Common questions patients pose online include what symptoms indicate, information about specific conditions, how a disease is diagnosed, treatment options with risk and benefits, potential outcomes, wellness and prevention strategies, financial issues and how to find a doctor. Although this information is often trusted as being accurate and helpful, because of the nature of the Internet, this trust may be misplaced. Factors that may influence an individual’s trust of online advice include the website attractiveness and visual anchors, ease of navigability, and perceived credibility and reliability, such as sponsorship, and the site’s underlying motivation, goals and integrity.
What sites appear and their ordering when performing a search is also important. A number of search engines are available, with Google, Bing, Yahoo! and Ask the most commonly used. The elements employed by search engines to determine a website’s ranking order are based on more than 200 factors in undisclosed proprietary algorithms that include key words, domain history, content length, reading level and how recently it was updated to name a few factors. In addition, websites may have paid advertising, which can significantly influence their ranking.
The National Institutes of Health (NIH), National Library of Medicine (NLM), the world’s largest biomedical library, produces electronic information resources that include PubMed, ClinicalTrials.gov and MedlinePlus. MedlinePlus is the NIH’s website for “patients and their families and friends” that provides reliable, up-to-date health information about diseases, treatments and wellness issues in understandable terms using text, picture and video formats. The site also gives links to the latest medical research and information about clinical trials. NLM has developed guidelines and a tutorial to assist individuals on how to evaluate health information from the Web.
The NLM and others suggest using the following principles to evaluate a website’s content:
Consider the Source
Determining the originator of a website is critical.
The domain name ending of a Web address (URL—Uniform Resource Locator) is a good starting point to identify the publisher of the site:
- .gov—associated with a government agency;
- .edu—signifies an educational institution;
- .org—belongs to a professional or nonprofit organization; and
- .com—a commercial or for-profit site (exceptions—a healthcare organization may use both .org and .com for their website).
Using the “about us” or the mission statement icon on the website home page can provide intended audience, information on the authorship, editorial boards, mission and intent. Also included may be the process of selecting or approving information, which may be called “editorial policy” or “selection policy” or “review policy.” This process can provide clues about biases. Is advertising included on the website, and is it clearly marked as such?
Although it’s easy to find arthritis & other health information on the Internet, the quality & reliability of the information are extremely variable.
Currency of the Site
Documentation of when the page was created, last updated or reviewed should be clearly visible. Larger sites may have a date on each topic page. Health information may change daily, so a site must be reviewed at least once a year. Sites like MedlinePlus.gov are updated daily.
Evidence & Facts, Not Opinion
The primary information source, such as biomedical literature, abstracts or links to other credible websites or experts in the field, should be easily located and verifiable on the Web page. The use of single cases and testimonials should not be used to constitute reliable proof confirmation. If statistics are used, do they come from a reliable source? Lastly, does the site provide links to other sites?
The site should clearly disclose the categories of personal information collected, website cookies, the ways in which that personal information may be used, the persons to whom the personal information may be disclosed and the security measures used to protect personal information.