Chapter 14
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The Empowered Consumer

Author Additions to Chapter 14

There are no author additions for chapter 14 except information under accessibility about using the built-in Windows accessibility helps.

Websites That Expand on Chapter 14's Knowledge

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Today's computers come with many tools that can be used to make it easier to access them for those with physical challenges. To make changes to a Windows computer,

After a short time a voice will narrate choices. When one that is desired is said, tap enter. Provides an onscreen keyboard, a narrator, high contrast and a magnifier. For more information see The commercial products that you will find below will offer many more options, but in many cases the built-in functions for Windows may suffice.

Access for the visually challenged

Computer Screen Readers for the Visually Impaired.

Screen Readers. A description of all types of screen readers.

Natural Reader. This software comes in three versions: a free version which only used a computer voice, a $40 version with one natural voice, and an enterprise version with many other extras.

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Designing Websites for Accessibility

Making Your Web site Senior Friendly. This site provides a description of many research-based features that should be implemented on a Web site to make it easier for those whose sight is not what it may have been at age 55 to use the site.

Web Accessibility Evaluation Tools: Overview (2006). From the World Wide Web Consortium (W3). Reliable information from the best source.

HiSoftware® Cynthia Says™ Portal. This is a joint Education and Outreach project of HiSoftware, ICDRI, and the Internet Society Disability and Special Needs Chapter. Checks a page for violations of Section 508 standards and/or the WCAG guidelines.

Berliss, J., Kraus, L. & Stoddard S. (1996). Design of Accessible Web Pages. One of the first guidelines to address this issue, it still is very helpful.

Introduction to Web Accessibility. A white paper that describes how people with disabilities use the Internet, and how their disability affects their use of the Internet. Visual impairments, hearing impairments, mobility impairments, cognitive impairments and seizure disorders are explored. This is an excellent site for an overview of this topic.

Checking how your page will render in the text only browser, Lynx.

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Access for the Physically and Mentally Challenged

Apple's Commitment to Accessibility. Apple products also have the ability to make access for the physically challenged to use not only it's computers,' but other products

Click-N-Type virtual keyboard. An on-screen virtual keyboard designed for anyone with a disability that prevents typing on a physical computer keyboard. As long as the person can control a mouse, trackball or other pointing device, he or she can send keystrokes to virtually any Windows application or DOS application that can run within a window. From the Web site "Oh yes, it's FREE. If you need it, you can have it."

Description of many different types of keyboards to make computer use easier for the physically challenged from the Guild of Accessible Web Designers. Use the menu on the right to find information about other tools such as mice, those for low vision users etc.

Consumer Health

From the Agency for Healthcare Research and Quality, Five Steps to Safer Health Care: Patient Fact Sheet

From the Centers for Disease Control. Patient Safety: Ten Things You Can Do to Be a Safe Patient

Organization for Consumer Health. An organization for sharing funding and dialog about consumer health. Links to articles pertinent to consumers such as "Should consumers get direct access to lab results?"

Alpay, L., J. Verhoef, et al. (2009). "Current Challenge in Consumer Health Informatics: Bridging the Gap between Access to Information and Information Understanding [Electronic Journal at

Danaher, Brian G., Boles, Shawn, Akers, Laura, Gordon, Judith S., & Severson, Herbert H. (2006). Defining Participant Exposure Measures in Web-Based Health Behavior Change Programs Journal of Internet Medical Research 8(3).

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Creating a Health Related Web Page

See also Designing for Accessibility.

HLOL #34: Creating Usable, Useful Health Websites for Readers at All Levels. Offers a podcast and a transcript (easiest to use the latter because you can skip the introductory material and get right down to the specifics). Includes motivating users, differentiates wellness from illness, also talks about testing the site. Excellent information.

Williams, Dawn. How to Create a Wellness Website. Ignore the adds and read the tips. Great if you are putting it up on your own.

Grant, Peter. How to Create Medical Websites. From the same outfit as above, but has some good suggestions.

Web Site Creation

A complete online book (you can also purchase this as a book) "Web Style Guide." This book is an offshoot of this web site maintained by the Yale University's Center for Advanced Media Instruction. Well worth a visit or many. Covers all aspects of creating a Web site.

Using graphics. Need an explanation of anti-aliasing and transparency? Spend five minutes at this site. It also has a great glossary of the terms used in web graphics.

Optimizing web graphics. This site contains an online tool to reduce the size of both gif and jpeg files and information on the use of color in web pages. Is a link from the PC Webopedia site, a must visit if you care about the user's time.

Tizag tutorials. A complete set of online tutorials from beginner to web host guide including information on creating cascading style sheets. Provides interactivity in learning by allowing learner to type into the tutorial and see results. Well thought out and helpful site. Even if you use a WYSWIG Web editor, you still need some basics in html.

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Nurse Created Web Sites

Check links in your page periodically. This checker gives you line numbers to help you locate the problem link.

Bandaids and Blackboards. A Web site for chronic ill children and their parents. Created and maintained by Joan Fleitas. Excellent page!!

Detecting Vision Problems in Preschoolers. Although not created by a nurse, this site is an excellent example of information that can help a group that could otherwise be missed.



Columbia University of Nursing. Assessing Suitability of Written Materials

Guidelines for Creating Healthcare Materials


This Wikipedia site, last updated August 6, 2011is very complete and well-balanced. Has links to many excellent resources on the topic.

Markoff, John (2008, November 24). Microsoft Examines Causes of ‘Cyberchondria’ A version of an article that was in the New York Times November 25. Interesting piece that is fairly well balanced.

Cyberchondria…The Sickness of Self-Diagnosing. From Family Health & Wellness. Posted March 30, 2011. A good presentation of the condition when looking for health information becomes an illness in itself without denigrating those who seek legitimate information.

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e-Health Initiative. This site provides information about the Work of the e-Health Initiative's Public-Private Sector Collaboration for Public Health. Excellent links that are kept up to date.

E-Health: Navigating The Internet For Health Information. Although written in 2002, there is still an excellent white paper about eHealth.

The Engaged E-patient Population (2008, April 29). Pew Internet Report.

Journal of Internet Medical Research. A peer-reviewed transdisciplinary journal on health and health care in the Internet age. Excellent articles, JIMR is top ranked as the #6 journal in the health sciences category (out of 57 leading journals) and #2 in the health informatics category (out of 20 journals). (Note that the #1 in this category, JAMIA, has an almost equal Impact Factor of 3.1)

Lee, Thomas H. (2009, May 18). Commodifying Content Through IT: Could Physicians Be Next?

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Empowered Healthcare Consumer

A group called the impatient patient has a site that supports the idea that one's health depends not only on IT, but patient engagement in their EHR.

How to be an Empowered Consumer (2010). Three good tips from how to evaluate news reports about health, to how to get needed information from your healthcare practitioner to being prepared for a visit to a healthcare practitioner.

Agency for Healthcare Research and Quality. Consumer Health Informatics and Patient Decision Making.

Alpay, L., J. Verhoef, et al. (2009). "Current Challenge in Consumer Health Informatics: Bridging the Gap between Access to Information and Information Understanding. Explores the need to help health information consumers to bridge the gap between access to information and information understanding—i.e. to help consumers understand health related web-based resources so that they can act upon it. Discusses the many issues involved.

Eysenbach, G. and A. R. Jadad (2001). "Evidence-based Patient Choice and Consumer health informatics in the Internet age Journal of Medical Internet Research 3(2). The article explores access to and barriers to health information and proposes that there be a new academic informatics discipline to explore the possibilities that are being created for consumers.

Murray E., Lo B, Pollack P.,Donelan K, Catania J, Lee K., Zapert K. &Turner R. (2003). The impact of health information on the Internet on health care and the physician-patient relationship: National U.S. survey among 1.050 U.S. physicians. Journal of Medical Internet Research 5(3). The article is exactly as the title suggests.

Cannoy, Sherrie Drye (2008). Consumer Empowerment in Healthcare Information Exchange: an Investigation Using the Grounded Theory Approach. Abstract at Dissertation at

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Health Numeracy

Osborne, Helen (2007). Health numeracy: How do patients handle the concept of quantity when it relates to their health? Great information on how to avoid this type of patient confusion.

Numeracy: Crucial to Your Health (2009). An Article from Psychology Today.

Osborne, Helen. (2007). Health numeracy: How do patients handle the concept of quantity when it relates to their health? Presents some good tips for helping patients with anything related to quantity such as blood sugar.

Hospital Comparisons

Site to compare hospitals from the US Department of Health and Human Services

Compare hospitals on heart attack, heart failure and pneumonia. From USA Today.

Medical Home, Patient Centered

It's unfortunate that these are not called health homes - the emphasis on medicine puts the emphasis on the wrong syllable.

A Complimentary Podcast: Medical Home at Oklahoma University. After registering you can download and listen to the 27 minute podcast describing the medical home at Oklahoma University.

This page from IBM offers links to the Executive Summary of their report on patient centered medical homes, and a chance to download the complete report, after free registration.

Patient Risks and Liability

Case Study A8 Discussion Part 3 - Risk Management. Has links to some excellent resources as well as providing a good outline. A few resources are no longer available, but enough are to make it worthwhile.

Start, Carol. How to Balance Patient Rights With Risk Management. From eHow Health. Contains excellent suggestions.

McClinton, Rebecca. Why Are Risk Management Teams Necessary For Hospitals? More information from eHow Health, this time from a financial standpoint.

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Support Groups

Wikipedia Discussion of Support Groups.

To find a group, use a search tool and enter "support group _______" but replace the blanks with the name of the condition for which you wish to find a support group.


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Websites from the Text in Chapter 14

Leapfrog ratings of hospitals

Health Canada site

United Kingdom health screening portal

Health sites

Health information sites

Australian government

New Zealand government

U.S. government

National Library of Medicine

Medline Plus

PubMed Home

United Kingdom, NHS Direct

Microsoft HealthVault

Google Health (No longer available). Read about its discontinuance at


My Family Health Portrait sponsored by the U.S. Surgeon




Ask Jeeves


Open Directory

Google Directory (No longer available)

Yahoo! Directory

Medical Library AssociationOnline user’s guide for finding and evaluating healthcare websites at

Health on the Net Foundation provides an evaluation tool online at

Ortho Biotech Products, L.P. (No longer available)

American Cancer Society

National Cancer Institute



Rite Aid

U.S. Department of Justice Drug Enforcement Administration maintains a website
that allows the public to report unlawful Internet pharmacies at

Advocacy white paper

National Networks of Libraries of Medicine (NNLM). Health literacy.


Mayo Clinic


YouTube video at

GriefNet Support

Comprehensive Health Enhancement Support System (CHESS)

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Websites from the Reference List in Chapter 14

American Nurses Association. (2010). NDNQI. Retrieved July 8, 2010, from

Balcezak, T. J., Lynch, P., Simon, P., Jackson, S., Jaffe, C.C.,& Cadman, E. C. (1997). Patient’s rights: Issues in risk management. Retrieved July 11, 2010, from (No longer available) For information on this topic see patient risks

BC Epilepsy Society. (2008). Epilepsy fact sheet. Retrieved July 31, 2010, from (No longer available). Instead can be found at

Center for Personal Assistance Service. (2010). Disability prevalence data from the current population survey (2008–2009). Retrieved July 31, 2010, from

Cohen, E. (2008). Are you a ‘cyberchondriac’? Retrieved July 30, 2010, from

European Commission. (2010). How search engines work. Retrieved July 29, 2010, from

Harris Interactive. (2002). 4-Country survey finds most cyberchondriacs believe online health care information is trustworthy, easy to find and understand. Healthcare News, 2(12). Retrieved from

Leapfrog Group. (2009a). About us. Retrieved June 10, 2010, from

Leapfrog Group. (2009b). Leapfrog quality hospital ratings. Retrieved July 6, 2010, from

Harris Interactive. (2008). Number of “cyberchondriacs” – adults going online for health information – has plateaued or declined. Retrieved July 10, 2010, from

Harris Interactive. (2010). Few Americans using ‘e’ medical
records. Retrieved June 29, 2010, from

Health on the Net Foundation. (2009, August 9). HONcode site evaluation form. Retrieved August 30, 2010, from

Hogans, A. (2010, July 28). Unverified pharmacies easy to search online. Retrieved July 30, 2010, from

Medical Library Association. (2009, August 20). A user’s guide to finding and evaluating health information on the web. Retrieved July 30, 2010, from

National Association of Boards of Pharmacy. (2010, July 21). Verified Internet pharmacy practice sites (VIPPS). Retrieved July 30, 2010 National Committee for Quality Assurance. (2010). About NCQA. Retrieved July 8, 2010, from

National Database of Nursing Quality Indicators. (n.d.). Transforming data into quality care. Retrieved July 8, 2010, from

National Institutes of Health. (2009). Making your website senior friendly: Tips from the National Institute on Aging and the National Library of Medicine. Retrieved July 31, 2010, from (No longer available). Instead is at

Office of the National Coordinator for Health Information Technology. (2009, March 3). Summary of strategic framework (TAB). Retrieved July 8, 2010, from

Shapiro, J. (2009, November 16). Patients turn to online community for help healing. Retrieved July 30, 2010, from

The Center for Health Enhancement Systems Studies. (2010, July). Current studies and projects. Retrieved July 30, 2010, from

Tung, T., & Organ, C. H., Jr. (2000). Ethics in surgery: Historical perspective. Archives of Surgery, 135(1), 10–13. Retrieved from

U.S. Department of Health & Human Services. (2000). Health People 2010 – Health literacy (Vol. I). Retrieved from

U.S. Department of Health & Human Services. (2010a, May 25). Hospital compare. Retrieved July 8, 2010, from

U.S. Department of Health & Human Services. (2010b). home. Retrieved July 31, 2010, from

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Created January 14, 2012

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