XIX.5 September + October 2012
Page: 22
Digital Citation

Will content credibility problems flatline health innovation?

Colleen Jones

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Digital content—the text, images, audio, and video that make up digital experiences—is in demand. And in few areas is it more in demand than health: Eight in 10 American Internet users have looked online for health information [1].

If you think about it, much health innovation explores how to get the right content to the right people at the right time. For example, Brightwhistle, one of Georgia's top 10 most innovative companies in 2012, matches patients with relevant content about potential clinicians to improve clinicians' patient acquisition experience. Another health startup example is, which curates health content from a variety of sources to answer health questions.

Yet discussions of innovative digital health products often leave out content. The focus becomes the design or the technology or the features, not the content itself. Why does this happen? In my experience, designers and developers assume the content will be there, ready and waiting to be molded to the innovation. The November + December 2011 issue of interactions, for example, spotlighted several examples of innovation, such as, that center on content [2]. And yet the role of content in the innovation was not mentioned.

Do product strategists, designers, and developers find content unimportant? In my experience, that's not the issue. When I talk with them, they agree content is critical and even strategic. More often, the issue is that they assume someone else is carefully sourcing or creating trustworthy content.

With today's skyrocketing demand for credible content, the assumption that "someone else has an eye on content" is no longer a safe one. It even risks stymieing health innovation. I've become so concerned about content credibility that I've spent the past year studying it in general and for health, in particular. My applied research and experience shed light on the credibility crisis, the risk it poses to health innovation, and hope for a solution.

back to top  Understanding Context for the Crisis

Three factors have created a perfect storm of challenges for content credibility. Let's review them briefly so we can better understand context for the credibility problem, especially for the U.S.

Intense demand for connection to content. The rise of social media and mobile devices over the past five years has given people a taste for having constant connection to their social networks and to content. That taste is turning into ravenous hunger. For example, Gartner recently found that when given a choice between an Internet connection and a car, 46 percent of 18- to 24-year-olds in the U.S. would rather have an Internet connection. Moreover, the Federal Highway Administration reports the number of American teenagers who have a driver's license is dropping. In 1998, 64 percent of teenagers had a license. That number dropped to 46 percent in 2008 [3].

In the U.S., cars have represented freedom for teens for many years. I remember many years ago when I was 15, I wanted nothing more than to get my license. I studied for the written test, I rolled out of bed at 4:30 am to take driving classes before school, and I practiced driving with my parents. For me, the license meant the freedom to work, stay after school, or hang out with my friends. That's no longer the case. American teens now want virtual freedom as much if not more than physical freedom. That shift is significant, if not seismic.

Explosion of content sources and personal health data. Today the media is not the only source of digital content. Any individual, organization, company, or government agency can publish content and be a source. Further complicating matters is the fact that personal health data tracking, or the quantified self movement, is on the rise. Myriad applications can track our personal health data and be a potential source of content. (The quantified self website [] lists more than 400.) This proliferation of sources, often with varying levels of content quality, can make choosing and vetting sources a daunting task for time-strapped users.

At the same time, anyone trying to be a trusted source of content faces the challenge of offering a unique and memorable voice in the cacophony. This challenge is especially great for health. Many of the digital innovators are startups and relatively unknown to most people. Have you ever heard of MeYouHealth, for example? Probably not. Neither would I if I didn't work in digital innovation.

Personal data tracking applications also tend to overwhelm users with numbers and lack distinct content to advise users. As Tom Chang notes in his recent TechCrunch article about the quantified self applications, people don't want to study the numbers (emphasis mine): "Most people would rather be told what the big takeaways are, what they really need to worry about, and what exactly to do next. This kind of 'so what?' is ultimately more valuable in the eyes of the consumer. (Anecdotally, I've seen enterprises pay 10 times more for business insight reports and consultations than for self-service analytics tools)" [4].

This bewildering array of health content sources and health data without advice risks disorienting users.

Limitations in content discovery. Search has long been the main way that people find digital content. Search-engine rankings have become so coveted that an entire industry has emerged to optimize websites for search engines. Even though search-engine algorithms are intended to make the best content rise to the top of search rankings, the optimization industry has changed the game so that the best-optimized websites rise to the top. For example, when I search for "colon cancer," a Wikipedia article consisting of user-generated content is one of the top three results. In fact, Wikipedia ranks that high for many topics in health and beyond Why? The reason is not because it's the highest-quality site or that it has most credible content. The reason is, Wikipedia has optimization features, such as lots of links.

The problem of website optimization versus credible content has become so dire that Google recently implemented a penalty for overoptimized sites. The penalty attempts to renew the importance of "great content" [5]. But for now, the content that a user discovers through search isn't necessarily the highest quality or the most credible.

Besides problems with discovering credible content through search, another method of content discovery has emerged. Social media offers a new gateway to digital content. People discover content by checking out what their colleagues, friends, or family recommend. In other words, social networks curate content. When social networks share content, the source of and original context for the content can become less important or lost. For example, rumors about immunizations causing autism persist partly because well-meaning people share misguided articles based on research that has proven to be false long since the article was written [6]. If my friend shared one of those articles in earnest, I'd probably at least give it a read.

back to top  The Resulting Credibility Crisis

The result of these three factors? People turn to digital content now more than ever, but they don't necessarily find that content credible. In my recent survey with 800 people in the U.S. and 800 in the U.K., I found the majority view content as "hit or miss" or "unreliable," even though they report using Web content much more now than they did five years ago (see Figure 1).

People are turning constantly to an advisor—digital content—they don't entirely trust. That's a big problem for the digital industry, as I explain in my book, Clout: The Art + Science of Influential Web Content. That's a massive problem for digital health innovation. Let's take a closer look at why.

back to top  Why the Content Stakes Are High for Health Innovation

The most elegant design or novel feature will flounder without credible content. Apple recognized this fact early in its quest to innovate personal devices and quickly found itself in the digital content business. Apple understands the connection between content and its product experiences. As a result, Apple created a system for sourcing, curating, and delivering content that meets its criteria for well-designed personal devices [7]. Getting terrible content on a wonderful device is as bad as getting wonderful content on a terrible device. The entire system is the innovation. In the same way, successful digital health innovations must bring together the right content and experience.

For health, the right content is both high quality and highly credible. People prize credibility when it comes to health decisions for themselves or their loved ones. In my survey, I asked people about the situations in which credible content was important to them. Not surprisingly, 61 percent of the U.S. participants and 56 percent of the U.K. participants ranked a health situation as the absolute most important.

Participants also reported they are likely to verify digital content about health. And other research suggests people will take the advice of a person over the advice of health content [8]. For health content to influence people's health decisions, it has to act like a trusted advisor. Health content needs to have recognizable clout, comparable to that of doctors, nurses, or other health experts, or else people could ignore it.

So, for health, the stakes for credible content are high. Because solving any problem requires understanding the problem, let's dig deeper into these credibility issues.

back to top  Pressing Health-Content Credibility Issues Today

I've tracked the specific content-credibility issues that arise repeatedly in my consulting as well as in my firm's recent applied research. In the summary below, I highlight the most urgent issues we have found so far.

Clarity of source. If people are unsure about the source of health content, they are less likely to find the content credible. In our research, we asked participants to rate the credibility of samples of health content. If participants rated a sample as not credible, we asked why. The top reason for both the U.S. and the U.K. was being confused about the source of content.

Credibility of source. If people find the source of health content is not credible, they likely will doubt the credibility of the content itself. In our research, content source was the top reason participants in the U.S. and U.K. rated samples of health content as credible. It was also the top reason participants rated samples of health content as not credible. Most participants rated health content from Wikipedia, for example, as not credible because they reported not trusting Wikipedia as a source.

Usefulness of content. If content seems useful to people, they will be more likely to judge it as credible. Content usefulness was the second most common reason our research participants rated content as credible. This finding is significant because past studies of Web credibility focus heavily on design cues, not content substance [9].

Consistency of distinct tone. We have noticed in the course of our project work that if content consistently "sounds" like the source, people will be more likely to recognize, remember, and trust it. Just as a logo or a color is a visual trademark of an experience, so tone is a verbal trademark. We are in the midst of testing to what extent tone affects people's perceptions of content credibility.

Geocultural and age factors. The way people determine content credibility isn't exactly the same across age and culture. For example, we found that British participants were more open than American participants to a personality, such as Dr. Oz, being a credible source of health content.

The issues above shed light on the credibility challenges people experience with health content. Together, these challenges pose a palpable threat to widespread adoption of digital health innovation. As far-reaching as the threat is, I believe overcoming it is possible.

back to top  Turn the Credibility Threat into an Opportunity to Thrive

Unwittingly ignoring content causes credibility problems, so naturally the solution is to turn our attention to content. The hard question is how? We must recognize content as an integral part of digital health innovation. That starts by talking about content when we talk about health innovation. But the solution doesn't stop with conversation. Consider, for a moment, an old riddle. Three frogs were sitting on a log. One decided to jump into the water. How many frogs are left on the log?

You might have said two, like I did when I first heard this riddle. The answer is three. The frog only decided to jump into the water. She talked about it but didn't jump. She paid lip service to it but didn't act.

When digital health innovation is literally the difference between existing or thriving and between living or dying, we can't sit like bumps on a log. We have to act. I see three important actions for the digital health area that innovators can take straight away:

  • Give content experts a seat at the product strategy table. Digital health innovation requires expertise in content strategy, editorial strategy, and content architecture. Bring the people with that expertise to the table. It's the only way to ensure you create content that explains the big takeaways, points out what users need to worry about, and emphasizes what exactly to do next.
  • Plan content governance. Health data requires governance to ensure accuracy. In the same way, content requires governance to ensure it's high quality, credible, and effectively doing its job. Governance for content is a system of oversight, roles, process, guides (or documentation), and evaluation. Without this system in place, you are at risk for offering content of poor quality, credibility, and efficacy (see Figure 2).
  • Test content credibility with representative users. Much testing of digital experiences stops at determining whether users can perform tasks or find content. That doesn't tell you whether users find your content useful, meaningful, or trustworthy. If you're talking about a global market, then people in different markets could have different perspectives. Test the impact of content tone and meaning on representative users. For example, we developed an iterative approach to test the impact of content tone for a health startup.

By taking these steps, you will start to turn the risk of thwarting digital health innovation into a prospect for making it thrive. Now, let's go innovate.

back to top  References


2. Holtzblatt, K. What makes things cool? Intentional design for innovation. interactions 18, 6 (November + December 2011), 40–47.

3. Chozick, A. As young lose interest in cars, G.M. turns to MTV for help. New York Times;

4. Chang, T. The 'so what' of the quantified self. TechCrunch;

5. Robles, P. SEOs beware: Google preps over-optimisation penalty.;

6. Retracted autism study an 'elaborate fraud,' British journal finds. CNN;


8. Moseley, K.L., Freed, G.L., and Goold, S.D. Which sources of child health advice do parents follow? Clin Pediatr (Phila) 50, 1 (2011), 50–56.

9. Past applied studies include the series of credibility studies by B.J. Fogg in 2001–2002 and the ongoing e-commerce research by Nielsen Norman Group.

back to top  Author

Colleen Jones is the principal and chief strategist at Content Science. She is the author of Clout: The Art + Science of Influential Web Content (New Riders, Berkeley, CA). Detailed reports of her firm's credibility research are available at

back to top  Figures

F1Figure 1. Most Americans (top) and Brits (bottom) find Web content less than trustworthy.

F2Figure 2. Content governance is a system of oversight, roles, process, guides, and evaluation.

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