A primary purpose of research is to generate new knowledge. Scientific advances have progressively identified optimal ways to achieve this purpose. Included in this evolution are the notions of evidence-based medicine, decision aids, shared decision making, measurement and evaluation as well as implementation. The importance of including qualitative and quantitative methods in our research is now understood. We have debated the meaning of evidence and how to implement it. However, we have yet to consider how to include in our study findings other types of information such as tacit and experiential knowledge. This key consideration needs to take place before we translate new findings or knowledge into clinical practice. This article critiques assumptions regarding the nature of knowledge and suggests a framework for implementing research findings into practice.

Background Systematic reviews are recognized as the most effective means of summarizing research evidence. However, they are limited by the time and effort required to keep them up to date. Wikis present a unique opportunity to facilitate collaboration among many authors. The purpose of this study was to examine the use of a wiki as an online collaborative tool for the updating of a type of systematic review known as a scoping review. Methods An existing peer-reviewed scoping review on asynchronous telehealth was previously published on an open, publicly available wiki. Log file analysis, user questionnaires and content analysis were used to collect descriptive and evaluative data on the use of the site from 9 June 2009 to 10 April 2010. Blog postings from referring sites were also analyzed. Results During the 10-month study period, there were a total of 1222 visits to the site, 3996 page views and 875 unique visitors from around the globe. Five unique visitors (0.6% of the total number of visitors) submitted a total of 6 contributions to the site: 3 contributions were made to the article itself, and 3 to the discussion pages. None of the contributions enhanced the evidence base of the scoping review. The commentary about the project in the blogosphere was positive, tempered with some skepticism. Interpretations Despite the fact that wikis provide an easy-to-use, free and powerful means to edit information, fewer than 1% of visitors contributed content to the wiki. These results may be a function of limited interest in the topic area, the review methodology itself, lack of familiarity with the wiki, and the incentive structure of academic publishing. Controversial and timely topics in addition to incentives and organizational support for Web 2.0 impact metrics might motivate greater participation in online collaborative efforts to keep scientific knowledge up to date.

BACKGROUND:Web sites with health-oriented content are potentially harmful if inaccurate or inappropriate medical information is used to make health-related decisions. Checklists, rating systems and guidelines have been developed to help people determine what is credible, but recent Internet technologies emphasize applications that are collaborative in nature, including tags and tag clouds, where site users 'tag' or label online content, each using their own labelling system. Concepts such as the date, reference, author, testimonial and quotations are considered predictors of credible content. An understanding of these descriptive tools, how they relate to the depiction of credibility and how this relates to overall efforts to label data in relation to the semantic web has yet to emerge. PURPOSE:This study investigates how structured (pre-determined) and unstructured (user-generated) tags and tag clouds with a multiple word search feature are used by participants to assess credibility of messages posted in online message forums. The targeted respondents were those using web sites message forums for disease self-management. We also explored the relevancy of our findings to the labelling or indexing of data in the context of the semantic web. METHOD:Diabetes was chosen as the content area in this study, since (a) this is a condition with increasing prevalence and (b) diabetics have been shown to actively use the Internet to manage their condition. From January to March 2010 participants were recruited using purposive sampling techniques. A screening instrument was used to determine eligibility. The study consisted of a demographic and computer usage survey, a series of usability tests and an interview. We tested participants (N=22) on two scenarios, each involving tasks that assessed their ability to tag content and search using a tag cloud that included six structured credibility terms (statistics, date, reference, author, testimonial and quotations). MORAE Usability software (version 3.1) was employed to record participants' use of the study environment. The surveys were analyzed using SPSS version 17. Interviews with participants were transcribed, coded and analyzed using thematic text analysis with the aid of NVivo8. FINDINGS:Most participants had experience with Internet resources. However, less than one quarter of this sample had seen or used tags or a tag clouds. The ways in which participants used tags to label the content posted in the message forums varied. Some participants were tagging the information for their own subsequent use, whereas others viewed this process from the perspective of others: they tagged the content in ways that they thought other users would find beneficial. Many participants did not use the structured credibility tags when asked to search for credible content. The interviews corroborated these findings by confirming participants were not considering credibility foremost when tagging. CONCLUSION:Many participants in this study focused on assessing whether the information was relevant to their current circumstances, after which they would proceed to determine its credibility by corroborating with other sources. The use of structured tags to label information may not be a useful way to encourage the use of tagging, or to indicate credibility in this context. Current applications used in the semantic web automate this process. Therefore it may be useful to engage consumers of online content, in particular health-related content, to be more directly involved in the annotation of this content.

A pesar de su atractivo teorico, el concepto de toma de decisiones compartidas en el entorno clinico aun tiene que trasladarse a la practica. En este articulo se revisa este enfoque y se sugiere una alternativa llamada ‘toma de decisiones colaborativas’, que puede conducir a obtener resultados mas equitativos y favorables.

Web sites with health-oriented content raise concerns about the potential for harm if members of the public use inaccurate or inappropriate medical advice to make health- related decisions. Checklists, rating systems and guidelines have been developed to help people determine what is credible, but recent Internet technologies emphasize applications that are collaborative in nature, such as tags and tag clouds, where a site's users 'tag' or label online content, each using their own indexing system or 'folksonomy.' These tags are then combined into tag cloud images that graphically display the relative importance or frequency of tags in an easily interpretable manner. Web users are developing tagging dialects in online environments to help themselves and one another navigate and assess the credibility and utility of information. A theoretical understanding of the key descriptive tools in this process - tagging and tag clouds - has yet to emerge. This theoretical void makes it impossible to discuss how best to evaluate and develop best practices for assessing the credibility of online information - a gap that may be particularly acute in the growing area of online health information exchange. This study investigates how tags and tag clouds are used in relation to credibility in online message forums.

The internet has been used to support and inform the lay person about health and healthcare services almost since its inception. One of the most popular elements of this is the exchange of information using electronic communications such as message boards or mailing lists. The purpose of this paper is to provide a guide for practitioners engaged in asynchronous moderating or facilitating online health communities. The paper outlines why facilitation of online support groups is important, and strategies to support these communities by promoting and maintaining participation, while outlining key characteristics of an effective facilitator. It also highlights some of the challenges involved in facilitating online environments, with emphasis on gender-related issues and 'groupthink'. Methods to evaluate these processes are also discussed. Electronic communication to support treatment decisions by patients is likely to continue to grow. As a result, so will the issues related to large groups working together. Ways to mediate and ensure equal and effective participation are an important option to support these endeavors.

Journal of Evaluation in Clinical PracticeVolume 15, Issue 4 p. 743-744 Free Access In search of health Richard Smith, Richard Smith Editor-in-Chief, Cases Journal, London, UKSearch for more papers by this authorLaura O'Grady, Laura O'Grady Postdoctoral Fellow, Centre for Global eHealth Innovation; Department of Health Policy, Management and Evaluation; Faculty of Medicine, University of Toronto; and University Health Network, Toronto, Canada M5G 2C4Search for more papers by this authorAlejandro R. Jadad, Alejandro R. Jadad Professor, Centre for Global eHealth Innovation; Department of Health Policy, Management and Evaluation; Dalla Lana School of Public Health; Faculty of Medicine, University of Toronto; and University Health Network, Toronto, Canada M5G 2C4Search for more papers by this author Richard Smith, Richard Smith Editor-in-Chief, Cases Journal, London, UKSearch for more papers by this authorLaura O'Grady, Laura O'Grady Postdoctoral Fellow, Centre for Global eHealth Innovation; Department of Health Policy, Management and Evaluation; Faculty of Medicine, University of Toronto; and University Health Network, Toronto, Canada M5G 2C4Search for more papers by this authorAlejandro R. Jadad, Alejandro R. Jadad Professor, Centre for Global eHealth Innovation; Department of Health Policy, Management and Evaluation; Dalla Lana School of Public Health; Faculty of Medicine, University of Toronto; and University Health Network, Toronto, Canada M5G 2C4Search for more papers by this author First published: 23 July 2009 https://doi.org/10.1111/j.1365-2753.2009.01263.xCitations: 2AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL We are grateful to be asked to contribute to this volume that considers – and tries to broaden – thinking on health. Our qualifications for contributing are small but need to be described. Two of us (AJ and LOG) tried to start a conversation on how health should be defined through an editorial in the BMJ, an entry in Wikipedia and a Facebook group in 2008, 60 years after the birth of the World Health Organization (WHO) [1]. The third one of us (RS) wrote a blog on 'The end of disease and the beginning of health', which is cited in the first article in this special issue and argued, somewhat flippantly, that we should think much more about health and less about disease [2]. Indeed, having a 'disease-led health system' may be increasingly counterproductive when many patients, particularly elderly ones, have multiple diseases but are concerned less about their diseases and more about personal, family and social issues. In 2002, RS also wrote: 'Is it possible to be severely disabled, in pain, close to death, and in some sense "healthy"? I believe it is'[3]. Our method in writing this piece has been to read the articles in this issue, revisit our own writings and reactions to them, and bring in other material we have been reading. Our general message is to welcome the articles in this issue, urge ongoing collaboration around the thinking about health and disease, and hope that we can move beyond the narrow confines of learned journals into a broader arena. We are unconvinced that there are any experts when it comes to debates on health, or that health could be defined. In fact, we agree with a philosopher-psychiatrist who recently said to one of us (RS): 'It's impossible to define health. It's like trying to describe time. It can't be done. It's a "higher order" question.' Most of the important things in life – love, freedom, charity – can't be operationally defined, but it's still worth attempting descriptions to deepen our understanding of these virtues. Health may be especially important to try and describe in that we are devoting huge amounts of resources to its pursuit. Are we using those resources – which might be devoted to other benefits including international aid, education, housing, and the arts – wisely? Upon review of submissions we noted that all but one of the six were single authored. This, coupled with the lack of collaboration in a previous attempt to define health [4] has led us to ponder whether this task is better suited to the individual. Or are only individuals interested in defining health? We wonder what kind of paper would have been produced if all seven of the authors had collaborated on one version. We also noted that in three of the papers the authors chose to present their ideas within the context of a particular illness (psychiatry, diabetes and environmental illness), which may limit their applicability to the overall concept of health. However, everyone who has contributed to this issue seems to agree that the first half of the infamous WHO definition of health –'a state of complete physical, mental, and social wellbeing'– is unhelpful. It is an aspiration that implies that anything less than such a state is 'unhealthy'. Most of us would be unhealthy most of the time with this definition. The other component of the definition, focused on 'the absence of disease or infirmity' may be driving countries to spend an ever increasing proportion of their resources on 'health care'. But the WHO is the world's leading health body. Should we be persuading it to rethink and adopt a more realistic definition of health? Or is it right that a United Nations body should have such a grand target, even if it is Utopian? Do we actually need a definition of health? Is it possible to define it? Could the attempt at definition be counterproductive? If the question is, 'what is the definition of health?' the answer may very well be 'it depends'. Perhaps the definition should depend on the context in which it is being used. For example, the legal definition of insanity is not the same as the medical definition. Contributors to this issue, however, seem to agree that health is definable, multidimensional and complex. Stephen Lewis [5] asks us to expand our biological concepts of health, pointing out that biology does not concentrate on individuals but on species, populations, and even gene pools. Stefan Topolski [6] suggests that 'maximum health may be represented by maximum complexity', an attractive idea except that it might imply that old age is inevitably associated with poor health. We like David Katerndahl's [7] argument that we should think of health in non-linear terms; it's perhaps one of medicine's failures that much of its theory and evidence is based on the world being linear when it isn't. Helen Cooper and Robert Geyser [8] emphasise that this failing may be aggravated by the worldwide transition from acute to chronic care, illustrating how embracing complexity theory may improve the management of patients with diabetes. Fiona Coyle illustrates how the traditional biomedical model of sickness and health cannot cope with the complexity of the poorly defined environmental illness and shows how complexity theory can help us better understand the conditon. (9)"World is crazier and more of it than we think, Incorrigbly plural," writes the poet Louis MacNeice. Recognising the role played by personal values also leads us away from the idea that there can be some global standard agreement on what constitutes health. For some people – for example, athletes and explorers – physical capacity might be essential, while for others physical capacity could be unimportant if they can read and listen to Schubert or perhaps communicate with their God. It's this recognition that we value different aspects of what might be called 'health' that undermines the concept of quality adjusted life years (QALYs) that depends on our capacity to define yet another construct – quality. In addition, there seems to be agreement among contributors to this issue that health can't be thought of as purely a property of individuals. We as individuals cannot be healthy if our families, friends, communities, countries and planet are unhealthy. This complicates any attempt at definition because it implies defining what constitutes a healthy community, country, or planet. Are communities or countries that have wide inequalities in life expectancy or infant mortality – which is most communities and countries – unhealthy? Are countries that stifle free expression healthy? Here health seems to begin to occupy some of the same territory as politics, something that many would regard as dangerous. All contributors also appear to recognize that adaptation is an important component of health. With something like the almost divine WHO definition of health we can but fall short. Yet, as Joachim Sturmberg [10] shows, people can react very differently to different insults. We can see people disabled by problems that seem minor; while others seem to have fulfilling lives while suffering very severe physical problems. And perhaps a very important component of health is how we as individuals and societies respond to death. For Epicurus and the ancients 'The art of living well and dying well are one'. Montaigne agreed: 'Death is one of the attributes you were created with; death is part of you. Your life's continual task is to build your death'. Yet as Ivan Illich argued so forcefully, modern medicine seems launched into an expensive, doomed, misguided, and 'unhealthy' campaign to defeat death. [11] Every society has created in myth its version of the nightmare of immortality accompanied by physical and mental decay, but in the western world we are creating it for real. Consider this quote from Lewis Lapham, the both wise and witty editor of Harpers: 'I know that dying is un-American, nowhere mentioned in our contractual agreement with providence, but to regard the mere fact of longevity as the supreme good – without asking why or to what end – strikes me as foolish, a misappropriation of time, thought, sentiment, electricity, and frequent-flier miles. Of the $2.4 trillion assigned last year to the care and feeding of our health-care apparatus, a substantial fraction paid the expenses of citizens in the last, often wretched, years of their lives. Who benefits from the inventory of suffering gathered in the Florida storage facilities?. . . Absent a coming to terms with death, how do we address the questions of environmental degradation and social injustice certain to denominate the misfortunes of the twenty-first century?' Ironically, it may be that the true route to health lies in us as individuals and societies developing a much healthier attitude to death, the inevitability that awaits us all. The ancients knew what we have forgotten. We may ponder the following, 'if a definition of health is said in the forest, does anyone find it useful?' Humans tend to like to label and measure. It is how we make sense of our world. However, we sometimes find ourselves in a bind when we know something exists but cannot measure it. We all know health exists, but we may never know how to define and measure it, which we may just have to accept. Although we have not had much success so far with our attempts to encourage a conversation on what is health, we urge readers of this journal to join our Facebook group and stimulate the conversation. The URL is: http://www.facebook.com/profile.php?id=727567149&v=info#/group.php?gid=51641068791 References 1 Jadad, A. R., O'Grady, L. (2008) How should health be defined? British Medical Journal, 337, a2900. 2 http://blogs.bmj.com/bmj/2008/07/08/richard-smith-the-end-of-disease-and-the-beginning-of-health/ (accessed 2 July 2009). 3 Smith, R. (2002) Spend (slightly) less on health and more on the arts. British Medical Journal, 325, 1432– 1433. 4 http://blogs.bmj.com/bmj/2008/12/10/alex-jadad-on-defining-health/ (accessed 2 July 2009). 5 Lewis, S. (2009) Seeking a new biomedical model. How evolutionary biology may contribute. Journal of Evaluation in Clinical Practice, 15 (4), 745– 748. 6 Topolski, S. (2009) Understanding health from a complex systems perspective. Journal of Evaluation in Clinical Practice, 15 (4), 749– 754. 7 Katerndahl, D. A. (2009) Lessons from Jurassic Park: patients as complex adaptive systems. Journal of Evaluation in Clinical Practice, 15 (4), 755– 760. 8 Cooper, H. C. & Geyer, R. (2009) What can complexity do for diabetes management? Linking theory to practice. Journal of Evaluation in Clinical Practice, 15 (4), 761– 765. 9 Coyle, F. (2009) 'It just doesn't seem to fit'. Environmental illness, corporeal chaos and the body as a complex system. Journal of Evaluation in Clinical Practice, 15 (4), 770– 775. 10 Sturmberg, J. P. (2009) The personal nature of health. Journal of Evaluation in Clinical Practice, 15 (4), 766– 769. 11 Illich, I. Limits to Medicine: Medical Nemesis – The Expropriation of Health. Harmondsworth, Penguin, 1977. Citing Literature Volume15, Issue4August 2009Pages 743-744 ReferencesRelatedInformation

Background: Website evaluation is a key issue for researchers, organizations, and others responsible for designing, maintaining, endorsing, approving, and/or assessing the use and impact of interventions designed to influence health and health services. Traditionally, these evaluations have included elements such as content credibility, interface usability, and overall design aesthetics. With the emergence of collaborative, adaptive, and interactive ("Web 2.0") technologies such as wikis and other forms of social networking applications, these metrics may no longer be sufficient to adequately assess the quality, use or impact of a health website. Collaborative, adaptive, interactive applications support different ways for people to interact with health information on the Web, including the potential for increased user participation in the design, creation, and maintenance of such sites. Objective: We propose a framework that addresses how to evaluate collaborative, adaptive, and interactive applications. Methods: In this paper, we conducted a comprehensive review of a variety of databases using terminology related to this area. Results: We present a review of evaluation frameworks and also propose a framework that incorporates collaborative, adaptive, and interactive technologies, grounded in evaluation theory. Conclusion: This framework can be applied by researchers who wish to compare Web-based interventions, non-profit organizations, and clinical groups who aim to provide health information and support about a particular health concern via the Web, and decisions about funding grants by agencies interested in the role of social networks and collaborative, adaptive, and interactive technologies technologies to improve health and the health system.

Web sites with health-oriented content raise concerns about the potential for harm if members of the public use inaccurate or inappropriate medical advice to make healthrelated decisions. Checklists, rating systems and guidelines have been developed to help people determine what is credible, but recent Internet technologies emphasize applications that are collaborative in nature, such as tags and tag clouds, where a site’s users ‘tag’ or label online content, each using their own indexing system or ‘folksonomy.’ These tags are then combined into tag cloud images that graphically display the relative importance or frequency of tags in an easily interpretable manner. Web users are developing tagging dialects in online environments to help themselves and one another navigate and assess the credibility and utility of information. A theoretical understanding of the key descriptive tools in this process - tagging and tag clouds - has yet to emerge. This theoretical void makes it impossible to discuss how best to evaluate and develop best practices for assessing the credibility of online information – a gap that may be particularly acute in the growing area of online health information exchange. This study investigates how tags and tag clouds are used in relation to credibility in online message forums.

BACKGROUND:Internet-based applications, in particular those that allow communication, have great potential to meet information needs. Limited research has indicated that people with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS; PHAs) use these technologies, but it has not yet been examined how resources are used collaboratively and in conjunction with offline sources.OBJECTIVES:The purpose of this study was to determine in what ways PHAs collaborate to meet treatment information needs and what role Internet-based computer-mediated communication (CMC) played in meeting this goal.METHODS:This exploratory study was implemented using surveys and focus groups with 23 participants in Toronto, Canada. The purposive sample included men and women.RESULTS:A variety of both off- and online resources were used to learn about HIV/AIDS treatment information, including web-based and print. All participants were communicating with others, primarily in person, and most desired anecdotal treatment information. However, few reported using CMC to accomplish this goal. Harris and Dewdney's Principles of Information Seeking was used to frame the findings.CONCLUSIONS:Despite technical proficiency with CMC, few participants in this study reported use of this communication tool. Information professionals need to ensure access to HIV health information including those in remote areas who have fewer resources.

Join a global conversation at http://blogs.bmj.com/bmj/2008/12/10/alex-jadad-on-defining-health/

Almost since its inception, the Internet has been used by ordinary people to connect with peers and to exchange health-related information and support. With the rapid development of software applications deliberately designed to facilitate social interaction, a new era is dawning in which patients and their loved ones can collaboratively build knowledge related to coping with illness, while meeting their mutual supportive care needs in a timely way, regardless of location. In this article, we provide background information on the use of "one-to-one" (for example, e-mail), "one-to-many" (for example, e-mail lists), and "many-to-many" (for example, message boards and chat rooms, and more recently, applications associated with Web 2.0) computer-mediated communication to nurture health-related social networks and online supportive care. We also discuss research that has investigated the use of social networks by patients, highlight opportunities for health professionals in this area, and describe new advances that are fuelling this new era of collaboration in the management of cancer.

Background First generation Internet technologies such as mailing lists or newsgroups afforded unprecedented levels of information exchange within a variety of interest groups, including those who seek health information. With emergence of the World Wide Web many communication applications were ported to web browsers. One of the driving factors in this phenomenon has been the exchange of experiential or anecdotal knowledge that patients share online, and there is emerging evidence that participation in these forums may be having an impact on people's health decision making. Theoretical frameworks supporting this form of information seeking and learning have yet to be proposed. Results In this article, we propose an adaptation of Kolb's experiential learning theory to begin to formulate an experiential health information processing model that may contribute to our understanding of online health information seeking behaviour in this context. Conclusion An experiential health information processing model is proposed that can be used as a research framework. Future research directions include investigating the utility of this model in the online health information seeking context, studying the impact of collaborating in these online environments on patient decision making and on health outcomes are provided.

BACKGROUND:Members of the HIV/AIDS community are known to use web-based tools to support learning about treatment issues. Initial research indicated components such as message forums or web-based documentation were effectively used by persons with HIV/AIDS. Video has also shown promise as a technology to aid consumer health education. However, no research has been published thus far investigating the impact of web-based environments combining these components in an educational workshop format.METHODS:In this qualitative study HIV/AIDS community members provided feedback on an integrated web-based consumer health education environment. Participants were recruited through organizations that serve the HIV/AIDS community located in Toronto, Canada. Demographics, data on Internet use, including messages exchanged in the study environment were collected. A group interview provided feedback on usability of the study environment, preferences for information formats, use of the message forum, and other sources for learning about treatment information.RESULTS:In this pilot study analysis of the posted messages did not demonstrate use for learning of the workshop content. Participants did not generally find the environment of value for learning about treatment information. However, participants did share how they were meeting these needs. It was indicated that a combination of resources are being used to find and discuss treatment information, including in-person sources.CONCLUSION:More research on the ways in which treatment information needs are being met by HIV/AIDS community members and how technology fits in this process is necessary before investing large amounts of money into web-based interventions. Although this study had a limited number of participants, the findings were unexpected and, therefore, of interest to those who intend to implement online consumer health education initiatives or interventions.

Objectives: The purpose of the paper was to determine appropriate terminology, criteria, implementation, and develop a theoretical framework by which credibility in health care web sites can be depicted. Future research directions for evaluating credibility in health care web sites was also discussed.Method: A comprehensive literature review of published articles, policy papers, and grey literature using relevant search terms was conducted. Sources for articles reviewed included MEDLINE (from 1966 to present), PsycINFO (from 1840 to present), ERIC (from 1966 to present), and the Association for Computing Machinery (ACM) databases. The Web of Science citation service was continuously searched using a subscription service from 2002 to 2004. The search engine Google was also implemented.Results: A common term, credibility, was purposed for use in this context. A comprehensive set of credibility criteria, presented within a theoretical framework was also developed. Implementation by means of a browser-based graphic icon was purposed.Conclusions: Relevancy and readiness of the purposed common terminology, criteria, and implementation within the theoretical framework must be further researched. More knowledge of consumers' behaviour regarding use of online health content and collaboration with others when implementing such information should be considered in future research. (c) 2005 Elsevier Ireland Ltd. All rights reserved.

Vast amounts of consumer-based health care information are widely available on the World Wide Web. However, for some this material is inaccessible due to reliance on specialized computer equipment or software known as assistive technology. These tools, designed for people with sensory, physical, or learning disabilities, act as a median to interpret Web pages in accessible ways. Unfortunately, many websites, including those with health-related content are not designed to accommodate this equipment. No research has yet been published examining the extent of this problem in Canadian consumer-oriented health care sites. The purpose of this study was to investigate the percentage of accessible consumer-based health care websites of Canadian origin. A listing of such sites was randomly sampled for study inclusion. Each was assessed for accessibility based on the World Wide Web Consortium (W3C) Web Accessibility Initiative (WAI) Web Content Accessibility Guidelines (WCAG) 1.0 using the validation software Bobby™. The results indicated that only about 40% of pages investigated were free of errors in accordance with WCAG 1.0 Priority 1 level. Websites should be constructed in compliance with these standards to better accommodate those using assistive devices.

Use of the World Wide Web (web) to distribute health care material has steadily increased in recent years. However, potentially detrimental health issues can arise when either accurate information is used inappropriately or when inaccurate information is assumed to be correct and implemented. Causes for this problem include the ease with which anyone can present health care material on the web. A rating system in the form of a graphic seal denoting the source as credible is one way to help the average site user discern the relative quality of information presented at a web site. Preliminary research on the effectiveness of this method has been inconclusive. The research outlined in this document will investigate a rating scheme within the context of a web credibility theoretical framework. The goal is to move towards a means of depicting credibility that is more usable as health information on the web becomes increasingly accessed around the world.