A recent study by two Brown professors determined that Web sites for some state health departments are inaccessible to non-English speakers and to Americans with disabilities and low levels of literacy.
More than a dozen undergraduates worked on the study, which was authored by Professor of Political Science Darrell West and Assistant Professor of Public Policy Edward Miller and recently released in the Journal of Health Care for the Poor and Underserved.
The study looked at the health department Web sites for all 50 states as well as trends on the sites over three- to five-year periods. Though the study does not rank the Web sites, it does discuss them individually and by region.
Inaccessibility "is a big problem because health is an area where accessibility needs to be the most important priority," West said.
The services and information available on health department Web sites vary from state to state, but most provide information about medicine, doctors and options for health care, according to West. Some states also rate providers and offer "great detail" about health care issues, West said.
The Rhode Island Department of Health Web site is at "the middle of the pack" among the 50 states, according to West. It has some useful forms and information about the health care industry but lacks services such as benefits applications, he said.
Many sites were deemed inaccessible in the study because they lack sufficient materials for non-English speakers. "Sometimes even though a lot of Web sites had non-English materials on them, they might only be a handful of reports," Miller said.
Carrie Bridges, acting chief of the Office of Minority Health at the Rhode Island Department of Health, said select materials such as an emergency preparedness guide have Spanish equivalents posted on the Rhode Island Department of Health Web site and that more documents will be added as part of its "strategic approach" to reaching out to minorities.
So far most efforts to reach people with limited English proficiency have been through printed materials distributed through community-based organizations and hospitals, Bridges said. Minority populations are more likely to have access to such means of information than to Web sites, Bridges said. "We do recognize that the Web site is a very important and growing channel for reaching different constituencies," she said, adding that it will be updated in the future to be more accessible.
Bridges said Rhode Island's health department has worked to implement national standards developed in 2003 that require state health departments to provide translation services in the three most commonly spoken languages in the state. The most commonly spoken languages in Rhode Island other than English, are Spanish, Portuguese, assorted southeast Asian languages, French and Haitian, according to Bridges.
One of the ways the Department of Health is addressing the issue is by providing a single phone number, publicized on its Web site, that non-English speakers can call, Bridges said.
Another problem the study identified was accessibility to Web sites for the disabled, which was determined by the evaluation software Watchfire's Bobby. The study suggested sites improve color contrasts between text and backgrounds to assist the visually impaired. Miller also suggested Web sites provide an option for larger-sized fonts and better mechanisms for acquiring information.
Such mechanisms include programs that help individuals with mobility impairments navigate complex databases and a program that converts pictures to audio descriptions for the visually impaired, Miller said.
"We've been very careful about font size, color contrasts and making sure the (Text Telephone) number is displayed," said Maria Wah-Fitta, public information officer for the Rhode Island Department of Health. Text Telephone is a service for the deaf or those with impaired speech.
A third problem the study identified in many sites was that materials were too challenging for people with low levels of literacy. According to the study, 62 percent of the 50 state Web sites were written at a 12th-grade reading level or higher, with a mean grade level of 10.9. Most enrollees in Medicaid, the government's health insurance program for the poor, read at the fifth-grade level, the study pointed out.
To test the grade level of written material on the sites, the study used the Flesch-Kincaid test, a standard reading evaluator used by the U.S. Department of Defense as well as Microsoft Word.
"Failure to write documents in a comprehensible way may also make it more difficult for state officials to address social, political, and economic inequities," the study states.
West identified several other problems with health department Web sites, including navigability, which he called the "most important" area in which states could improve. Right now it can take "a couple minutes to learn how to navigate ... a site," he said.
Another improvement would be the addition of more online services, such as benefits applications and information on health care quality. A number of states are including more online services so people don't have to travel to the state health department to access information, West said.
"I think the depth (of information) varies with the state," West said.
Wah-Fitta, however, said Rhode Island's health department has set up a hotline that provides forms and other materials that is "very heavily accessed."
It is clear some states "haven't put a lot of thought into presentations" of information, while other states have, West said. However, design of state Web sites is constantly evolving across the nation, he said.
"The whole field is in a state of flux," he said.
