The Quality, Readability, Completeness, and Accuracy of PTSD Websites for Firefighters

Abstract

Firefighters appear at an increased risk for post-traumatic stress disorder (PTSD). Because of PTSD-related stigma, firefighters may search for information online. The current study evaluated the quality, readability, and completeness of PTSD online resources, and to determine how the online treatment recommendations align with current evidence. Google.ca (Canada) searches were performed using four phrases: 'firefighter PTSD', 'firefighter operational stress', 'PTSD symptoms', and 'PTSD treatment'. The 75 websites identified were assessed using quality criteria for consumer health information (DISCERN), readability and health literacy statistics, content analysis, and a comparison of treatments mentioned to the current best evidence. The average DISCERN score was 43.8 out of 75 (indicating 'fair' quality), with 9 'poor' websites (16-30), 31 'fair' websites (31-45), 26 "good" websites (46-60), and nine excellent websites (61-75). The average grade level required to understand the health-related content was 10.6. The most mentioned content was PTSD symptoms (48/75 websites) and PTSD treatments (60/75 websites). The most frequently mentioned treatments were medications (41/75 websites) and cognitive behavioural therapy (40/75 websites). Cognitive behavioural therapy is supported by strong evidence, but evidence for medications appears inconsistent in current systematic reviews. Online PTSD resources exist for firefighters, but the information is challenging to read and lacks evidence-based treatment recommendations.

Keywords: firefighters; first responders; health resources; internet; mental health; operational stress injury; posttraumatic stress disorder; public safety personnel; readability; website.

Figure 1

The number of websites out of the total 75 websites that addressed, partially addressed, and did not address each of the 15 DISCERN criteria. The DISCERN criteria include: (1) Are the aims of the website clear and is the target population of the website clear; (2) Does the website achieve the intended aims; (3) Is the website relevant to the needs of the user (in this case, firefighters with post-traumatic stress disorder (PTSD)); (4) Are the sources of information used for the website clear (i.e., proper referencing); (5) Does the website provide publication dates for the sources of the information included; (6) Does the website provide balanced and unbiased information (i.e., regarding treatment options for PTSD); (7) Does the website provide links to additional sources of information and support for treatment choices; (8) Does the website refer to area of uncertainty when it comes to the best treatment choice; (9) Does the website include information about how the treatments work (i.e., effects on the body, the condition, and the symptoms); (10) Are the benefits of each treatment explained; (11) Are the risks of each treatment explained; (12) Does the website explain what happens when the condition is not treated; (13) Does the website explain how the treatment will affect quality of life and activities of daily living; (14) Does the website make it clear that there are different possible treatment options; (15) Does the website promote discussing treatment choices with all involved in the patient’s care (i.e., shared decision-making) [35,36].

Figure 2

The average score of each of the 15 DISCERN criteria, based on the average of all 75 websites from the searches. Each DISCERN criteria is rated between 1 (does not address) and 5 (does address). The DISCERN criteria definitions can be found in Figure 1.

Figure 3

The number of websites that agreed or disagreed with the evidence-based statements for the potential treatments that have inconclusive evidence to support their effectiveness. Additionally included are the number of studies that did not mention the potential treatments. All studies that disagreed with evidence-statements had a positive focus and only presented the evidence to support the treatment effectiveness. None of the websites disagreed with a negative focus, meaning that the unsuccessful treatment of PTSD was not mentioned.

Figure 4

The number of websites that agreed or disagreed with the evidence-based statements that these established treatments have either strong evidence or no evidence to support their effectiveness. Additionally included are the number of websites that did not mention the treatments. For the treatments with strong evidence to support effective PTSD treatment (i.e., exposure therapy, cognitive-behavioural therapy (CBT), eye movement desensitisation and reprocessing (EMDR)), none of the websites disagreed with the evidence-based statements. For peer support, which has no evidence as an effective PTSD treatment, none of the websites agreed with the evidence-based statements.