Letters to the Editor


1 October 2007

Dear Editor,


Second to consulting a health-care professional, the Internet is one of the most common sources of health information for parents.1–4 Eighteen per cent of parents in an Australian study indicated that information they read online altered their health-care decisions3– yet many health web sites have been found to be incomplete, inaccurate or not written at an appropriate reading level.5–7

In 2004, a group of Royal Children's Hospital staff launched a collection of parent information fact sheets online for public access (http://www.rch.org.au/kidsinfo). These factsheets, covering acute and chronic complaints and diseases and in-hospital tests and procedures, now number in excess of 200 and receive more than 1500 visitors a day. The goal was to provide evidence-based and medically accurate information, presented in an appropriate and accessible way. While factsheets were developed in response to requests from parents and health-care providers, it was not clear if they were actually meeting the needs of the web site's target group.

To facilitate ongoing improvement we analysed the voluntary online survey attached to each factsheet between September 2006 and May 2007. The survey was approved as an audit by the hospital Ethics Committee. The survey was composed of two parts. Part A asked about the usefulness of the factsheet. Participants could then choose to complete Part B, containing four more questions and an area for any comments.

During the 8-month study period there were approximately 360 000 visitors to the Kids Health Info web site. There were 574 survey responses to Part A and 308 to Part B representing 0.16% and 0.06% of visitors respectively. Web site usage statistics indicated that 63% of all visitors found it through a google.com or google.com.au search.

The 574 respondents to Part A had accessed 142 different factsheets; 63% of respondents thought the factsheet they read was ‘very useful’, 24% ‘useful’, 4% ‘not useful’ and 1% thought it was ‘really bad’. Seven per cent gave a ‘neutral’ rating.

The data from the 308 respondents to Part B indicated that 66% were viewing the factsheet for their own child and 16% were health-care providers accessing the factsheets for a patient. The three most common reasons respondents accessed the factsheets were ‘to find out usual treatment’ (54%), ‘causes’ (52%) and ‘how to help a child at home’ (42%) (Fig. 1). Ninety-three per cent rated the information as ‘easy to understand’; 83% said the factsheet they wanted was ‘easy to find’ and 81% thought the factsheet ‘answered all their questions’. Twenty-four per cent thought the factsheet needed more detailed information.

Figure 1.

Online health information – user feedback.

Sixty-three respondents provided constructive feedback that could be used to review or update factsheets either immediately or during bi-annual reviews. For example, evidence-based treatment options were updated following paediatrician feedback, information on the impact of certain diseases on families was altered based on feedback of families and information about local support agencies was added. Wherever possible, parents were involved in the review process.

In contrast to our expectations that respondents would mainly complete the survey if they were dissatisfied, most online survey feedback for the Kids Health Info web site was positive. Feedback indicated that overall, factsheets were written appropriately and clearly, were of the right length and were meeting a need. Although there is limited comparable literature, an NHS study of parent feedback on immunisation information indicated that 20% were not satisfied, mainly because the information was insufficient.8

A small but important number of factsheets were identified that needed significant review. Constructive suggestions could be addressed either immediately or during the next update, depending on the urgency of the recommendation.

Parents mainly used the web site to find out about usual treatment, causes and care at home for their child's problem. This information was used to review the standard template for developing new factsheets.

Of interest is that 12% of respondents were accessing the factsheet to find out who they should see for medical attention. This suggests that the factsheets may influence health-care seeking behaviour among parents.

It is unclear how representative this sample is compared to the large number of visitors (360 000) over the study period. Survey feedback has also been limited to an English-speaking, Internet-using audience only.

In summary, the online feedback survey for a child health information web site indicated that overall, factsheets were written appropriately and meeting a need. To become and remain a valued and trusted resource for parent information on child health issues, consumers can and should play an important part of an ongoing improvement process.


We thank Dr Jemma Skeat, Ms Marina Norio, and RCH volunteer Ms Debra Shaw for helping to set up the survey and maintain the web site. We thank the numerous clinicians, non-clinical staff and parents who have made the web site a success through their ongoing involvement.