What can we learn from LabTestsOnlineAU about Australians’ use of online health education resources?
Empowering patients as partners in their care is enshrined in the Australian Charter of Healthcare Rights1. Provision of information for consumers to support better health and participation is integral to that goal. This raises important questions about how Australia can most effectively achieve this goal of informing and empowering health consumers.
Lab Tests Online Australasia (LTOAU) is a non-commercial online consumer health resource explaining laboratory tests in plain language2. LTOAU is in high demand, with 2.2 million users in the last 12 months. How is this relevant to the broader discussion about consumer health literacy? Pathology tests are a critical component of health care, since 70% of medical decisions are made on the basis of laboratory test results3. Consumer exposure to pathology tests is common, with one in two Australians having at least one pathology test each year. The need for accessible information on pathology tests is especially acute now that consumers can have access to their test results in Australia’s national My Health Record4. It follows that understanding lab tests is an essential component of the consumer health literacy curriculum. Examination of LTOAU Google Analytics data and user surveys, provides insights into Australian’s health information seeking behaviour. This represents a rich repository of information that can be used to inform strategies that drive patient-centred care in Australia.
What are the specifics of the information in LTOAU?
LTOAU explains pathology tests, related medical conditions with additional information on the specimen collection, laboratory processes and other common issues. There is a specific section with illustrations and instructions on how to read test results. The delivery of information uses a mixture of text, infographics, animations and videos with a dedicated YouTube channel in order to cater for a broad range of literacy and user preferences. The material is specific to the Australian healthcare system with all government funded tests covered.
A unique feature of LTOAU is that it is an initiative driven by pathology and laboratory science professionals. The content is written by volunteer Australian pathology scientists and pathologists. The small management group have backgrounds in pathology with a pathologist medical editor and a professional medical writer. It has been funded by the Australian Department of Health through the Quality Use of Pathology Program. The site is supported by the Australian Association of Clinical Biochemists (AACB) and the Royal College of Pathologists of Australasia and complements the RCPA Manual, which is a more detailed resource for doctors. LTOAU does not provide or interpret individual pathology results or give clinical advice on patient care.
What does the use of this website tell us about the demand for online health information?
More than 10 million people have visited the site since its 2007 launch. The site is used year-round and twenty-four hours a day with between 200,000-250,000 users per month. LTOAU visitors are from both metropolitan as well as rural and remote regions.
Pathology tests are arguably one of the more complex medical subject areas. The popularity of the site suggests that consumers have an appetite for grasping the more technical health subject areas.
What do we know about the users of this online resource?
The majority of users are under 40 years old. More recently there has been an increase in the number of older people accessing the site. Females have visited more than males. Four out of five visitors find the site via organic web searches for terms related to pathology tests. Other sources are either by directly searching for the site by name. The remaining 7% come from pathology, other health-related and range of miscellaneous sites. Two thirds of visitors are from the general public, followed by health professionals and a smaller percentage of students.
Why are people seeking information on lab testing?
Health consumers are visiting the site predominantly in relation to their own health. Some have undergone their pathology tests and have had a follow-up visit with their doctor but are seeking out more information. A considerable number of users who search for information either before or after they have had their tests, do so before visiting their doctor. The most popular content is information on tests. The top three tests are liver function tests, full blood count and urine cultures. Popular non-test specific pages are those on how samples are collected, explanations of reference ranges, accuracy, specificity and sensitivity.
What do consumers think of the website and the resources offered?
Overwhelmingly, consumers have rated the site as either useful or extremely useful. Most have found the information provided to be sufficient, with minority indicating they would like more details about the tests. The information, for the majority of users, was easy to understand. The survey respondents appreciated having the technical aspects of lab tests explained, and they also felt better informed about their diagnosis and condition. Increased confidence to discuss their care with their doctor was another listed benefit, as well as the time saved during visits to their doctor due to a better understanding of the issues. In terms of the format and design of the site, respondents have listed its ease of use as an important factor, as well as the fact that the content is written by Australian pathology experts. The fact that the site is non-commercial and is being regularly updated also rated of high importance.
How could the benefits of LTOAU be scaled up for greater impact?
What is striking is that LTOAU has achieved the current level of success almost entirely as a stand-alone entity. If LTOAU could be embraced more widely across the health system it isn’t difficult to envisage how its impact would be increased. Increased awareness and promotion of LTOAU by consumer and other health organisations is a starting point. There is also the potential to incorporate the provision of consumer information as part of clinical care processes. This could be done by simple redesign of care delivery and electronic systems. Pathology providers and clinical services could embrace digital tools to message health consumers the links to online information at the time of consultation or testing.
The Choosing Wisely campaign5 and the Medical Benefits Schedule Review of Diagnostic Medicine6 have endorsed consumer education for shared decision making about the use of pathology tests. This could be achieved if the existing popular consumer information resources included these recommendations.
A further initiative to assist consumers is to redesign pathology for easier interpretation7 and add links to the LTOAU consumer guides.
What are the next steps for LTOAU and consumer health resources generally?
The consumer perspective and input is pivotal to health literacy. To achieve this at scale, LTOAU is in the process of establishing an online community of LTOAU users to routinely review all the content on the site and to assist in decisions about the priority of topics to be added to the site.
A new section to guide patients on how to access and make use of their pathology results in My Health Record is planned along with information on test use indications and point of care testing.
LTOAU
has also entered an industry partnership with Curtin University and the WA
Health Consumer Council. Students and their academic supervisors from the
schools of marketing, media communications and data science have embarked on a
range of LTOAU projects. These include the use of data science tools
to identify excessively complex content on the website, harnessing the
extensive Google Analytics data to better understand health information seeking
behaviour, qualitative research on user experience, and ways to improve the
social media reach of LTOAU. This is exciting initiative brings valuable expertise to LTO at
the same time as it builds future capacity in the delivery of consumer health
education.
It has become clear that despite the high number of users, the majority are finding LTOAU through web searches. LTOAU is seeking out opportunities to collaborate not only with health consumers but with consumer health bodies, primary care providers, hospitals, pathology services and educational organisations to expand the reach and usefulness of the resource.
The LTOAU experience demonstrates that online health education resources are important. Health consumers value Australian, trustworthy non-commercial information. Web-based consumer health sites have the potential to deliver the support required for better consumer health literacy and assist in promoting the quality and effectiveness of healthcare
1. Australian Commission on Safety and Quality in Health Care. Australian Charter of Healthcare Rights.; 2019. https://www.safetyandquality.gov.au/australian-charter-healthcare-rights. Accessed October 28, 2019.
2. Lab Tests Online Australasia. https://labtestsonline.org.au/. Accessed October 29, 2019.
3. Rohr U-P, Binder C, Dieterle T, et al. The Value of In Vitro Diagnostic Testing in Medical Practice: A Status Report. Wang Y, ed. PLOS ONE. 2016;11(3):e0149856. doi:10/f8wq22
4. Carroll P. Diagnostic reports and My Health Record. Presented at the: RCPA QAP Key Incident Monitoring and Management System Quality Workshop; March 19, 2019; Sydney, Australia.
5. Choosing Wisely Australia. Choosing Wisely Australia. http://www.choosingwisely.org.au/home. Accessed October 29, 2019.
6. Australian Government Department of Health. Diagnostic Medicine Clinical Committee of the Medicare Benefits Schedule Review Taskforce. https://www1.health.gov.au/internet/main/publishing.nsf/Content/MBSR-committees-diagnostic-medicine. Published 2019. Accessed October 28, 2019.
7. O’Kane M, Freedman D, Zikmund-Fisher BJ. Can patients use test results effectively if they have direct access? BMJ. 2015;350(feb11 18):h673-h673. doi:10.1136/bmj.h673
