title: Content and quality of information websites about congenital heart defects following a prenatal diagnosis.
abstract: BACKGROUND
  Pregnant women and their partners use the Internet to search for information following a prenatal diagnosis of congenital heart defect.
  
  
  OBJECTIVE
  Our aim was to explore central subjects of content and to assess the accessibility, reliability, usability, and quality of written information on publicly available information websites about congenital heart defects following a prenatal diagnosis.
  
  
  METHODS
  Following searches on Bing and Google, we included websites containing patient information in English. Hits ranged from 340,000-67,500,000 and the first 50 hits from each search were screened for inclusion (N=600). Of these hits, 39.3% (236/600) were irrelevant. A total of 67 websites were included, of which 37% (25/67) were affiliated with independent information websites, 25% (17/67) with charity/private organizations, 25% (17/67) with hospitals/clinics, and 13% (8/67) had other affiliations. The majority of the websites (76%, 51/67) could not be attributed to an author. A manifest content analysis was performed to explore central subjects of content. The DISCERN instrument was used to assess the quality of information, and the LIDA tool was used to assess accessibility, usability, and reliability of the included websites.
  
  
  RESULTS
  The content on the majority of the websites included care and treatment of children with congenital heart defects (88%, 59/67), causes of congenital heart defects (88%, 59/67), symptoms of congenital heart defects (85%, 57/67), prevalence of congenital heart defects (81%, 54/67), potential complications of congenital heart defects (75%, 50/67), prenatal diagnostics/screening methods (72%, 48/67), and specific congenital heart defects (72%, 48/67), whereas less than 10% included information about termination of pregnancy (6%, 4/67), care during pregnancy (5%, 3/67), and information specifically directed to partners (1%, 1/67). The mean of the total DISCERN score was 27.9 (SD 9.7, range 16-53). According to the instrument, a majority of the websites were categorized as very poor regarding information about effects of no treatment (88%, 59/67), support for shared decision making (85%, 57/67), achievement of its aims (84%, 56/67), explicit aims (82%, 55/67), risks of each treatment (82%, 55/67), how treatment choices affect overall quality of life (76%, 51/67), and areas of uncertainty (76%, 51/67). The mean of the total LIDA score was 92.3 (SD 13.1, range 61-127). According to the tool, a majority of the websites were categorized as good with regard to registration (97%, 65/67) and browser test (75%, 50/67), whereas a majority were categorized as poor with regard to currency (87%, 58/67), content production (84%, 56/67), and engagability (75%, 50/67).
  
  
  CONCLUSIONS
  Difficulties in finding relevant information sources using Web search engines and quality deficits on websites are an incentive for health professionals to take an active part in providing adequate and reliable information online about congenital heart defects.
authors.affiliation: Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden. tommy.carlsson@pubcare.uu.se.
authors.forename: Tommy
authors.identifier: http://orcid.org/0000-0003-4141-8692
authors.initials: T
authors.lastname: Carlsson
authors.forename: Gunnar
authors.identifier: http://orcid.org/0000-0003-1619-0171
authors.initials: G
authors.lastname: Bergman
authors.forename: Anna-Malin
authors.identifier: http://orcid.org/0000-0002-5618-9573
authors.initials: AM
authors.lastname: Karlsson
authors.forename: Elisabet
authors.identifier: http://orcid.org/0000-0001-5104-1281
authors.initials: E
authors.lastname: Mattsson
keywords: Internet; consumer health information; heart defects, congenital; prenatal diagnosis