Disease management and the Internet

Websites as a mode of delivering mental health information: perceptions from the Australian public

BACKGROUND

Many people with a mental disorder do not access help from mental health services. Internet websites may be a useful tool for disseminating mental health information to those who remain untreated, however little is known about people's perceptions of websites as mental health information sources. The current study examined characteristics that may influence belief in the helpfulness of websites as modes of delivering information about mental health. The study compared belief in the helpfulness websites to two traditional sources (bibliotherapy and health educators).

METHODS

A total of 3,998 Australians aged 18 and above were surveyed. Logistic regression was used to explore the factors associated with rating a website, book and health educator as helpful sources of mental health information for a person described as having either depression, depression with suicidal thoughts, early schizophrenia or chronic schizophrenia. Factors investigated were demographics, exposure to mental illness, beliefs about dealing with mental illness alone, and personal and perceived stigmatising attitudes.

RESULTS

Considerably more participants rated bibliotherapy and health educators as helpful in comparison to websites. Predictors of rating a website and book as helpful were identical; younger age, belief that it is helpful to deal with mental illness alone and being presented with depression and early schizophrenia vignettes in comparison to chronic schizophrenia. Predictors of rating a health educator as helpful were younger age, less personal stigma and being presented with a depression (without suicidal thoughts) vignette in comparison to chronic schizophrenia.

CONCLUSIONS

These findings suggest the need for multiple modes of delivering mental health information. While many people feel that information delivered face-to-face is likely to be helpful, websites and other tools that maintain anonymity may be preferred by those who choose to or find themselves dealing with mental illness alone.

Internet interventions for long-term conditions: patient and caregiver quality criteria

Background

Interactive health communication applications (IHCAs) that combine high-quality health information with interactive components, such as self-assessment tools, behavior change support, peer support, or decision support, are likely to benefit people with long-term conditions. IHCAs are now largely Web-based and are becoming known as "Internet interventions." Although there are numerous professionally generated criteria to assess health-related websites, to date there has been scant exploration of patient-generated assessment criteria even though patients and professionals use different criteria for assessing the quality of traditional sources of health information.

Objective

We aimed to determine patients' and caregivers' requirements of IHCAs for long-term conditions as well as their criteria for assessing the quality of different programs.

Methods

This was a qualitative study with focus groups. Patients and caregivers managing long-term conditions used three (predominantly Web-based) IHCAs relevant to their condition and subsequently discussed the strengths and weaknesses of the different IHCAs in focus groups. Participants in any one focus group all shared the same long-term condition and viewed the same three IHCAs. Patient and caregiver criteria for IHCAs emerged from the data.

Results

There were 40 patients and caregivers who participated in 10 focus groups. Participants welcomed the potential of Internet interventions but felt that many were not achieving their full potential. Participants generated detailed and specific quality criteria relating to information content, presentation, interactivity, and trustworthiness, which can be used by developers and purchasers of Internet interventions.

Conclusions

The user-generated quality criteria reported in this paper should help developers and purchasers provide Internet interventions that better meet user needs.

A case study of a retracted systematic review on interactive health communication applications: impact on media, scientists, and patients

BACKGROUND

In October 2004, a flawed systematic review entitled "Interactive Health Communication Applications for People with Chronic Disease" was published in the Cochrane Library, accompanied by several press releases in which authors warned the public of the negative health consequences of interactive health communication applications, including the Internet. Within days of the review's publication, scientists identified major coding errors and other methodological problems that invalidated the principal conclusions of the study and led to a retraction. While the original study results and their negative conclusions were widely publicized in the media, the retraction seemed to go unnoticed.

OBJECTIVE

This paper aims to document an unprecedented case of misinformation from a Cochrane review and its impact on media, scientists, and patients. As well, it aims to identify the generic factors leading to the incident and suggest remedies.

METHODS

This was a qualitative study of the events leading to the retraction of the publication and of the reactions from media, scientists, and patients. This includes a review and content analysis of academic and mass media articles responding to the publication and retraction. Mass media articles were retrieved in May 2005 from LexisNexis Academic and Google and were classified and tallied. The extended case method is employed, and the analysis is also applied to comparable publishing events.

RESULTS

A search on LexisNexis Academic database with the query "Elizabeth Murray AND health" for the period of June 2004 to May 2005 revealed a total of 15 press reports, of which only 1 addressed the retraction. Google was searched for references to the review, and the first 200 retrieved hits were analyzed. Of these, 170 pages were not related to the review. Of the remaining 30 pages, 23 (77%) were reports about the original publication that did not mention the retraction, 1 (3%) was a bibliography not mentioning the retraction, and 6 (20%) addressed the retraction, of which only 1 was a non-Cochrane-related source.

CONCLUSIONS

Analyzed retrievals showed that the mass media gave more coverage to the Cochrane review than to the retraction or to a related systematic review with a similar scope but a different conclusion. Questionable results were prematurely disseminated, oversimplified, and sensationalized, while the retraction was hardly noticed by the public. Open commentary by scientists and patients helped to rapidly identify the errors but did not prevent or correct the dissemination of misinformation.