eHealth, health literacy, heart failure, Internet, patient education



  1. Cajita, Maan Isabella BSN, RN-BC
  2. Rodney, Tamar MSN, RN
  3. Xu, Jingzhi BSN, RN
  4. Hladek, Melissa MSN, RN
  5. Han, Hae-Ra PhD, RN, FAAN


Background: The ubiquity of the Internet is changing the way people obtain their health information. Although there is an abundance of heart failure information online, the quality and health literacy demand of these information are still unknown.


Objective: The purpose of this study is to evaluate the quality and health literacy demand (readability, understandability, and actionability) of the heart failure information found online.


Methods: Google, Yahoo, Bing,, and DuckDuckGo were searched for relevant heart failure Web sites. Two independent raters then assessed the quality and health literacy demand of the included Web sites. The quality of the heart failure information was assessed using the DISCERN instrument. Readability was assessed using 7 established readability tests. Finally, understandability and actionability were assessed using the Patient Education Materials Assessment Tool for Print Materials.


Results: A total of 46 Web sites were included in this analysis. The overall mean quality rating was 46.0 +/- 8.9 and the mean readability score was 12.6 grade reading level. The overall mean understandability score was 56.3% +/- 16.2%. Finally, the overall mean actionability score was 34.7% +/- 28.7%.


Conclusions: The heart failure information found online was of fair quality but required a relatively high health literacy level. Web content authors need to consider not just the quality but also the health literacy demand of the information found in their Web sites. This is especially important considering that low health literacy is likely prevalent among the usual audience.