The Pharmaceutical Journal
Vol 279 No 7463 p124
4 August 2007

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Why we need to study websites that provide information about medicines

By Donald J. Nicolson

People are increasingly accessing information about health and medicines on the internet and pharmacists may be called on more and more often to recommend internet-based medicines information sites that are easy to use.

Internet-based medicines information (IBMI) sites have the potential to be a useful resource for the general public, but to realise this potential, they need to be easy to use, and pharmacy practitioners and researchers need to develop an evidence-base of their usability.

Unfortunately research has been slow in evaluating the ease of use of IBMI sites for supporting the public in understanding their medicines, with no known research examining the sites’ usability or evaluating their effectiveness. We therefore do not know if these websites increase patients’ knowledge about their medicines.

This presents a challenge to researchers to bridge this gap. Research thus far on IBMI sites has been limited in what it can tell us about them. A modest number of studies have assessed the quality and content of medicines information websites, but the drawback has been that they have tended to evaluate them as an “off line” exercise: they have recorded the sites’ content, and assessed their comprehensiveness and accuracy as if they were conducting a census.

These studies have shed light on what the sites contain, but they have ignored what it is actually to use them — whether they are easy to use or not. I would argue such content analyses of IBMI sites may be of most value when they precede a usability study, allowing the ease of use of the websites to be related back to their design features and content (although this remains to be seen).

Research based on focus groups, which have examined consumer opinions about websites, share a similar problem. While they provide important indications of people’s collective thoughts about the sites’ content and ease of use, the findings are inconclusive because a discrepancy between respondents reported and actual use of IBMI sites cannot be discounted. Either of these study designs, while delivering valuable insights, are unable to show how easy-to-use IBMI sites are, which only a usability study can do.

Examining IBMI site usability should be underpinned by sound theory recognising the importance of a site’s design features. The design features of any object can make it easier or harder for someone to learn and remember how to use it, as well as affecting whether or not they enjoy using it, irrespective of knowledge or skills. This holds for a kettle or mobile telephone as much as for any internet site.

The design features of an IBMI site (for example, the presence of a search bar or table of contents) can determine what information an individual is able to place; a site without these features will be more difficult to navigate. Therefore it is only once people are able to access the content on an IBMI site with ease that they are in a position to judge whether or not the information is credible or trustworthy, or even attempt to understand it.

Examining the accuracy of the content and the ease with which IBMI sites can be understood are undoubtedly of importance, as is the case for patient information leaflets, whose usability is now governed by EU law. How the user can locate and draw on this information should be considered the first goal of research into IBMI sites. It can be said that the ease of use of a site will precede the understandability of its information.

Following on from this, examining the usability of a website will highlight what features impede or facilitate locating the information it contains. The findings of usability studies can then be relayed to designers who, acting on the evidence, can change the sites so as to make them easier to use. So there is a parallel between usability research and medicines information research.

Testing the usability of an IBMI site will have the same underlying principles as the user-testing of a medicines leaflet: it is the usability and understandability of the site or leaflet that is examined, and not the knowledge or expertise of the user. The responsibility then lies with the designer of the website or leaflet to make changes to improve its content and layout, rather than on the consumer having to adjust to it.

Examining the usability of IBMI sites can give insight into the cognitive processes of the person using them. Usability research has its roots in cognitive psychology, which is based on the tenet that behavioural reactions to an external stimulus are best understood by examining the mediating cognitive processes, whereby behaviour is a product of the way information has been processed. This necessitates an examination of the individual’s cognitive processes when using IBMI sites.

By asking the participant to think aloud when using a website, it is possible to collect data on his or her thought processes involved in the task. The insight gained from these “verbal protocols”, when used in conjunction with a detailed observation and recording of participants’ online actions, makes this an invaluable method for examining usability. This is because it allows the observer to determine why a participant is doing something, as much as what they are doing.

In this way, research moves beyond simple stimulus-response analyses, and can start to explain the link between using the site and finding and then understanding the information it contains.

The internet is the latest, and perhaps most radical, medium to offer people information about health care and medicines. It crosses national borders, goes largely unregulated (for both good and bad) and has the potential to have an immense impact on the public provision of health care information.

Although patient information leaflets are regulated by EU law, it seems unlikely that IBMI sites could be governed in a similar manner. At present research can only derive recommendations on what makes the websites generally easy to use and their information understandable; therefore it is left to the goodwill of IBMI site manufacturers to respond favourably to any findings and recommendations, to improve the design and content of their sites.

For the reasons presented above, it is essential that pharmacy puts the evaluation of medicines information websites firmly on its research agenda, and as soon as possible, as more and more people are using the internet to find information about medicines. In particular, research needs to evaluate how easy to use the websites sites are, which will require the adoption of research methods from human-computer interaction research, and may even necessitate working with other research disciplines.

Internet-based information is different from that presented on paper, and therefore research cannot simply apply paper-based methods for analysing its usefulness. There is no denying that the ideas proposed present a challenge to pharmacy practice and to pharmacy researchers, but the potential benefits can only make this worthwhile.

There is a need to ensure that patients seeking to know more about their medicines and to make an informed choice about them are easily able to access reliable, understandable information online.