Bill and Ernie
Evaluating Health/Medical Information on the Internet
Internet Health Information:
CAN YOU READ IT?
CAN YOU BELIEVE IT?
From Worksite Health
Summer Issue 1999
Readability - what is the reading level of the user?
The Internet has become an increasingly popular venue for employees and health professionals searching for health related information. According to a recent Harris poll (UPI, 1999), sixty million people searched the World Wide Web for health care information in the last 12 months. This accounted for 68 percent of the 88 million people using the Internet in the last 12 months. The majority of these respondents reported searching for health care information related to a particular disease or medical condition. The Internet is supplying access to a virtual community of health support groups and health information providers never before available.
Although the volume of health information available on the Internet is without dispute, the quality of much of the information is questionable. A study commissioned by the Emerging Technologies Research Group (Brown, 1997) to review 160 randomly selected consumer-oriented, health and medical information Websites, found that more than half of the sites are owned by organizations or individuals who may be providing biased or inaccurate information.
With so many individuals using the Internet to access health information - and with no reasonable way to control the quality of information one may find - worksite health promotion specialists must be very wary of online information that they quote or use in health promotion programs. In addition, as we begin to build web based information/referral content for our friends, colleagues, and clients, we would do well to be thoughtful and thorough in our creative efforts. If we focus on the users of the information we create, we will quickly realize that we may need different versions of the material, depending on the reader/viewer. Consider these issues:
Comprehension - what is the baseline level of topic or content understanding by user?
Comprehensiveness - is the user interested in "Just the Facts" or the detailed analysis?
Preferred Language - what is the native language for the user/viewer?
If we imagine the user/viewer sitting in front of their computer, and just talk to them, we will probably use the correct words. One of the advantages of web based education is that tools are being created that make it easy to convert language to be better matched to the desired client preferences. Hyperlinks can quickly take the user to similar pages that are customized to their preferences.
http://hov.cancer.med.umich.edu/ Victor Strecher and his associates have been working on this issue for several years.
http://babelfish.altavista.com/cgi-bin/translate Try this free site to translate some text into one of 5 languages.
http://www.wordswork.com/medical/ If you have a budget to help with content creation there are services that can assist you with content development.
Professionals must begin to do a better job of teaching individuals how to evaluate the appropriateness of information that they find on the Internet.
A number of individuals and groups have published extensive guides on the evaluation of Web based health information (Michigan Electronic Library, 1998; Teach, L., 1998; Pealer, L. N. & Dorman, S. M., 1997; Richetelle, A., 1997). The process of evaluating health related Web pages can be summarized into four areas: Authorship, Purpose, Currency, and Scientific Validity. One must first decide if the author, or authors are qualified to offer health related information. Virtually anyone can publish a Web page, but that does not assure that everyone has the specialized training necessary for the responsible communication of health information. A Ph.D. in European history does not necessarily qualify one to provide nutritional advice. Author/s credentials and qualifications should be available on a health or medical Web page so that one can assess how qualified the individual is to provide health information.
Another criteria for Website evaluation involves the purpose of the page. One must ask, are the page producers trying to sell a product, service, or political point of view? The reader must determine what biases are evident and how these may effect the content that is being presented. As an example, most of the information available on the Internet about nutritional supplements is provided by those who sell nutritional supplements.
Another example of innovative/business oriented use of the web is the example of database development as a not so obvious side activity to the provision of quality material. Some sites offer valuable "free" content in exchange for the user giving up fairly detailed person information to the sponsor of the site. This information is then used to create personally prepared marketing materials aimed at the user. Some of this is done with forewarning and in other cases this is done more surreptitiously.
The third criteria for evaluation concerns how old the material is. People often assume that information provided on the Internet is the most current available. Unfortunately, health information changes rapidly (e.g., treatment for those who are HIV+) and those who post material are not always diligent at updating a page once it is posted. A recent investigation (McClung, Murray & Heitlinger, 1998) found that Web pages from seemingly reputable sources (i.e., medical training hospitals) occasionally provided misleading and out of date health information. Quality sites will date the origin of the page and also when it was last updated, so that readers can better evaluate the currency of information.
The consumer of health information must most importantly attempt to evaluate the scientific validity of the health information. This may be difficult for the lay individual who has not been trained in research design or statistical methods, however general common sense can be helpful in determining if the material has logical origins. Having knowledge of how a study was conducted is crucial in determining if information and recommendations are valid. As and example, the reader should be able to determine if the study was a clinical trial involving humans or an animal study, was it basic laboratory research or an epidemiological study that was looking for associations? What was the sample size of the study and are the conclusions consistent with the methodology. An excellent article for the lay person titled, How to Understand and Interpret Food and Health-Related Scientific Studies (International Food Information Council, 1997) provides useful information on how to evaluate research. At the very least consumers must realize that a page that provides citations from peer reviewed journals and other reputable sources is one way to assure the validity of its information.
http://www.scipich.org/ Science Panel on Interactive Communication and Health (SciPICH)
One advantage of the Internet is that it does provide an easy means of searching for corroborating evidence. Individuals should not base future health action on recommendations from any one source. The availability of increasingly sophisticated search engines make it relatively easy to find additional sites that either support or refute the health information provided on a Web page. A comparison of information and sources should allow one to make healthier choices. As in all things "Caveat Emptor" let the buyer beware.
International Food Information Council (1997). IFIC review: How to understand and interpret food and health-related scientific studies. [On-line]. Available: http://ific.org/
Michigan Electronic Library (1999). Evaluating Health Information on the Internet. [On-line]. Available: http://mel.lib.mi.us/health/health-evaluating.html.
McClung, J. H., Murray, R. D., & Heitlinger, L. A. (1998). The Internet as a Source for Current Patient Information. Pediatrics. 101(6): e2.
Pealer, L. N. & Dorman, S. M., (1997). Evaluating health-related web sites. Journal of School Health. 67(6): 232-235.
Richetelle, A. (1997) Evaluating web sites for consumer health information. Healthnet: Connecticut Consumer Health Information Network, [On-line]. Available: http://w3.nai.net/~wla/eval.htm.
Teach, L. (1998). Evaluating Health-related Web Sites. [On-line]. Available: http://www.sph.emory.edu/WELLNESS/abstract.html
UPI (1999). Harris Poll: Most Net users want health info. Taylor, H. (1999) Explosive growth of a new breed of "cyberchondriacs". (Press Release), Louis Harris & Associates, February 11, 1999, New York, pp 1-6.