Adding dimensions to the analysis of the quality of health information of websites returned by Google. Cluster analysis identifies patterns of websites according to their classification and the type of intervention described.

Background and aims: Most of the instruments used to assess the quality of health information on the Web (e.g. the JAMA criteria) only analyze one dimension of information quality, trustworthiness. We try to compare these characteristics with the type of treatments the website describe, whether evidence-based medicine or note, and correlate this with the established criteria. Methods: We searched Google for “migraine cure” and analyzed the first 200 websites for: 1) JAMA criteria (authorship, attribution, disclosure, currency); 2) class of websites (commercial, health portals, professional, patient groups, no-profit); and 3) type of intervention described (approved drugs, alternative medicine, food, procedures, lifestyle, drugs still at the research stage). We used hierarchical cluster analysis to assess associations between classes of websites and types of intervention described. Subgroup analysis on the first 10 websites returned was performed. Results: Google returned health portals (44%), followed by commercial websites (31%) and journalism websites (11%). The type of intervention mentioned most often was alternative medicine (55%), followed by procedures (49%), lifestyle (42%), food (41%) and approved drugs (35%). Cluster analysis indicated that health portals are more likely to describe more than one type of treatment while commercial websites most often describe only one. The average JAMA score of commercial websites was significantly lower than for health portals or journalism websites, and this was mainly due to lack of information on the authors of the text and indication of the date the information was written. Looking at the first 10 websites from Google, commercial websites are under-represented and approved drugs over-represented. Conclusions: This approach allows the appraisal of the quality of health-related information on the Internet focusing on the type of therapies/prevention methods that are shown to the patient

The Readability of Online Health Information on Middle East Respiratory Syndrome Coronavirus Disease

Objectives: The study aims at exploring the readability of health websites on Middle East respiratory syndrome coronavirus (MERS‐CoV). Methods: The term "MERS" was searched in Google, Yahoo, and Bing search engines. The readability of the first 30 results for each search engine was evaluated by using the five readability scales, including Flesch-Kincaid Grade Level (FKGL), Flesch Reading Ease (FRE), Simple Measure of Gobbledygook (SMOG), Coleman-Liau Index (CLI) and Gunning Fog. Moreover, the official HONcode toolbar was used to identify websites that had been officially certified by the HON foundation.  Results: Almost half of the retrieved websites were governmental (44.2%). All the surveyed websites were written above the recommended level and so, their readability is suitable for those with a high school or a college degree. The mean grade level for the MERS related websites was in a similar range across the five readability scales. Furthermore, there was no association between the search rank, credibility, and readability Discussion: The readability level of MERS information available through search engines results, exceeds the recommended 6th-grade level, and they do not currently adhere to the recommended readability guidelines. Even credible websites have provided the contents that are not readable enough for the public. Conclusion: Considering the lack of a specific policy about the providing of readable health information on the web, it is recommended for healthcare providers to advise their patients to use the online information after consulting with the physicians

Web-based information on oral dysplasia and precancer of the mouth - Quality and readability

OBJECTIVES: The numbers of individuals with oral cancer are increasing. This cancer is preceded by oral epithelial dysplasia (OED). There remains no detailed study of the online information presently available for patients with OED or indeed what information such patients may require to be appropriately informed regarding their condition. Hence, the aim of the present study is to assess the patient-oriented web content with respect to OED. METHODS: The first 100 websites yielded from nine searches performed using different search terms and engines were considered. These were assessed for content, quality (DISCERN instrument, Journal of the American Medical Association benchmarks, and Health on Net seal) and readability (Flesch Reading Ease Score and Flesch-Kincaid Grade Level). RESULTS: There was a general scarcity of OED content across the identified websites. Information about authors, sources used to compile the publication, treatment, and shared decision were limited or absent. Only 6% and 27% of the websites achieved all the four JAMA benchmarks and HON seal, respectively. The average readability level was at 10th grade (US schools), which far exceeds the recommended levels of written health information. CONCLUSION: At present patients seeking information on OED are likely to have difficulty in finding reliable information from the Web about this disorder and its possible impact upon their life. Further work is thus required to develop a web-based resource regarding OED that addresses the shortfalls demonstrated by the current study

Quality and readability of online patient information for abdominal aortic aneurysms

ObjectiveWe assessed the quality and readability of patient information for abdominal aortic aneurysms (AAAs) on the World Wide Web, as accessed from the United Kingdom.MethodsWeb sites returned by a simple Web search using the three largest search engines by market share were objectively and subjectively assessed for quality and readability. The Internet search engines Google, Yahoo!, and Bing were interrogated for the term “abdominal aortic aneurysm” and the first 50 hits screened. Organization type and Health on the Net status were recorded. Each unique site containing AAA information was scored for quality using the University of Michigan Consumer Health Web site Evaluation Checklist by two authors, and readability was calculated using the Flesch Reading Ease (FRE) score. Subjective content assessment was also undertaken.ResultsOf 150 hits, 112 were relevant, with 55 unique sites for assessment. Overall, the FRE score was 39 (range, 29-47) and the Michigan score was 36 (range, 25-56), with good interobserver agreement (rs = 0.83; P = .01). Michigan and FRE scores were poorly correlated (rs = 0.064; P = .6). Sites containing discussion on the merits of endovascular/open repair and the concept of an intervention threshold had the highest Michigan scores (58.5 [50-59.75] vs 28 [13-36.5]; P < .001). Search engine ranking, Health on the Net status, country of origin, and organization type did not affect quality or readability.ConclusionsThe current quality and readability of online patient information for AAAs is poor and requires significant improvement. Clinicians treating patients with AAAs should be aware of the limitations of the online “lay literature.

Online Information on Dysmenorrhea: An Evaluation of Readability, Credibility, Quality, and Usability

Aims and objectives To evaluate online information on dysmenorrhoea, including readability, credibility, quality and usability. Background Menstrual pain impacts 45%–95% of women of reproductive age globally and is the leading cause of school and work absences among women. Women often seek online information on dysmenorrhoea; however, little is known about the information quality. Design This was a descriptive study to evaluate online information on dysmenorrhoea. Methods We imitated search strategies of the general public. Specifically, we employed the three most popular search engines worldwide—Google, Yahoo and Bing—and used lay search terms, “period pain” and “menstrual cramps.” We screened 60 web pages. Following removal of duplicates and irrelevant web pages, 25 met the eligibility criteria. Two team members independently evaluated the included web pages using standardised tools. Readability was evaluated with the Flesch–Kincaid Reading Ease and Flesch–Kincaid Grade formulas; credibility, quality and usability were evaluated with established tools. We followed the STROBE checklist for reporting this study. Results For readability, the mean Flesch–Kincaid level was 10th grade. For credibility, 8% of web pages referenced scientific literature and 28% stated the author's name and qualifications. For quality, no web page employed user‐driven content production; 8% of web pages referenced evidence‐based guidelines, 32% of web pages had accurate content, and 4% of web pages recommended shared decision‐making. Most web pages were interactive and included nontextual information. Some nontextual information was inaccurate. Conclusion Online information on dysmenorrhoea has generally low readability, mixed credibility and variable quality. Relevance to clinical practice Strategies to improve health information on dysmenorrhoea include avoiding complex terms, incorporating visual aids, presenting evidence‐based information and developing a decision aid to support shared decision‐making. Healthcare providers should be aware of the problematic health information that individuals are exposed to and provide education about how to navigate online health information

The quality and readability of online consumer information about gynaecological cancer

Aleksandra Sobota’s PhD is funded by the Danuta Richardson Medical Scholarship.Objective: The Internet has become an important source of health-related information for consumers, among whom younger women constitute a notable group. The aims of this study were: (1) to evaluate the quality and readability of online information about gynaecological cancer using validated instruments; and (2) to relate the quality of information to its readability. Methods: Using the Alexa Rank we obtained a list of 35 webpages providing information about 7 gynaecological malignancies. These were assessed using the HON seal of approval, the JAMA benchmarks, and the DISCERN instrument. Flesch readability score was calculated for sections related to symptoms and signs, and treatment. Results: Less than 30% of the webpages displayed the HON seal or achieved all JAMA benchmarks. The majority of the treatment sections were of moderate to high quality according to the DISCERN. There was no significant relationship between the presence of the HON seal and readability. Webpages achieving all JAMA benchmarks were significantly more difficult to read and understand than webpages that missed any of the JAMA benchmarks. Treatment-related content of moderate to high quality as assessed by the DISCERN had a significantly better readability score than the low quality content. Conclusions: The online information about gynaecological cancer provided by the most frequently visited webpages is of variable quality and in general difficult to read and understand. The relationship between the quality and readability remains unclear. Healthcare providers should direct their patients to reliable material online since patients consider the Internet as an important source of information.PostprintPeer reviewe

Evaluating the trustworthiness of consumer-oriented health websites on diabetes

Objective: The patients involvement in disease management can decrease economic burden on diabetic patients and society. Quality health information may help patients to involve in their health management. Thus, individuals need to find the additional information from other information resources such as health websites. Nevertheless, health websites vary in quality and reliability. Therefore, it is of great importance to identify trustable health websites on diabetes. Thus, the aim of the present study was to evaluate the reliability of health websites concerning diabetes. Materials and methods: The keyword ‘’diabetes mellitus ‘’ was entered as a search term into the three most used search engines Google, Yahoo and Bing. The results for first three pages reported by each search engine were selected. After excluding 19 websites, 71 unique websites were eligible for examination. The reliability of websites was evaluated manually using the HONcode of conduct tool by both researchers. Furthermore, HONcode toolbar function was used to recognize officially verified websites. Results: Only 19 out of 71 websites were officially verified by HONcode foundation. None of the other retrieved websites achieved all 8 principles. Most of the retrieved websites were commercial (67.6%) and the minimum number of the them belongs to university websites (1.4%). The highest and lowest compliance with the HON principles belonged to justifiability (99%), and attribution (51%). Conclusion: Diabetic patients need high quality information from trustworthy websites to decide better about their health. Thus, physicians should have knowledge about the variable quality of health websites and guide their patients to reliable online resources

Web-based information on the treatment of tobacco dependence for oral health professionals: analysis of english-written websites

Background: Studies have been conducted on the content and quality of Web-based information for patients who are interested in smoking cessation advice and for health care practitioners regarding the content of e-learning programs about tobacco cessation. However, to the best of our knowledge, there is no such information about the quality of Web-based learning resources regarding smoking cessation dedicated to oral health professionals. Objective: The aim of this study was to identify and evaluate the quality of the content of webpages providing information about smoking cessation for oral health care professionals. Methods: Websites were identified using Google and Health on Net (HON) search engines using the terms: smoking cessation OR quit smoking OR stop smoking OR 3As OR 5As OR tobacco counselling AND dentistry OR dental clinic OR dentist OR dental hygienist OR oral health professionals. The first 100 consecutive results of the 2 search engines were considered for the study. Quality assessment was rated using the DISCERN questionnaire, the Journal of the American Medical Association (JAMA) benchmarks, and the HON seal. In addition, smoking cessation content on each site was assessed using an abbreviated version of the Smoke Treatment Scale (STS-C) and the Smoking Treatment Scale-Rating (STS-R). To assess legibility of the selected websites, the Flesch Reading Ease (FRES) and the Flesch-Kinkaid Reading Grade Level (FKRGL) were used. Websites were also classified into multimedia and nonmultimedia and friendly and nonfriendly usability. Results: Of the first 200 sites selected (100 of Google and 100 of HON), only 11 met the inclusion criteria and mainly belonged to governmental institutions (n=8), with the others being prepared by Professional Associations (n=2) and nonprofit organizations (n=1). Only 3 were exclusively dedicated to smoking cessation. The average score obtained with the DISCERN was 3.0, and the average score in the FKRGL and FRES was 13.31 (standard deviation, SD 3.34) and 40.73 (SD 15.46), respectively. Of the 11 websites evaluated, none achieved all the four JAMA benchmarks. The mean score of STS-R among all the websites was 2.81 (SD 0.95) out of 5. A significant strong positive correlation was obtained between the DISCERN mean values and the STS-R (R=.89, P=.01)This project was cofunded by the EU’s Erasmus+ program “Smoking Cession Advice: Healthcare Professional Training” under grant agreement No. 2016-1-UK01-KA202-024266S