Medical Reconciliation
Emir7
ReviewofMCDoHWebsite_10062022.pdf
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Review of Madison County Department of Health Website
INTRODUCTION Health literacy is defined as the degree to which a person can locate, comprehend, and make use of information and services to support health-related decisions and actions for themselves and others.1 Most individuals in the United States have little health literacy. According to the 2003 National Assessment of Adult Literacy (NAAL) survey, 35% of the US population had basic and below-basic health literacy, while 53% had an intermediate health literacy level.2 Examples of Health Literacy Level are:
1. Below Basic – Reading a brief set of instructions and recognizing the acceptable liquid foods to consume prior to a medical examination.2
2. Basic – Give two reasons for why a person with no symptoms should get tested for a disease after reading a flyer.2
3. Intermediate – Determine the best time to take the medication by reading the directions on the prescription.2
People with low health literacy have difficulty understanding complex health information and identifying services available, and therefore, are more likely to make poor health decisions.3 The internet has quickly become one of the most popular sites for younger generation to look for health-related information and the use of it as a source of health information increased from 37.3 percent to 67.9 percent between 2010 and 2014.4 In addition, social media has become a source of public health education given its capacity to remove physical boundaries that has previously limited access to healthcare services and resources.3,5 As a result, the quality in which health information is presented online is a top concern amongst public health professionals and the medical community.3,5 This literature review will discuss two major criteria for website design through a public health lens.
REVIEW OF LITERATURE The two major criteria for website design are website reliability and website usability.3 WEBSITE RELIABILITY: Website reliability is the most important indicator in designing a website. It refers to accuracy and credibility of the website content.3 Criteria for website reliability include
a. Identity b. Purpose
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c. Privacy d. Content updating e. Quality of information
a. Identity
A well-designed website should outline the identity of the organization/agency. Identity includes name, street address, and contact details of the organization responsible for the website.3 Madison County Department of Health has all these details mentioned on the homepage of their website.6
Name - Madison County Department of Health Street address – Building 5, 138 N Court Street, Wampsville, NY 13163
Phone number – 315-366-2361 Email - [email protected]
b. Purpose
A well-designed website should state the mission of the organization on the home page of their website.3 The mission of Madison County Department of Health (MCDOH) is to protect and enhance the health of the community.6
Figure 1: Mission of Madison County Department of Health6
c. Privacy
Protecting the personal information of the community members should be a top priority. It becomes crucial to have a privacy policy page with information on what health information is collected/protected and with whom it is shared.3 The Health Insurance Portability and Accountability Act (HIPAA) of 1996 protects the privacy and security of community health information.7 Prior to HIPAA, there was no act to protect the health information. To protect the health information of a patient, HIPAA has a privacy rule and a security rule.7 The privacy rule protects the individuals’ medical records and other private health information and applies to health plans and electronic health care transactions.7 The Rule establishes limits and criteria on the uses and disclosures of protected health information that may be made without a person's consent. It also mandates proper protections to preserve the privacy of such information.7 A covered entity that creates, receives, uses, or maintains electronic
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personal health information about people must adhere to national security regulations set out under the HIPAA Security Rule.7 To guarantee the confidentiality, integrity, and security of electronic protected health information, the Security Rule mandates the use of the proper administrative, physical, and technical protections.7
MCDOH has a privacy policy tab at the bottom of their homepage, but the tab leads to an empty page with no privacy policies mentioned.6
Figure 4 depicts that Privacy policies are presented under see through Madison Health Insurance Portability and
Accountability Act notice of privacy practices. This page states that any health care/treatment related information such as name, address, birth date, contact number, social security number, medical history, and other information collected is maintained in records and protected.6 This personal information may be shared with medical staff, such as interns, physicians, and nurses,
to offer the essential care and services, as well as with government and insurance organizations to process payments.6 Organization of the policies on the Madison County website could be confusing for people to access information. So, organizing all the information under privacy policies tab might be simpler and easier.
Figure 2: Homepage of MCDOH with privacy policy tab on the bottom of the page6
Figure 3: Privacy policy page of MCDOH6
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Figure 4: HIPAA guidelines with privacy practices on Madison County Department website6
Figure 5, 6, and 7 depicts that departments like Florida Health, King County Public Health Department, and Washington State Department of Health have a privacy policy tab at the bottom of their homepage with all the policies organized under it.8,9,10
https://kingcounty.gov/depts/health.aspx
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Figure 5: Homepage of King County Health Department with privacy policy tab on the bottom of the page8
https://www.floridahealth.gov/
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Figure 6: Homepage of Florida Health Department with privacy policy tab on the bottom of the page9
https://doh.wa.gov/node/8511
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Figure 7: Homepage of Washington Department of Health with privacy policy tab on the bottom of the page10
d. Content Updating
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A reliable website regularly updates website content with the most up-to-date health information, alerts, and guidelines. Each webpage should have health content created date, content reviewed/revised date, along with copyright date if applicable.3
MCDOH does a poor job being consistent with dates on webpage content. The publication date of each health article at MCDOH website is noted, although not on every page.6 Example includes:
https://www.madisoncounty.ny.gov/DocumentCenter/View/9721/ACES-FINAL- DRAFT_Updated10JULY2019?bidId=
Some of the health departments provide a great example of content updating. For example, Centers for Disease Control and Prevention (CDC) has the publication date/year on each page of health content and King County has content updated date on the website page. For example, https://www.cdc.gov/vaccines/parents/downloads/parent-ver-sch-0-6yrs.pdf https://kingcounty.gov/depts/health.aspx
e. Quality of information
A well-designed website should have relevant and consistent information for the target audience.11 For example, the homepage must include continuous updates, alerts, guidelines, and key information of health issues. Websites should also have convergence of information across different sources like Centers for Disease Control and Prevention (CDC) and the state department websites.11 MCDOH has relevant health information with health programs and services provided.6 Their website also contains information about 2022 Rabies Vaccination Clinics, Food Safety Recalls, Monkeypox, and 2022 Opioid Epidemic Report, which are the current health issues.6 The website presents content adapted from reliable sources of information, such as the CDC and New York State Department of Health (NYSDOH), which makes the website reliable. For example:
1. NYS Sanitary Code, Subpart 5-1 Public Water Systems – under Water and Sewer public systems.
2. Centers for Disease Control and Prevention (CDC) – under E. coli.
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WEBSITE RELIABILITY
Criteria Aspects in which Madison County has done well
Aspects in which Madison County could make changes
Identity Name - Madison County Department of Health Street address – Building 5, 138 N Court Street, Wampsville, NY 13163 Phone number – 315-366-2361 Email - [email protected]
N/A
Purpose The mission of Madison County Department of Health is to protect and enhance the health of the community.
N/A
Privacy The privacy policy page of Madison County Department states that any health care/ treatment related information such as name, address, birth date, contact number, social security number, medical history, and other information are collected.
The collected information is maintained in records and protected. This personal information may be shared with medical staff, such as interns, physicians, and nurses, to offer the essential care and services, as well as with government and insurance organizations to process payments.
MCDOH has a privacy policy tab at the bottom of their homepage, but the tab leads to an empty page with
no privacy policies mentioned. Privacy policies are presented under
see through Madison Health Insurance Portability and Accountability Act notice of privacy practices. This could be confusing for people to access information. So, organizing all the information under privacy policies tab on homepage of the website might be simpler and easier.
Content updating
N/A
MCDOH does a poor job being consistent with dates on webpage content. The publication date of each health article at MCDOH website is noted, although not on every page. It is recommended to have publication date, month, and year on each page of the health article published on the website.
It is also advised to include content updated date on the website page.
Quality of information
MCDOH has relevant and consistent health information with health programs
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and services provided. Their website also contains information about 2022 Rabies Vaccination Clinics, Food Safety Recalls, Monkeypox, and 2022 Opioid Epidemic Report, which are the current health issues.
The website presents content adapted from reliable sources of information, such as the CDC and New York State Department of Health (NYSDOH), which makes the website reliable.
N/A
WEBSITE USABILITY: Website usability refers to quality and ease of website usage.3 It is a way of designing that focuses on the users’ needs. Criteria for website usability include
a. Information architecture b. Site design c. Content design
a. Information Architecture
Information architecture refers to organization of information on the website. 1. The text size and style should be legible and consistent throughout the website, along
with content categories labelled clearly.9 Figure 8 depicts the programs and services of MCDOH. The text size and style in Figure 1 is legible and consistent.6
Figure 8: Programs and services of Madison County Department of Health6
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2. All related health topics should be grouped together. Websites that are user friendly do not overload the website with content. It is easier for users to navigate the website when health-related information is organized alphabetically.3 Figure 9 depicts the health information of MCDOH, and the health-related topics are grouped alphabetically on their website, making it easier for the users to search for information.6
Figure 9: Health information of Madison County Department of Health6
3. Highlight the links on web pages12,5 – Links from external sources like CDC and state departments should be either underlined or colored. Figure 10 depicts information about monkeypox on MCDOH website. Their website has links from external sources like New York State Department of Health, CDC, and WHO. All the links are colored and underlined in red to enhance the user experience.6
Figure 10: Monkeypox information on Madison County Department of Health6
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4. A frequently asked questions (FAQs) tab provides users with quick and simple answers to common questions in an organized and structured manner.3 MCDOH has a COVID-19 FAQ tab which provides information about Excelsior Pass, a digital proof of COVID-19 vaccination.6 There is no other FAQ section for any other health related information and the MCDOH should consider adding an FAQ section for other health queries.6
Figure 11: COVID-19 Vaccination FAQ tab on Madison County Department of Health website6
b. Site Design
Site design refers to navigation of information on the website.3 One of the primary reasons why visitors abandon a website is poor navigation. Therefore, it is important to evaluate navigational elements for designing a website.
1. Search functionality5 – It is one of the most important navigational elements because users tend to resort to search bar if they cannot locate the information they are looking for. Advanced search options allow visitors to refine search queries through selection of parameters. MCDOH website has a search bar on the homepage to search for any health-related information or queries.6
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Figure 12: Search functionality of Madison County Department of Health website6
2. Integrate chatbots5 – A chatbot is an interactive chat interface that is designed to be
used by web users. They are designed to closely resemble human behavior and engage in interaction with website visitors. They are available to answer visitors’ queries 24/7. MCDOH does not have a chatbot feature. Incorporating this feature on the website would increase the usability of the website.
3. To provide a more streamlined user experience, minimize vertical scrolling and download delays, and ensure that the back button functions properly.3 MCDOH has been consistent with these navigational features making the website reliable and usable.
4. Expandable boxes and clickable list of contents5 – These navigation features should
have a title that best describes content of the expandable boxes. They provide additional information about the health topic (to the users who are interested in learning more). Madison County Department of Health has “Read on” expandable text that provides more information about health issue. It also includes a clickable list of contents.6 For example,
Figure 13: 2022 Rabies Vaccination Clinic information on MCDOH website6
Clickable list of contents on MCDOH website -
https://www.madisoncounty.ny.gov/2641/General-Information
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c. Content Design Content design refers to interaction of users with website content.3 Content must be designed according to the target audience.3 Using simple language and minimizing technical terms enhances user interaction.3 MCDOH has been consistent with simple language usage, making the information readable and understandable for the target audience.6
WEBSITE USABILITY Criteria Aspects in which Madison County has
done well Aspects in which Madison County
could make changes
Information architecture The text size and style in MCDOH website is legible and consistent.4
The health-related topics on MCDOH website are grouped alphabetically, making it easier for the users to search for information.4
MCODH website has links from external sources like New York State Department of Health, CDC, and WHO. All the links are colored and underlined in red to enhance the user experience.
MCDOH has a COVID-19 FAQ tab which provides information about Excelsior Pass, a digital proof of COVID-19 vaccination.
There is no other FAQ section for any other health related information and the MCDOH should consider adding an FAQ section for other health queries.
Site design MCDOH website has a search bar on the homepage to search for any health-related information or queries.
MCDOH has been consistent with navigational features like minimizing vertical scrolling, download delays, making the website reliable and usable.
Madison County Department of Health has “Read on” expandable text that provides more information about health issue. It also includes a clickable list of contents.
MCDOH does not have a chatbot feature. Incorporating this feature on the website would increase the usability of the website.
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Content design MCDOH has been consistent with using simple language, making the information readable and understandable for the target audience.
N/A
HEALTH INFORMATION ON THE WEBSITE
Topic Area Page Link and links that do not work Date of revision
Reading level Local Data Sources are
available Adverse Childhood Experiences (ACEs)
https://www.madisoncounty.ny.gov/2454/Adverse- Childhood-Experiences-ACEs Links that do not work - https://www.pacesconnection.com/g/resource- center/blog/parent-handouts https://pediatriesociale.fondationdrjulien.org/wp- content/uploads/2017/05/CYW_ACEQ_UserGuide.pdf
No Grade 11-12 Yes, the page has a link to Madison County’s ACEs profile
Yes
Algal Blooms and Health
https://www.madisoncounty.ny.gov/1614/Algae-Blooms- Health All the links work.
No Grade 6-9
No, the page only has NY state data
Yes
Animals in Public Setting
https://www.madisoncounty.ny.gov/quicklinks.aspx?CID=110 9 All the links work.
No The page has data and links from external sources and is not in particular about Madison County.
No, has country data.
Yes, in the external links
Bat Rabies https://www.madisoncounty.ny.gov/1694/Rabies All the links work.
No Grade 8 No, has NYS data
Yes
Bed Bugs https://www.madisoncounty.ny.gov/1624/Bed-Bugs All the links work.
No Grade 7 No, has data from other sources
Yes
Blue-Green Algae
https://www.madisoncounty.ny.gov/1614/Algae-Blooms- Health Same as Algal Blooms and Health
- - - -
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Carbon Monoxide
https://www.madisoncounty.ny.gov/1634/Carbon-Monoxide All the links work.
No Grade 9 No, has data from other sources
Yes
Community Economic Developmen t and Health
https://www.madisoncounty.ny.gov/1635/Community- Economic-Development-Health All the links work.
No Grade 11-12
Yes, has local data. A Healthy Design for Madison County: Primer for Smart Growth (PDF)
Yes
COVID-19
https://www.madisoncounty.ny.gov/2479/COVID-19 All the links work.
No College level No. Has links to CDC and NYS COVID- 19 data tracker.
Yes
Dental Health and Water Fluoridation
https://www.madisoncounty.ny.gov/1668/Fluoridation-of- Water All the links work.
No Grade 12 – College
Has very minimal local data.
Yes
E. coli https://www.madisoncounty.ny.gov/1643/E-coli All the links work.
No Grade 11-12 No local data. Has only country and NYS data.
Yes
EEE https://www.madisoncounty.ny.gov/1642/Eastern-Equine- Encephalitis All the links work.
No Grade 8 Includes 2022 Mosquito- Borne Disease Surveillance Data
Yes
Enteroviruse s
https://www.madisoncounty.ny.gov/1644/Enterovirus All the links work.
No Grade 9 No Yes
Flood Response and Recovery
https://www.madisoncounty.ny.gov/1647/Flood-Response- Recovery All the links work.
No Grade 8-9 No Yes
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Flu https://www.madisoncounty.ny.gov/1679/Influenza All the links work.
No Grade 8 Has Madison County Disease Surveillance Data
Yes
Fluoridation of water
https://www.madisoncounty.ny.gov/1668/Fluoridation- of-Water Same as Dental Health and Water Fluoridation.
- - - -
Food Safety https://www.madisoncounty.ny.gov/quicklinks.aspx?CID =1124 All the links work.
No The page has only links from external sources.
No local data. Yes
Gas Drilling https://www.madisoncounty.ny.gov/1672/Gas-Drilling All the links work.
No The page has only links from external sources.
No local data Yes
Healthy Homes
https://www.madisoncounty.ny.gov/2867/Healthy- Homes All the links work.
No Grade 5-6 No Yes
Health Literacy
https://www.madisoncounty.ny.gov/1673/Literacy- Health-Literacy All the links work.
No Grade 11 Yes, in Madison County Literacy Needs Assessment
Yes
Heat Illness (Stroke)
https://www.madisoncounty.ny.gov/1675/Heat-Illness- Sunstroke All the links work.
No Grade 9 Yes, has a list of cooling centers in Madison County.
Yes
Hypothermia and Frostbite
https://www.madisoncounty.ny.gov/quicklinks.aspx?CID =1130 All the links work.
No The page has only links from external sources.
No Yes
Influenza (Flu)
https://www.madisoncounty.ny.gov/1679/Influenza Same as Flu
- - - -
Lead https://www.madisoncounty.ny.gov/quicklinks.aspx?CID =1132 All the links work.
No College Yes, includes a childhood lead poisoning prevention
Yes
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program in Madison County.
Legionella https://www.madisoncounty.ny.gov/1683/Legionella All the links work.
No College graduate No Yes
Lyme Disease https://www.madisoncounty.ny.gov/1684/Lyme-Disease All the links work.
No Grade 6 Yes, this page includes a Madison County Lyme Disease health profile
Yes
Methicillin- Resistant Staphylococc us Aureus
https://www.madisoncounty.ny.gov/1689/Methicillin- Resistant-Staphylococcus-Aur All the links work.
No College graduate and above
No Yes
Mosquito- Borne Diseases
https://www.madisoncounty.ny.gov/1663/Mosquito- Borne-Diseases All the links work.
No Grade 9-10 Includes 2022 Mosquito- Borne Disease Surveillance Data
Yes
Norovirus https://www.madisoncounty.ny.gov/1690/Norovirus All the links work.
No College No Yes
Obesity https://www.madisoncounty.ny.gov/1691/Obesity- Overweight All the links work.
No College Yes, this page includes a Madison County Health Profile.
Yes
Opioids and Heroin
https://www.madisoncounty.ny.gov/2876/Opioids- including-Heroin-Prescription-Dr# All the links work.
No College graduate and above.
Yes, this page includes Madison County health data.
Yes
Pertussis https://www.madisoncounty.ny.gov/1693/Pertussis- Whooping-Cough All the links work.
No Grade 8-10 No Yes
Rabies https://www.madisoncounty.ny.gov/1694/Rabies Same as Bat Rabies
- - - -
Radon https://www.madisoncounty.ny.gov/1695/Radon All the links work.
No Grade 8-9 Website just contains a graphic of percent of houses tested for radon.
Yes
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Sexually Transmitted Infections
https://www.madisoncounty.ny.gov/quicklinks.aspx?CID=1119 All the links work.
No This page has only links from external sources
No local data Yes
Substance use - Alcohol, Tobacco, and other Drugs
https://www.madisoncounty.ny.gov/1676/Substance-Use- Alcohol-Tobacco-and-Other- All the links work.
No Grade 12 Yes, local data for each substance type.
Yes
Sunstroke https://www.madisoncounty.ny.gov/1675/Heat-Illness-Sunstroke Same as Heat Illness
- - - -
Tick-Borne Diseases
https://www.madisoncounty.ny.gov/1684/Lyme-Disease Same as Lyme disease.
- - - -
Vaccinations/ Immunizations
https://www.madisoncounty.ny.gov/1703/Vaccinations- Immunizations All the links work.
No Grade 11-12 No Yes
West Nile Virus
https://www.madisoncounty.ny.gov/1704/West-Nile-Virus All the links work.
No Grade 7 Includes 2022 Mosquito- Borne Disease Surveillance Data
Yes
Zika Virus https://www.madisoncounty.ny.gov/FAQ.aspx?TID=36 All the links work.
No Grade 10-11 No Yes
Worker Health Improvement
https://www.madisoncounty.ny.gov/2329/Worker-Health- Improvement All the links work.
No College Yes, a local health profile for healthy workplaces by Madison County.
Yes
Suicide https://www.madisoncounty.ny.gov/2481/Suicide All the links work.
No Grade 8 Yes, Madison County Suicide report
Yes
Table 1: Adapted from Madison County Department of Health website.
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RECOMMENDATIONS
1. MCDOH has a privacy policy tab at the bottom of their homepage, but the tab leads to an empty page with no privacy policies mentioned. Privacy policies are presented under see through Madison Health Insurance Portability and Accountability Act notice of privacy practices. This could be confusing for people to access information. So, organizing all the information under privacy policies tab on homepage of the website might be simpler and easier.
2. MCDOH does a poor job being consistent with dates on webpage content. The publication date of each health article at MCDOH website is noted, although not on every page. It is recommended to have publication date, month, and year on each page of the health article published on the website. It is also advised to include content updated date on the website page.
3. MCDOH has FAQ tab only for COVID-19 vaccination information. They should consider adding an FAQ section for other health-related queries.
4. MCDOH does not have a chatbot feature. Incorporating this feature on the website would increase the usability of the website.
5. Some of the leading health issues in the US that must be included in the health information page of the website are a. Cardiovascular diseases – like coronary artery diseases, hypertension, and heart
valve disease b. Cancer c. Respiratory diseases d. Motor vehicle diseases e. Gun violence f. Mental health
6. Some of the health topics are repeated on the website, which needs to be taken off. For
example, Blue-Green Algae, Fluoridation of water, Influenza, Rabies, Sunstroke, and Tick-Borne Diseases.
7. All the health information topics should try to include Madison County local data, as
users tend to learn more about topics pertinent to their County.
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REFERENCES
1. CDC. What is health literacy? Take action. Find out. Centers for Disease Control and Prevention. Published February 2, 2022. Accessed June 29, 2022. https://www.cdc.gov/healthliteracy/learn/index.html
2. U.S. Department of Health and Human Services. America’s Health Literacy: Why We Need Accessible Health Information. :8.
3. Devine T, Broderick J, Harris LM, Wu H, Hilfiker SW. Making Quality Health Websites a National Public Health Priority: Toward Quality Standards. J Med Internet Res. 2016;18(8):e211. doi:10.2196/jmir.5999
4. Ducrot P, Montagni I, Thanh VN, Serry AJ, Richard JB. Evolution of Online Health-Related Information Seeking in France From 2010 to 2017: Results From Nationally Representative Surveys. Journal of Medical Internet Research. 2021;23(4):e18799. doi:10.2196/18799
5. Momenipour A, Rojas-Murillo S, Murphy B, Pennathur P, Pennathur A. Usability of state public health department websites for communication during a pandemic: A heuristic evaluation. Int J Ind Ergon. 2021;86:103216. doi:10.1016/j.ergon.2021.103216
6. Department of Health | Madison County, NY. Accessed June 29, 2022. https://www.madisoncounty.ny.gov/206/Health-Department
7. Rights (OCR) O for C. Summary of the HIPAA Security Rule. HHS.gov. Published November 20, 2009. Accessed July 6, 2022. https://www.hhs.gov/hipaa/for- professionals/security/laws-regulations/index.html
8. Public Health — Seattle & King County - King County. Accessed June 29, 2022. https://kingcounty.gov/depts/health.aspx
9. Florida Department of Health. Accessed June 29, 2022. https://www.floridahealth.gov/
10. Privacy and Copyright Information | Washington State Department of Health. Accessed June 29, 2022. https://doh.wa.gov/node/8511
11. Kim Y. Trust in health information websites: A systematic literature review on the antecedents of trust. Health Informatics J. 2016;22(2):355-369. doi:10.1177/1460458214559432
12. Adams A, Davies V, Stubbs B. Producing a new website for a paediatric liaison mental health team with our service users. BMJ Open Qual. 2020;9(4):e001128. doi:10.1136/bmjoq-2020- 001128
