul 23];80:169–76. Available from: https://www.jstor.org/stable/30192145

Karreman J, van der Geest T, Buursink E. Accessible Website Content Guidelines for Users with Intellectual Disabilities. J Appl Res Intellect Disabil [Internet]. 2007 Nov [cited 2017 Jul 23];20(6):510–8. Available from: http://doi.wiley.com/10.1111/j.1468-3148.2006.00353.x

Borgmann H, Wölm J-H, Vallo S, Mager R, Huber J, Breyer J, et al. Prostate Cancer on the Web—Expedient Tool for Patients’ Decision-Making? J Cancer Educ [Internet]. 2017 Mar 4 [cited 2017 Aug 22];32(1):135–40. Available from: http://link.springer.com/10.1007/s13187-015-0891-3

San Norberto EM, Taylor J, Salvador R, Revilla Á, Merino B, Vaquero C. The Quality of Information Available on the Internet About Aortic Aneurysm and Its Endovascular Treatment. Rev Española Cardiol (English Ed [Internet]. 2011 Oct 1 [cited 2017 Aug 26];64(10):869–75. Available from: http://linkinghub.elsevier.com/retrieve/pii/S1885585711003525

Zeng X, Parmanto B. Evaluation of web accessibility of consumer health information websites. AMIA . Annu Symp proceedings AMIA Symp [Internet]. 2003 [cited 2017 Aug 16];2003:743–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/14728272

Mancini C, Zedda M, Barbaro A. Health information in Italian public health websites: moving from inaccessibility to accessibility. Heal Inf Libr J [Internet]. 2005 Nov 16 [cited 2017 Aug 16];22(4):276–85. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16293170

Niu L, Luo D, Liu Y, Xiao S. The Accessibility, Usability, and Reliability of Chinese Web-Based Information on HIV/AIDS. Int J Environ Res Public Health [Internet]. 2016 Aug 20 [cited 2017 Aug 16];13(8):834. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27556475

Shneiderman B. Research-Based Web Design & Usability Guidelines. Igarss 2014. 2014. 1-5 p.

Harper S, Yesilada Y, editors. Web accessibility: a foundation for research. Springer Science & Business Media; 2008. 364 p.

Sierkowski B, Brian. Achieving web accessibility. In: Proceedings of the 30th annual ACM SIGUCCS conference on User services - SIGUCCS ’02 [Internet]. New York, New York, USA: ACM Press; 2002 [cited 2017 Aug 27]. p. 288–91. Available from: http://portal.acm.org/citation.cfm?doid=588646.588725

Finding and Evaluating Online Resources [Internet]. National Center for Complimentary and Integrative Health. 2014 [cited 2017 Aug 27]. Available from: https://nccih.nih.gov/health/webresources

Lazar J, Dudley-Sponaugle A, Greenidge K-D. Improving web accessibility: a study of webmaster perceptions. Comput Human Behav [Internet]. 2004 Mar [cited 2017 Aug 15];20(2):269–88. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0747563203000906

Alsafi A, Kaya G, Patel H, Hamady MS. A comparison of the quality of the information available on the internet on interventional radiology, vascular surgery, and cardiology. J Postgrad Med [Internet]. 2013 [cited 2017 Aug 22];59(1):69–75. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23525067

DOI: http://dx.doi.org/10.22037/uj.v0i0.4252


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