Mapping the quality of Norwegian health information - Does it facilitate informed choices?

Background and aim: Health literacy is the ability to use relevant information to make informed choices. However, the quality of the information available will determine how well a person can make those choices. Evidence-based recommendations for the development and design of health information have recently been published. Our study mapped the quality of Norwegian web-based health information in selected public health domains. Methods: Using a multiple-cross-sectional design we assessed information in 16 health domains relevant to infants, children, and youth. Convenience samples were drawn using structured Google searches. Quality appraisal was carried out by three independent raters applying the 19 criteria of the MAPPinfo-checklist. Inter-rater reliabilities were calculated using T-coefficients. Information quality was statistically described. To explain variance of quality, mean quality scores were compared across three independent variables: the type of the health problem, the target group and the provider classes to explain variance of quality. Results: Throughout the surveys in 64 subdomains 1948 health information materials were assessed. Inter-rater reliability was excellent (mean T=.89 / .90). On average, the materials complied with 22% (range 0-73%, SD=.09) of the current minimal standard. Differences between types of problems or target groups were marginal. No differences were found between information provided by health authorities, health services or commercial entities. Conclusion: Norwegian web-based health information is not of sufficient quality to facilitate informed health choices made by citizens. These findings apply to a wide range of public health domains relating to infants, children, and youth. In the absence of appropriate health information of acceptable quality estimates on the public's levels of health literacy might need to be reconsidered. Further research is needed to appraise the quality of information in other health domains and countries.