In reference to a recent study, ^{Reference Jorm, Fischer and Oh1} we do not agree with the use of email as a sole medium to provide feedback to website administrators. Electronic communication by an unknown, unexpected source has a high chance of ending up in the spam box and going unnoticed by the recipient. Sending the email on a letterhead or with a university logo could not have added enough authenticity to suspicious-looking mail, given that we are all wary of opening emails, let alone attachments, from unknown senders. Further, the recipient may have lacked the expertise to decipher it as genuine feedback. Lack of acknowledgement of the receipt by a large proportion of websites makes us wonder whether the results should be interpreted as a human failure or a technical failure. An alternative medium could have been a fully addressed, official communication posted or couriered personally to the administrator, with a formal acknowledgement of receipt. Another medium could have been follow-up via telephone acknowledging receipt of the email. But an essential component for feedback to be successfully conveyed is to ensure that the message reached the recipient, that the message was at the very least received, if not acknowledged or acted upon.

The authors state ‘this trial can be seen as an effectiveness rather than an efficacy trial, because it evaluated feedback under realistic conditions’. We wish to say that, generally speaking, the effectiveness of an intervention is meaningful after the efficacy has been established. Although there was an attempt to provide feedback, we felt that the one-time sending of an electronic communication is neither complete nor strong enough an effort at feedback and, realistically speaking, is likely to go unnoticed. The study, however, highlights an important point regarding the poor quality of most websites concerning serious medical or public health matters. Although quacks or uncertified self-claimed experts can be prosecuted under law, there are a number of websites promising help for people who are suicidal, but which fail to deliver on the quality or extent of information available to individuals seeking help. ^{Reference Van Ballegooijen, van Spijker and Kerkhof2} There is a need for regulation or a mandatory professional certification of the content of websites, especially in such matters where life can be at stake. Short of that, interventions need to be planned so that they are readily acceptable and effective in ensuring a positive change in the content of suicide prevention websites.