# Training Objective: Be able to quickly identify reliable consumer health resources on the Internet 

# Introduction -- the issue

# Consumers have access to medical information like never before. The Internet and its sophisticated search tools have resulted in:

1.  A greater number of patients accessing information on the Internet.

2.  A number of people creating health-related websites

3.  A number of research studies evaluating the search skills,
    information gained and quality of health information on the
    Internet. Every one of these studies shows over and over again that
    the quality of health information on the web varies tremendously.

4.  There are valuable nuggets of information amid masses of JUNK.

5.  Patients are believing that the Web is a reliable source of
    information...if it is on the Web, it must be true.

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A.  The results of one study was published in JAMA \[JAMA. 2001 May
    23-30;285(20):2612-21.\].

> In it, the investigators searched the Internet for information on
> obesity, depression, breast cancer and childhood asthma. The results
> showed that less than ¼ of the first page of "hits" led to relevant
> content and the results showed that "Accessing health information
> using search engines and simple search terms is not efficient."

B.  The best way to find Information on the Internet is to go to sites
    that we know have reliable, accurate, current, unbiased information.
    However, sometimes we HAVE to do that *Google* search to find
    information for a patron. When we do this, we must be sure that the
    information we provide is the best possible.

C.  As librarians we have the necessary skills to do this since we do
    this with print resources all the time.

# Web vs Print

A.  Evaluating the Web is inherently different than evaluating print
    resources. *Ask class what techniques they use to evaluate print
    resources.* Print sources range from vanity publications to
    scholarly publications. Web pages have an even wider range, often
    with a blending of information, entertainment and advertising.

# III. Types of Web sites

A.  The first thing to determine is what is the **purpose** of the Web
    page?

B.  Suggested types of Web sites may include:

    1.  Advocacy (ex. American Heart Association)

    2.  Business/marketing (ex. Pfizer)

    3.  Informational (ex. National Center for Health Statistics)

    4.  News (CNN)

    5.  Personal / Vanity (My Sailboat)

    6.  Entertainment (Official Star Wars Fan Club)

**IV. There are 5 basic criteria for website evaluation:** Accuracy,
Authority, Bias, Currency, Coverage

Each of these alone is meaningless, but together they create solid
guidelines for evaluation. If you cannot answer the following questions,
the Web site your patient is looking at is suspect.

## ACCURACY

1.  Is the information accurate? Remember:

-   Anyone can publish on the Web.

-   Many Web pages are not reviewed or verified by editors or peers.

-   Web standards to ensure accuracy don't exist.

    1.  Ask yourself the following:

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-   are the facts accurate.

-   Are the sources of the information clearly given? Is the author
    drawing conclusions and generalizations based on his or her
    experience, and are they appropriate?

-   Is the information consistent with other sources?

-   Is the information well written, well organized, and logically
    presented? Is it free from spelling and grammatical errors, which
    may indicate some care in its presentation?

    1.  Examples:

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-   Male Pregnancy
    ([http://www.malepregnancy.com](http://www.malepregnancy.com/)) Take
    a few minutes to check it for accuracy.

-   Two towns: Aitkin, MN ([www.aitkin.com](http://www.aitkin.com/))

-   New Hartford, MN
    ([www.lme.mnsu.edu/newhartford/newhtfd.html](http://www.lme.mnsu.edu/newhartford/newhtfd.html))

A.  **AUTHORITY**

    1.  Is the author an authority on the subject? Remember:

-   It's often difficult to determine the authorship of Web pages.

-   If a name is listed, his/her qualifications are frequently absent

-   check if the Web page has the backing of a well-established
    organization, institution, or agency.

    1.  Be sure to ask yourself these questions:

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-   Do you know who the author of the information is?

-   If it is unsigned, is it posted in a usually authoritative place?
    (at the National Institutes of Health, for example)

-   What can you tell about the author? Is the author a student,
    physician, or firefighter?

-   Does the author bring any biases in posting the information?

    1.  **The URL:**

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-   **The tilde**.

-   **The domain**. "Dot coms", "dot orgs" & foreign.

> **4.** **Contact information.**
>
> **5.** **About us.**

.

> **6. Examples:**

-   Facts about Tourette Syndrome
    (<http://members.tripod.com/~tourette13/>

-   Questions for discussion:

    -   Check URL: \~, what is [www.tripod.com](http://www.tripod.com/)
        ? (a free Web site provider)

    -   Who is the author, and what are his/her credentials? Where did
        you find this out? (Disclaimer)

    -   Does the information appear to be accurate? Why?

    -   What type of site is this? (personal) What is its purpose? (To
        provide information and support for other Tourette patients)

    -   When might a Web site written by a person who has the disease be
        helpful? (for support, to share information about living with
        the disease).

-   CureZone.com (<http://www.curezone.com/>)

-   Questions for discussion:

    -   Who are the authors and what are their credentials? (Agnes &
        Lillian, a housewife and health coach, no obvious credentials)

    -   Is there a sponsor?

    -   Does the information appear to be accurate? Why?

    -   What type of site is this? (alternative, selling something?)
        What is its purpose? (promote alternative therapies)

# BIAS

1.  Does the author bring any biases in posting the information?
    Remember:

-   Web pages often function as virtual "soapboxes".

-   Goals of the person presenting the material aren't clearly stated.

-   Watch out for the emotional "kick"...photographs, exclamation
    points, huge fonts.

    1.  Questions to ask:

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-   Can you judge the author's purpose in posting the information? If
    the author's purpose is to persuade you or sell to you, you must
    judge the information accordingly. For example, an evaluation of a
    pharmaceutical is questionable if it is posted on a competing
    pharmaceutical manufacturer's site. It is more credible if it is
    posted by a truly independent laboratory.

-   Who paid for the Web page?

> **3. Examples:**

-   Toilet Training: Signs of Readiness  go to
    [www.pampers.com](http://www.pampers.com/) / click on United States
    / in search box type in "readiness" / find article title "Toilet
    Training: Signs of Readiness"

([www.pampers.com/en_US/display.jhtml?id=/repository/article/en_US/2309.xml](http://www.pampers.com/en_US/display.jhtml?id=/repository/article/en_US/2309.xml))

-   Questions for discussion:

    -   What about this statement:

"While children begin to master most of the necessary skills between the
ages of 18 and 30 months, your toddler may not be ready to master toilet
training until as late as the end of her fourth year."

-   DHMO---The Truth ([www.dhmo.org](http://www.dhmo.org/))
    (<http://www.dhmo.org/truth/Dihydrogen-Monoxide.html>)

## CURRENCY

1.  Is the information current and timely? Remember:

-   Dates are not always included on Web pages.

-   If dates are included, it may not be clear if the date is the date
    created, the date revised, or the date the page was placed on the
    Web.

    1.  Questions to ask:

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-   Is the information dated or can you tell from the content when it
    was written?

-   Is the information likely to change?

-   Is it recent enough to be useful?

> Sample site: Hormone Replacement
> ([www.pslgroup.com/dg950925.htm](http://www.pslgroup.com/dg950925.htm))

### COVERAGE

1.  Many health sites are not comprehensive. The information they give
    may be accurate, but important information may be left out.

2.  Don't stop with a single site unless you can answer these questions
    to your satisfaction.

-   How does this information compare with other sources (including
    published print sources) on the same topic?

-   Is a better source available? (Consider varying your approach to
    searching for relevant information.)

-   Does the site have a disclaimer that describes any limitations,
    purpose, scope, currency or authority of the information?

> Sample site:
> [www.medical-library.net](http://www.medical-library.net/)
>
> Click on "symptom correlation" and type in "runny nose"
>
> **F. OTHER SITES**

1.  Quackwatch.com ([www.quackwatch.com](http://www.quackwatch.com/))

    -   site developed by a psychiatrist

    -   he is anti-alternative/anti-complementary treatments. Site
        claims there is no "science" to alternative medicine".

    -   However, one can use this site to gather background information
        on questionable treatments (ex: Dr. Barefoot and coral calcium)

2.  MEDLINEplus

> (check under "health fraud")

**G. BREAK**

**H. EXERCISES**

> (Break the class into groups of 2-3 students and have each group
> evaluate a Web site listed on the "exercises" handout), according to
> the five basic criteria, and report back to the class the pluses and
> minuses of the site and whether the Web site is reliable.)