The validity of health claims on the World Wide Web: a systematic survey of the herbal remedy Opuntia

PURPOSE: The World Wide Web has become a significant source of health information for the public, but there is concern that much of the information is inaccurate, misleading, and unsupported by scientific evidence. To explore this issue, the validity of health claims for the herb Opuntia on the World Wide Web was analyzed. DATA SOURCES: From December 1998 to May 1999, health claims were identified from Web sites utilizing nine search engines. A corresponding search was conducted of the scientific literature. Search terms included common and botanical names for Opuntia. INCLUSION AND EXCLUSION CRITERIA: Nutritional support guidelines for herbs were used to identify claims from relevant sites. Scientific studies included established methodological designs with no restrictions on source, language, type of subjects, or dosage forms for Opuntia. DATA EXTRACTION METHODS: A checklist of significant information was prepared for Web sites and scientific studies. The quality of scientific studies was assessed with two instruments, the Jadad and the Journal of the American Medical Association (JAMA) scales. DATA SYNTHESIS: Validity of health claims on Web sites was compared with scientific reports. Searches retrieved 184 Web sites, 98 with health claims and 51 with research studies. Only 34% of the claims were addressed in the scientific literature, and evidence was conflicting or contradictory. For human studies, none met the criteria for high quality as determined by the Jadad and JAMA scales. MAJOR CONCLUSIONS: The majority of health claims were based on folklore or indirect scientific evidence and could not be validated by scientific research. This suggests a need to check the validity of herbal information on the World Wide Web.     

Die Stecknadel im Heuhaufen

The World Wide Web is becoming a primary platform for health-related information,and powerful retrieval tools play a crucial role. The popular web search engines cover only a part of the World Wide Web and are also affected by the intricacies of medical terminology. However, domain-specific search engines have not yet become generally accepted. Future challenges for medical search engines lie in the improvement of natural language user interfaces and especially in uncovering hidden web contents.     

Quality of information on emergency contraception on the Internet

OBJECTIVE: To evaluate the quality of patient information about emergency contraception on the Internet. DESIGN: We performed an on-line search of the Internet and found relevant World Wide Web sites by combining the key phrases 'emergency contraception' and 'patient information' in two Web subject guides and two search engines. We defined quality as the extent to which the characteristics of a Web site satisfied its stated and implied objectives. Our assessment focused on credibility and content of each Web site. Credibility was assessed by source, currency and editorial review process and content of Web site was assessed by hierarchy and accuracy of evidence. RESULTS: Our search revealed 32 relevant Web sites, none of which complied with all of the criteria for quality of credibility and content. Twenty-eight Web sites displayed the source clearly, 17 Web sites showed currency, and none of the Web sites had an editorial review process. Only six of the 32 sites mentioned hierarchy of evidence. None of the Web sites depicted all the criteria for accuracy of contents. CONCLUSION: None of the Web sites provided complete information to patients about emergency contraception according to the quality criteria used in this study. As previous studies have shown, people need to be wary about the quality of information on the Internet.     

Online information for parents caring for their premature baby at home: A focus group study and systematic web search

Background

Online resources are a source of information for parents of premature babies when their baby is discharged from hospital.

Objectives

To explore what topics parents deemed important after returning home from hospital with their premature baby and to evaluate the quality of existing websites that provide information for parents post‐discharge.

Methods

In stage 1, 23 parents living in Northern Ireland participated in three focus groups and shared their information and support needs following the discharge of their infant(s). In stage 2, a World Wide Web (WWW) search was conducted using Google, Yahoo and Bing search engines. Websites meeting pre‐specified inclusion criteria were reviewed using two website assessment tools and by calculating a readability score. Website content was compared to the topics identified by parents in the focus groups.

Results

Five overarching topics were identified across the three focus groups: life at home after neonatal care, taking care of our family, taking care of our premature baby, baby's growth and development and help with getting support and advice. Twenty‐nine sites were identified that met the systematic web search inclusion criteria. Fifteen (52%) covered all five topics identified by parents to some extent and 9 (31%) provided current, accurate and relevant information based on the assessment criteria.

Conclusion

Parents reported the need for information and support post‐discharge from hospital. This was not always available to them, and relevant online resources were of varying quality. Listening to parents needs and preferences can facilitate the development of high‐quality, evidence‐based, parent‐centred resources.     

Using the World Wide Web to answer clinical questions: how efficient are different methods of information retrieval?

BACKGROUND: The World Wide Web (Web) has the potential to revolutionize information retrieval in medicine. However, the best method of information retrieval from the Web is not known. The purpose of our study was to compare medical search engines, general-purpose search engines, medical meta-lists, and commercial sites on the Web with regard to their efficiency in retrieving medical information. METHODS: Ten questions were identified from a database of questions posed by primary care clinicians. Authoritative answers were identified. Searches were performed using 1 commercial site, 4 general search engines, 9 medicine-specific search engines, and 2 medical meta-lists. The main outcome measures were the number of questions answered by each Web site, the correctness of the answers, the number of links followed to get an answer, and how well documented the answer was using the Health on the Net criteria. RESULTS: MD Consult, a commercial site, answered 6 of 10 questions. Hardin MD (a meta-list) and Excite and HotBot (general search engines) each answered 5 questions. The medicine-specific search engines performed poorly, answering an average of only 1 question. MD Consult and HotBot required the least number of links to find an answer. MD Consult and Hardin MD had the best documented answers. CONCLUSIONS: Medicine-specific search engines on the Web fare poorly in answering clinical questions when compared with general search engines. MD Consult, Excite, HotBot, and Hardin MD found the greatest number of answers.     

Quality of the patient-oriented information on thyroid cancer in the internet

ObjectivesThis study was conducted to analyse the readability and quality of patient education websites about thyroid cancer.MethodsYahoo!, Google and Bing were searched with their default settings using the keywords thyroid cancer, thyroid tumour, thyroid tumor, and thyroid malignancy for relevant websites. The first 50 websites obtained for each keyword and search engine were evaluated using validated Flesch Reading Ease Score (FRES), LIDA and DISCERN scores to assess readability, usability and reliability, and quality of information. Statistical analysis were done using non-parametric tests.ResultsThe analysis included 49 eligible websites selected out of 600 websites obtained from the search engines. Twenty-two (44.9%) web sites had obtained Health on the net foundation code of conduct (HON-code) certification. The included websites had a median FRES score of 55.3(range 25.3–85.3) and the LIDA reliability and usability scores were 22.0(range 14–30) and 39.0(range 28–50), respectively. The median DISCERN score was 48.0(range 33–63). A total DISCERN score of 50% or less (low score) was found in 28.5%(n = 14) of the websites. A significant association was found between LIDA usability and, reliability scores and DISCERN score (p<0.001, p=0.001, respectively).ConclusionThe quality of the websites, readability and usability scores were moderate or low based on the criteria used. Access to quality information may help with better informed decisions on treatment, follow up and prognosis. As the internet use by the public is ever increasing, implementing measures to ensure the quality information without a bias should be considered a priority.     

STD/HIV prevention for teenagers: a look at the Internet universe

The objective was to determine how the Internet is used to promote sexual health among adolescents. Six key words were entered into three search engines producing 87,180 results. Three percent (n = 36) were educational Web sites targeted at teenagers and covered a range of sexually transmitted diseases (STDs). These were content analyzed using sexuality education and usability guidelines. All sites addressed some STD information, but only two covered negotiation. Navigability results were mixed; only one third offered a site map. Sexual health educators may need to include more information on how to negotiate safe sex and improve Web navigability for teenagers.     

A New Shot for Success—Immunization and Vaccine Preparedness

The objective was to determine how the Internet is used to promote sexual health among adolescents. Six key words were entered into three search engines producing 87,180 results. Three percent (n = 36) were educational Web sites targeted at teenagers and covered a range of sexually transmitted diseases (STDs). These were content analyzed using sexuality education and usability guidelines. All sites addressed some STD information, but only two covered negotiation. Navigability results were mixed; only one third offered a site map. Sexual health educators may need to include more information on how to negotiate safe sex and improve Web navigability for teenagers.     

Internet及其在公共卫生工作中的应用

本文介绍了常用Internet (因特网) 工具, 重点介绍了万维网、电子邮件、专题讨论组在公共卫生工作中的应用。同时提供了Internet上国内外与公共卫生有关的常用网址及公共卫生网络搜索引擎。对Internet公共卫生资源作了简要评价     

Age-related macular degeneration: what do patients find on the internet?

OBJECTIVE: To assess the quality of information and readability of the top internet sites for age-related macular degeneration (AMD). DESIGN: An examination of the technical information provision, quality and readability of websites found during an internet search for 'age-related macular degeneration'. Setting Six internet search engines were used to find 26 unique sites on AMD. MAIN OUTCOME MEASURES: Technical information and quality were assessed using a simple grading system. Readability was assessed using a Simple Measure Of Gobbledygook (SMOG) rating. RESULTS: Twelve organizational, seven academic and seven commercial sites were identified. The average technical scores were 82.3%, 67.9% and 65.2% for each type of site, respectively (P=0.097, one way ANOVA). The average quality scores were 62.2%, 62.6%, and 49.5% for each type of site, respectively (P=0.356, one-way ANOVA). The average SMOG ratings were 16.3, 16.1, and 16.2 for each type of site, respectively (P=0.983, one-way ANOVA). Fifteen of the sites provided details of new and emerging treatments, with seven providing a detailed discussion. CONCLUSIONS: Many websites are now meeting the challenge of providing comprehensive information about AMD and its new treatments. Quality scores were disappointing, with sites needing to provide more evidence of authorship and attribution of information. The majority of sites had SMOG scores above 10, making them difficult for the average person to understand. As physicians we need to help design and direct patients to sites that provide high quality, current information.     

Computers and the Internet: tools for lifelong learning.

Mastery of computer technology and the resources it brings to renal dietitians will be essential for future practice. The Internet, probably the most valuable resource computers bring to clinical practice, is a potential tool to fulfill goals of lifelong learning. A basic introduction to the Internet and a review of search engines and successful search strategies are provided. Major flaws of the Internet include uncertain quality and accuracy of many materials it provides. Guidelines to evaluate World Wide Web (WWW) materials are similar to guidelines dietitians use to assess written materials. The identification of certain anchor WWW sites with reliable information is a key to successful information retrieval on the Internet.     

The quality of dietary information on the World Wide Web

The quality of dietary information on the World Wide Web (WWW) is determined solely by the organizations and individuals who publish it. To evaluate the accuracy of nutrition resources on the Internet, a survey of WWW sites that provided dietary recommendations were reviewed and compared to the "Canadian Guidelines for Healthy Eating and Nutrition Recommendations for Canadians." Web sites were accessed using "diet," "food," and "nutrition" as keywords in searches. Of the 365 documents accessed, 167 contained dietary recommendations. Forty-five percent (n = 76) of these provided information that was not consistent with one or more of the Canadian eating standards and included information in the forms of advertisements recommending supplements, herbal remedies, weight-loss products, and promotion of specific diets. The total number of web sites that provided information that was inconsistent with Canadian guidelines per each keyword search was 25 (29.8%) for "diet," 11 (13.1%) for "food," and 48 (57.1%) for "nutrition." Sources of differing information included individual web pages (n = 31, 40.8%), private vendors (n = 44, 57.9%), and health organizations (n = 1, 1.3%). Because Internet resources continue to increase at an incredible pace, health professionals need to take an active role in this technology and develop strategies to address inconsistent dietary information provided through this avenue.     

Applying Semantic Web technologies to improve the retrieval, credibility and use of health-related web resources

The number of health-related websites is increasing day-by-day; however, their quality is variable and difficult to assess. Various "trust marks" and filtering portals have been created in order to assist consumers in retrieving quality medical information. Consumers are using search engines as the main tool to get health information; however, the major problem is that the meaning of the web content is not machine-readable in the sense that computers cannot understand words and sentences as humans can. In addition, trust marks are invisible to search engines, thus limiting their usefulness in practice. During the last five years there have been different attempts to use Semantic Web tools to label health-related web resources to help internet users identify trustworthy resources. This paper discusses how Semantic Web technologies can be applied in practice to generate machine-readable labels and display their content, as well as to empower end-users by providing them with the infrastructure for expressing and sharing their opinions on the quality of health-related web resources.     

Nursing on the Web: the creation and validation process of a web site on coronary artery disease

The World Wide Web is an important health information research source. A challenge for the Brazilian Nursing Informatics area is to use its potential to promote health education. This paper aims to present a developing and validating model used in an educational Web site, named CardioSite, which subject is Coronary Heart Disease. In its creation it was adopted a method with phases of conceptual modeling, development, implementation, and evaluation. In the evaluation phase, the validation was performed through an online informatics and health experts panel. The results demonstrated that information was reliable and valid. Considering that national official systems are not available to that approach, this model demonstrated effectiveness in assessing the quality of the Web site content.     

Comparison of Quality of Internet Pages on Human Papillomavirus Immunization in Italian and in English

PurposeInformation available on the Internet about immunizations may influence parents' perception about human papillomavirus (HPV) immunization and their attitude toward vaccinating their daughters. We hypothesized that the quality of information on HPV available on the Internet may vary with language and with the level of knowledge of parents. To this end we compared the quality of a sample of Web pages in Italian with a sample of Web pages in English.MethodsFive reviewers assessed the quality of Web pages retrieved with popular search engines using criteria adapted from the Good Information Practice Essential Criteria for Vaccine Safety Web Sites recommended by the World Health Organization. Quality of Web pages was assessed in the domains of accessibility, credibility, content, and design. Scores in these domains were compared through nonparametric statistical tests.ResultsWe retrieved and reviewed 74 Web sites in Italian and 117 in English. Most retrieved Web pages (33.5%) were from private agencies. Median scores were higher in Web pages in English compared with those in Italian in the domain of accessibility (p < .01), credibility (p < .01), and content (p < .01). The highest credibility and content scores were those of Web pages from governmental agencies or universities. Accessibility scores were positively associated with content scores (p < .01) and with credibility scores (p < .01). A total of 16.2% of Web pages in Italian opposed HPV immunization compared with 6.0% of those in English (p < .05).ConclusionsQuality of information and number of Web pages opposing HPV immunization may vary with the Web site language. High-quality Web pages on HPV, especially from public health agencies and universities, should be easily accessible and retrievable with common Web search engines.     

An assessment of the quality and usability of smoking cessation information on the Internet

Little is known about the quality and usability of on-line health information. This analysis evaluated smoking cessation Web sites' content quality and usability. Thirty sites were analyzed to determine their adherence to established tobacco cessation guidelines and their accessibility, usability, credibility, and currency. Most explained addiction (86.7%) and mentioned nicotine replacement therapy (NRT) (93.3%) and social support (93.3%). However, few explained potential side effects of NRT (33.3%) or which smokers should avoid using NRT (30.0%). Two sites advocated substituting smokeless tobacco or herbal cigarettes when quitting, and 16 (53.3%) provided information written at greater than an eighth-grade level. Few sites provided a search mechanism (40.0%) or offered text-only versions (30.0%), and most (83.3%) failed to indicate when content pages were last updated. Most sites adhered to established cessation guidelines. A small subset offered erroneous and potentially harmful information. Applying fundamental design principles would improve accessibility, usability, credibility, and currency.     

Peer Reviewed: A Comprehensive Assessment of the Difficulty Level and Cultural Sensitivity of Online Cancer Prevention Resources for Older Minority Men

Introduction

Older men are at increased risk for prostate cancer. As seniors turn to the Internet for cancer information, it is important that the resources they locate about lifestyle behaviors and screening are culturally appropriate and easy to understand. This study was a comprehensive analysis of prostate cancer risk as portrayed on the Internet with assessment of content readability and cultural sensitivity.

Methods

We selected Web sites about prostate cancer risk and prevention by comparing common sites across three top-rated search engines (Google, Yahoo!, and MSN). A total of 70 Web sites on prostate cancer containing a Web page on risk factors or prevention or both for racial and ethnic populations were included. We assessed readability of one page per Web site using Simple Measure of Gobbledygook (SMOG), Flesch-Kincaid (FK), and Flesch Reading Ease (FRE) measures. Cultural sensitivity of the Web page was evaluated using the Cultural Sensitivity Assessment Tool (CSAT) and questions from a cultural sensitivity checklist.

Results

Mean readability of Web pages was Grade 12.90 (high school graduate level) using SMOG and Grade 11.20 according to FK. Mean FRE was 45.04 (fairly difficult to read). The mean CSAT score was 2.78 and classified as culturally sensitive. Of the 36 Web pages considered culturally sensitive (CSAT >2.50), 75% did not portray images of representative racial or ethnic individuals as intended readers or as being at high risk for prostate cancer. Older adults and seniors were identified as intended readers on 73% of Web pages.

Conclusion

Online cancer resources are targeting appropriate age groups (high-risk older adults). However, the pages required fairly high-level reading skills and had limited cultural sensitivity. These factors make the pages unsuitable for diverse Internet users.     

Web page quality: can we measure it and what do we find? A report of exploratory findings

BACKGROUND: The aim of this study was to report exploratory findings from an attempt to quantify the quality of a sample of World Wide Web (WWW) pages relating to MMR vaccine that a typical user might locate. METHOD: Forty pages obtained from a search of the WWW using two search engines and the search expression 'mmr vaccine' were analysed using a standard proforma. The proforma looked at the information the pages contained in terms of three categories: content, authorship and aesthetics. The information from each category was then quantified into a summary statistic, and receiver operating characteristic (ROC) curves were generated using a 'gold standard' of quality derived from the published literature. Optimal cut-off points for each of the three sections were calculated that best discriminated 'good' from 'bad' pages. Pages were also assessed as to whether they were pro- or anti-vaccination. RESULTS: For this sample, the combined contents and authorship score, with a cut-off of five, was a good discriminator, having 88 per cent sensitivity and 92 per cent specificity. Aesthetics was not a good discriminator. In the sample, 32.5 per cent of pages were pro-vaccination; 42.5 per cent were anti-vaccination and 25 per cent were neutral. The relative risk of being of poor quality if anti-vaccination was 3.3 (95 per cent confidence interval 1.8, 6.1). CONCLUSION: The sample of Web pages did contain some quality information on MMR vaccine. It also contained a great deal of misleading, inaccurate data. The proforma, combined with a knowledge of the literature, may help to distinguish between the two.     

Increasing nutrition literacy: testing the effectiveness of print, web site, and game modalities

OBJECTIVE: To examine the effectiveness of three modalities for delivery of nutrition education. DESIGN: Between-subjects, repeated-measures design. SETTING: Data were collected at community agencies or during home visits. PARTICIPANTS: Low-income, European American and African American mothers (N = 155). INTERVENTION: Participants were exposed to nutrition education material in 1 of 3 modalities (a computer game, The Fantastic Food Challenge; Web site; or pamphlet). Likeability, nutrition knowledge, intention to use, and demographic measures followed the intervention at T1 and T2. MAIN OUTCOME MEASURES: 5-point Likert-type scales measured likeability (5 items), and 33 multiple-choice questions measured knowledge. ANALYSIS: Data were analyzed using analysis of variance (ANOVA) and analysis of covariance (ANCOVA) procedures using SPSS version 15.0 (SPSS Inc., Chicago, IL) software, P < .05. RESULTS: Overall, the Web site was liked more than the other conditions with this audience of women. Significant differences in attention, understanding, and intent to use the information existed across modalities. The Web site performed better than other modalities on knowledge outcomes, with no differences in knowledge retention from T1 to T2. CONCLUSIONS AND IMPLICATIONS: The Web site modality performed best with this audience of women, indicating that interactive computer games may not confer greater benefits than traditional modes of information delivery for all audiences, particularly those with low computer skills.