title: Reading level of privacy policies on Internet health Web sites.
abstract: OBJECTIVE
  Most individuals would like to maintain the privacy of their medical information on the World Wide Web (WWW). In response, commercial interests and other sites post privacy policies that are designed to inform users of how their information will be used. However, it is not known if these statements are comprehensible to most WWW users. The purpose of this study was to determine the reading level of privacy statements on Internet health Web sites and to determine whether these statements can inform users of their rights.
  
  
  METHODS
  This was a descriptive study. Eighty Internet health sites were examined and the readability of their privacy policies was determined. The selected sample included the top 25 Internet health sites as well as other sites that a user might encounter while researching a common problem such as high blood pressure. Sixty percent of the sites were commercial (.com), 17.5% were organizations (.org), 8.8% were from the United Kingdom (.uk), 3.8% were United States governmental (.gov), and 2.5% were educational (.edu).
  
  
  METHODS
  The readability level of the privacy policies was calculated using the Flesch, the Fry, and the SMOG readability levels.
  
  
  RESULTS
  Of the 80 Internet health Web sites studied, 30% (including 23% of the commercial Web sites) had no privacy policy posted. The average readability level of the remaining sites required 2 years of college level education to comprehend, and no Web site had a privacy policy that was comprehensible by most English-speaking individuals in the United States.
  
  
  CONCLUSIONS
  The privacy policies of health Web sites are not easily understood by most individuals in the United States and do not serve to inform users of their rights. Possible remedies include rewriting policies to make them comprehensible and protecting online health information by using legal statutes or standardized insignias indicating compliance with a set of privacy standards (eg, "Health on the Net" [HON] http://www.hon.ch).
authors.affiliation: Department of Family Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52246, USA. mark-grader@uiowa.edu
authors.forename: Mark A
authors.initials: MA
authors.lastname: Graber
authors.forename: Donna M
authors.initials: DM
authors.lastname: D'Alessandro
authors.forename: Jill
authors.initials: J
authors.lastname: Johnson-West
mesh_terms: D003219:Confidentiality; D006801:Humans; D020407:Internet; D011932:Reading; D006113:United Kingdom; D014481:United States