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Effect of feedback on the quality of suicide prevention websites: randomised controlled trial

  • Anthony F. Jorm (a1), Julie-Anne Fischer (a1) and Elizabeth Oh (a1)

Summary

There is concern regarding the quality of information about mental health problems on the internet. A trial was carried out to see whether sending feedback to website administrators about the quality of information on their website would lead to an improvement (ACTRN12609000449235). Fifty-two suicide prevention websites were identified by means of an online search. The quality of information about how to help someone who is suicidal was scored against expert consensus guidelines. Websites were randomised to receive feedback or serve as controls. The information on the websites varied greatly in quality. However, feedback did not lead to an improvement.

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Copyright

Corresponding author

Anthony F. Jorm, Orygen Youth Health Research Centre, Locked Bag 10, Parkville, Victoria 3052, Australia. Email: ajorm@unimelb.edu.au

Footnotes

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Declaration of interest

None.

Footnotes

References

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Effect of feedback on the quality of suicide prevention websites: randomised controlled trial

  • Anthony F. Jorm (a1), Julie-Anne Fischer (a1) and Elizabeth Oh (a1)

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Effect of feedback on the quality of suicide prevention websites: randomised controlled trial

  • Anthony F. Jorm (a1), Julie-Anne Fischer (a1) and Elizabeth Oh (a1)
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eLetters

Response to Pattanayak

Anthony F Jorm, Professorial Fellow
11 August 2010

The point of our study was to see whether a very simple, cheap feedback intervention might work to improve quality of website information. Clearly, it either did not work or the effect was small. It is quite possible that more elaborate feedback interventions might work. This needs to be tested. However, if these were to work, would they be of any practical use? Is anyone going to go to the trouble of routinely monitoring website quality and personally contacting website developers togive them feedback? Who would fund this sort of work? There is also the related issue of who would resource website owners to carry out substantial revisions. In this regard, it is interesting that after our trial was over, one website administrator wrote to us saying that they hadnow revised their website in response to our feedback. The reason they cited for the delay is the limited resources they had as a non-government organisation.

Readers of our article may be interested in another study on feedbackwhich only came to our attention after our trial was completed. This was amuch larger randomised controlled trial (N = 299 URLs) from the field of pharmacology and gave feedback on quality of information on the drug sildenafil. Like our trial, this one found no effect of emailed feedback letters.

Reference

Martin-Facklam M, Kostrzewa M, Martin P, Haefeli WE. Quality of drug information on the World Wide Web and strategies to improve pages with poor information quality. An intervention study on pages about sildenafil.Br J Clin Pharmacol 2003; 57: 80-5.
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Conflict of interest: None Declared

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Failure to communicate effectively or failure of feedback?

Raman D Pattanayak, Senior Research Associate
03 August 2010

In reference to the recently published study 1, we do not agree with the use of e-mail as a sole medium to provide feedback to the website administrators. The electronic communication by an unknown, unexpected source has high chances of ending up in the spam box and going unnoticed by the concerned person. Sending it on a letterhead or with a university logo could not have added enough authenticity to a suspicious looking mail, given that we are all a little wary of opening mails, let alone attachments, received from unknown senders. Further, the person at the receiving end may have lacked the expertise to decipher it as a genuine feedback. A lack of acknowledgement of the receipt by a large proportion of websites makes us wonder if the results should be interpreted as a human failure or a technical failure. An alternate medium could have been a fully addressed, official communication posted or couriered personally to the administrator, with a formal acknowledgement of the receipt. Another medium could have been a follow-up on telephone confirming the acknowledgement of the e-mail. But an essential component of feedback to be successfully conveyed is the surety that the message reached out to the receiver, that message was in the least received, if not appreciated, or acted upon. To the author’s statement “…this trial can be seen as an effectiveness rather than an efficacy trial, because it evaluated feedback under realistic conditions.”, we wish to say that generally speaking, the effectiveness ofan intervention is meaningful after the efficacy has been established. While there was an attempt to provide feedback, we felt that the one-time sending of an electronic communication is neither complete nor strong enough an effort at feedback and realistically speaking, is likely to go unnoticed. The study, however, highlights an important point regarding the poor quality of most websites concerning serious medical or public health matters. While the quacks or uncertified self claimed experts can be prosecuted under law, we have ample number of websites promising help for suicidal persons, but failing to deliver on the quality or extent of information available to the help-seekers (2). There is a need for regulation or a mandatory professional certification of the content of websites, especially in such matters where life can be at stake. Short of that, there is a need to plan interventions for suicide help websites which are readily acceptable and effective in ensuring a positive change in content of these websites. Reference:1.Jorm AF, Fischer JA, Oh E. Effect of feedback on the quality of suicideprevention websites: randomised controlled trial. British J Psychiatry 2010; 197: 73-74 2.Van Ballegooijen W, van Spijker BA, Kerkhof AJ. The quality of online suicide prevention in the Netherlands and Flanders in 2007. (Article in Dutch). Tijdschr Psychiatr. 2009;51(2):117-122 ... More

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