Reliability of health information for the public on the World Wide Web: systematic survey of advice on managing fever in children at home

A Systematic Quality Assessment of Online Resources on Eyelid Ptosis Using the Modified Ensuring Quality Information for Patients (mEQIP) Tool

BACKGROUND

Eyelid ptosis is an underestimated pathology deeply affecting patients' quality of life. Internet has increasingly become the major source of information regarding health care, and patients often browse on websites to acquire an initial knowledge on the subject. However, there is lack of data concerning the quality of available information focusing on the eyelid ptosis and its treatment. We systematically evaluated online information quality on eyelid ptosis by using the "Ensuring Quality Information for Patients" (EQIP) scale.

MATERIALS AND METHODS

Google, Yahoo and Bing have been searched for the keywords "Eyelid ptosis," "Eyelid ptosis surgery" and "Blepharoptosis." The first 50 hits were included, evaluating the quality of information with the expanded EQIP tool. Websites in English and intended for general non-medical public use were included. Irrelevant documents, videos, pictures, blogs and articles with no access were excluded.

RESULTS

Out of 138 eligible websites, 79 (57,7%) addressed more than 20 EQIP items, with an overall median score of 20,2. Only 2% discussed procedure complication rates. The majority fail to disclose severe complications and quantifying risks, fewer than 18% clarified the potential need for additional treatments. Surgical procedure details were lacking, and there was insufficient information about pre-/postoperative precautions for patients. Currently, online quality information has not improved since COVID-19 pandemic.

CONCLUSIONS

This study highlights the urgent requirement for improved patient-oriented websites adhering to international standards for plastic and oculoplastic surgery. Healthcare providers should effectively guide their patients in finding trustworthy and reliable eyelid ptosis correction information.

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Quality Assessment of Online Resources for Gender-affirming Surgery

Background

As visibility of the transgender patient population and utilization of online resources increases, it is imperative that web-based gender-affirming surgery (GAS) materials for patients are readable, accessible, and of high quality.

Methods

A search trends analysis was performed to determine frequency of GAS-related searches over time. The top 100 most common results for GAS-related terms were analyzed using six readability formulas. Accessibility of patient-facing GAS sources was determined by categorizing types of search results. Frequency of article types was compared in low- and high-population dense areas. Quality was assigned to GAS web-based sources using the DISCERN score.

Results

Search engine trend data demonstrates increasing occurrence of searches related to GAS. Readability scores of the top 100 online sources for GAS were discovered to exceed recommended levels for patient proficiency. Availability of patient-facing online information related to GAS was found to be 60%, followed by information provided by insurance companies (17%). Differences in availability of online resources in varying dense cities were found to be minimal. The average quality of sources determined by the DISCERN score was found to be 3, indicating "potential important shortcomings."

Conclusions

Despite increasing demand for web-based GAS information, the readability of online resources related to GAS was found to be significantly greater than the grade level of proficiency recommended for patients. A high number of nonpatient-facing search results appear in response to GAS search terms. Quality sources are still difficult for patients to find, as search results have a high incidence of low-quality resources.

Current Situations and Challenges in the Development of Health Information Literacy

Health information literacy (HIL) is a significant concept that has gradually become known to the broader public in recent years. Although the definitions of HIL and health literacy seem to overlap, as an independent subconcept, HIL still shows a unique influence on improvements in people's health and health education. Remarkable evidence indicates that online health information (OHI) can effectively enrich people's knowledge and encourage patients to actively join the medical process, which is also accompanied by the emergence of various assessment tools. Although the current assessment tools, to a certain extent, can help people identify their shortcomings and improve their HIL, many studies have indicated that the deficiencies of the scales induce incomplete or unreal results of their HIL. In addition, continuing research has revealed an increasing number of influencing factors that have great effects on HIL and even regulate the different trends in doctor-patient relationships. Simultaneously, most of the uncensored OHI broadcasts have also affected the improvement in HIL in various ways. Thus, this review aims to summarize the assessment tools, influencing factors and current situations and challenges related to HIL. Further studies are required to provide more trusted and deeper references for the development of HIL.

Irritable Bowel Syndrome Demographics: A Middle Eastern Multinational Cross-sectional Study

BACKGROUND: Irritable bowel syndrome (IBS) is the most frequent functional gastrointestinal (GI) disorder. In this study, we aimed to evaluate the different aspects of IBS among Middle Eastern residents. METHODS: During the study period, patients attending gastroenterology clinics of nine tertiary referral centers in four Middle Eastern couturiers (Iran, Egypt, Kuwait, and Turkey) were evaluated by Rome IV diagnostic criteria, and those who fulfilled the diagnostic criteria of IBS were asked to fill in a questionnaire covering different demographics and clinical aspects. RESULTS: Overall, during a 6-month period, 509 patients with IBS were included. 41.3% of the participants were male (210 patients), and 37.4% of them had academic education. 50% of the participants were Caucasian, and 34% were Arab, and originally, they were citizens of 18 countries. 77.4% of the participants were residents of subtropical areas, while 22.2% were living in temperate regions. The average age of the participants during the first presentation in subtropical and temperate areas were 38.4 ± 12.19 and 38.06 ± 12.18 years, respectively (P = 0.726). The most common subtypes of IBS in subtropical areas were unclassified (IBS-U, 44.4%), constipation dominant (IBS-C, 27.6%), mixed pattern (IBS-M, 21%), and diarrhea dominant (IBS-D, 6.8%) in descending order while in temperate areas the most common subtypes were IBS-U (43.3%), and IBS-D (22.1%), respectively (P < 0.001). Besides abdominal pain, the most common symptom of patients in each region was bloating (62.2% and 68.1%, respectively, P = 0.246). The rate of depression and anxiety were significantly higher among the residents of temperate areas in comparison with subtropical regions (41.6% vs. 16.5% and 80.5% vs. 58.4%, respectively, P < 0.001). CONCLUSION: Although the average age of IBS presentation is the same in subtropical and temperate areas, it seems that in temperate areas, the rate of IBS-D is more prevalent than in subtropical regions. The rate of anxiety and depression are significantly higher among those who searched social media and the internet to get information about their problems.

Laparoscopic Cholecystectomy: Evaluation of Web-Based Information

Introduction

Laparoscopic cholecystectomy (LC), the gold standard treatment for symptomatic gallstone disease, is the most common procedure performed by general surgeons worldwide. The internet remains to be a popular source of medical information. Our aim was to evaluate the quality and readability of information available on the web for patients undergoing LC and to compare the information provided by the National Health Service (NHS) and non-NHS websites. 

Methods

We searched for the keywords ‘laparoscopic cholecystectomy’ using the three most popular search engines (Google, Yahoo and MSN) and looked at the first 50 websites only. The readability of each document was assessed using the Flesch Reading Ease (FRE) score. We checked Health on the Net Foundation Code of Conduct (HONcode) certification status, whether the sites had been checked by an expert and when the information was last updated.

Results

Fifty-five of the possible 150 sites were analysed thus excluding repetitions (n=65), irrelevant content (n=26) or inaccessible links (n=3). Only seven of those were HONcode-certified. The mean FRE score was 46 (range 0-68, SD=16.13). There were 13 NHS sites and 42 non-NHS sites. The mean FRE score for the NHS sites was significantly better compared to the non-NHS sites [58.31 (SD=5.01) vs 42.21 (SD=16.35); p=0.001]. Fifty-four per cent (54%) of the analysed websites had been checked by a medical expert and 22% were updated within the last year.

Conclusions

This study highlights the poor quality and readability of information on medical websites. The information provided by NHS sites have significantly better readability compared to non-NHS sites.

Infodemics and infodemiology: a short history, a long future

An "infodemic" is defined as "an overabundance of information - some accurate and some not - occurring during an epidemic". This paper describes the characteristics of an infodemic, which combines an inordinately high volume of information (leading to problems relating to locating the information, storage capacity, ensuring quality, visibility and validity) and rapid output (making it hard to assess its value, manage the gatekeeping process, apply results, track its history, and leading to a waste of effort). This is bound up with the collateral growth of misinformation, disinformation and malinformation. Solutions to the problems posed by an infodemic will be sought in improved technology and changed social and regulatory frameworks. One solution could be a new trusted top-level domain for health information. The World Health Organization has so far made two unsuccessful attempts to create such a domain, but it is suggested this could be attempted again, in the light of the COVID-19 infodemic experience. The vital role of reliable information in public health should also be explicitly recognized in the Sustainable Development Goals, with explicit targets. All countries should develop knowledge preparedness plans for future emergencies.

Neural side effect discovery from user credibility and experience-assessed online health discussions

BACKGROUND

Health 2.0 allows patients and caregivers to conveniently seek medical information and advice via e-portals and online discussion forums, especially regarding potential drug side effects. Although online health communities are helpful platforms for obtaining non-professional opinions, they pose risks in communicating unreliable and insufficient information in terms of quality and quantity. Existing methods in extracting user-reported adverse drug reactions (ADRs) in online health forums are not only insufficiently accurate as they disregard user credibility and drug experience, but are also expensive as they rely on supervised ground truth annotation of individual statement. We propose a NEural ArchiTecture for Drug side effect prediction (NEAT), which is optimized on the task of drug side effect discovery based on a complete discussion while being attentive to user credibility and experience, thus, addressing the mentioned shortcomings. We train our neural model in a self-supervised fashion using ground truth drug side effects from mayoclinic.org. NEAT learns to assign each user a score that is descriptive of their credibility and highlights the critical textual segments of their post.

RESULTS

Experiments show that NEAT improves drug side effect discovery from online health discussion by 3.04% from user-credibility agnostic baselines, and by 9.94% from non-neural baselines in term of F1. Additionally, the latent credibility scores learned by the model correlate well with trustworthiness signals, such as the number of "thanks" received by other forum members, and improve credibility heuristics such as number of posts by 0.113 in term of Spearman's rank correlation coefficient. Experience-based self-supervised attention highlights critical phrases such as mentioned side effects, and enhances fully supervised ADR extraction models based on sequence labelling by 5.502% in terms of precision.

CONCLUSIONS

NEAT considers both user credibility and experience in online health forums, making feasible a self-supervised approach to side effect prediction for mentioned drugs. The derived user credibility and attention mechanism are transferable and improve downstream ADR extraction models. Our approach enhances automatic drug side effect discovery and fosters research in several domains including pharmacovigilance and clinical studies.

How to Fight an Infodemic: The Four Pillars of Infodemic Management

In this issue of the Journal of Medical Internet Research, the World Health Organization (WHO) is presenting a framework for managing the coronavirus disease (COVID-19) infodemic. Infodemiology is now acknowledged by public health organizations and the WHO as an important emerging scientific field and critical area of practice during a pandemic. From the perspective of being the first “infodemiolgist” who originally coined the term almost two decades ago, I am positing four pillars of infodemic management: (1) information monitoring (infoveillance); (2) building eHealth Literacy and science literacy capacity; (3) encouraging knowledge refinement and quality improvement processes such as fact checking and peer-review; and (4) accurate and timely knowledge translation, minimizing distorting factors such as political or commercial influences. In the current COVID-19 pandemic, the United Nations has advocated that facts and science should be promoted and that these constitute the antidote to the current infodemic. This is in stark contrast to the realities of infodemic mismanagement and misguided upstream filtering, where social media platforms such as Twitter have advertising policies that sideline science organizations and science publishers, treating peer-reviewed science as “inappropriate content.”

Parental Experience of Potential Adverse Drug Reactions Related to Their Oral Administration of Antipyretic Analgesic Medicines in Children in Saudi Arabia

BACKGROUND

Oral antipyretic analgesic medicines are commonly used in children and have the potential for adverse drug reactions (ADRs).

OBJECTIVE

The aim of this study was to explore parental experiences of potential ADRs related to their oral administration of antipyretic analgesics in children in the Kingdom of Saudi Arabia.

METHODS

For this cross-sectional survey, a paper-based questionnaire, consent form and information sheet were handed out to 1000 parents who had administered an oral antipyretic analgesic medicine to their children during the previous 3 months. Data were entered and analyzed using SPSS version 21.0 (IBM-SPSS Inc, Armonk, NY). Simple descriptive and inferential statistics were used. Management and ethical approvals were attained.

RESULTS

During March to April 2017, 661 parents agreed to participate, giving a response rate of 66.1%. Of the surveyed sample, 208 parents had observed 1 or more potential ADRs (31.5%, n = 208 out of 661). Parents' (n = 208) most commonly reported potential ADRs (n = 523) were loss of appetite (23%, n = 120 out of 523), stomachache (20.3%, n = 106 out of 523), abdominal colic (13%, n = 68 out of 523), and diarrhea (10.3%, n = 54 out of 523). Parents described severity of the ADRs as slight (71.8%, n = 342 out of 476), annoying to the child (7.9%, n = 85 to of 476), significant and affecting daily tasks (3.6%, n = 17 out of 476) and significant and led to the hospital (6.7%, n = 32 out of 476). Fever was the top-ranked reason for using antipyretic analgesic medicines (41.0%, n = 271 out of 661), followed by toothache (25.0%, n = 165 out of 661) and tonsillitis/laryngitis (24.7%, n = 163 out of 661). Among parents, 34.7% (n = 165 out of 476) did not seek medical attention when a potential ADR occurred, whereas 26.3% (n = 125 out of 476) of parents took their children to hospital clinics.

CONCLUSIONS

Although the majority of parentally reported (but not proven) ADRs were mild, a number of significant ADRs were reported. Future research should consider whether there is a role for physicians and pharmacists in educating parents in Saudi Arabia, and perhaps more widely, about the optimal use of oral antipyretic and analgesic medicines in children. (Curr Ther Res Clin Exp. 2020; 81:XXX-XXX)© 2020 Elsevier HS Journals, Inc.

Paediatric clinicians' experiences of parental online health information seeking: A qualitative study

AIM

The aim of this research was to explore clinicians' experiences of parents' online health information seeking (OHIS) behaviour about selective dorsal rhizotomy for the management of cerebral palsy.

METHODS

Using qualitative methodology, clinicians likely to have had experience with parents requesting selective dorsal rhizotomy were invited to participate in semi-structured interviews. Interviews with 13 clinicians were recorded, transcribed and inductive content analysis was used to identify, code and organise the data into themes.

RESULTS

Participants highlighted how parental OHIS was changing clinical communication. Negative effects included a shift in clinicians' attention from giving advice and guidance to spending time discussing online findings, justifying how this information applies to a particular child and managing parents' judgments about clinical views. Positive effects included more collaboration and sharing of ideas. These results are presented in three main themes: (i) the informed parent; (ii) the clinicians' role; and (iii) a new clinical dynamic.

CONCLUSION

This research reinforces the notion that OHIS is changing the communication dynamic and clinicians' and parents' roles within the clinical encounter. Of significance was the number of challenges clinicians are facing as a result of online information, including managing parental understanding of non-evidenced information and responding to negative feedback about their practice. This research suggests a need for educational support and ongoing professional development for clinicians to assist them to adjust to new goals and expectations of clinical interactions with 'informed' parents.

Development of an Instrument to Assess Parents' Excessive Web-Based Searches for Information Pertaining to Their Children's Health: The "Children's Health Internet Research, Parental Inventory" (CHIRPI)

Background

People often search the internet to obtain health-related information not only for themselves but also for family members and, in particular, their children. However, for a minority of parents, such searches may become excessive and distressing. Little is known about excessive web-based searching by parents for information regarding their children’s health.

Objective

This study aimed to develop and validate an instrument designed to assess parents' web-based health information searching behavior, the Children’s Health Internet Research, Parental Inventory (CHIRPI).

Methods

A pilot survey was used to establish the instrument (21 items). CHIRPI was validated online in a second sample (372/384, 96.9% mothers; mean age 32.7 years, SD 5.8). Item analyses, an exploratory factor analysis (EFA), and correlations with parents’ perception of their children’s health-related vulnerability (Child Vulnerability Scale, CVS), parental health anxiety (modified short Health Anxiety Inventory, mSHAI), and parental cyberchondria (Cyberchondria Severity Scale, CSS-15) were calculated. A subset of participants (n=73) provided retest data after 4 weeks. CHIRPI scores (total scores and subscale scores) of parents with a chronically ill child and parents who perceived their child to be vulnerable (CVS+; CVS>10) were compared with 2×2 analyses of variances (ANOVAs) with the factors Child’s Health Status (chronically ill vs healthy) and perceived vulnerability (CVS+ vs CVS−).

Results

CHIRPI’s internal consistency was standardized alpha=.89. The EFA identified three subscales: Symptom Focus (standardized alpha=.87), Implementing Advice (standardized alpha=.74) and Distress (standardized alpha=.89). The retest reliability of CHIRPI was measured as r_tt=0.78. CHIRPI correlated strongly with CSS-15 (r=0.66) and mSHAI (r=0.39). The ANOVAs comparing the CHIRPI total score and the subscale scores for parents having a chronically ill child and parents perceiving their child as vulnerable revealed the main effects for perceiving one’s child as vulnerable but not for having a chronically ill child. No interactions were found. This pattern was observed for the CHIRPI total score (η²=0.053) and each subscale (Symptom Focus η²=0.012; Distress η²=0.113; and Implementing Advice η²=0.018).

Conclusions

The psychometric properties of CHIRPI are excellent. Correlations with mSHAI and CSS-15 indicate its validity. CHIRPI appears to be differentially sensitive to excessive searches owing to parents perceiving their child’s health to be vulnerable rather than to higher informational needs of parents with chronically ill children. Therefore, it may help to identify parents who search excessively for web-based health information. CHIRPI (and, in particular, the Distress subscale) seems to capture a pattern of factors related to anxious health-related cognitions, emotions, and behaviors of parents, which is also applied to their children.

Assessment of quality and readability of internet-based health information related to commonly prescribed angiotensin receptor blockers

Introduction

Hypertension is a global public health burden. Angiotensin receptor blockers (ARBs) have proven efficacy in the management of hypertension and related complications. The Internet has become a major source of health information for patients and healthcare professionals. The study aimed to assess the quality and readability of internet-based information related to selected Angiotensin Receptor Blockers (ARBs).

Methods

The three most widely used ARBs were identified from published literature, after which internet-based patient information was identified from the first five pages of three search engines (Google, Yahoo and Bing). Quality of identified websites were assessed using the DISCERN instrument, while readability was evaluated using the SMOG instrument and the Flesch-Kincaid readability algorithm. Final ratings were then calculated as described by the instruments developers. Further, inter-class correlation coefficients (ICC) were calculated using the Statistical Package for Social Sciences.

Results

The average overall DISCERN score in this study was 2.99 (SD±1.05). No website received an excellent rating, 15% were rated good, 66% as moderate and 19% as poor. The inter-class reliability was 0.804 for losartan and 0.695 for valsartan. The mean Flesch Reading Ease score for the websites was 48.87 (SD±16.12), mean Flesch-Kincaid Reading Grade Level was 9.29 (SD±1.98) while mean SMOG value was 11.29 (SD±1.70).

Conclusion

Overall, patient information on the reviewed ARBs websites was found to be of moderate quality and suboptimal readability. Content providers on websites should ensure that health information is of favorable quality and easy to read by patients with varying degree of health literacy.

Bilateral assessment of body core temperature through axillar, tympanic and inner canthi thermometers in a young population

There are several sites in which the human body core temperature can be estimated and used to identify febrile states in a threat of pandemic situations at high-populational-traffic places (e.g. airports, ports, universities, schools, public buildings). In these locations, a fast method is required for temperature screening of masses. The most common methods are axillar and tympanic thermometers. However, in addition, measurement of the inner canthi (IC) of the eye with infrared thermal (IRT) imaging has been suggested as a fast mass measurement screening tool.

OBJECTIVE

It is the aim of this research to identify the bilateral difference of the available body temperature screening methods with potential use for large-scale fever screening and to verify if such a difference is acceptable.

APPROACH

A total of 206 young participants (104 females and 102 males) were recruited, having their temperatures taken with the different methods bilaterally under neutral environmental conditions. The obtained results were statistically processed.

MAIN RESULTS

Results established absent reference data for site and method in west European populations. The bilateral differences were minor using the IC of the eye monitored with infrared imaging, which was also proved with the Bland-Altmann limits of agreement.

SIGNIFICANCE

Based on the findings of this research, despite all methods being able to estimate body core temperature, it is suggested to use IRT images of the IC of the eye, due to its fast, reliable and reproducible procedure for mass screening. Further research is required to understand the higher bilateral variability in using the traditional thermometer axilla and tympanic membrane assessments, since these are the methods currently used within a clinical setup. The same procedure must be applied to fever cases to establish a decision threshold per method.

A Qualitative Study of Parents' Conceptualizations on Fever in Children Aged 0 to 12 Years

Many parents experience “fever phobia”, based on misconceptions regarding the repercussions of fever in their children. The aim of this paper was to explore the conceptualizations of parents who are health professionals and parents without health qualifications on childhood fever. This qualitative study was based on grounded theory using a triangulated sample (theoretical sampling and snowball sampling) of parents of children aged 0 to 12 years old who received care for fever in the Emergency Primary Care Services two in Spanish municipalities. Data collection was based on focus groups segmented by gender, place of residence and education. Data analysis followed the constant comparative method and involved a coding process. Results show that independently of the parents’ place of residence or education, their perceptions of fever were somewhat ambivalent, beneficial at times, but also harmful. Parents acknowledged feelings of concern, fear, being overwhelmed, freezing up and relief once the fever was controlled. Health professional parents considered they had an extra responsibility for caring. Finally, parents without health education demanded more information from professionals. These results provide key information for the design of interventions directed at the management of fever in children.

Tracker-Based Personal Advice to Support the Baby's Healthy Development in a Novel Parenting App: Data-Driven Innovation

BACKGROUND

The current generation of millennial parents prefers digital communications and makes use of apps on a daily basis to find information about child-rearing topics. Given this, an increasing amount of parenting apps have become available. These apps also allow parents to track their baby's development with increasing completeness and precision. The large amounts of data collected in this process provide ample opportunity for data-driven innovation (DDI). Subsequently, apps are increasingly personalized by offering information that is based on the data tracked in the app. In line with this, Philips Avent has developed the uGrow app, a medical-grade app dedicated to new parents for tracking their baby's development. Through so-called insights, the uGrow app seeks to provide a data-driven solution by offering parents personal advice that is sourced from user-tracked behavioral and contextual data.

OBJECTIVE

The aim of this study was twofold. First, it aimed to give a description of the development process of the insights for the uGrow app. Second, it aimed to present results from a study about parents' experiences with the insights.

METHODS

The development process comprised 3 phases: a formative phase, development phase, and summative phase. In the formative phase, 3 substudies were executed in series to understand and identify parents' and health care professionals' (HCPs) needs for insights, using qualitative and quantitative methods. After the formative phase, insights were created during the development phase. Subsequently, in the summative phase, these insights were validated against parents' experience using a quantitative approach.

RESULTS

As part of the formative phase, parents indicated having a need for smart information based on a data analysis of the data they track in an app. HCPs supported the general concept of insights for the uGrow app, although specific types of insights were considered irrelevant or even risky. After implementing a preliminary set of insights in a prototype version of the uGrow app and testing it with parents, the majority of parents (87%) reported being satisfied with the insights. From these outcomes, a total of 89 insights were implemented in a final version of the uGrow app. In the summative phase, the majority of parents reported experiencing these insights as reassuring and useful (94%), as adding enjoyment (85%), and as motivating for continuing tracking for a longer period of time (77%).

CONCLUSIONS

Parents experienced the insights in the uGrow app as useful and reassuring and as adding enjoyment to their use of the uGrow app and tracking their baby's development. The insights development process we followed showed how the quality of insights can be guaranteed by ensuring that insights are relevant, appropriate, and evidence based. In this way, insights are an example of meaningful DDI.

Differences in Perceptions of Health Information Between the Public and Health Care Professionals: Nonprobability Sampling Questionnaire Survey

Background

In the new media age, the public searches for information both online and offline. Many studies have examined how the public reads and understands this information but very few investigate how people assess the quality of journalistic articles as opposed to information generated by health professionals.

Objective

The aim of this study was to examine how public health care workers (HCWs) and the general public seek, read, and understand health information and to investigate the criteria by which they assess the quality of journalistic articles.

Methods

A Web-based nonprobability sampling questionnaire survey was distributed to Israeli HCWs and members of the public via 3 social media outlets: Facebook, WhatsApp, and Instagram. A total of 979 respondents participated in the online survey via the Qualtrics XM platform.

Results

The findings indicate that HCWs find academic articles more reliable than do members of the general public (44.4% and 28.4%, respectively, P<.001). Within each group, we found disparities between the places where people search for information and the sources they consider reliable. HCWs consider academic articles to be the most reliable, yet these are not their main information sources. In addition, HCWs often use social networks to search for information (18.2%, P<.001), despite considering them very unreliable (only 2.2% found them reliable, P<.001). The same paradoxes were found among the general public, where 37.5% (P<.001) seek information via social networks yet only 8.4% (P<.001) find them reliable. Out of 6 quality criteria, 4 were important both to HCWs and to the general public.

Conclusions

In the new media age where information is accessible to all, the quality of articles about health is of critical importance. It is important that the criteria examined in this research become the norm in health writing for all stakeholders who write about health, whether they are professional journalists or citizen journalists writing in the new media.

Palliative Cancer Patients and Their Families on the Internet: Motivation and Impact

Increasingly, palliative patients and their families are going online. A series of cases are presented to explore the reasons they go online and the effects of their online activity, both harmful and beneficial. This paper highlights the need to take this growing phenomenon and its effects on patient care seriously, and identifies key areas that need to be explored further.

Evaluating the Quality of Health Information in a Changing Digital Ecosystem

BACKGROUND

Critical evaluation of online health information has always been central to consumer health informatics. However, with the emergence of new Web media platforms and the ubiquity of social media, the issue has taken on a new dimension and urgency. At the same time, many established existing information quality evaluation guidelines address information characteristics other than the content (eg, authority and currency), target information creators rather than users as their main audience, or do not address information presented via novel Web technologies.

OBJECTIVE

The aim of this formative study was to (1) develop a methodological approach for analyzing health-related Web pages and (2) apply it to a set of relevant Web pages.

METHODS

This qualitative study analyzed 25 type 2 diabetes pages, which were derived from the results of a Google search with the keywords "diabetes," "reversal," and "natural." The coding scheme, developed via a combination of theory- and data-driven approaches, includes 5 categories from existing guidelines (resource type, information authority, validity of background information sources, objectivity, and currency) and 7 novel categories (treatment or reversal method, promises and certainty, criticisms of establishment, emotional appeal, vocabulary, rhetoric and presentation, and use of science in argumentation). The coding involves both categorical judgment and in-depth narrative characterization. On establishing satisfactory level of agreement on the narrative coding, the team coded the complete dataset of 25 pages.

RESULTS

The results set included "traditional" static pages, videos, and digitized versions of printed newspapers or magazine articles. Treatments proposed by the pages included a mixture of conventional evidence-based treatments (eg, healthy balanced diet exercise) and unconventional treatments (eg, dietary supplements, optimizing gut flora). Most pages either promised or strongly implied high likelihood of complete recovery. Pages varied greatly with respect to the authors' stated background and credentials as well as the information sources they referenced or mentioned. The majority included criticisms of the traditional health care establishment. Many sold commercial products ranging from dietary supplements to books. The pages frequently used colloquial language. A significant number included emotional personal anecdotes, made positive mentions of the word cure, and included references to nature as a positive healing force. Most pages presented some biological explanations of their proposed treatments. Some of the explanations involved the level of complexity well beyond the level of an educated layperson.

CONCLUSIONS

Both traditional and data-driven categories of codes used in this work yielded insights about the resources and highlighted challenges faced by their users. This exploratory study underscores the challenges of consumer health information seeking and the importance of developing support tools that would help users seek, evaluate, and analyze information in the changing digital ecosystem.

Predicting the quality of health web documents using their characteristics

Purpose

The quality of consumer-oriented health information on the web has been defined and evaluated in several studies. Usually it is based on evaluation criteria identified by the researchers and, so far, there is no agreed standard for the quality indicators to use. Based on such indicators, tools have been developed to evaluate the quality of web information. The HONcode is one of such tools. The purpose of this paper is to investigate the influence of web document features on their quality, using HONcode as ground truth, with the aim of finding whether it is possible to predict the quality of a document using its characteristics.

Design/methodology/approach

The present work uses a set of health documents and analyzes how their characteristics (e.g. web domain, last update, type, mention of places of treatment and prevention strategies) are associated with their quality. Based on these features, statistical models are built which predict whether health-related web documents have certification-level quality. Multivariate analysis is performed, using classification to estimate the probability of a document having quality given its characteristics. This approach tells us which predictors are important. Three types of full and reduced logistic regression models are built and evaluated. The first one includes every feature, without any exclusion, the second one disregards the Utilization Review Accreditation Commission variable, due to it being a quality indicator, and the third one excludes the variables related to the HONcode principles, which might also be indicators of quality. The reduced models were built with the aim to see whether they reach similar results with a smaller number of features.

Findings

The prediction models have high accuracy, even without including the characteristics of Health on the Net code principles in the models. The most informative prediction model considers characteristics that can be assessed automatically (e.g. split content, type, process of revision and place of treatment). It has an accuracy of 89 percent.

Originality/value

This paper proposes models that automatically predict whether a document has quality or not. Some of the used features (e.g. prevention, prognosis or treatment) have not yet been explicitly considered in this context. The findings of the present study may be used by search engines to promote high-quality documents. This will improve health information retrieval and may contribute to reduce the problems caused by inaccurate information.

Online Patient Resources for Gender Affirmation Surgery: An Analysis of Readability

BACKGROUND

Gender affirmation surgery is an important treatment for patient with gender dysphoria. It consists of a series of complex procedures, and well-informed patients have been shown to have better outcomes. However, there are no published data regarding the readability of currently available online patient recourses for gender affirmation surgery. This study aims at identifying the most popular online resources and evaluating the readability of these documents in the context of average literacy within the United States.

METHODS

An online search with the terms "gender affirmation surgery," "gender reassignment surgery," "top surgery," and "bottom surgery" was performed. Location, cookies, and user account information was disabled before each search to avoid bias in the results. Readability assessment was performed using the 10 commonly used readability scales.

RESULTS

The overall mean readability level was 13.4. The mean reading level was 14 (range, 7.6-17.0) for the search term "gender affirmation surgery," 14.2 (range, 11.9-16.7) for the search term "gender reassignment surgery," 13 (range, 8.9-17.5) for the search term "top surgery," and 12.6 (range, 7.1-15.0) for the search term "bottom surgery." There was no statistically significant difference between the search terms.

CONCLUSIONS

Our findings demonstrate that the articles most commonly seen by patients who perform an Internet search for information on gender reassignment surgery are more difficult than the recommended readability level.

Educational interventions to improve people's understanding of key concepts in assessing the effects of health interventions: a systematic review

BACKGROUND

Health information is readily accessible but is of variable quality. General knowledge about how to assess whether claims about health interventions are trustworthy is not common, so people's health decisions can be ill-informed, unnecessarily costly and even unsafe. This review aims to identify and evaluate studies of educational interventions designed to improve people's understanding of key concepts for evaluating claims about the effects of health interventions.

METHODS/DESIGN

We searched multiple electronic databases and sources of grey literature. Inclusion criteria included all study types that included a comparison, any participants (except health professionals or health professional students) and educational interventions aimed at improving people's understanding of one or more of the key concepts considered necessary for assessing health intervention claims. Knowledge and/or understanding of concepts or skills relevant to evaluating health information were our primary outcome measures. Secondary outcomes included behaviour, confidence, attitude and satisfaction with the educational interventions. Two authors independently screened search results, assessed study eligibility and risk of bias and extracted data. Results were summarised using descriptive synthesis.

RESULTS

Among 24 eligible studies, 14 were randomised trials and 10 used other study designs. There was heterogeneity across study participants, settings and educational intervention type, content and delivery. The risk of bias was high in at least one domain for all randomised studies. Most studies measured outcomes immediately after the educational intervention, with few measuring later. In most of the comparisons, measures of knowledge and skills were better among those who had received educational interventions than among controls, and some of these differences were statistically significant. The effects on secondary outcomes were inconsistent.

CONCLUSIONS

Educational interventions to improve people's understanding of key concepts for evaluating health intervention claims can improve people's knowledge and skills, at least in the short term. Effects on confidence, attitude and behaviour are uncertain. Many of the studies were at moderate or greater risk of bias. Improvements in study quality, consistency of outcome measures and measures of longer-term effects are needed to improve confidence in estimates of the effects of educational interventions to improve people's understanding of key concepts for evaluating health intervention claims.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42016033103.

Clefts of the lip and palate: is the Internet a trustworthy source of information for patients?

Great numbers of patients use the Internet to obtain information and familiarize themselves with medical conditions. However, the quality of Internet-based information on clefts of the lip and palate has not yet been examined. The goal of this study was to assess the quality of Internet-based patient information on orofacial clefts. Websites were evaluated based on the modified Ensuring Quality Information for Patients (EQIP) instrument (36 items). Three hundred websites were identified using the most popular search engines. Of these, 146 were assessed after the exclusion of duplicates, irrelevant sites, and web pages in languages other than English. Thirty-four (23.2%) web pages, designed mostly by academic centres and hospitals, covered more than 22 items and were classified as high-score websites. The EQIP score achieved by websites ranged between 4 and 30, out of a total possible 36 points; the median score was 19 points. The top five high-scoring web pages are highlighted. The overall quality of Internet-based patient information on orofacial clefts is low. Also, the majority of web pages created by medical practitioners have a marketing perspective and in order to attract more patients/customers avoid mentioning the risks of the reconstructive procedures needed.

Participatory Design of an Online Self-Management Tool for Users With Spinal Cord Injury: Qualitative Study

Background

Rehospitalization rates resulting from secondary conditions in persons with spinal cord injuries (SCI) are high. Self-management programs for many chronic conditions have been associated with decreases in hospital readmissions. However, in the SCI community, evidence suggests that satisfaction with traditional self-management programs is low. Users with SCI have indicated preference for programs that are online (rather than in-person), that target SCI-specific concerns, and are led by peers with SCI. There is currently no program with all of these features, which addresses self-management of secondary conditions after SCI.

Objective

The aim of this study was to provide details of a participatory design (PD) process for an internet-mediated self-management program for users with SCI (called SCI & U) and illustrate how it has been used to define design constraints and solutions.

Methods

Users were involved in development as codesigners, codevelopers, and key informants. Codesigners and codevelopers were recruited from consumer advocacy groups and worked with a core development team. Key informants were recruited from geographically distributed advocacy groups to form a product advisory council that met regularly with the core team. During meetings, codesigners and informants walked through stages of work that typify PD processes such as exploration, discovery, and prototyping. This paper details the process by analyzing 10 meetings that took place between August 2015 and May 2016. Meetings were recorded, transcribed, and subjected to an inductive thematic analysis; resulting themes were organized according to their relationship to PD stages.

Results

A total of 16 individuals participated in meeting discussions, including 7 researchers and 9 persons with SCI from 4 Canadian provinces. Themes of trust, expertise, and community emerged in every group discussion. The exploration stage revealed interest in online self-management resources coupled with concerns about information credibility. In general, participants indicated that they felt more confident with information received from trusted, in-person sources (eg, peers or health care professionals) than information found online. The discovery stage saw participants propose and discuss concepts to filter credible information and highlight community expertise, namely (1) a community-curated resource database, (2) online information navigators, and (3) group chats with peers. Several tools and techniques were collectively prototyped in an effort to foster trust and community; these are illustrated in the Results section.

Conclusions

A PD process engaging users as codesigners, codevelopers, and informants can be used to identify design concerns and prototype online solutions to promote self-management after SCI. Future work will assess the usability of the collectively designed tools among a broad population of Canadians with SCI and the tools’ impact on self-efficacy and health.

Facial Plastic Surgery Patient Resources Exceed National Institute Recommendations

Patient education is essential in enhancing the physician-patient therapeutic alliance, patient satisfaction, and clinical outcomes. The American Medical Association and National Institute of Health recommend that information be written at a 6th-grade reading level, but online resources often exceed patient literacy. The purpose of this study is to assess readability of online material for facial plastics procedures presented on academic plastic surgery and otolaryngology websites.An Internet search was performed of all academic institutions that had both plastic surgery and otolaryngology training programs who offered patient information on facial plastic surgery procedures. National society websites for both plastic surgery and otolaryngology were also analyzed. All procedural information was compiled and readability analyses were performed. A 2-tailed Z-test was used to compare scores, and statistical significance was set at P < 0.05.Sixty-three programs were identified; 42 had educational material. The overall average readability for all information was at a 10th-grade reading level. The national plastic surgery website had a significantly higher word count and number of syllables per word compared to the national otolaryngology website (P < 0.001, P = 0.04).The complexity of written resources represents an obstacle to online patient education and efforts to improve readability could benefit patients seeking medical information online. Current online education materials are a potential hindrance to patient education, satisfaction, and decision making. Healthcare institutions should consider writing new materials with simpler language that would be accessible to patients.

Emerging challenges in using health information from the internet

In 2000, about 350 million adults used the internet and people increasingly take articles from websites to medical appointments. The quality and safety of websites vary widely and some users are reluctant to access mainstream sites. People are vulnerable to misinformation and exploitation: there is evidence that online purchases have caused morbidity and mortality. This paper reviews the current evidence on the dissemination of health information on the internet and the various strategies that are developing to assess and screen site quality. Such strategies include ‘quality assurance’ marking, specially designed search engines, and operational criteria for individuals to apply to sites. It also discusses the medical community's roles and responsibilities in relation to this burgeoning area.

Seeking Health Information on Social Media

In the past few years, social media has changed the ways that health seekers seek health information. However, despite the tremendous growth of social media applications in the health-care industry, trust is still among the biggest challenges for social media health services in gaining greater acceptance. Drawn from previous literature on self-determination theory, social support, and trust, this study investigates people's intentions to seek health-information on social media. The authors carefully selected a sample from Italy with subjects who already had experience in seeking health information on social media. The empirical results show that informational support, emotional support, and the satisfaction of people's autonomy and relatedness needs play an important role through trust in influencing people's health-information-seeking intentions on social media. This study is among the first to adopt the theories of self-determination, social support, and trust to investigate people's intentions to seek health information on social media.

Systematic Review of Quality of Patient Information on Phalloplasty in the Internet

BACKGROUND

An increasing number of patients, considering aesthetic surgery, use Internet health information as their first source of information. However, the quality of information available in the Internet on phalloplasty is currently unknown. This study aimed to assess the quality of patient information on phalloplasty available in the Internet.

METHODS

The assessment of the Web sites was based on the modified Ensuring Quality Information for Patients (EQIP) instrument (36 items). Three hundred Web sites were identified by the most popular Web search engines.

RESULTS

Ninety Web sites were assessed after, duplicates, irrelevant sources and Web sites in other languages rather than English were excluded. Only 16 (18%) Web sites addressed >21 items, and scores tended to be higher for Web sites developed by academic centers and the industry than for Web sites developed by private practicing surgeons. The EQIP score achieved by Web sites ranged between 4 and 29 of the total 36 points, with a median value of 17.5 points (interquartile range, 13-21). The top 5 Web sites with the highest scores were identified.

CONCLUSIONS

The quality of patient information on phalloplasty in the Internet is substandard, and the existing Web sites present inadequate information. There is a dire need to improve the quality of Internet phalloplasty resources for potential patients who might consider this procedure.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Internet Usage by Parents Prior to Seeking Care at a Pediatric Emergency Department: Observational Study

BACKGROUND

Little is known about how parents utilize medical information on the Internet prior to an emergency department (ED) visit.

OBJECTIVE

The objective of the study was to determine the proportion of parents who accessed the Internet for medical information related to their child's illness in the 24 hours prior to an ED visit (IPED), to identify the websites used, and to understand how the content contributed to the decision to visit the ED.

METHODS

A 40-question interview was conducted with parents presenting to an ED within a freestanding children's hospital. If parents reported IPED, the number and names of websites were documented. Parents indicated the helpfulness of Web-based content using a 100-mm visual analog scale and the degree to which it contributed to the decision to visit the ED using 5-point Likert-type responses.

RESULTS

About 11.8 % (31/262) reported IPED (95% CI 7.3-5.3). Parents who reported IPED were more likely to have at least some college education (P=.04), higher annual household income (P=.001), and older children (P=.04) than those who did not report IPED. About 35% (11/31) could not name any websites used. Mean level of helpfulness of Web-based content was 62 mm (standard deviation, SD=25 mm). After Internet use, some parents (29%, 9/31) were more certain they needed to visit the ED, whereas 19% (6/31) were less certain. A majority (87%, 195/224) of parents who used the Internet stated that they would be somewhat likely or very likely to visit a website recommended by a physician.

CONCLUSIONS

Nearly 1 out of 8 parents presenting to an urban pediatric ED reported using the Internet in the 24 hours prior to the ED visit. Among privately insured, at least one in 5 parents reported using the Internet prior to visiting the ED. Web-based medical information often influences decision making regarding ED utilization. Pediatric providers should provide parents with recommendations for high-quality sources of health information available on the Internet.

Social Media and Multiple Sclerosis in the Posttruth Age

Over the last few decades, patients have increasingly been searching for health information on the Internet. This aspect of information seeking is really important, especially for people affected by chronic pathologies and require lifelong treatment and management. These people are usually very well informed about the disease, but are nonetheless vulnerable to hopes of being cured or saved, often amplified by misinformation, myths, legends, and therapies that are not always scientifically proven. Many studies suggest that some individuals prefer to rely on the Internet as their main source of information, often hindering the patient-doctor relationship. This is why a professional approach is imperative in this posttruth age, in order to maintain confidentiality, honesty, and trust in the medical profession.

Evaluating Internet Drug Information

For many consumers, the Internet has become a primary resource for health-related information. A study was conducted to evaluate the reliability and validity of consumer drug-information sites on the Internet. To assess reliability, the researchers identified sites with an “ask the pharmacist” option. Questions about the education and experience of the drug-information personnel, volume of inquiries received, reference utilization, and characteristics of inquirers were submitted to each of the sites. To assess validity, a drug information question was submitted to each of the sites. The responses received were evaluated by comparing them with responses from trained drug-information specialists working in established institutional services. Fewer than 70% of the sites answered the drug information question correctly. The conclusion: Drug information communicated via “ask the pharmacist” Internet sites may be unreliable.

Scoliosis and the Social Media: Facebook as a Means of Information Exchange

BACKGROUND CONTEXT

Over the last decade, the emergence of social networking websites such as Facebook have revolutionized information dissemination and broadened opportunities to engage in discussions. In particular, having been widely adopted in the younger generation, the use of this medium has become more prevalent in health disorders such as scoliosis in the adolescent population. However, the quality of information on Facebook is unregulated and variable, which may mislead patients in their decision making.

PURPOSE

To document the various types of information available and assess the quality of information on Facebook discussion boards using recognized scoring systems.

STUDY DESIGN

To evaluate the quality of information on the social network.

PATIENT SAMPLE

A search for the keyword "scoliosis" on Facebook was performed and the first 100 pages generated were reviewed.

OUTCOMES MEASURED

SCSS and DISCERN score.

METHODS

Content analysis was performed on discussion boards and personal blogs. Two independent examiners evaluated each site according to scoliosis-specific content score (SCSS) and the DISCERN criteria, both previously used instruments to judge the quality of information on the Internet pertaining to scoliosis. The SCSS range from 0 to 32 (higher score better) and the DISCERN 16 to 80 (higher score better).

RESULTS

Of the 100 sites reviewed, 33 were discussion boards and personal blogs. Of these, the overall average SCSS was 5.7 (SD 5.8, range 0-20) and the DISCERN was 22.5 (SD 7.6, range 16-45), indicating that using general scoring systems the quality of information provided was overall poor.

CONCLUSION

Using recognized scoring systems to analyze Facebook pages used as discussion forums or blogs, we showed that the quality in general was poor. For modern practices to adapt to an era of information exchange via the social network, the orthopedic community should develop ways to incorporate the social media in future patient education.

Parent's use of the Internet in the search for healthcare information and subsequent impact on the doctor-patient relationship

BACKGROUND

The Internet is an unavoidable source of healthcare information. This information, both reliable and unreliable, has previously been shown to influence carer's decisions.

AIMS

Our aim was to evaluate this information seeking behavior among parents and its subsequent potential impact on the doctor-patient relationship.

METHOD

We undertook a cross-sectional questionnaire-based survey of paediatric outpatients. Enrollment took place over 4 weeks in March 2015. There were no inclusion or exclusion criteria and enrollment was voluntary. In total 100 questionnaires were completed.

RESULTS

General Practitioners were the most common source of healthcare information. The Internet ranked third as a reliable source of healthcare information. The Internet was commonly used as an educational resource to learn about causes, treatment, and medications. A significant percentage of our population expressed concern regarding Internet information reliability. A small percentage of parents were concerned that disclosing Internet usage may worsen the relationship with their doctor.

CONCLUSIONS

Parents showed a willingness to learn about diseases and treatments, and felt that the Internet was a good resource to do so. This study shows that open discussion about Internet usage between parents and doctors is not common and carers feel at risk of judgment should they admit to Internet usage. The Internet should be seen as a positive adjunct to patient education which can improve understanding, thus strengthening the doctor-patient relationship. The Internet will never replace the role of healthcare professionals but must be seen as an integral part of a multi-disciplinary approach.

The Quality of Online Health-Related Information – an Emergent Consumer Health Issue

The Internet has become one of the main means of communication used by people who search for health-related information. The quality of online health-related information affects the users’ knowledge, their attitude, and their risk or health behaviour in complex ways and influences a substantial number of users in their decisions regarding diagnostic and treatment procedures.

The aim of this review is to explore the benefits and risks associated with using the Internet as a source of health-related information; the relationship between the quality of the health-related information available on the Internet and the potential risks; the multiple conceptual components of the quality of health-related information; the evaluation criteria for quality health-related information; and the main approaches and initiatives that have been implemented worldwide to help improve users’ access to high-quality health-related information.

Associations Between Patient Characteristics and the Amount of Arthritis Medication Information Patients Receive

Little is known about factors associated with the receipt of medication information among arthritis patients. This study explores information source receipt and associations between demographic and clinical/patient characteristics and the amount of arthritis medication information patients receive. Adult patients with osteoarthritis (OA) or rheumatoid arthritis (RA; n = 328) completed an online cross-sectional survey. Patients reported demographic and clinical/patient characteristics and the amount of arthritis medication information received from 15 information sources. Bivariate and multivariate linear regression analyses were used to investigate whether those characteristics were associated with the amount of medication information patients received. Arthritis patients received the most information from health professionals, followed by printed materials, media sources, and interpersonal sources. Greater receipt of information was associated with greater medication adherence, taking more medications, greater medication-taking concerns, more satisfaction with doctor medication-related support, and Black compared to White race. RA patients reported receiving more information compared to OA patients, and differences were found between RA patients and OA patients in characteristics associated with more information receipt. In conclusion, arthritis patients received the most medication information from professional sources, and both positive (e.g., greater satisfaction with doctor support) and negative (e.g., more medication-taking concerns) characteristics were associated with receiving more medication information.

Quality of information available over internet on laparoscopic cholecystectomy

BACKGROUND:

The purpose of this study was to evaluate the quality of information available on the internet to patients undergoing laparoscopic cholecystectomy.

MATERIALS AND METHODS:

The sources of information were obtained the keyword ‘laparoscopic cholecystectomy’, from internet searches using Google, Bing, Yahoo!, Ask and AOL search engines with default settings. The first 50 web links were evaluated for their accessibility, usability and reliability using the LIDA tool (validation instrument for healthcare websites by Minervation). The readability of the websites was assessed by using the Flesch Reading Ease Score (FRES) and the Gunning Fog Index (GFI).

RESULTS:

Of the 250 links, 90 were new links. Others were repetitions, restricted access sites or inactive links. The websites had an average accessibility score of 52/63 (83.2%; range 40-62), a usability score of 39/54 (73.1%; range 23-49) and a reliability score of 14/27 (51.6%; range 5-24). Average FRES was 41.07 (4.3-86.4) and average GFI was 11.2 (0.6-86.4).

DISCUSSION AND CONCLUSION:

Today, most people use the internet as a convenient source of information. With regard to health issues, the information available on the internet varies greatly in accessibility, usability and reliability. Websites appearing at the top of the search results page may not be the most appropriate sites for the target audience. Generally, the websites scored low on reliability with low scores on content production and conflict-of-interest declaration. Therefore, previously evaluated references on the World Wide Web should be given to patients and caregivers to prevent them from being exposed to commercially motivated or inaccurate information.

Evaluation of Websites that Provide Information on Alzheimer's Disease

Good quality health-related information on the Internet is important for patients and their carers, enabling them to take greater responsibility in healthcare decisions. Carers of people with Alzheimer's disease require access to high quality medical, personal, practical and financial information. The Internet contains large quantities of health-related information and potentially has an important role to play in providing information for carers of people with Alzheimer's disease. The aim of the study was to evaluate a sample of Websites that provide information about Alzheimer's disease for carers of people with this condition using a selection of Website evaluation tools. A sample of 15 Websites providing information on Alzheimer's disease were evaluated using each of four evaluation tools. The Websites were ranked according to the scores they achieved with each tool. The correlation coefficient of the rankings of the Websites for each pair of tools was determined. There was a significant correlation between four of the six pairs of evaluation tools. Several Websites were ranked highly across the evaluation tools. The study identified problems in using generic health-information Website evaluation tools for sites providing information about specific diseases. The need to develop specific health-information Website evaluation tools and possibilities of how they might be further refined in the future were highlighted.

Resource Discovery: Identifying, Evaluating and Integrating Digital Networked Resources Within the Learning Process

The phenomenal popularity of the World Wide Web (WWW) is now well documented, and there is a broad acceptance of the range of digital networked educational materials in the field of medicine available through this medium. Such is the popularity of the WWW, that students will increasingly expect an element of course delivery to be supported through it: they will be aware that lecture notes, case studies, MCQs and entire courses even, are available worldwide. The pervasive nature of the medium is convincingly illustrated by the example of UCLA this summer, where the provision of a web page for every undergraduate course in its largest unit, the College of Letters and Science, became mandatory (Young 1997).

According to the Dearing Report (point 13.3), 'for the majority of students, over the next ten years the delivery of some course materials and much of the organisation and communication of course arrangements will be conducted by computer' (NCEHE, 1997). While the WWW offers an excellent medium for course administration, this paper focuses primarily on issues relating to the use of the WWW for course content delivery: examples of evaluation initiatives that have been undertaken to date are reviewed, and models of integrating networked resources in the context of course delivery are considered.

Development and Application of a Tool Designed to Evaluate Web Sites Providing Information on Alzheimer's Disease

Informal carers of people with Alzheimer's disease require access to high-quality information, which may be available through the Internet. Tools that have been developed to evaluate the contents of health-related web sites tend to be generic and not specific for diseases or patient groups. The aim of this study was to develop a tool that was specifically designed to evaluate web sites that provide information about Alzheimer's disease for informal carers of people with the disease. The tool was used to evaluate a sample of 15 web sites. The results were compared with those obtained using four generic tools in an earlier study. Several web sites attained high scores using the specific tool, although almost half of the 15 web sites achieved scores of less than 50%. There was a poor correlation between the rankings obtained using the specific tool compared with the generic tool. Web sites generally scored lower using the specific tool compared with one of the generic tools. Further work is required to develop and evaluate the Alzheimer's disease web site evaluation tool to help improve the quality of information available to carers through the Internet.