Health Equity Focus Often Lacking in Online Women’s Health Resources.
Health Equity Focus Often Lacking in Online Women’s Health Resources
A new white paper, released in advance of International Women’s Day on March 8, is a collaboration between SPH researchers and a team from Ernst & Young.
A review of websites that focus on women’s health found that most sites did not emphasize health equity in their written or visual content, a critical omission that could negatively affect health beliefs, behaviors, and outcomes.
The findings outlined in a new white paper may underscore “the need for equity to be more clearly addressed and integrated into women’s online health information,” potentially via collaborations between local public health experts and content creators and designers.
“While health-related websites are only one component of the resources needed to support the overall health of people and populations, they give us an important lens into how to improve development and deployment of health-equity-focused digital health content,” the authors wrote. “Digital education and engagement resources, such as the women’s health websites reviewed, can be a meaningful accelerator of health equity goals if built with intent and consciousness.”
As defined by the Robert Wood Johnson Foundation, health equity indicates that everyone has a fair and just opportunity to be as healthy as possible, which requires “removing obstacles to health such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care.”
Women frequently use the Internet for health information, and according to U.S. Department of Labor data cited in a 2014 Health Resources and Services Administration study, women make approximately 80% of the health care decisions for their families and are more likely than men to be caregivers to family members.
The project, released in advance of International Women’s Day on March 8, is a collaboration between SPH researchers and a team from Ernst & Young led by Susan Garfield, chief public health officer for EY Americas. Garfield received her DrPH from BUSPH in 2011 and is a member of the Dean’s Advisory Board.
Researchers reviewed 75 US-based websites that offer educational or informational content on one or more women’s health topics. They established a set of criteria that included whether the site language contained keywords, some of them being “equity,” “inequity,” and “disparity”; whether the site offered translation links or offered written content in multiple languages; whether alt text was included for photos and graphics; and whether pictures of people displayed on the site showed a range of ethnicities, gender expressions, body sizes, and visible disabilities.
“The pandemic intensified how much women, and all people, relied on online resources to get life or death health information,” says co-author Allegra Gordon, an assistant professor of community health sciences at SPH. “So, it is more important than ever to pay attention to what kinds of resources women will encounter when trying to get their health questions answered.”
Of the 75 sites reviewed by the researchers:
- 73 sites (97 percent) did not include any images of people with visible disabilities
- 69 sites (92 percent) did not include any images suggesting sexual or gender diversity
- 52 sites (69 percent) did not include any images of people living in larger bodies
- 23 sites (31 percent) included only images of people who appeared to be of white race/ethnicity.
The team also searched each for terms related to diversity, equity, inclusion and the health of marginalized populations.
- 21 sites (28 percent) used one of the following terms: equity, inequity, disparity
- 23 sites (31 percent) used the term diversity
- 20 sites (27 percent) used the terms inclusion or inclusivity
Accessibility measures also differed widely among the sites, with 58 (77 percent) providing alt text for those with vision impairment, while just 20 (27 percent) offered translation or other multi-language options.
The analysis was facilitated by idea hub, the innovation incubator at BUSPH that helps researchers think like entrepreneurs, with the goal of accelerating improvements in population health. Malu Foley of EY was part of the research team, as was Jennifer Conti and Vanessa Edouard of SPH. One of the intriguing aspects of this project was parsing the language used by business-focused audiences versus the language used in the academic and public health world, Garfield says.
“When we talk about how websites are communicating healthcare challenges or what images they’re using, business audiences might think about that as target audiences, engagement index, the visual content we’re leveraging, click rates and other things,” Garfield says. “Whereas from an academic and public health setting, we might think about it very, very differently. So it was also important to understand how to discuss a topic that’s relevant in both sectors, but find the language that was both common and also distinct.”
Co-author Kimberly Nelson, an associate professor of community health sciences, says that women’s health experiences—and their health information needs—vary based on their identities and experiences.
“The persistent health inequities experienced by marginalized women highlights the importance of addressing the needs of these women in particular so that websites are not systematically excluding or misinforming these women or perpetuating the health inequities they are already more likely to experience,” Nelson says. “This means that women’s health websites need to be attuned to the needs of marginalized women which will in turn serve the needs of all women.”
Foley, a senior consultant at EY, said the project shed light on a particular sub-set of women’s health that isn’t widely seen as a research area. “The collaboration allowed us to invest our collective resources towards a very worthwhile area to look at. But the findings are applicable to broader populations and thinking about any specific population,” Foley said.
During the review, researchers said they hoped to see more language that acknowledged health inequities experienced by many women and expected more visual representations of the full spectrum of women who may be accessing the sites, Gordon says. “It was also noteworthy that so many of the sites we saw included language about dieting, exercise and weight loss as well as parenting and caregiving—topic areas that are stereotypically associated with women but were not necessarily related to the health concern the site was focused on.”