Rx medication information for the public and the WWW: quality issues

Evaluation of Quality and Readability of Health Information Websites Identified through India's Major Search Engines

Background. The available health information on websites should be reliable and accurate in order to make informed decisions by community. This study was done to assess the quality and readability of health information websites on World Wide Web in India. Methods. This cross-sectional study was carried out in June 2014. The key words “Health” and “Information” were used on search engines “Google” and “Yahoo.” Out of 50 websites (25 from each search engines), after exclusion, 32 websites were evaluated. LIDA tool was used to assess the quality whereas the readability was assessed using Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), and SMOG. Results. Forty percent of websites (n = 13) were sponsored by government. Health On the Net Code of Conduct (HONcode) certification was present on 50% (n = 16) of websites. The mean LIDA score (74.31) was average. Only 3 websites scored high on LIDA score. Only five had readability scores at recommended sixth-grade level. Conclusion. Most health information websites had average quality especially in terms of usability and reliability and were written at high readability levels. Efforts are needed to develop the health information websites which can help general population in informed decision making.

Online Patient Education for Chronic Disease Management: Consumer Perspectives

Patient education plays an important role in chronic disease management. The aim of this study is to identify patients' preferences in regard to the design features of effective online patient education (OPE) and the benefits. A review of the existing literature was conducted in order to identify the benefits of OPE and its essential design features. These design features were empirically tested by conducting survey with patients and caregivers. Reliability analysis, construct validity and regression analysis were performed for data analysis. The results identified patient-tailored information, interactivity, content credibility, clear presentation of content, use of multimedia and interpretability as the essential design features of online patient education websites for chronic disease management.

Stroke Education Materials on the World Wide Web: An Evaluation of Their Quality and Suitability

Web-based information is a valuable resource for people affected by stroke, however its accuracy and quality have been questioned. In this study, 30 stroke education websites were reviewed using accountability, readability, and reliability measures. Fifteen consumers and 11 health professionals evaluated six sites in terms of their design, content, and ease of use. The websites mostly met accountability criteria, but their reliability scores were low and their readability was high. Consumers' opinions were consistently higher than health professionals', but scores indicated their preferences for particular websites, especially in terms of design. The importance of considering consumers' preferences when designing and recommending websites is highlighted.

Patients with rare diseases using pharmacists for medication information

OBJECTIVES

To determine whether patients with a rare illness (1) use pharmacists for medication information more or less frequently than physicians and the Internet, (2) perceive pharmacists as a more or less credible medical information resource than physicians and the Internet, and (3) obtain different types of medication information from pharmacists, physicians, and the Internet.

DESIGN

Cross-sectional survey.

SETTING

Online data collected between 2008 and 2009.

PATIENTS

Adult, English-proficient vasculitis patients (n = 232) who were taking at least one medication to treat their vasculitis.

INTERVENTION

Administration of online survey.

MAIN OUTCOME MEASURES

Patient use of pharmacists, physicians, and the Internet for medication information; perceived credibility of pharmacists, physicians, and the Internet as sources of medication information; and types of medication information obtained from pharmacists, physicians, and the Internet.

RESULTS

Participants consulted physicians and the Internet more than pharmacists for medication information; only 96 participants (41.4%) ever used pharmacists for vasculitis medication information. Females and participants who used community pharmacies were significantly more likely to consult pharmacists for medication information as compared with males and patients who did not use community pharmacies. Participants perceived pharmacists were a less credible source of medication information than physicians and the Internet. Participants used physicians and/or the Internet more than pharmacists for five of eight types of medication information, including adverse effects and drug effectiveness.

CONCLUSION

Vasculitis patients consulted sources other than pharmacists for medication information. Several factors, including perceived pharmacist credibility and a noncommunity-based pharmacy, may contribute to infrequent patient use of pharmacists as a medication information source. Future qualitative research should document how patients with rare disease perceive and interact with pharmacists to understand why many view pharmacists as only moderately credible sources of medication information.

Miracle drug, poison, or placebo: patients' experiences with antidepressant medications as described in postings on an online message board

Messages posted on the MSN Health message board in response to a news story reporting that antidepressant medications are placebos were examined. Over 37 days, 1,624 messages were posted by 1,238 unique authors. The sampling unit consisted of 960 authors who were users. Users' messages were gathered in real time and content analyzed. Few users explicitly responded to the question posed in the article: 2.5% of the users stated their antidepressant was a miracle drug, 2.0% stated it was a poison, and only 0.2% stated it was a placebo. Users reported positive experiences with antidepressants more than twice as often as they reported negative experiences.

Drugs on the Internet, part II: antidepressant medication web sites

Antidepressant medications have been the fastest growing category of use of pharmaceutical products over the past decade. Selected Internet web sites providing information on antidepressant medications were identified and assessed using code of conduct criteria for posting health information on the Internet as developed by the Health on the Internet Foundation. Thirteen representative web sites were evaluated. Degree of compliance with each of the eight criterion varied by site, though all 13 sites met the criterion for legality of content and conduct on their web site. WebMD and FamilyDoctor.org met most of the criteria, while pharmaceutical company sites tended to meet the fewest criteria.

Evaluation of website medicines information content, in comparison with official patient information

Objective

To evaluate the content and presentation of websites accessed by the public for information about two non-steroidal anti-inflammatory drugs, ibuprofen and naproxen. To assess the accuracy and completeness of website content compared with official patient leaflets, and assess the quality of presentation of each site.

Setting

Medicines are the most frequent intervention in healthcare, and people need appropriate information to use them safely and effectively. There is evidence that the leaflets supplied with medicines do not meet peoples' needs. There are many websites containing medicines information, but it is not known how the content compares with the official information.

Method

The search words ‘Brufen’ and then ‘Naprosyn’ were used in the Google search engine. We identified the first 10 sites containing information comparable to that in conventional medicines leaflets (more than 100 words and at least three of five categories of information). Each site was scored for presence and accuracy of each point of information included in official leaflets. Each site was also scored for quality of presentation, assessing 10 attributes (scored 1–3).

Key findings

We found 7 Brufen and 10 Naprosyn sites meeting the inclusion criteria and the mean score for completeness of information was 50% (range 23–79%). Eight inaccuracies were found in 7 out of the 17 sites. Four had significant potential clinical impact (all relating to dose) and four were minor in significance. The overall mean score for website presentation was 77%.

Conclusion

Compared to official leaflets, information found on websites generally contained about half the total amount of pieces of information. There were a small number of inaccuracies related to dose, which are potentially dangerous. The websites scored well overall for quality of presentation. The two overall highest-scoring websites were a manufacturer's site and one aimed at health professionals.

[Assessment of websites with information on medicines]

AIMS

To identify websites with information on medicines and assess, using experts, their adherence to codes of conduct and recommendations by the WHO.

DESIGN

Cross-sectional study based on an ad hoc designed questionnaire (performed independently by 2 reviewers). The websites were identified by the Delphi technique (35 experts).

SETTING

Websites with information on medicines.

PARTICIPANTS

A total of 35 websites selected by the Delphi technique. An acceptable level of stability was achieved in the third round (interquartile variability; <0.05).

MAIN MEASUREMENTS

Responsibility, transparency and honesty, authorship of the information, content review policy, privacy and data protection policies, updated information and accessibility. A descriptive analysis of compliance was carried out and the kappa coefficient was estimated to evaluate the agreement between assessors (Fleiss's Criteria).

RESULTS

The National Prescribing Service Limited (NPS), PubMed, British Medical Journal, New England Journal of Medicine, Journal of American Medical Association, The Lancet, Fisterra and National Institute for Health and Clinical Excellence stood out with an overall high fulfilment of the questionnaire. The updated information dimension was the lowest evaluation for the different websites.

CONCLUSIONS

The quality of the web sites evaluated varied widely. Although there are several websites, which are detailed in the article, with high overall scores.

Exploring antecedents of consumer satisfaction and repeated search behavior on e-health information

E-health information has become an important resource for people seeking health information. Even though many studies have been conducted to examine the quality of e-health information, only a few studies have explored the effects of the information seekers' motivations on the perceived quality of e-health information. There is even less information about repeated searches for e-health information after the users' initial experience of e-health information use. Using an online survey of information seekers, 252 e-health information users' responses were collected. The research examines the relationship among motivation, perceived quality, satisfaction, and intention to repeat-search e-health information. The results identify motivations to search e-health information and confirm the relationship among motivation, perceived quality dimensions, and satisfaction and intention to repeat searches for e-health information.

Quality of anaesthesia-related information accessed via Internet searches

BACKGROUND

We conducted a study to examine the quality and stability of information available from the Internet on four anaesthesia-related topics.

METHODS

In January 2006, we searched using four key words (porphyria, scleroderma, transfusion risk, and epidural analgesia risk) with five search engines (Google, HotBot, AltaVista, Excite, and Yahoo). We used a published scoring system (NetScoring) to evaluate the first 15 sites identified by each of these 20 searches. We also used a simple four-point scale to assess the first 100 sites in the Google search on one of our four topics ('epidural analgesia risk'). In November 2006, we conducted a second evaluation, using three search engines (Google, AltaVista, and Yahoo) with 14 synonyms for 'epidural analgesia risk'.

RESULTS

The five search engines performed similarly. NetScoring scores were lower for transfusion risk (P < 0.001). One or more high-quality sites was identified consistently among the first 15 sites in each search. Quality scored using the simple scale correlated closely with medical content and design by NetScoring and with the number of references (P < 0.05). Synonyms of 'epidural analgesia risk' yielded similar results. The quality of accessed information improved somewhat over the 11 month period with Yahoo and AltaVista, but declined with Google.

CONCLUSIONS

The Internet is a valuable tool for obtaining medical information, but the quality of websites varies between different topics. A simple rating scale may facilitate the quality scoring on individual websites. Differences in precise search terms used for a given topic did not appear to affect the quality of the information obtained.

Brief report: development of a prescription medication information webliography for consumers

BACKGROUND

Websites offering drug information vary in coverage and quality, and most health care consumers are poorly equipped to assess the quality of internet medication information.

OBJECTIVE

To establish a webliography of recommended prescription medication information websites for health care consumers and providers.

DESIGN AND METHODS

Drug information websites were systematically identified based on recommendations from health professionals and text-word searches of MEDLINE and Google. The resulting sample of websites was evaluated in a 2-step process. Candidate websites were first screened using inclusion/exclusion criteria representing minimum information requirements. Websites that passed the inclusion/exclusion criteria were then rated on 16 quality criteria using a 5-point scale by 3 trained judges. Website ratings were averaged, then multiplied by the corresponding importance weight of each criterion and summed to generate a total score. Websites with the highest total scores were included in the webliography.

RESULTS

Ten websites were selected for inclusion in the webliography. The 3 highest-scoring websites were Anthem Blue Cross and Blue Shield (http://home.anthemhealth.com/topic/drugcenter), U.S. National Library of Medicine (https://www.nlm.nih.gov/medlineplus/druginformation.html), and Healthvision (http://www.yourhealthinformation.com/library/healthguide/en-us/drugguide/default.htm).

CONCLUSION

Medication information websites vary widely in quality and content. The online webliography is a valuable and easily accessed tool that can be recommended by health care professionals to patients who request referral to reliable websites.

Design and implementation considerations for a personalized patient education system in burn care

Patient education is a significant factor in the provision of health care services, contributing to improved disease management and health care outcomes. Personalization has been suggested as a means for increasing patient education effectiveness and computer-based approaches have been explored as a possible means of achieving this goal. The success and capabilities of the resulting applications have been restricted by the absence of a direct link to patient data and the reliance on locally produced written material, which is expensive to produce, update and tailor. In our research project STructured Evaluated Personalized Patient Support (STEPPS), we are investigating the potential of a novel strategy for personalized or tailored patient education, based on the integration of electronic patient record data and material derived from online health information resources. In this paper we present an overview of the pertinent technical issues and the way we have addressed them in the context of our development work in the domain of burn care. Further, we discuss how the choices made in the design of the system interrelate with the considerations for its implementation in health care practice settings.

Developing and validating a nursing website evaluation questionnaire

AIM

The aim of this paper is to report on the development and validation of an evaluation questionnaire for nursing websites.

BACKGROUND

Increasing numbers of the general public and health care professionals are using the Internet to access health and health care-related information. The quality of such websites, therefore, needs to be evaluated.

METHODS

A total of 24 websites in the United States and Taiwan, including websites in 13 leading schools and 11 hospitals, were selected as test websites. A total of 120 participants with Master's degrees in either nursing or mechanical engineering were invited to examine the 24 websites using a nursing website evaluation questionnaire. A 32-item questionnaire was developed, covering overall impression, download and switch speed, accessibility and convenience, web page content, service function and compatibility with common browsers. Participants were requested to connect to the specific websites and browse the contents before filling in the questionnaire. The results were arranged into 12 different sequences and prepared on a CD using Macromedia Dreamweaver. Data were analysed using Cronbach's alpha, Guttman split-half reliability and factor analysis.

FINDINGS

Internal consistency was good, with a Cronbach's alpha of 0.93 in Part I and a KR-20 (Kuder Richardson) of 0.85 in Part II. Four factors given in Part I were identified as content truth, accessibility and convenience, speed and connection, and overall impression.

CONCLUSION

The nursing website evaluation questionnaire had good construct validity and internal consistency.

Internet websites selling herbal treatments for erectile dysfunction

The objective of the study was to investigate the safety and reliability of internet websites selling and providing medical information regarding herbal substitutes for Viagra. Using keywords 'Herbal' and 'Viagra', websites selling and providing medical information regarding herbal substitutes were identified. The top 50 sequential sites were assessed for safety and reliability against the Health on the Net (HON) criteria. Medically trained staff provided information in only 21% of the sites yet just 24% stated that the information was not a replacement for medical advice. No sites warned patients about erectile dysfunction (ED)-associated cardiovascular disease. In all, 88 and 70% of sites indicated drug efficacy and ingredients but only 36 and 21% provided contraindications and side effects, respectively. All sites fell short of the HON requirements. In conclusion, acquiring medical information and herbal substitutes for ED from the internet is convenient and easy. However, patients should be cautious as safety and reliability of this approach is poor.

Accuracy of emergency medical information on the web

A large amount of EM information can be found on the Internet, but the accuracy of this information has not been determined. This study compares the "gold standards" of EM information on four common emergencies with top healthcare web sites. The study also examines the relationship of web sites' credentials and certification on content. Checklists were developed for four emergency medical topics: influenza, febrile child, chest pain, and stroke from the "gold standards" promoted by the American Stroke Association, the American Heart Association, the National Heart, Lung and Blood Institute, and the American College of Emergency Physicians. Information found at the 20 most visited health information web sites were compared with the "gold standards." Completeness of the information, certification, and credentials were used to judge the accuracy of the web sites. Inaccurate or incorrect information from these web sites were noted. Correlations between the site's credentials and its content were also measured. This study, conducted from January 18, 2002, to January 31, 2002, excluded eight of the top 20 health web sites because they did not cater to the lay public. MEDLINEplus was the most complete web site with 74.8% of the items noted contained in the web site; MayoClinic.com had 54.5% and Medscape had 50.9%. Half of the web sites fell between 35% and 50%, including WebMD at 46.9%, InteliHealth at 45.5%, HealthWorld Online at 44.8%, Yahoo! Health at 41.3%, AllHealth.com at 40.6%, and Health.excite.com at 36.4%. Healthcentral.com at 35%, Drkoop.com at 35%, and AskDrWeil at 26.8% were the bottom three sites. Information on stroke was the most complete overall in 11 of 12 web sites. Four web sites contained questionable or concerning information. No correlation was found between possession of certification and the completeness of content (Pearson correlation -0.264 with a two-tailed significance of .406). Despite recent efforts to improve web site content through certification, few web sites contained a significant amount of EM information on all four topics investigated. In fact, some of the information provided on these health information web sites has the potential to be dangerous. Thus, most web sites are not good sources of reference for the public to find out what to do in the case of a medical emergency.

Producing an information leaflet to help patients access high quality drug information on the Internet: a local study

OBJECTIVES

To develop a patient information leaflet (PIL) to help local patients meet their drug information needs using the Internet, and to perform a preliminary evaluation of this tool.

METHODS

Development--a cross-sectional survey of the drug information needs of local patients using a semi-structured questionnaire; assessment of websites offering free, consumer-orientated medicines information using set criteria; identification of consensus criteria to evaluate the quality of health-related on-line information; evaluation--views on a draft patient information leaflet from a focus group.

RESULTS

Those surveyed felt that being directed to high-quality websites and being provided with assessment criteria for on-line information would be useful. The three websites fulfilling most of the set quality criteria were Surgery Door (www.surgerydoor.co.uk), InteliHealth (www.intelihealth.com) and medlineplus (www.nlm.nih.gov/medlineplus). The six most frequently cited assessment criteria were currency, authorship, commerciality, relevance, links and attribution. A draft leaflet was constructed listing the above three websites and six criteria along with tips on how to search the Internet effectively. A focus group reacted favourably.

CONCLUSION

The Internet is a source of drug information--an information leaflet may help to guide local patients through its variable information quality.