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How Patients and Experts Evalulate Websites

Patients think if health Web sites are pretty, they must be smart

Two studies of Internet health sites reveal that users who lack medical knowledge tend to rely on look and design to measure credibility.

By Tyler Chin, AMNews staff. Nov. 25, 2002

Physicians say you can't judge a health Web site by its cover, but patients don't agree.

Nearly 42% of consumers tend to view online health information as credible based on some aspect of a site's visual design, according to a study commissioned by Consumer WebWatch and led by Stanford University's Persuasive Technology Lab. But another Consumer WebWatch study, led by Sliced Bread Design LLC, found that only 7.6% of health experts even took note of a site's design, tending to rely on substance over style.

The finding is consistent with previous research showing that patients and physicians perceive quality from opposite ends. Lacking medical training, patients judge the skill and professionalism of physicians by what doctors wear, their bedside manner and the d├ęcor and cleanliness of their exam and waiting rooms. Doctors, on the other hand, judge each other based on their quality of care.

The findings suggest that, while the growing number of physicians with Web, sites -- by the AMA's last count, 29% of doctors -- may get their peers' respect with solid information, they could retain or gain additional patients if they pay attention to layout, typography, font size, color schemes and other visual design details that patients think make sites look professional and polished.

The studies also shed some light on why even the most educated patients might bring seemingly obviously shoddy information to their physicians' attention.

"The study clearly shows that people put a lot of emphasis on the visual design of a Web site in determining whether the site is credible or not. We didn't expect to find that," said B.J. Fogg, PhD, lead author of "How Do People Evaluate a Web
Site's Credibility?" and director of Stanford's Persuasive Technology Lab.

"But in retrospect, as we look at the evidence and talk to other people about our finding, it really does line up with what happens in other parts of life. When people evaluate politicians or TV news, [the evaluation] is really about presentation rather than substance. Why would the Web be any different? We would like to think it is, but it's not."

Patients Versus Experts

While the Stanford University study focused on how consumers evaluate sites, the study by Mountain View, Calif.-based consulting firm Sliced Bread examined how eight health care experts make the same decision by asking them to rank 10 health sites from the most to least credible.

About 44% of the experts, including three doctors, said they relied on the reputation of the site operator; 26% cited the source of the content and 23% noted their perception of the site's motive. Consumer WebWatch, a division of Consumers Union, collaborated with participating researchers to select the 10 health sites. Some sites were selected because their operators had an impeccable reputation. Others were selected because the researchers wanted to see what impact the name of a famous doctor had on credibility, others because they were consumer-focused, and others because they offered both consumer and physician portals.

The health care experts were asked to rank all 10 sites. Consumers were asked to rank only two sites that were randomly assigned to them.

Experts ranked the sites of the National Institutes of Health and MayoClinic.com first and second while consumers placed Mayoclinic.com in first place and the NIH in third. Some experts cited the NIH's "sterling reputation" and "lack of self-interest" as the reason for their ranking.

"I don't have to look at their Web site [although I did] to know that I trust this site," one expert told the researchers. "It is more about knowing the sources and the processes rather than credibility markers such as design."

In picking one site as more credible than another, some consumers made comments such as "just looks more credible," "more pleasing graphics, higher-quality look and feel" and "the design is sloppy and looks like some adolescent boys in a garage threw this together."

"What was disturbing was that our consumers were actually rather savvy about the Web," said Leslie Marable, co-author and project manager of the studies for Consumer WebWatch. "These are people who are used to going online, they are used to getting information online, knowing where to go to get it, and yet for the most part they still judge the credibility of sites on superficial aspects."

Some Doctors, However, Aren't Surprised by That

"I think that the study is correct," said Jack Jue Jr., MD, family physician at the University of California, Davis Health System in Sacramento. "A lot of times, consumers look at a Web site and think that because it's professionally done, looks fancy and there's lots of money put into it, that it's more professional. They may not think the site is professionally done if it doesn't have a lot of eye-catching graphics. If it's basically a lot of text, they [also], may not necessarily think it's that reputable."

It is not uncommon for patients to hand him information they print off the Web, Dr. Jue said, estimating that half the time the information is bad. Patients have to wade through a huge glut of information on the Internet. "I think that, just like with any other form of advertising, if a Web site is done well and it looks like there's some person with [official medical] titles giving information, patients may rely on it, whereas it may not necessarily be accurate information."

To help patients access reliable health information -- and make office visits more efficient -- Dr. Jue put up a site five years ago that he got from Physicians Online, a physician Web portal. He signed up with Physicians Online because the site was free, had a simple design and offered patients quick and easy access to information, Dr. Jue said.

The same qualities that led Dr. Jue to sign with Physicians Online are among the things that doctors should consider when they put up Web sites, Dr. Fogg advised.

"Recognize that people are what psychologists call 'cognitive misers.' We don't want to think hard if we don't have to, and that applies to looking for information on the Web. The site doesn't have to be flashy to be good design. It just has to be solid, straightforward and easy to use. It's not a matter of getting flash animation and all the gee-whiz stuff. Previous studies have shown that people don't like that gee-whiz stuff. ... So the bar may not be as high as people imagine."

ADDITIONAL INFORMATION:

Health Site Runoff

Consumers and health care experts were asked to assess the credibility of 10 health sites. Here's how each group ranked the sites:

Consumers
1. MayoClinic.com
2. InteliHealth
3. National Institutes of Health
4. MDChoice
5. Dr. Koop
6. WebMD
7. HealthWorld
8. Dr. Weil
9. Health Bulletin
10. Oxygen Health and Fitness

Experts
1. National Institutes of Health
2. MayoClinic.com
3. WebMD
4. InteliHealth
5. MDChoice
6. Dr. Koop
7. HealthWorld *
7. Dr. Weil*
9. Oxygen Health and Fitness
10. Health Bulletin

* HealthWorld and Dr. Weil tied for 7th.
Source: Sliced Bread Design LLC, Stanford University's Persuasive
Technology Lab, Consumer WebWatch

First Impressions

Here's a list on how to make your site look credible, professional and visually appealing to your patients, according to B.J. Fogg, PhD, director of Stanford University's Persuasive Technology Lab:

Copyright 2002 American Medical Association. All rights reserved.