Quality of health information for consumers on the web: A systematic review of indicators, criteria, tools, and evaluation results

Toward a Medication Information Literacy Indicator System for Older Adults: A Delphi Study

BACKGROUND

The safety of medication use among older adults is a growing concern, given the aging population. Despite widespread attention, the exploration of medication literacy in older adults, particularly from the perspective of information literacy, is in its nascent stages.

METHODS

This study utilized the existing literature to define medication information literacy (MIL) as a theoretical framework. A two-round Delphi survey was conducted to identify the essential components of a MIL indicator system for older adults. The analytic hierarchy process (AHP) was then used to assign weights to each indicator.

RESULTS

The study observed relatively high response rates in both rounds of the questionnaire, which, along with expert authority coefficients (Cr) of 0.86 and 0.89, underscores the credibility and expertise of the panellists. Additionally, Kendall's coefficient of concordance (Kendall's W) ranging from 0.157 to 0.33 (p < 0.05) indicates a consensus among experts on the identified indicators. Utilizing the Delphi process, a MIL indicator system for older adults was developed, comprising five primary and 23 secondary indicators. These indicators were weighted, with medication information cognition and acquisition emerging as pivotal factors in enhancing medication literacy among older adults.

CONCLUSIONS

This study developed a MIL indicator system tailored for older adults using the Delphi approach. The findings can inform healthcare professionals in providing customized medication guidance and assist policymakers in crafting policies to enhance medication safety among older adults.

PATIENT OR PUBLIC CONTRIBUTION

Patient and public engagement played a pivotal role in the development of our medication information literacy indicator system for older adults. Their involvement contributed to shaping research questions, facilitating study participation, and enriching evidence interpretation. Collaborations with experts in geriatric nursing, medicine, and public health, along with discussions with caregivers and individuals with lived experience, provided invaluable insights into medication management among older adults. Their input guided our research direction and ensured the relevance and comprehensiveness of our findings.

Fifteen-minute consultation: Empowering children, young people and families through shared decision-making: a practical guide

Shared decision-making (SDM) is a collaborative approach to healthcare decision-making that involves patients and healthcare professionals working together to make decisions that are informed by the best available medical evidence, as well as the patient's values, preferences and goals. The importance of SDM and the intricate interplay among parents, children and young people (CYP), and healthcare professionals are increasingly acknowledged as the crucial aspects of delivering high-quality paediatric care. While there is a substantial evidence base for SDM improving knowledge and reducing decisional conflict, the evidence for long-term measures such as improved health outcomes is limited and mainly inconclusive. To support healthcare teams in implementing SDM, the authors offer a practical guide to enhance decision-making processes and empower CYP and their families.

Using Google web search to analyze and evaluate the application of ChatGPT in femoroacetabular impingement syndrome

Background

Chat Generative Pre-trained Transformer (ChatGPT) is a new machine learning tool that allows patients to access health information online, specifically compared to Google, the most commonly used search engine in the United States. Patients can use ChatGPT to better understand medical issues. This study compared the two search engines based on: (i) frequently asked questions (FAQs) about Femoroacetabular Impingement Syndrome (FAI), (ii) the corresponding answers to these FAQs, and (iii) the most FAQs yielding a numerical response.

Purpose

To assess the suitability of ChatGPT as an online health information resource for patients by replicating their internet searches.

Study design

Cross-sectional study.

Methods

The same keywords were used to search the 10 most common questions about FAI on both Google and ChatGPT. The responses from both search engines were recorded and analyzed.

Results

Of the 20 questions, 8 (40%) were similar. Among the 10 questions searched on Google, 7 were provided by a medical practice. For numerical questions, there was a notable difference in answers between Google and ChatGPT for 3 out of the top 5 most common questions (60%). Expert evaluation indicated that 67.5% of experts were satisfied or highly satisfied with the accuracy of ChatGPT's descriptions of both conservative and surgical treatment options for FAI. Additionally, 62.5% of experts were satisfied or highly satisfied with the safety of the information provided. Regarding the etiology of FAI, including cam and pincer impingements, 52.5% of experts expressed satisfaction or high satisfaction with ChatGPT's explanations. Overall, 62.5% of experts affirmed that ChatGPT could serve effectively as a reliable medical resource for initial information retrieval.

Conclusion

This study confirms that ChatGPT, despite being a new tool, shows significant potential as a supplementary resource for health information on FAI. Expert evaluations commend its capacity to provide accurate and comprehensive responses, valued by medical professionals for relevance and safety. Nonetheless, continuous improvements in its medical content's depth and precision are recommended for ongoing reliability. While ChatGPT offers a promising alternative to traditional search engines, meticulous validation is imperative before it can be fully embraced as a trusted medical resource.

The Performance of Chatbots and the AAPOS Website as a Tool for Amblyopia Education

PURPOSE

To evaluate the understandability, actionability, and readability of responses provided by the website of the American Association for Pediatric Ophthalmology and Strabismus (AAPOS), ChatGPT-3.5, Bard, and Bing Chat about amblyopia and the appropriateness of the responses generated by the chatbots.

METHOD

Twenty-five questions provided by the AAPOS website were directed three times to fresh ChatGPT-3.5, Bard, and Bing Chat interfaces. Two experienced pediatric ophthalmologists categorized the responses of the chatbots in terms of their appropriateness. Flesch Reading Ease (FRE), Flesch Kincaid Grade Level (FKGL), and Coleman-Liau Index (CLI) were used to evaluate the readability of the responses of the AAPOS website and chatbots. Furthermore, the understandability scores were evaluated using the Patient Education Materials Assessment Tool (PEMAT).

RESULTS

The appropriateness of the chatbots' responses was 84.0% for ChatGPT-3.5 and Bard and 80% for Bing Chat (P > .05). For understandability (mean PEMAT-U score AAPOS website: 81.5%, Bard: 77.6%, ChatGPT-3.5: 76.1%, and Bing Chat: 71.5%, P < .05) and actionability (mean PEMAT-A score AAPOS website: 74.6%, Bard: 69.2%, ChatGPT-3.5: 67.8%, and Bing Chat: 64.8%, P < .05), the AAPOs website scored better than the chat-bots. Three readability analyses showed that Bard had the highest mean score, followed by the AAPOS website, Bing Chat, and ChatGPT-3.5, and these scores were more challenging than the recommended level.

CONCLUSIONS

Chatbots have the potential to provide detailed and appropriate responses at acceptable levels. The AAPOS website has the advantage of providing information that is more understandable and actionable. The AAPOS website and chatbots, especially Chat-GPT, provided difficult-to-read data for patient education regarding amblyopia. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XXX-XXX.].

Development and Evaluation of a Clinician-Vetted Dementia Caregiver Resources Website: Mixed Methods Approach

BACKGROUND

About 11 million Americans are caregivers for the 6.7 million Americans currently living with dementia. They provide over 18 billion hours of unpaid care per year, yet most have no formal dementia education or support. It is extremely difficult for clinicians to keep up with the demand for caregiver education, especially as dementia is neurodegenerative in nature, requiring different information at different stages of the disease process. In this digital age, caregivers often seek dementia information on the internet, but clinicians lack a single, reliable compendium of expert-approved digital resources to provide to dementia caregivers.

OBJECTIVE

Our aim was to create a dementia caregiver resources website to serve as a hub for user-friendly, high-quality, and expert-reviewed dementia educational resources that clinicians can easily supply to family caregivers of people with dementia.

METHODS

An interdisciplinary website development team (representing dementia experts from occupational therapy, nursing, social work, geriatrics, and neurology) went through 6 iterative steps of website development to ensure resource selection quality and eligibility rigor. Steps included (1) resource collection, (2) creation of eligibility criteria, (3) resource organization by topic, (4) additional content identification, (5) finalize resource selection, and (6) website testing and launch. Website visits were tracked, and a 20-item survey about website usability and utility was sent to Veterans Affairs tele-geriatrics interdisciplinary specialty care groups.

RESULTS

Following website development, the dementia caregiver resource website was launched in February 2022. Over the first 9 months, the site averaged 1100 visits per month. The 3 subcategories with the highest number of visits were "general dementia information," "activities of daily living," and "self-care and support." Most (44/45, 98%) respondents agreed or strongly agreed that the website was easy to navigate, and all respondents agreed or strongly agreed that the resources were useful.

CONCLUSIONS

The iterative process of creating the dementia caregiver resources website included continuous identification, categorization, and prioritization of resources, followed by clinician feedback on website usability, accessibility, and suggestions for improvement. The website received thousands of visits and positive clinician reviews in its first 9 months. Results demonstrate that an expert-vetted, nationally, and remotely available resource website allows for easy access to dementia education for clinicians to provide for their patients and caregivers. This process of website development can serve as a model for other clinical subspecialty groups seeking to create a comprehensive educational resource for populations who lack easy access to specialty care.

Discharge Information About Adverse Drug Reactions Indicates Lower Self-Reported Adverse Drug Reactions and Fewer Concerns in Patients After Percutaneous Coronary Intervention

AIM

There are discrepancies between the information patients desire about adverse drug reactions (ADRs) and the information they receive from healthcare providers; this is an impediment to shared decision-making. This study aimed to establish whether patients received information about ADRs resulting from prescribed pharmacotherapy, before hospital discharge, after percutaneous coronary intervention (PCI) and to determine whether receiving information about ADRs was associated with incidence of self-reported ADRs or concerns related to prescribed pharmacotherapy.

METHODS

CONCARDPCI, a prospective multicentre cohort study including 3,417 consecutive patients after PCI, was conducted at seven high-volume referral PCI centres in two Nordic countries. Clinical data were collected from patients' medical records and national quality registries. Patient-reported outcome measures were registered 2 months (T1), 6 months (T2), and 12 months (T3) after discharge. Covariate-adjusted logistic regression yielded adjusted odds ratios (aORs) with 95% confidence intervals (CIs).

RESULTS

At discharge, 38% of participants had been informed about potential ADRs. For these patients, the incidence of self-reported ADRs was significantly lower at T1 (aOR 0.61, 95% CI 0.50-0.74; p<0.001), T2 (aOR 0.60, 95% CI 0.49-0.74; p<0.001), and T3 (aOR 0.57, 95% CI 0.46-0.71; p<0.001). Those who were not informed reported higher levels of concern about prescribed pharmacotherapy at all measuring points (p<0.001 for all comparisons). Those living alone (aOR 0.73, 95% CI 0.57-0.92; p=0.008), who were female (aOR 0.57, 95% CI 0.44-0.72; p<0.001), and with three or more versus no comorbidities (aOR 0.61, 95% CI 0.44-0.84; p=0.002) were less likely to receive information.

CONCLUSION

A substantial proportion of patients were not informed about potential ADRs from prescribed pharmacotherapy after PCI. Patients informed about ADRs had lower incidences of self-reported ADRs and fewer concerns about prescribed pharmacotherapy.

Evaluating online health information utilisation and its psychosocial implications among breast cancer survivors: Qualitative explorations

Background

This study investigated the online information-seeking behaviours of breast cancer patients at Jordan University Hospital, focusing on their dissatisfaction with available online health resources and its impact on their well-being and anxiety levels.

Methods

Employing descriptive phenomenology and convenience sampling, we conducted five Skype-based focus groups with 4-6 breast cancer survivors each, from March to July 2020. Data analysis was performed using NVivo, following Braun and Clark's inductive thematic analysis framework.

Results

The thematic analysis revealed critical insights into survivors' interactions with online cancer resources, identifying key subthemes such as the quality of online information, cyberchondriasis, health literacy and search strategies, the distress caused by counterproductive searches, and the tendency to avoid internet searches.

Conclusion

The study underscores the challenges breast cancer survivors face in accessing online health information, especially in Arabic. It highlights the need to improve the quality and accessibility of these resources. Enhancing the cultural relevance of online materials and educating patients on effective information evaluation are crucial. These measures can significantly boost health literacy, mitigate anxiety, and provide better support for breast cancer survivors.

ChatGPT as a Source of Patient Information for Lumbar Spinal Fusion and Laminectomy: A Comparative Analysis Against Google Web Search

STUDY DESIGN

Retrospective Observational Study.

OBJECTIVE

The objective of this study was to assess the utility of ChatGPT, an artificial intelligence chatbot, in providing patient information for lumbar spinal fusion and lumbar laminectomy in comparison with the Google search engine.

SUMMARY OF BACKGROUND DATA

ChatGPT, an artificial intelligence chatbot with seemingly unlimited functionality, may present an alternative to a Google web search for patients seeking information about medical questions. With widespread misinformation and suboptimal quality of online health information, it is imperative to assess ChatGPT as a resource for this purpose.

METHODS

The first 10 frequently asked questions (FAQs) related to the search terms "lumbar spinal fusion" and "lumbar laminectomy" were extracted from Google and ChatGPT. Responses to shared questions were compared regarding length and readability, using the Flesch Reading Ease score and Flesch-Kincaid Grade Level. Numerical FAQs from Google were replicated in ChatGPT.

RESULTS

Two of 10 (20%) questions for both lumbar spinal fusion and lumbar laminectomy were asked similarly between ChatGPT and Google. Compared with Google, ChatGPT's responses were lengthier (340.0 vs. 159.3 words) and of lower readability (Flesch Reading Ease score: 34.0 vs. 58.2; Flesch-Kincaid grade level: 11.6 vs. 8.8). Subjectively, we evaluated these responses to be accurate and adequately nonspecific. Each response concluded with a recommendation to discuss further with a health care provider. Over half of the numerical questions from Google produced a varying or nonnumerical response in ChatGPT.

CONCLUSIONS

FAQs and responses regarding lumbar spinal fusion and lumbar laminectomy were highly variable between Google and ChatGPT. While ChatGPT may be able to produce relatively accurate responses in select questions, its role remains as a supplement or starting point to a consultation with a physician, not as a replacement, and should be taken with caution until its functionality can be validated.

The quality and reliability of patient education regarding sound therapy videos for tinnitus on YouTube

Background

Numerous online videos are available on sound therapy as a treatment modality for tinnitus, but it is uncertain if these videos are adequate for patient education. This study aims to evaluate the quality and reliability of tinnitus sound therapy videos on YouTube for patient education.

Methods

YouTube videos were searched using keywords related to "tinnitus sound therapy". The top 100 videos were analyzed after excluding those were repetitive, irrelevant, less than 3 min, or not in English. After categorising the videos based on their authorship and content, the video power index (VPI) was relied to determine their popularity. The DISCERN questionnaire (DISCERN), the Global Quality Score (GQS), the Journal of the American Medical Association benchmark criteria (JAMA), and the Patient Education Materials Assessment Tool (PEMAT) were utilized to evaluate the quality, transparency, and patient education.

Results

Over half (56%) of the videos were published by professional organizations. A total of 93% of them contained sound only. Only 17% followed the recommendations of the Clinical Management of Tinnitus Guidelines, and 3% provided literature referenced by the video. A variety types of sound were used, among which music accounting for 35%. The videos were highly popular with an average views of 7,335,003.28 ± 24,174,764.02 and an average VPI of 4,610.33 ± 11,531.10. However, their quality was poor (the median scores: 38/80 for DISCERN, 2/5 for GQS, 1/4 for JAMA, and 50%/100% for PEMAT). There was a negative correlation between the popularity of the videos and their quality, indicated by PEMAT: -0.207, DISCERN: -0.307, GQS: -0.302, and JAMA: -0.233. Several dimensions of the videos require improvement, especially actionability, treatment options, and transparency with lacks of 100%, 63%, and 75% respectively.

Conclusion

The tinnitus sound therapy videos available on YouTube exhibit low quality. Nevertheless, they also hold potential for health education if refined and utilized suitably.

Trust in Mass Media as Sources of Cancer Information: Findings from a Nationally Representative Cross-Sectional Survey in Japan

Trust is a major factor in effective public dissemination and use of relevant health information to guide important health decisions. To examine mass media as a communication channel for delivering cancer information among Japanese adults, we identified the level of trust in various types of mass media as sources of cancer information, and examined factors associated with trust, including exposure to mass media, sociodemographic factors, and cancer history. Data were analyzed for 3,109 Japanese adults who responded to a nationally representative cross-sectional mail survey. Data included trust in cancer information sources, sociodemographic variables, cancer history, and exposure to mass media. Logistic regression analysis was used. The prevalence of high trust in cancer information sources was highest for physicians (94.7%). Among mass media, Internet (47.2%) was the most trusted source of cancer-related information, followed by television (44.3%), newspapers/magazines (42.7%), and radio (32.7%). The high-exposure group for newspapers (AOR = 1.28, 95%CI = 1.07-1.54) was more likely to trust newspapers. Similarly, high-exposure groups for radio (1.22, 1.02-1.45), Internet (1.21, 1.01-1.45), and television (1.30, 1.10-1.53) were positively associated with trust in each media type. Although trust in mass media was lower than trust in physicians, the study found that a large group of respondents had high levels of trust in mass media sources. Trust in cancer information from each mass media type was mainly related to the level of exposure to each mass media type. Developing health communication strategies using mass media may be effective for disseminating relevant cancer information in Japan.

Do ChatGPT and Google differ in answers to commonly asked patient questions regarding total shoulder and total elbow arthroplasty?

BACKGROUND

Artificial intelligence (AI) and large language models (LLMs) offer a new potential resource for patient education. The answers by Chat Generative Pre-Trained Transformer (ChatGPT), a LLM AI text bot, to frequently asked questions (FAQs) were compared to answers provided by a contemporary Google search to determine the reliability of information provided by these sources for patient education in upper extremity arthroplasty.

METHODS

"Total shoulder arthroplasty" (TSA) and "total elbow arthroplasty" (TEA) were entered into Google Search and ChatGPT 3.0 to determine the ten most FAQs. On Google, the FAQs were obtained through the "people also ask" section, while ChatGPT was asked to provide the ten most FAQs. Each question, answer, and reference(s) cited were recorded. A modified version of the Rothwell system was used to categorize questions into 10 subtopics: special activities, timeline of recovery, restrictions, technical details, cost, indications/management, risks and complications, pain, longevity, and evaluation of surgery. Each reference was categorized into the following groups: commercial, academic, medical practice, single surgeon personal, or social media. Questions for TSA and TEA were combined for analysis and compared between Google and ChatGPT with a 2 sample Z-test for proportions.

RESULTS

Overall, most questions were related to procedural indications or management (17.5%). There were no significant differences between Google and ChatGPT between question categories. The majority of references were from academic websites (65%). ChatGPT produced a greater number of academic references compared to Google (80% vs. 50%; P = .047), while Google more commonly provided medical practice references (25% vs. 0%; P = .017).

CONCLUSION

In conjunction with patient-physician discussions, AI LLMs may provide a reliable resource for patients. By providing information based on academic references, these tools have the potential to improve health literacy and improved shared decision making for patients searching for information about TSA and TEA.

CLINICAL SIGNIFICANCE

With the rising prevalence of AI programs, it is essential to understand how these applications affect patient education in medicine.

A novel system to provide information via online YouTube videos and an evaluation of current online information about hereditary breast cancer

BACKGROUND

The internet, especially YouTube, has become a prominent source of health information. However, the quality and accuracy of medical content on YouTube vary, posing concerns about misinformation. This study focuses on providing reliable information about hereditary breast cancer on YouTube, given its importance for decision-making among patients and families. The study examines the quality and accessibility of such content in Japanese, where limited research has been conducted.

METHODS

A nonprofit organization called BC Tube was established in May 2020 to create informative videos about breast cancer. The study analyzed 85 YouTube videos selected using the Japanese keywords "hereditary breast cancer" and "HBOC", categorized into six groups based on the source of upload: BC Tube, hospitals/governments, individual physicians, public-interest organizations/companies, breast cancer survivors, and others. The videos were evaluated based on various factors, including content length, view counts, likes, comments, and the presence of advertisements. The content was evaluated using the PEMAT and DISCERN quality criteria.

RESULTS

BC Tube created high-quality videos with high scores on PEMAT understandability, significantly outperforming other sources. Videos from public-interest organizations/companies received the most views and likes, despite their lower quality. Videos from medical institutions and governments were of superior quality but attracted less attention.

CONCLUSIONS

Our study emphasizes the importance of promoting accessible, easy-to-understand, and widely recognized medical information online. The popularity of videos does not always correspond to their quality, emphasizing the importance of quality evaluation. BC Tube provides a peer-reviewed platform to disseminate high-quality health information. We need to develop high-quality online health information and encourage the promotion of evidence-based information on YouTube.

Are popular books about diet and health written based on scientific evidence? A comparison of citations between the USA and Japan

OBJECTIVES

To describe and compare the references cited in popular books about diet and health between the USA and Japan.

DESIGN

Books were selected based on their best-seller rankings in the diet and health category of online bookstores. We identified references throughout all pages of the books and examined the number of references, reference format (identifiable or not) and presence of specific types of references, such as systematic reviews of human research. We compared the characteristics of references between the two countries and examined related factors to citation.

SETTING

Cross-sectional study.

PARTICIPANTS

Books (n 100 in each country).

RESULTS

Among 100 books from each country, sixty-five US and sixty-six Japanese books had references. Forty-five US books cited more than 100 references, against only five Japanese books. The number of books that cited systematic reviews of human research differed between the USA (n 49) and Japan (n 9). Additionally, the number of books that provided identifiable information for all references was significantly higher in the USA (n 63) than in Japan (n 42). Books whose first authors have licences of medical doctors were more likely to cite references than those without in both countries.

CONCLUSIONS

Two-thirds of books about diet and health cited references in both the USA and Japan, but Japanese books cited fewer references and were less likely to cite systematic reviews and provide identifiable references than US books. Further research into the scientific reliability of information in books about diet and health is warranted.

Is There a Relationship Between Online Health Information Seeking and Health Anxiety? A Systematic Review and Meta-Analysis

The internet has revolutionized how we live, providing unprecedented convenience and up-to-date information. Consequently, an increasing number of individuals are turning to the internet for health-related information, despite research suggesting a correlation between this behavior and health anxiety. Therefore, drawing on cognitive - behavioral theory, we explore the link between online health information seeking and health anxiety via a systematic review and meta-analysis of cross-sectional studies. Following the Preferred Reporting Items for Systematic Reviews and Meta-analysis, we ran searches in multiple databases, including PubMed, Web of Science, Embase, Elsevier/Science Direct, Cochrane Database, China National Knowledge Infrastructure, VIP Chinese Database, and Wanfang Data. Our searches identified 16 studies eligible for review, involving 4,920 participants across seven countries. The random-effects meta-analysis revealed a significant positive correlation between online health information seeking and health anxiety (r = 0.28, 95% confidence interval [0.16, 0.41], p < .0001), despite considerable heterogeneity. Furthermore, meta-regression analysis demonstrated that the identity characteristics of the sample, female percentage, sample size, and country all contributed to the heterogeneity across studies. Overall, this meta-analysis provides support for the association between online health information seeking and health anxiety, and helps to elucidate the cognitive - behavioral theory underpinning this phenomenon.

Utilizing ChatGPT-4 for Providing Information on Periodontal Disease to Patients: A DISCERN Quality Analysis

BACKGROUND

Due to their ability to mimic human responses, anthropomorphic entities such as ChatGPT have a higher likelihood of gaining people's trust. This study aimed to evaluate the quality of information generated by ChatGPT-4, as an artificial intelligence (AI) chatbot, on periodontal disease (PD) using the DISCERN instrument.

METHODS

Using Google Bard, the topics related to PD that had the highest search volume according to Google Trends were identified. An interactive dialogue was created by placing the topics in the standard question pattern. As a patient with PD, detailed information was requested from ChatGPT-4 regarding the relevant topics. The 'regenerate response' feature was not employed, and the initial response generated by ChatGPT-4 was carefully considered for each topic as new prompts in the form of questions were entered. The response to each question was independently assessed and rated by two experienced raters using the DISCERN instrument.

RESULTS

Based on the total DISCERN scores, the qualities of the responses generated by ChatGPT-4 were 'good', except for the two responses that rater-2 scored as 'fair'. It was also observed that the 'treatment choices' section of both raters had significantly fewer scores than the other sections. In both weighted kappa and Krippendorff alpha measures, the strength of agreement varied from 'substantial' to 'almost-perfect', and the correlation between values was statistically significant.

CONCLUSION

Despite some limitations in providing complete treatment choice information according to the DISCERN instrument, it is considered valuable for PD patients seeking information, as it consistently offered accurate guidance in the majority of responses.

Using a Google Web Search Analysis to Assess the Utility of ChatGPT in Total Joint Arthroplasty

BACKGROUND

Rapid technological advancements have laid the foundations for the use of artificial intelligence in medicine. The promise of machine learning (ML) lies in its potential ability to improve treatment decision making, predict adverse outcomes, and streamline the management of perioperative healthcare. In an increasing consumer-focused health care model, unprecedented access to information may extend to patients using ChatGPT to gain insight into medical questions. The main objective of our study was to replicate a patient's internet search in order to assess the appropriateness of ChatGPT, a novel machine learning tool released in 2022 that provides dialogue responses to queries, in comparison to Google Web Search, the most widely used search engine in the United States today, as a resource for patients for online health information. For the 2 different search engines, we compared i) the most frequently asked questions (FAQs) associated with total knee arthroplasty (TKA) and total hip arthroplasty (THA) by question type and topic; ii) the answers to the most frequently asked questions; as well as iii) the FAQs yielding a numerical response.

METHODS

A Google web search was performed with the following search terms: "total knee replacement" and "total hip replacement." These terms were individually entered and the first 10 FAQs were extracted along with the source of the associated website for each question. The following statements were inputted into ChatGPT: 1) "Perform a google search with the search term 'total knee replacement' and record the 10 most FAQs related to the search term" as well as 2) "Perform a google search with the search term 'total hip replacement' and record the 10 most FAQs related to the search term." A Google web search was repeated with the same search terms to identify the first 10 FAQs that included a numerical response for both "total knee replacement" and "total hip replacement." These questions were then inputted into ChatGPT and the questions and answers were recorded.

RESULTS

There were 5 of 20 (25%) questions that were similar when performing a Google web search and a search of ChatGPT for all search terms. Of the 20 questions asked for the Google Web Search, 13 of 20 were provided by commercial websites. For ChatGPT, 15 of 20 (75%) questions were answered by government websites, with the most frequent one being PubMed. In terms of numerical questions, 11 of 20 (55%) of the most FAQs provided different responses between a Google web search and ChatGPT.

CONCLUSION

A comparison of the FAQs by a Google web search with attempted replication by ChatGPT revealed heterogenous questions and responses for open and discrete questions. ChatGPT should remain a trending use as a potential resource to patients that needs further corroboration until its ability to provide credible information is verified and concordant with the goals of the physician and the patient alike.

Quality and accuracy of online nutrition-related information: a systematic review of content analysis studies

OBJECTIVE

This systematic review aimed to summarise the level of quality and accuracy of nutrition-related information on websites and social media and determine if quality and accuracy varied between websites and social media or publishers of information.

DESIGN

This systematic review was registered with PROSPERO (CRD42021224277). CINAHL, MEDLINE, Embase, Global Health and Academic Search Complete were systematically searched on 15 January 2021 to identify content analysis studies, published in English after 1989, that evaluated the quality and/or accuracy of nutrition-related information published on websites or social media. A coding framework was used to classify studies' findings about information quality and/or accuracy as poor, good, moderate or varied. The Academy of Nutrition and Dietetics Quality Criteria Checklist was used to assess the risk of bias.

SETTING

N/A.

PARTICIPANTS

N/A.

RESULTS

From 10 482 articles retrieved, sixty-four were included. Most studies evaluated information from websites (n 53, 82·8 %). Similar numbers of studies assessed quality (n 41, 64·1 %) and accuracy (n 47, 73·4 %). Almost half of the studies reported that quality (n 20, 48·8 %) or accuracy (n 23, 48·9 %) was low. Quality and accuracy of information were similar on social media and websites, however, varied between information publishers. High risk of bias in sample selection and quality or accuracy evaluations was a common limitation.

CONCLUSION

Online nutrition-related information is often inaccurate and of low quality. Consumers seeking information online are at risk of being misinformed. More action is needed to improve the public's eHealth and media literacy and the reliability of online nutrition-related information.

Is the internet a sufficient source of information on sarcoidosis?

Introduction

Many patients use the internet as a source of health information. Sarcoidosis is a complex disease, and internet resources have not yet been analyzed for reliability and content on sarcoidosis.

Aims

Our study aimed to investigate the content and the quality of information on sarcoidosis provided by internet resources.

Methods

Google, Yahoo, and Bing were searched for the term "sarcoidosis," and the first 200 hits were saved in each case. Those websites that met the inclusion criteria (English language, no registration fees, and relevant to sarcoidosis) were then analyzed by two independent investigators for readability, quality (HON, JAMA, and DISCERN), and content (25 predefined key facts) of the provided information.

Results

The websites were most commonly scientific or governmental (n = 57, 46%), and the median time since the last update was 24 months. Quality was rated with a median JAMA score of 2 (1; 4) and a median overall DISCERN score of 2.4 (1.1; 4.1), both scores represent partially sufficient information. In total, 15% of websites had a HON certificate. Website content measured by the median key fact score was 19 (ranging from 2.5 to 25) with the lowest scores for acute vs. chronic course of the disease, screening for extrapulmonary disease, and diffuse body pain. Poor results were achieved in industry websites and blogs (p = 0.047) with significant differences regarding definition (p = 0.004) and evaluation (p = 0.021).

Discussion

Sarcoidosis-related content of internet resources is partially sufficient; however, several important aspects are frequently not addressed, and the quality of information is moderate. Future directions should focus on providing reliable and comprehensive information on sarcoidosis; physicians from different disciplines and patients including self-support groups should collaborate on achieving this.

Health-Seeking Behaviors and Misconceptions about Osteoarthritis in Patients and the General Population in Saudi Arabia

Osteoarthritis (OA) is a public health disease that causes decreased mobility and leads to poor quality of life. A person's health-seeking behavior can influence their understanding of a disease, which in turn can alter its course. The objectives of this study were to measure the misconceptions about osteoarthritis and to identify the associated health-seeking behaviors. An online, self-administered, questionnaire-based study was conducted with 872 Arabic-speaking participants divided into three strata, group 1 comprising of patients with OA, group 2 participants with joint pain (without OA) and group 3 comprised of general population. Multivariate logistic regression analysis found that seeking care from general practitioners [3.29 (1.19, 9.16)], taking advice from friends [2.83 (1.08, 7.42)], seeking care from chiropractors [3.67 (1.02, 13.60)] and podiatrist [4.64 (1.31, 16.51)] were significantly associated with misconceptions, whereas, the odds were lower for those using social media [0.16 (0.06, 0.46)] and expert websites [0.63 (0.40, 0.99)]. The findings of this study imply that the level of misconceptions is high amongst all three strata.. Expert websites and social media have a positive effect on the management of osteoarthritis. However, general practitioners and allied health workers should regularly update their knowledge using refresher courses.

Development and testing of the health information website evaluation tool on neck pain websites - An analysis of reliability, validity, and utility

OBJECTIVE

Online health information contributes to patient education and knowledge on disease management. The aims of this study were to design the Health Information Website Evaluation Tool (HIWET) to evaluate the quality of online information, and to investigate the reliability, validity, and utility of HIWET.

METHODS

HIWET was developed by a literature search and small-scale pilot testing. Upon development, psychometric properties of HIWET were evaluated on 20 neck pain websites. Reliability was analysed using Intra class correlation coefficient (ICC). Validity was analysed using Pearson and Spearman correlation coefficients. Utility was analysed using an independent samples t-test.

RESULTS

HIWET demonstrated excellent intra-rater reliability (0.94 (0.98-0.99), p < .001) and fair inter-rater reliability (0.55 (0.88-0.10), p = .04). HIWET demonstrated validity with strong correlation against DISCERN (r = 0.656, n = 20, p = .002) and LIDA (r = 0.564, n = 20, p = 0.010). HIWET was time-efficient when compared to three comparison tools combined.

CONCLUSION

HIWET is a reliable and valid tool for evaluating the qualities of online health information.

PRACTICAL IMPLICATIONS

HIWET has the advantages of being a simple, quick to use and freely accessible tool. It can be implemented into clinical practice, education, and research to evaluate quality of online health information.

Mpox (monkeypox) information on TikTok: analysis of quality and audience engagement

BACKGROUND

Online information on mpox (monkeypox) is not well studied. We have analysed the video content, information quality, and audience engagement of mpox-related videos on TikTok.

METHODS

Using a hashtag-based searching strategy, we identified 2462 mpox-related videos on TikTok from 1 January to 11 August 2022; 85 were included after exclusion criteria screening. Videos were evaluated for content on features and treatment of mpox. Video and information quality was assessed using the DISCERN instrument and the Journal of the American Medical Association (JAMA) criteria. We recorded video source, evaluation scores, and viewer engagement metrics. The Kruskal-Wallis test was used for statistical analysis and multiple linear regression for factor-association studies.

RESULTS

Of the 85 videos, two assessed all content topics and highlighted 33% of all content items in clinical guidelines. The overall average score for the videos was 39.56 of 80 on the DISCERN instrument and 1.93 of 4 on the JAMA criteria. No video met all JAMA criteria. Subgroup analysis based on author identity suggested the variance in video scores by source (p<0.05 for all). Overall scores were higher for videos produced by doctors and science communicators than for those made by institutional users, nurses, and the general public. Multiple linear regression analysis showed that having people in the video (69.20, p=0.0001) and including information on treatment choices (1.15, p=0.045) were significant, independent determinants of audience engagement.

CONCLUSION

Public-directed TikTok videos on mpox frequently provide incomplete, inaccurate information, highlighting the potential risks of using TikTok as a health information source.

The quality of informational social support in online health communities: A content analysis of cancer-related discussions

Objective

Informational social support is one of the main reasons for patients to visit online health communities (OHCs). Calls have been made to investigate the objective quality of such support in the light of a worrying number of inaccurate online health-related information. The main aim of this study is to conceptualize the Quality of Informational Social Support (QISS) and develop and test a measure of QISS for content analysis. A further aim is to investigate the level of QISS in cancer-related messages in the largest OHC in Slovenia and examine the differences among various types of discussion forums, namely, online consultation forums, online support group forums, and socializing forums.

Methods

A multidimensional measurement instrument was developed, which included 20 items in a coding scheme for a content analysis of cancer-related messages. On a set of almost three million posts published between 2015 and 2019, a machine-learning algorithm was used to detect cancer-related discussions in the OHC. We then identified the messages providing informational social support, and through quantitative content analysis, three experts coded a random sample of 403 cancer-related messages for the QISS.

Results

The results demonstrate a good level of interrater reliability and agreement for a QISS scale with six dimensions, each demonstrating good internal consistency. The results reveal large differences among the social support, socializing, and consultation forums, with the latter recording significantly higher quality in terms of accuracy (M = 4.48, P < .001), trustworthiness (M = 4.65, P < .001), relevance (M = 3.59, P < .001), and justification (M = 3.81, P = .05) in messages providing informational social support regarding cancer-related issues.

Conclusions

This study provides the research field with a valid tool to further investigate the factors and consequences of varying quality of information exchanged in supportive communication. From a practical perspective, OHCs should dedicate more resources and develop mechanisms for the professional moderation of health-related topics in socializing forums and thereby suppress the publication and dissemination of low-quality information among OHC users and visitors.

Quality Assessment of Online Resources for the Most Common Cancers

The internet is a common source of health information for patients with cancer. Despite research surrounding the quality of online resources for individual types of cancer, these results may not necessarily be easily extrapolated to cancer resources as a whole. Thus, we aim to use a standardized tool to produce generalizable results by analyzing the quality of online resources for the most common cancers. Educational websites pertaining to breast, lung, prostate, and colorectal cancers were searched using multiple search engines. After screening against pre-specified inclusion criteria, the most visible 100 websites for each cancer were extracted for analysis. A validated tool was then used to assess their quality. Pooled results were evaluated using descriptive and inferential statistics. Of the 400 analyzed websites, 43% were commercially affiliated, and these were significantly associated with greater use of biased language. Thirty percent of websites disclosed authorship, 47% cited at least one reliable source, and 43% were updated within the last 2 years. The average Flesch-Kincaid readability was determined to be at a grade 10.9 level, which is significantly more difficult than the recommended grade 6 level. Risk factors, symptoms, and detection were the most accurately covered topics. However, most websites did not cover prognosis. This study comprehensively examines the quality of online cancer resources for the four most common cancers. Our results could help guide the development of future resources, support patient education endeavors, and raise awareness among healthcare providers about the limitations of online cancer resources.

Patient education information material assessment criteria: A scoping review

BACKGROUND

Patient education information material (PEIM) is an essential component of patient education programs in increasing patients' ability to cope with their diseases. Therefore, it is essential to consider the criteria that will be used to prepare and evaluate these resources.

OBJECTIVE

This paper aims to identify these criteria and recognize the tools or methods used to evaluate them.

METHODS

National and international databases and indexing banks, including PubMed, Scopus, Web of Science, ProQuest, the Cochrane Library, Magiran, SID and ISC, were searched for this review. Original or review articles, theses, short surveys, and conference papers published between January 1990 and June 2022 were included.

RESULTS

Overall, 4688 documents were retrieved, of which 298 documents met the inclusion criteria. The criteria were grouped into 24 overarching criteria. The most frequently used criteria were readability, quality, suitability, comprehensibility and understandability.

CONCLUSION

This review has provided empirical evidence to identify criteria, tools, techniques or methods for developing or evaluating a PEIM. The authors suggest that developing a comprehensive tool based on these findings is critical for evaluating the overall efficiency of PEIM using effective criteria.

Mobile healthcare platforms' sustainability: The perspective of health information quality

As an emerging form of medical organization, Chinese mobile healthcare (mHealth) platforms are inherently linked to the continuous use of users, which depends on the quality of the health information provided. However, improving the health information quality of mHealth platforms is still a problem that needs to be studied and solved in order to make the platforms sustainable. Based on the reputation mechanism, this study creates a behavioral evolutionary game model for health information providers (physicians) and managers (mHealth platforms), explores the evolution process and evolutionarily stable strategy of the behaviors in various situations, and uses numerical simulation technology to analyze mHealth platforms' constraints and the influencing factors of health information quality. This study presents three key findings. First, considering reputation, health information managers and mHealth platform providers should not unilaterally optimize health information. Instead, mHealth platforms should have active quality control, and physician groups should provide high-quality health information, which is the ideal evolution of the model. Second, the rewards that physicians receive from patients and mHealth platforms for providing quality health information, the reputation benefits, the penalties that physicians suffer for providing low-quality health information, and the increased probability and cost of rent-seeking behavior that physicians may choose can effectively promote the choice of physicians to provide high-quality health information. Third, the reputation gain of mHealth platforms, the probability of mHealth platforms being exposed, and increased losses suffered from exposure can effectively promote the choice of mHealth platforms to control the quality of health information. This study can provide a theoretical basis for mHealth platforms' health information quality control, which is conducive to the healthy and sustainable development of mHealth platforms and the improvement of user satisfaction.

Growing Taller without Hormones? Dr. Consult Google-An Evaluation of Online Information Related to Limb Lengthening

PURPOSE

The aim of this study was to investigate the reliability, content and readability of the information available on the Internet related to limb lengthening surgeries, which have recently been progressively in fashion.

METHODS

The three most commonly used browsers on the Internet were determined and a search term for "Limb Lengthening Surgery" was typed for each browser. The websites were categorized by their type, and the content and the quality of them was evaluated using the DISCERN score, the Journal of American Medical Association (JAMA) benchmark and the Global Quality Score (GQS). The Flesch Kincaid Grade Level (FKGL) and the Flesch Reading Ease Score (FKRS) were used to evaluate the readability. Each website also assessed the presence (or absence) of the Health on Net (HON) code.

RESULTS

The academic category was found to be significantly higher than the medical and commercial categories. Mean FKGL and FCRS scores, DISCERN score values, JAMA, GQS and LLCS score values of Websites with HON code were significantly higher than those without.

CONCLUSIONS

The quality of online information related to limb lengthening was of low quality. Although some websites, especially academic resources, were of higher quality, the readability of their content is just about 2.5 degrees higher than the sixth-grade reading level.

Evaluating online health information quality using machine learning and deep learning: A systematic literature review

Background

Due to the large volume of online health information, while quality remains dubious, understanding the usage of artificial intelligence to evaluate health information and surpass human-level performance is crucial. However, the existing studies still need a comprehensive review highlighting the vital machine, and Deep learning techniques for the automatic health information evaluation process.

Objective

Therefore, this study outlines the most recent developments and the current state of the art regarding evaluating the quality of online health information on web pages and specifies the direction of future research.

Methods

In this article, a systematic literature is conducted according to the PRISMA statement in eight online databases PubMed, Science Direct, Scopus, ACM, Springer Link, Wiley Online Library, Emerald Insight, and Web of Science to identify all empirical studies that use machine and deep learning models for evaluating the online health information quality. Furthermore, the selected techniques are compared based on their characteristics, such as health quality criteria, quality measurement tools, algorithm type, and achieved performance.

Results

The included papers evaluate health information on web pages using over 100 quality criteria. The results show no universal quality dimensions used by health professionals and machine or deep learning practitioners while evaluating health information quality. In addition, the metrics used to assess the model performance are not the same as those used to evaluate human performance.

Conclusions

This systemic review offers a novel perspective in approaching the health information quality in web pages that can be used by machine and deep learning practitioners to tackle the problem more effectively.

A Comprehensive Evaluation of the Quality, Readability, and Technical Quality of Online Information on Glaucoma

PURPOSE

To evaluate the quality and reliability of medical information, the technical quality of the presentation of information, and the readability of informational websites that publish content on the definition, causes, symptoms, and treatment of glaucoma.

DESIGN

A cross-sectional study was conducted to assess information published on websites with regard to glaucoma.

SUBJECTS

The top 150 websites populated on a Google search using the keywords glaucoma, high intraocular pressure, and high eye pressure were chosen for evaluation.

METHODS

Two independent reviewers assessed quality and reliability of each website using the DISCERN, Health on the Net Code (HONcode), and Journal of the American Medical Association (JAMA) criteria. The reviewers also evaluated technical quality by determining each website's ability to satisfy 10 unique features. Readability was assessed using the Readability Studio software (Oleander Software).

MAIN OUTCOME MEASURES

Quality of information was analyzed using the DISCERN, HONcode, and JAMA criteria. To assess readability, the Bormuth Cloze Mean, Bormuth Grade Placement, Flesch Kincaid Reading Ease, Coleman-Liau Index, Gunning Fog Score, Simple Measure of Gobbledygook Index, Readability Score, Fry Estimate, Raygor Estimate, and the Overall Mean Readability metrics were used. A separate subanalysis categorized websites into institutional and private categories.

RESULTS

Readability was poor among all websites, with most websites requiring a reading level higher than the 11th grade. The overall mean DISCERN score ± standard deviation (SD) was 3.0 ± 0.4, the mean HONcode score ± SD was 9.6 ± 1.8, and the mean JAMA score ± SD was 2.1 ± 1.1. The reviewers had moderate to excellent interrater reliability. Institutional websites (n = 39) had a higher mean DISCERN score (3.18 ± 0.33 vs. 2.95 ± 0.39, P < 0.05) and mean HONcode score (10.18 ± 1.90 vs. 9.34 ± 1.71, P < 0.05) than those of private websites (n = 111). Technical quality was higher among institutional websites (P < 0.05).

CONCLUSIONS

An overwhelming majority of websites presented information of low quality, reliability, and readability. Institutional websites generally received higher scores than those received by private websites; however, overall scores were still substandard, which necessitates improvement of online information on glaucoma.

Development and validation of a quality assessment tool to assess online nutrition information

Setting

The internet is an important source of health information but is unregulated. Little research has focused on the assessment of digital information related to nutrition.

Aim

To develop and validate a novel online quality assessment tool (OQAT) for quality assessment of online nutrition information.

Method

The OQAT was developed and validated in six distinct stages. After reviewing the literature, a framework and criteria were developed and formalised. Next, the quality assessment criteria were piloted on a subset of data and criteria refined. The established criteria were then validated against a previously validated assessment tool, and reliability was tested. Finally, the validated OQAT was used to assess the quality of articles from a 24-h collection period, 19 April 2021.

Results

The final OQAT consisted of 10 key questions. Twenty-six news articles were assessed independently by two raters. Comparison of scores found moderate internal consistency (α = 0.382). Cohen's Kappa coefficient demonstrated high interrater agreement (k = 0.653, p < 0.001). The OQAT was tested on 291 relevant Uniform Resource Locators (URLs), which were determined to be either poor 3% (n = 9), satisfactory 49% (n = 144), or high-quality 48% (n = 139) articles. There was a statistically significant difference in OQAT scores between blogs, news articles, and press releases, χ2(2) = 23.22, p < 0.001, with a mean rank OQAT score of 138.2 for blogs, 216.6 for news articles, and 188.7 for press releases.

Conclusion

This novel tool provides a reliable and objective method for assessing the quality of nutrition content online. It could potentially be used by researchers to assess the quality of online information in different settings and by organisations to inform readers of the quality of information being accessed.

The Assessment of TikTok as a Source of Quality Health Information on Varicoceles

OBJECTIVE

To evaluate the quality of varicocele information on TikTok, a popular video platform that adolescent patients are now turning to as a source of medical information before visiting a doctor.

METHODS

Using the key word "varicocele," we retrieved the top 225 videos listed on TikTok in May 2022. We extracted general video and engagement data. Video information was coded and analyzed for the completeness of different types of content (definition, symptoms, evaluation, management, and outcomes). The quality of consumer health information was rated using the DISCERN instrument.

RESULTS

Thirty-six videos met inclusion criteria; 17 were created by general users, 16 by healthcare professionals or systems (2 by urologists), and 3 by scientific communities. Healthcare professionals had more views than non-healthcare (P = .05). The quality of health information using the DISCERN instrument was "poor" from health care professional videos and "very poor" from non-health care professionals. However, the quality of information provided by healthcare professionals was statistically better than that of non-healthcare (P< .05). Video content mainly focused on symptoms: 50% of videos from healthcare providers had some or extensive content and 41% of non-healthcare had some content. 23% of videos had misinformation.

CONCLUSION

The overall quality of information for varicoceles on TikTok is not acceptable and does not meet patient needs. It is imperative that urologists create robust, accurate content, and partner with these platforms to connect users with higher quality information. TikTok users should also be mindful that information may not be medically accurate.

Assessment of the quality of health information on the Internet: evidence-based accuracy indicators for tuberculosis

ABSTRACT Not long ago, someone had to buy a newspaper, a book, or a magazine or go to a library to obtain information. Today, the Internet quickly facilitates a myriad of information. However, the information provided may be obsolete, incomplete, incorrect, or deliberately false: fake news. In the health field, this information can affect well-being or harm individuals and society. Thus, professionals, researchers, and institutions have assessed the quality of information on health websites to address this issue. Evaluations often verify the accuracy of the information provided. However, the information accuracy indicators have yet to be constructed from Evidence-Based Medicine (EBM). This article aims to build indicators from EBM practices, analyzing the case of tuberculosis. This manuscript proposes 43 information accuracy indicators that evaluated the tuberculosis information available on the Brazilian Ministry of Health. The results indicate that much information needs to be included, and some data must be corrected. This evaluation reiterates the importance of building EBM accuracy indicators. This work intends to encourage new studies about assessing the quality of health information on the Internet.

Avaliação da qualidade da informação de saúde na internet: indicadores de acurácia baseados em evidência para tuberculose

RESUMO Pouco tempo atrás, para alguém obter informação, era preciso comprar um jornal, um livro, uma revista ou ir até uma biblioteca. Hoje, a internet disponibiliza uma miríade de informação rapidamente. Entretanto, as informações veiculadas podem estar desatualizadas, incompletas, incorretas ou deliberadamente mentirosas: as fakenews. Na saúde, essas informações podem afetar o bem-estar ou causar dano ao indivíduo e à sociedade. Para enfrentar esse problema, avaliações da qualidade da informação de sites de saúde têm sido realizadas por profissionais, pesquisadores e instituições. As avaliações verificam frequentemente a exatidão da informação oferecida. Contudo, os indicadores de acurácia da informação não têm sido construídos a partir da Medicina Baseada em Evidências (MBE). O objetivo desse artigo é construir indicadores a partir das práticas da MBE, analisando o caso da tuberculose. O artigo propõe 43 indicadores de acurácia da informação. Com eles, foi avaliada a informação disponível sobre tuberculose no site do Ministério da Saúde do Brasil. Os resultados indicam que falta muita informação e há informação incorreta. Essa avaliação reitera a importância da construção de indicadores de acurácia da informação a partir da MBE. Este trabalho pretende incentivar a realização de novos estudos sobre avaliação da qualidade da informação de saúde na internet.

TikTok and YouTube as sources of information on anal fissure: A comparative analysis

Introduction

Anal fissure is a common colorectal disease impacting patients' life quality with high incidence. Social media platforms are becoming a kind of health information source nowadays. This study aims to evaluate and compare the quality of anal fissure-related videos on TikTok and YouTube.

Materials and methods

One hundred videos were sourced from TikTok and YouTube, respectively and videos were screened further. The completeness of six types of content within the videos is assessed, including the definition of disease, symptoms, risk factors, evaluation, management and outcomes. Finally, the DISCERN instrument, Patient Education Materials Assessment Tool and Global Quality scale are used to assess video display quality and content. A correlation analysis is undertaken considering the video features, DISCERN, PEMAT and GQS scores.

Results

Physicians and non-profit organizations contributed almost all video content among selected videos. A statistically significant correlation between DISCERN classification and duration, PEMAT understandability, PEMAT actionability and GQS scores is recorded. DISCERN total scores were significantly positively correlated with video duration, PEMAT understandability, PEMAT actionability and GQS scores. GQS scores were significantly positively correlated with duration, PEMAT understandability and PEMAT actionability scores. For content, the videos mainly described management and symptoms while containing limited information on the disease evaluation, and outcomes.

Conclusions

The sources of uploaders on YouTube are more diverse than TikTok, and the quality of videos is also relatively higher on YouTube. Even so, the video quality of the two platforms still needs to be further improved. Health information without integrity, reliability and practicability impacts patients' disease perception and health-seeking behavior, leading to serious consequences. Much effort must be taken to improve the quality of videos regarding anal fissures on the two platforms, which will facilitate the development of public health education on this issue.

The role of base-rate neglect in cyberchondria and health anxiety

Cyberchondria is characterized by excessive health-related online search behavior associated with an unfounded escalation of concerns about common symptomatology. It often co-occurs with health anxiety. We investigated whether base-rate neglect-the cognitive bias to ignore a priori probabilities (e.g., of serious diseases)-plays a significant role in cyberchondria and health anxiety. 368 participants were randomly assigned to eight experimental conditions, manipulating the base-rate (30 % vs. 70 %), the judgment domain (health-neutral versus health-related), and the salience of base-rate information (low vs. high) in a 2×2×2 between-subjects design when asking them for probability judgments with versus without disease relevance. We found that high salience decreased base-rate neglect in participants with low, but not in those with elevated levels of either cyberchondria or health anxiety. Under low salience conditions, however, both cyberchondria and health anxiety severity were uncorrelated with base-rate neglect. These effects were independent of whether health-related or health-neutral problems were evaluated. Our findings suggest a domain-general probabilistic reasoning style that may play a causal role in the pathogenesis of cyberchondria and health anxiety.

Online Symptom Checkers are Poor Tools for Diagnosing Men's Health Conditions

OBJECTIVE

To analyze the accuracy of the four most commonly used online symptom checkers (OSCs) in diagnosing erectile dysfunction (ED), scrotal pain (SP), Peyronie's disease (PD), and low testosterone (LT).

METHODS AND OUTCOMES

One-hundred and sixty artificial vignettes were created by de-identifying recent initial outpatient consults presenting to discuss ED (40), SP (40), PD (40), and LT (40). The vignettes were entered into the 4 most frequently used OSCs (WebMD, MedicineNet, EverydayHealth, and SutterHealth) as determined by web traffic analysis tools. The top 5 conditions listed in the OSC differential diagnosis were recorded and scored.

RESULTS

WebMD's accuracy for ED, SP, PD, and LT vignettes was 0%, 22.5%, 0%, and 95%, respectively. EverydayHealth was only able to diagnose SP 20% of the time, and failed to diagnose ED, PD, or LT on all occasions. MedicineNet diagnosed ED, PD, SP, and LT in 100%, 98%, 27.5%, and 0% of vignettes, respectively. SutterHealth correctly diagnosed ED, SP, and LT in 100%, 20%, and 80% of patients, respectively. Cumulatively, the OSCs were most accurate in diagnosing ED and least accurate in diagnosing SP when using the Top 1 (37.5% vs. 6.9%) and Top 5 (50% vs. 24.5%) of the suggested conditions.

CONCLUSIONS

No OSC could accurately diagnose all the conditions tested. The OSCs, on average, were poor at suggesting precise diagnoses for ED, PD, LT, SP. Patients and practitioners should be cautioned regarding the accuracy of OSCs.

Social Workers as Information Navigators: Insights into the Use of the Web for Serving Clients

Social workers' critical role as service navigators on behalf of their clients is expanding in the online space at a faster pace than ever before. This study examined the process and outcome of online information navigation through the lens of service providers and service users based on observational and interactive surveys. T tests and correlation results showed that human services providers demonstrated a higher capacity to visit more websites and yield more accurate search outcomes in a similar duration of time compared with general service users. Results suggest that digital literacy for navigating information online can be improved through educational opportunities. At the same time, both groups shared some common feedback on desired features for future service navigation online, including but not limited to an open search bar, search filters, instruction videos, live chat, and discussion forums for seeking mutual help and networking. The findings bear implications for formulating the roles, responsibilities, and desired competencies of social workers for online service navigation in the digital and postpandemic future.

Development of Principles for Health-Related Information on Social Media: Delphi Study

Background

Health-related misinformation can be propagated via social media and is a threat to public health. Several quality assessment tools and principles to evaluate health-related information in the public domain exist; however, these were not designed specifically for social media.

Objective

This study aims to develop Principles for Health-related Information on Social Media (PRHISM), which can be used to evaluate the quality of health-related social media content.

Methods

A modified Delphi approach was used to obtain expert consensus on the principles and functions of PRHISM. Health and social media experts were recruited via Twitter, email, and snowballing. A total of 3 surveys were administered between February 2021 and May 2021. The first survey was informed by a literature review and included open-ended questions and items from existing quality assessment tools. Subsequent surveys were informed by the results of the proceeding survey. Consensus was deemed if ≥80% agreement was reached, and items with consensus were considered relevant to include in PRHISM. After the third survey, principles were finalized, and an instruction manual and scoring tool for PRHISM were developed and circulated to expert participants for final feedback.

Results

A total of 34 experts consented to participate, of whom 18 (53%) responded to all 3 Delphi surveys. In total, 13 principles were considered relevant and were included in PRHISM. When the instructions and PRHISM scoring tool were circulated, no objections to the wording of the final principles were received.

Conclusions

A total of 13 quality principles were included in the PRHISM tool, along with a scoring system and implementation tool. The principles promote accessibility, transparency, provision of authoritative and evidence-based information and support for consumers’ relationships with health care providers. PRHISM can be used to evaluate the quality of health-related information provided on social media. These principles may also be useful to content creators for developing high-quality health-related social media content and assist consumers in discerning high- and low-quality information.

Laypeople's Online Health Information Search Strategies and Use for Health-Related Problems: Cross-sectional Survey

Background

With the increase in the use of the internet to search for health information about health-related problems, there is a need for health care professionals to better understand how their patients search for and use the online health information that may influence their medical decision making.

Objective

The aims of this study are to explore laypeople’s online health information search strategies and examine the relationships between their search strategies and utilization behavior of online health information.

Methods

Two scales, namely match and elaboration, were used to measure patients’ basic search strategies (ie, simple approach) and advanced search strategies (ie, integrative approach), respectively. In addition, the consultation scale was used to evaluate the participants’ use of online health information to consult doctors and others. A total of 253 outpatients without university education were purposely selected and surveyed. The participants were outpatients at a university-affiliated teaching hospital. Partial least squares-structural equation modeling (PLS-SEM) was performed to analyze the measurement model to specify the measurement validation. In addition, the structure model of PLS-SEM was evaluated to examine the path correlations between variables and to execute interaction effect and curvilinear relationship analyses.

Results

The results of the path correlation analysis by PLS-SEM showed that both elaboration strategy (path coefficient=0.55, P<.001) and match strategy (path coefficient=0.36, P<.001) were positively correlated with consultation on online health information with doctors and others. In addition, interaction effect and curvilinear relationship analyses indicated that there was a significant interaction effect between elaboration and match on consultation (path coefficient=–0.34, P<.001) and a significant curvilinear relationship between match and consultation (path coefficient=–0.09, P=.046).

Conclusions

Increasing patients’ exposure to online health information through both a simple search approach (ie, match strategy) and a complex search approach (ie, elaboration strategy) may lead them to appropriately use the information to consult doctors and others. However, the results of interaction effect and curvilinear relationship analyses highlighted the essential role of the elaboration strategy to properly locate, evaluate, and apply online health information. The findings of this study may help health care professionals better understand how to communicate with their patients through the health information on the internet.

Cancer Misinformation and Harmful Information on Facebook and Other Social Media: A Brief Report

There are few data on the quality of cancer treatment information available on social media. Here, we quantify the accuracy of cancer treatment information on social media and its potential for harm. Two cancer experts reviewed 50 of the most popular social media articles on each of the 4 most common cancers. The proportion of misinformation and potential for harm were reported for all 200 articles and their association with the number of social media engagements using a 2-sample Wilcoxon rank-sum test. All statistical tests were 2-sided. Of 200 total articles, 32.5% (n = 65) contained misinformation and 30.5% (n = 61) contained harmful information. Among articles containing misinformation, 76.9% (50 of 65) contained harmful information. The median number of engagements for articles with misinformation was greater than factual articles (median [interquartile range] = 2300 [1200-4700] vs 1600 [819-4700], P = .05). The median number of engagements for articles with harmful information was statistically significantly greater than safe articles (median [interquartile range] = 2300 [1400-4700] vs 1500 [810-4700], P = .007).

Evaluation of Web-Based Health Information From the Perspective of Women With Eating Disorders: Thematic Analysis

Background

Users with experience of eating disorders use the internet as a source of information, whether for prorecovery activities (such as web-based treatment, looking for information, support, and sharing) or activities that promote eating disorder behavior as a desirable lifestyle choice (such as pro–eating disorder communities and reading and creating pro–eating disorder posts). Their assessment of web-based eating disorder–related information is crucial for understanding the context of the illness and for health professionals and their web-based interventions.

Objective

This study aimed to understand the criteria young women with the experience of eating disorders use in evaluating eating disorder–related web-based information and what eating disorder–related characteristics of these women are involved in their evaluation.

Methods

We analyzed 30 semistructured individual interviews with Czech women aged 16 to 28 years with past or present eating disorder experience using a qualitative approach. Thematic analysis was adopted as an analytical tool.

Results

The specifics of eating disorder phases (the disorder stage and the treatment process) emerged as important aspects in the process of information assessment. Other specific characteristics of respondents (eg, motivation, abilities, and resources) addressed how the respondents arrived at certain web-based information and how they evaluated it. In addition, the respondents described some content cues as features of information (eg, novelty and social information pooling). Another finding is that other users’ attitudes, experiences, activities, and personal features are involved in the information evaluation of these users and the information presented by them. Finally, the respondents evaluated the websites’ visual look and graphic components.

Conclusions

This study shows that web-based information evaluation reported by women with experience of eating disorders is a complex process. The assessment is influenced by current personal characteristics related to the illness (mainly the motivation for maintaining or curing the eating disorder) using cues associated with information content, other users, and website look. The study findings have important implications for health professionals, who should ask their clients questions about web-based communities and their needs to understand what information and sources they choose.

Takotsubo syndrome on TikTok: An analysis of information quality and audience engagement (Preprint)

Background

The incidence of Takotsubo syndrome (TTS), also known as the broken heart syndrome or stress cardiomyopathy, is increasing worldwide. The understanding of its prognosis has been progressively evolving and currently appears to be poorer than previously thought, which has attracted the attention of researchers. An attempt to recognize the awareness of this condition among the general population drove us to analyze the dissemination of this topic on TikTok, a popular short-video–based social media platform. We found a considerable number of videos on TTS on TikTok; however, the quality of the presented information remains unknown.

Objective

The aim of this study was to analyze the quality and audience engagement of TTS-related videos on TikTok.

Methods

Videos on the TikTok platform were explored on August 2, 2021 to identify those related to TTS by using 6 Chinese keywords. A total of 2549 videos were found, of which 80 met our inclusion criteria and were evaluated for their characteristics, content, quality, and reliability. The quality and reliability were rated using the DISCERN instrument and the Journal of the American Medical Association (JAMA) criteria by 2 reviewers independently, and a score was assigned. Descriptive statistics were generated, and the Kruskal-Wallis test was used for statistical analysis. Multiple linear regression was performed to evaluate the association between audience engagement and other factors such as video content, video quality, and author types.

Results

The scores assigned to the selected video content were low with regard to the diagnosis (0.66/2) and management (0.34/2) of TTS. The evaluated videos were found to have an average score of 36.93 out of 80 on the DISCERN instrument and 1.51 out of 4 per the JAMA criteria. None of the evaluated videos met all the JAMA criteria. The quality of the relayed information varied by source (All P<.05). TTS-related videos made by health care professionals accounted for 28% (22/80) of all the evaluated videos and had the highest DISCERN scores with an average of 40.59 out of 80. Multiple linear regression analysis showed that author types that identified as health professionals (exponentiated regression coefficient 17.48, 95% CI 2.29-133.52; P=.006) and individual science communicators (exponentiated regression coefficient 13.38, 95% CI 1.83-97.88; P=.01) were significant and independent determinants of audience engagement (in terms of the number of likes). Other author types of videos, video content, and DISCERN document scores were not associated with higher likes.

Conclusions

We found that the quality of videos regarding TTS for patient education on TikTok is poor. Patients should be cautious about health-related information on TikTok. The formulation of a measure for video quality review is necessary, especially when the purpose of the published content is to educate and increase awareness on a health-related topic.

Online Health Information Seeking for Self and Child: An Experimental Study of Parental Symptom Search

BACKGROUND

Parents often search the web for health-related information for themselves or on behalf of their children, which may impact their health-related decision-making and behaviors. In particular, searching for somatic symptoms such as headaches, fever, or fatigue is common. However, little is known about how psychological and relational factors relate to the characteristics of successful symptom-related internet searches. To date, few studies have used experimental designs that connect participant subjective search evaluation with objective search behavior metrics.

OBJECTIVE

This study aimed to examine the features of web-based health-related search behaviors based on video-coded observational data, to investigate which psychological and relational factors are related to successful symptom search appraisal, and to examine the differences in search-related outcomes among self-seekers and by-proxy seekers.

METHODS

In a laboratory setting, parents living in Austria (N=46) with a child aged between 0 and 6 years were randomized to search their own (n=23, 50%) or their child's (n=23, 50%) most recent somatic symptom on the web. Web-based activity was recorded and transcribed. Health anxiety, eHealth literacy, attitude toward web-based health information, relational variables, state of stress, participants' search appraisals, and quantitative properties of the search session were assessed. Differences in search appraisals and search characteristics among parents who searched for themselves or their children were examined.

RESULTS

Across both groups, searches were carried out for 17 different symptom clusters. Almost all parents started with Google (44/46, 96%), and a majority used initial elaborated key phrases with >1 search keyword (38/45, 84%) and performed on average 2.95 (SD 1.83) search queries per session. Search success was negatively associated with health anxiety (r_s=-0.39, P=.01), stress after the search (r_s=-0.33, P=.02), and the number of search queries (r_s=-0.29, P=.04) but was not significantly associated with eHealth literacy (r_s=0.22, P=.13). Of note, eHealth literacy was strongly and positively correlated with satisfaction during the search (r_s=0.50, P<.001) but did not significantly correlate with search characteristics as measured by search duration (r_s=0.08, P=.56), number of performed search queries (r_s=0.20, P=.17), or total clicks (r_s=0.14, P=.32). No differences were found between parents searching for their own symptoms and parents searching for their child's symptoms.

CONCLUSIONS

This study provides exploratory findings regarding relevant dimensions of appraisals for symptom-based information seeking on the web. Consistent with previous literature, health anxiety was found to be associated with poorer search evaluation. Contrary to expectations, eHealth literacy was related neither to search success nor to search characteristics. Interestingly, we did not find significant differences between self-seekers and by-proxy seekers, suggesting similar search and evaluation patterns in our sample. Further research with larger samples is needed to identify and evaluate guidelines for enhanced web-based health information seeking among parents and the general public.

Impact of language preference and health literacy on health information-seeking experiences among a low-income, multilingual cohort

OBJECTIVE

We examined the impact of language preference and health literacy on health information-seeking experiences in a multilingual, low-income cohort.

METHODS

We administered a modified Health Information National Trends Survey in English, Spanish, and Chinese to a sample of San Francisco city/county residents. Using multivariable logistic regression analyses, we assessed how language and health literacy impact health information-seeking experiences (confidence, effort, frustration, quality concerns, and difficulty understanding information), adjusting for age, gender, race/ethnicity, education, usual place of care, health status, information-seeking behaviors, and smartphone ownership.

RESULTS

Of 1000 participants (487 English-speaking, 256 Spanish-speaking, 257 Chinese-speaking), 820 (82%) reported at least one negative health information-seeking experience. Chinese-language was associated with frustration (aOR = 2.56; 1.12-5.86). Difficulty understanding information was more likely in Spanish-language respondents (aOR = 3.58; 1.25-10.24). Participants with limited health literacy reported more effort (aOR = 1.97; 1.22-3.17), frustration (aOR = 2.09; 1.28-3.43), concern about quality (aOR = 2.72; 1.60-4.61), and difficulty understanding information (aOR = 2.53; 1.58-4.05). Language and literacy impacted confidence only in the interaction term between Chinese-speakers and health literacy.

CONCLUSION

We found that negative health information-seeking experiences were common in non-English speaking populations those with limited health literacy.

PRACTICE IMPLICATIONS

Health communication efforts should consider both language preference and health literacy to ensure accessibility for all patients.

Digital Neurology Platform: Developing and implementing a rigorous content quality guideline

Background

Digital communication has emerged as a major source of scientific and medical information for health care professionals. There is a need to set up an effective and reliable methodology to assess and monitor the quality of content that is published on the internet.

Objective

The aim of this project was to develop content quality guidelines for Neurodiem, an independent scientific information platform dedicated to neurology for health care professionals and neuroscientists. These content quality guidelines are intended to be used by (1) content providers as a framework to meet content quality standards and (2) reviewers as a tool for analyzing and scoring quality of content.

Methods

Specific scientific criteria were designed using a 5-point scale to measure the quality of curated and original content published on the website: for Summaries, (1) source reliability and topic relevance for neurologists, (2) structure, and (3) scientific and didactic value; for Congress highlights, (1) relevance of congress selection, (2) congress coverage based on the original program, and (3) scientific and didactic value of individual abstracts; for Expert points of view and talks, (1) credibility (authorship) and topic relevance for neurologists, (2) scientific and didactic value, and (3) reliability (references) and format. The criteria were utilized on a monthly basis and endorsed by an independent scientific committee of widely recognized medical experts in neurology.

Results

Summary content quality for the 3 domains (reliability and relevance, structure, and scientific and didactic value) increased in the second month after the implementation of the guidelines. The domain scientific and didactic value had a mean score of 8.20/10. Scores for the domains reliability and relevance (8-9/10) and structure (45-55/60) showed that the maintenance of these 2 quality items over time was more challenging. Talks (either in the format of interviews or slide deck–supported scientific presentations) and expert point of view demonstrated high quality after the implementation of the content quality guidelines that was maintained over time (15-25/25).

Conclusions

Our findings support that content quality guidelines provide both (1) a reliable framework for generating independent high-quality content that addresses the educational needs of neurologists and (2) are an objective evaluation tool for improving and maintaining scientific quality level. The use of these criteria and this scoring system could serve as a standard and reference to build an editorial strategy and review process for any medical news or platforms.

A Review of Web-Based Nutrition Information in Spanish for Cancer Patients and Survivors

Nutrition education resources are of interest for cancer patients and survivors throughout the cancer continuum. We examined the web-based nutrition information in Spanish for cancer patients and survivors provided by national cancer organizations (NCOs). The Guide to Internet Resources for Cancer and the membership list of the Union for International Cancer Control were searched to identify the NCOs. The International Patients Decisions Aid Standards (IPDAS) was used to describe the quality of the available information. We identified 20 NCOs that provided nutrition information aimed at a general audience on their websites. Web-based resources of nine NCOs were selected for presentation in this review. Website scores ranged between 20 and 24 in the IPDAS scale (maximum score = 31). The selected NCOs offered reliable and safe information. Healthy eating information for cancer patients and management of side-effects was provided by all websites. Information was more limited for cancer survivors. We recommend that NCOs increase the possibilities for personalized recommendations and interaction with the content by including instrumental tools on their websites.

Social Media for ImpLementing Evidence (SMILE): Conceptual Framework

Background

Social media has become widely used by individual researchers and professional organizations to translate research evidence into health care practice. Despite its increasing popularity, few social media initiatives consider the theoretical perspectives of how social media works as a knowledge translation strategy to affect research use.

Objective

The purpose of this paper is to propose a conceptual framework to understand how social media works as a knowledge translation strategy for health care providers, policy makers, and patients to inform their health care decision-making.

Methods

We developed this framework using an integrative approach that first involved reviewing 5 long-standing social media initiatives. We then drafted the initial framework using a deductive approach by referring to 5 theories on social media studies and knowledge translation. A total of 58 empirical studies on factors that influenced the use of social media and its messages and strategies for promoting the use of research evidence via social media were further integrated to substantiate and fine-tune our initial framework. Through an iterative process, we developed the Social Media for ImpLementing Evidence (SMILE) framework.

Results

The SMILE framework has six key constructs: developers, messages and delivery strategies, recipients, context, triggers, and outcomes. For social media to effectively enable recipients to use research evidence in their decision-making, the framework proposes that social media content developers respond to target recipients’ needs and context and develop relevant messages and appropriate delivery strategies. The recipients’ use of social media messages is influenced by the virtual–technical, individual, organizational, and system contexts and can be activated by three types of triggers: sparks, facilitators, and signals.

Conclusions

The SMILE framework maps the factors that are hypothesized to influence the use of social media messages by recipients and offers a heuristic device for social media content developers to create interventions for promoting the use of evidence in health care decision-making. Empirical studies are now needed to test the propositions of this framework.