Dutch health websites and their ability to inform people with low health literacy

Objective
To evaluate whether Dutch online health information (OHI) generally reflects message elements that support information processing and understanding among people with low health literacy.

Methods
We content-analyzed one hundred Dutch webpages about Ebola, fibromyalgia, ALS, losing weight, borderline personality disorder, hemorrhoids, ADD, bladder infection, shingles, and chicken pox. The codebook covered the following domains: images and videos, readability level, Suitability Assessment of Materials (SAM), advertising, interactive features, and reliability cues.

Results
Thirty-seven webpages contained informative images that visualized the text. Twelve webpages incorporated videos, six of which were animations. Readability varied widely, but 79.2% of the texts exceeded the recommended B1 level. Half of the webpages had inadequate SAM scores; five were classified as superior. Interactive features were infrequently used. Many webpages included only a few elements that help users evaluate the reliability of OHI. Four presented a quality label.

Conclusion
Over a wide range of health-related topics, Dutch OHI does not generally contain message elements that improve information processing among people with low health literacy.

Practice implications
Communication professionals should make better use of digital message features. Videos, narration, and interactivity are scarcely used but can be valuable for people with low health literacy.