Quality of breast cancer sites on the World Wide Web

Burn Prevention in Spanish: Assessment of Content Accuracy, Website Quality, and Readability of Online Sources

Burn prevention information may be inadequate or inaccessible to communities with non-English language preference. Our objective was to systematically analyze the content accuracy, website quality, and readability of online Spanish information for burn prevention in the home and compare it to English websites. We collected the top ten burn prevention results from a search on Google, Bing, and Yahoo using a list of Spanish key terms. Using recommendations from national organizations and a burn care expert team, content accuracy was evaluated for each website. We assessed website quality following the "Health on the Net" Code of Conduct. Readability was scored by averaging five validated readability tests for the Spanish language. After using the same protocol, a comparison was made with English websites as a control. Once duplicates and non-relevant search results were removed, 23 Spanish websites were assessed. Out of 21 possible points for content accuracy, the top website scored 14 (67%) and the average score was 6.6 (31%). For website quality, the average score was 50%. The average grade level needed to read the websites was 8.6. Compared to English, Spanish websites were less accurate (31% vs 41%), harder to read (9.8 vs 7.8), but were of higher website quality (50% vs 43%). Online burn prevention information in Spanish is often inaccurate, incomplete, and inferior to available English language websites. We propose a call to action to increase the quality of online burn prevention material available in Spanish.

Adapting systematic scoping study methods to identify cancer-specific physical activity opportunities in Ontario, Canada

BACKGROUND

Identifying cancer-specific physical activity programs and post-secondary courses targeting students in academic settings (i.e., "real world" opportunities) may promote physical activity behaviors among cancer survivors. Using knowledge synthesis methods such as systematic scoping study methods may facilitate knowledge tool development and guide evidence-based practice to improve knowledge transfer. However, identifying these opportunities poses a challenge as systematic scoping study methods have yet to be applied and adapted to this context. Thus, to extend systematic scoping study methods, the purpose of the current investigation is to describe the adaptation of systematic scoping study methods in the context of cancer-specific "real world" opportunities in Ontario, Canada.

METHODS

Systematic scoping study methods were adapted to develop a knowledge tool, which was a credible resource website for researchers, clinicians, and survivors. Three search strategies including Advanced Google Search, targeted website search, and consultations with experts were used to identify eligible (e.g., appropriate for cancer survivors, offered in the community) cancer-specific physical activity programs. Only the targeted website search was used to search post-secondary institutions because they are centralized onto one government website.

RESULTS

Fifty-eight programs and 10 post-secondary courses met the eligibility criteria. Relevant data from these opportunities were extracted, charted, synthesized, and uploaded onto the resource website. The most successful search strategy for cancer-specific physical activity programs was the targeted website search followed by Google Advanced Search and consultations with content experts.

CONCLUSIONS

Challenges were experienced due to lack of standard reporting among opportunities, bias of potentially relevant records, and changing nature of resulting records. The current investigation demonstrated that systematic scoping study methods can be applied to cancer-specific physical activity programs and post-secondary courses in the context of cancer survivorship in Ontario yielding robust results. The method can be further adapted and updated in future knowledge syntheses in health-related contexts.

SYSTEMATIC REVIEW REGISTRATION

The systematic scoping review method protocol has not been registered.

Age differences in patterns and confidence of using internet and social media for cancer-care among cancer survivors

OBJECTIVES

The internet and social media provide information and support to cancer survivors, and adolescent and young adults (AYA, age < 40 years), adults, and older (age 65+ years) cancer survivors may have different needs. We evaluated the impact of age on cancer-related internet and social media use and confidence in evaluating online information for cancer-care decision making.

MATERIALS AND METHODS

Cancer survivors completed a convenience cross-sectional survey evaluating their cancer-related internet and social media use and their confidence in using these resources for decision making. Multivariable regression models evaluated the impact of age on usage patterns and confidence.

RESULTS

Among 371 cancer survivors, 58 were older adults and 138 were AYA; 74% used the internet and 39% social media for cancer care; 48% felt confident in using online information for cancer-care decisions. Compared to adult survivors, there was a non-significant trend for older survivors to be less likely to use the internet for cancer-care information(aOR = 0.49, 95% CI[0.23-1.03], P = .06), while AYA were more likely to use social media for cancer-care (aOR = 1.79[1.08-2.99], P = .03). Although confidence at using online information for cancer-care decision making did not differ between age groups, increasing age had a non-significant trend towards reduced confidence (aOR = 0.99 per year [0.97-1.00], P = .09). Most commonly researched and desired online information were causes/risk factors/symptoms, treatment options, and prognosis/outcomes.

CONCLUSIONS

Age may influence the use of internet and social media for cancer-care, and older cancer survivors may be less confident at evaluating online information for cancer-care decision making. Future research should explore other strategies at meeting the informational needs of older cancer survivors.

Effects of a web-based intervention on women's breast health behaviors

Helping women make choices to reduce cancer risk and to improve breast health behaviors is important, but the best ways to reach more people with intervention assistance is not known. To test the efficacy of a web-based intervention designed to help women make better breast health choices, we adapted our previously tested, successful breast health intervention package to be delivered on the Internet, and then we tested it in a randomized trial. We recruited women from the general public to be randomized to either an active intervention group or a delayed intervention control group. The intervention consisted of a specialized website providing tailored and personalized risk information to all participants, followed by offers of additional support if needed. Follow-up at one-year post randomization revealed significant improvements in mammography screening in intervention women compared with control women (improvement of 13 percentage points). The intervention effects were more powerful in women who increased breast health knowledge and decreased cancer worry during intervention. These data indicate that increases in mammography can be accomplished in population-based mostly insured samples by implementing this simple, low resource intensive intervention.

Examining the Light and Dark of an Online Young Adult Cancer Support Community

The young adult (YA) cancer community represents an understudied population in interpersonal and health communication scholarship. Through qualitative analysis, this study sought to advance a dark side perspective by exploring the content of messages shared in an online support forum for YAs with cancer. Our findings highlight a variety of complexities YAs face in an online cancer support community, including the light and dark of soliciting support, disclosing to a community, advocacy online, negative sentiment evaluating health care services, and asynchronous communication. Understanding the light and dark nuances involved with participating in an online YA support forum advances a dark side perspective on the scholarly research in health communication that can ultimately help care providers recommend resources and coach YAs to optimally and effectively use and navigate online support groups.

Quality of Breast Cancer Information on the Internet by African Organizations: An Appraisal

Objective. The aim of this study was to appraise the quality of information on BC available at websites run by organizations in Africa. Methods. Three searches were conducted using Google search engine to generate a list of websites. The identified websites were assessed using European Commission (EC) quality criteria for health-related websites, which comprises different assessment areas including, completeness, transparency and honesty, authority, privacy and data protection, updating of information, accountability, and accessibility. Results. Thirteen (13) websites were included in the evaluation. Majority of the websites evaluated had low scores on the completeness and transparency of their websites. Scores on accessibility were however moderate and high for most of the websites. Breast cancer-specific organizations provided the highest quality information, particularly in terms of completeness. The overall lowest and highest quality scores were 9 and 43 out of 63, respectively, and 77% of the included websites scored less than 50% of the total quality score. Conclusion. This review has provided evidence of inadequate and inaccurate BC information provided by some cancer organizations in Africa. Considerable effort is required to make BC information on the Internet a valuable and up-to-date source for both professionals and patients.

Inaccurate, inadequate and inconsistent: A content analysis of burn first aid information online

OBJECTIVE

With the popularity of the Internet as a primary source of health-related information, the aim of this website content analysis was to assess the accuracy and quality of burn first aid information available on the Internet.

METHODS

Using the search term 'burn first aid' in four popular search engines, the first 10 websites from each search engine were recorded. From a total of 40 websites recorded, 14 websites were evaluated after removing duplicates. Websites were assessed on content accuracy by four independent reviewers with checks conducted on inter-rater reliability. Website quality was recorded based on Health on the Net Code of Conduct (HONcode) principles.

RESULTS

Country of origin for the 14 websites was the US (7), Australia (6), and New Zealand (1). The mean content accuracy score was 5.6 out of 10. The mean website quality score was 6.6 out of 12. Australasian websites scored lower for quality but higher for accuracy. The US websites scored higher for quality than accuracy. Website usability and accuracy in a crisis situation were also assessed. The median crisis usability score was 3 out of five, and the median crisis accuracy score was 3.5 out of five.

CONCLUSIONS

The inaccurate and inconsistent burn first aid treatments that appear online are reflected in the often-incorrect burn first aid treatments seen in patients attending emergency departments. Global consistency in burn first aid information is needed to avoid confusion by members of the public.

Building a Web of Support for Caregivers of Persons with Stroke

Stroke is the leading cause of disability in the United States, with a cost of 30 billion US dollars annually. Most persons with stroke return home after initial treatment and are cared for by family members. Few researchers, however, have focused on Web-based interventions to strengthen caregivers'efforts. This article describes the development of Caring~Web, an online, in-home intervention of support for caregivers of persons with stroke. Through specifically designed Web pages, caregivers are able to ask questions of a nurse specialist and rehabilitation team, discuss issues with other caregivers and the nurse via email, and obtain educational information on stroke.

Tangled in the breast cancer web: an evaluation of the usage of web-based information resources by breast cancer patients

This study describes Internet use by breast cancer patients highlighting search patterns and examining the impact of web-based information on the clinical encounter. From September 2011 to January 2012, breast cancer patients at a cancer center completed a survey. Answers were closed and open-ended. Eighty-one patients were approached and 56 completed the survey. Forty-five (80 %) respondents used the Internet and 32 (71 %) searched for breast cancer information. All used Google as their principal search engine. To evaluate quality, 47 % referred to author credentials and 41 % examined references. Most sought information with respect to treatment or prognosis. Eighty percent felt that the information increased their knowledge and influenced treatment decision making for 53 %. This study highlights search patterns and factors used by breast cancer patients in seeking web-based information. Physicians must appreciate that patients use the Internet and address discrepancies between information sought and that which is available.

Online communities for breast cancer survivors: a review and analysis of their characteristics and levels of use

PURPOSE

Online communities have been heralded as one of the most promising health resources on the Internet. The purpose of this study was to identify the characteristics and levels of use of online communities for breast cancer survivors.

METHODS

Using Google, we identified websites with a string of computer-mediated communication terms and individual queries of three to five words of online community terms. This was complemented by a review of website resource lists and personal libraries. Two reviewers independently extracted information on their general characteristics and number of members and message board posts. A coding scheme guided content analysis.

RESULTS

We found 111 websites. Most sites (n = 64, 65.8 %) had a broad focus (e.g., health, cancer, or general). One third (n = 38, 34.2 %) were exclusive to breast cancer and 11 catered to specific disease characteristics. The majority were American (n = 79, 75.2 %), nonprofit (55.0 %), and moderated (69.5 %). Most moderators (85.7 %) were staff or community members; eight sites were moderated by health professionals. Greater than one-third of sites (n = 40, 36 %) were initiated by breast cancer survivors or loved ones. Breast cancer-specific sites contained a total of 4,186,275 posts. One-third (n = 10) contained 93.4 % of posts, displaying over 100,000 posts each. As of April 3, 2012, eight sites were discontinued.

CONCLUSIONS

There is a wide range of online communities available for breast cancer survivors with extensive archives of personal illness experiences. Future efforts should focus on identifying the factors that determine their success and effectiveness.

eviQ cancer treatments online: how does the web-based protocol system fare in a comprehensive quality assessment?

AIMS

There have been few evaluations of the quality of computerized decision support tools in medical oncology despite their widespread use in clinical practice. In this article, we provide an in-depth quality assessment of eviQ, an Australian web-based protocol system.

METHODS

We used the Appraisal of Guidelines for Research and Evaluation (AGREE-II) instrument to examine the quality of eviQ chemotherapy protocols across six domains: scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability, editorial independence and overall quality rating. Domain scores were categorized as high quality (scores of >70%), moderate quality (30-70%), and low quality (<30%).

RESULTS

eviQ was rated highly with respect to articulating its scope and purpose, clarity of presentation, applicability and on the overall rating item (scores of 72-80%). Domains addressing the involvement of stakeholders in the development process and the rigor with which protocols were developed were of moderate quality (scores of 34-37%) and the management of editorial independence and conflict of interest issues were rated in the low quality range (22%).

CONCLUSION

Our evaluation demonstrated the eviQ protocol system is generally of high quality. However, we identified a number of areas in which eviQ could improve either its development processes or the means by which these processes are communicated to end-users. This research represents the first comprehensive evaluation of oncology protocols and paves the way for continued quality assurance research to ensure that these tools meet their objective of facilitating evidence-based medicine, standardizing treatment and, ultimately, improving patient outcomes.

A survey of public health and consumer health informatics programmes and courses in Canadian universities and colleges

INTRODUCTION

As information technology becomes more widely used by people for health-care decisions, training in consumer and public health informatics will be important for health practitioners working directly with the public.

METHODS

Using information from 74 universities and colleges across Canada, we searched websites and online calendars for programmes (undergraduate, graduate) regarding availability and scope of education in programmes, courses and topics geared to public health and/or consumer health informatics.

RESULTS

Of the 74 institutions searched, 31 provided some content relevant to health informatics (HI) and 8 institutions offered full HI-related programmes. Of these 8 HI programmes, only 1 course was identified with content relevant to public health informatics and 1 with content about consumer health informatics. Some institutions (n  =  22) - which do not offer HI-degree programmes - provide health informatics-related courses, including one on consumer health informatics. We found few programmes, courses or topic areas within courses in Canadian universities and colleges that focus on consumer or public health informatics education.

DISCUSSION

Given the increasing emphasis on personal responsibility for health and health-care decision-making, skills training for health professionals who help consumers navigate the Internet should be considered in health informatics education.

An examination into audience targeting and the use of storytelling or statistical evidence on breast cancer websites

OBJECTIVE

This research sought to address the presence of information targeting low literacy, racially diverse, non-English speaking, and age diverse audiences on breast cancer websites. In addition, this study documented the utilization of evidence strategies, either statistics or storytelling, for these audiences.

METHODS

This research examined these relationships on 157 breast cancer websites through content analysis.

RESULTS

Nearly half of websites did not contain any of the elements targeting diverse literacy, racial/ethnic, language, and age audiences. Websites with multiple languages were more likely than monolingual websites to use statistics, and websites with low literacy sections were less likely than others to do so. Websites with ethnic or racial diversity and age diversity were more likely than other websites to use first person storytelling about breast cancer.

CONCLUSION

Current breast cancer websites demonstrate promising use of targeting specific audiences and employing evidence strategies prescribed as effective by past research, however there is room for improvement.

PRACTICE IMPLICATIONS

Tip sheets for incorporating audience targeting, readability, and storytelling should be created for health organizations to use in the process of developing their websites, as these constructs were found only sparingly on the assessed sites.

Effects of a Web-based intervention on women's breast health behaviors

Helping women make choices to reduce cancer risk and to improve breast health behaviors is important, but the best ways to reach more people with intervention assistance is not known. To test the efficacy of a Web-based intervention designed to help women make better breast health choices, we adapted our previously tested, successful breast health intervention package to be delivered on the Internet, and then we tested it in a randomized trial. We recruited women from the general public to be randomized to either an active intervention group or a delayed intervention control group. The intervention consisted of a specialized Web site providing tailored and personalized risk information to all participants, followed by offers of additional support if needed. Follow-up at 1-year post-randomization revealed significant improvements in mammography screening in intervention women compared with control women (improvement of 13 percentage points). The intervention effects were more powerful in women who increased breast health knowledge and decreased cancer worry during intervention. These data indicate that increases in mammography can be accomplished in population-based mostly insured samples by implementing this simple, low resource intensive intervention.

Psychosocial determinants of cancer-related information seeking among cancer patients

This study explores the utility of using the Integrative Model of Behavioral Prediction as a framework for predicting cancer patients' intentions to seek information about their cancer from sources other than a physician, and to examine the relation between patients' baseline intentions to seek information and their actual seeking behavior at follow-up. Within 1 year of their diagnosis with colon, breast, or prostate cancer, 1,641 patients responded to a mailed questionnaire assessing intentions to seek cancer-related information from a source other than their doctor, as well as their attitudes, perceived normative pressure, and perceived behavioral control with respect to this behavior. In addition, the survey assessed their cancer-related information seeking. One year later, 1,049 of these patients responded to a follow-up survey assessing cancer-related information seeking during the previous year. Attitudes, perceived normative pressure, and perceived behavioral control were predictive of information-seeking intentions, although attitudes emerged as the primary predictor. Intentions to seek information, perceived normative pressure regarding information seeking, baseline information-seeking behavior, and being diagnosed with stage 4 cancer were predictive of actual information-seeking behavior at follow-up. Practical implications are discussed.

An investigation of the quality of breast cancer information provided on the internet by voluntary organisations in Great Britain

OBJECTIVE

Patients increasingly use the internet to source health information. Voluntary organisations offering information and support often provide such information on their websites. However, the internet is unregulated and information can be of poor quality. The aim of this study was to evaluate the quality of breast cancer information provided by 10 Great Britain (GB) voluntary organisations' websites.

METHODS

Quality of websites was evaluated using an investigator-designed appraisal tool based on European Commission (EC) quality criteria for health-related websites. Completeness and transparency of breast cancer information, and usability of websites, were appraised.

RESULTS

Typically, breast cancer-specific organisations provided the highest quality information, particularly in terms of its completeness. However, great variability in quality was identified. Areas of weakness related to transparency of information, in particular disclosure of authorship, and its apparent currency.

CONCLUSION

Voluntary organisations providing web-based breast cancer information have progress to make to ensure information provided is complete and transparent, and websites are user-friendly. Unfortunately, informed decision-making will not be optimised if patients cannot access quality information.

PRACTICE IMPLICATIONS

Voluntary organisations should regularly review the quality of information on their websites. Grading of websites allows healthcare professionals to identify and signpost patients to trustworthy, up-to-date websites. Thus, ensuring patients receive high quality information.

Common sources of skin care education: a cross-sectional study

BACKGROUND

The resources used by the public to locate health information are important.

AIM

To expose the sources from which the public gains a knowledge of dermatology.

METHODS

An anonymous, multiple-choice questionnaire was distributed to adults in college campuses, shopping malls, and community parks over a 4-month period.

RESULTS

Sixty-six percent of individuals stated that they felt physicians had the most authority for making recommendations regarding the skin. When questioned about the sources of skin care advice, however, there was a discrepancy, with only 35% stating that they actually consulted professionals. Indeed, 37% admitted to using family and friends as their primary source of information, and 28% used the media first.

CONCLUSIONS

In our opinion, the best method to ensure healthy skin habits and early diagnosis of disease would be to combine the efforts of healthcare and the media. These public resources should make people aware of skin diseases and preventative measures, whilst encouraging regular check-ups with dermatologists and persuading patients to employ open conversation with their physicians regarding care of their skin.

MRI of the breast: does the internet accurately report its beneficial uses and limitations?

As consumer use of the Internet for medical information grows, continuing evaluation of the medical content on the Internet is needed. We evaluated Internet sites describing breast magnetic resonance imaging (MRI), an emerging technology tool in breast cancer diagnosis and screening. We searched Google for sites describing breast MRI and abstracted the affiliation, content, media type, readability, and quality of 90 most popular unique sites. Over half (56%) of the sites were commercially sponsored. The content varied by site and included medical and procedural facts, information about clinical trials, grants and journal articles, as well as human interest stories. Most (82%) sites described potentially beneficial uses of breast MRI, such as further evaluation of newly diagnosed breast cancers (58%); screening women at high risk for breast cancer (54%); evaluation of abnormal breast findings (48%); screening women with dense breasts (48%) or implants (27%); and surveillance for breast cancer recurrences (24%). Approximately half (56%) of the sites described the limitations of breast MRI, most commonly false positive findings (44%) and costs (24%). Website quality, including the display of contact information, sponsorship, currency of information, authorship, and references varied. The reading level was close to high school graduate. Internet sites describing breast MRI were mostly commercially sponsored, more often described the potential beneficial uses of the procedure than its limitations, and were of variable quality and high reading level. With the lack of enforceable standards for display of medical information on the Internet, providers should encourage patients to direct their searches to the most credible sites.

Communication Assessment of the Most Frequented Breast Cancer Websites: Evaluation of Design and Theoretical Criteria

The internet is a prominent source of health information for the public. This research evaluated both basic use and design tenets and the presence of theoretical components to motivate healthy breast cancer behavior for users of the most frequented breast cancer websites.

METHODOLOGY

Each website was evaluated with 2 sets of questions. The first attends to the basic use and design tenets of the website. The second coding form assessed the websites use of 3 behavior change theories.

RESULTS

The majority of the websites fared well with regards to their use of basic tenet and design principles. Theoretical components were used sparingly on the majority of websites.

DISCUSSION

The most frequented breast cancer websites are currently well equipped with basic use and design tenets. However, their lack of behavioral change components is likely to impede users' motivations to protect themselves against breast cancer.

A qualitative study of Canadian Aboriginal women's beliefs about "credible" cancer information on the internet

BACKGROUND

Criteria for evaluating the quality of cancer information on the Internet include source credibility and accuracy and currency of content. Cultural relevance of cancer resources is often overlooked in assessments of quality of Internet Web sites.

METHODS

Interviews with senior Aboriginal women (n = 25) were conducted in Ontario Canada to determine their beliefs about "high quality" and "credible" cancer prevention resources.

RESULTS

Participants did not regard online cancer information from the medical community to be completely credible. They recommended that cancer resources include contact information for traditional healers in addition to local cancer agencies.

CONCLUSIONS

Cultural appropriateness of cancer information should be assessed. Web resources considered credible according to published criteria may not be as relevant for Aboriginal populations.

Where one size does not fit all: understanding the needs of potential users of a portal to breast cancer knowledge online

The article argues that, although the Internet has great potential for assisting people to find information on breast cancer, at present that potential is not being realised. The literature shows considerable dissatisfaction with information provision for breast cancer, including on the Internet where appropriate information suited to particular needs often cannot be found. An Australian project (Breast Cancer Knowledge Online [BCKOnline]), in its first stage, set out to explore the needs for breast cancer information using an ethnographic method and a purposive sample of 77 participants, most of them women with breast cancer. A portal, which will enable users to tailor information to their particular needs, is at present being developed based on the results of the needs analysis. The process includes user-selected profiles, enabled through "user-centric" resource descriptions, and a metadata repository that links the profiles with specific information resources. The article presents limited results from the needs analysis-those highlighting the differences between younger and older women and the problems with present Internet information provision as seen by the sample. The final section discusses how the portal will both tailor information to needs and assist with the problems with the Internet revealed in the literature.

Reducing the cancer burden of lifestyle factors: opportunities and challenges of the Internet

This paper focuses on the Internet as a tool for enhancing behavior and lifestyle changes to reduce the burden of cancer at a population level. The premise of this paper is that the Internet can and should be leveraged to bridge the chasm between basic science, clinical trials, and public health. Our focus is specifically on the opportunity to disseminate effective behavioral science interventions via the Internet in order to decrease the prevalence of behavioral risk factors for cancer. The examples herein are primarily drawn from tobacco use to illustrate issues that can be applied more generally to other behavioral risk factors for cancer. Four areas will be addressed: (1) the scientific basis and rationale for delivering lifestyle behavior change interventions via the Internet; (2) the need to determine the quality of Internet interventions; (3) methodological considerations in conducting evaluations of Internet interventions; and (4) recommendations for a transdisciplinary approach to Internet intervention development and evaluation.

Cancer patients' self-reported attitudes about the Internet

BACKGROUND

Increasing numbers of cancer patients are using the Internet, but little is known about their attitudes toward online health care.

OBJECTIVE

The purpose of this substudy was to analyze cancer patients' attitudes toward online health care.

METHODS

This was a substudy of 41 persons with cancer who used the Internet for health care information and support and who completed the Attitudes Toward Online Health Care (ATOHC) survey.

RESULTS

The majority of study participants were married, held graduate degrees, and had high incomes. Using a five-point Likert scale, means for the five dimensions of the ATOHC survey were as follows: community and news 3.22 (SD = 1.01), outcomes 3.20 (SD = 1.08), trusted information and advice 2.73 (SD = 0.66), self-efficacy in evaluating information and intention 3.46 (SD = 0.65), and disclosure 3.15 (SD = 1.06). The average response fell between "About half the time" and "Usually." Favorite websites for content were Medscape and WebMD, while favorite sites for support were WebMD and Mediconsult.

CONCLUSIONS

Respondents were generally eager to obtain and offer cancer information and support online, but they were skeptical of unknown sources. They were comfortable both giving and receiving information and support. Respondents were interested in the experiences of other patients and benefited by their direct and indirect interactions with them. Respondents felt that they coped better with their illness and experienced less uncertainty and anxiety as a result of their online experiences. They reported a certain level of trust, primarily for established reputable sources of information, and they were confident in their ability to evaluate the information, including research reports. In addition, cancer patients displayed a healthy skepticism when presented with the option of divulging their personal health information; however, they were willing to provide personal details if, as a result, a website provided them with individualized information.

Creating a framework for online cancer services research to facilitate timely and interdisciplinary applications

Researchers from a wide array of disciplines have conducted engaging and informative studies in recent years concerning the use of the Internet for cancer-related services. Typically, these publications provide key data related to utilization statistics, how online information can be used, what users want or expect from the Internet, outcomes or impacts, and quality and credibility of websites. These are important themes for understanding online cancer issues. However, this special issue of the Journal of Medical Internet Research seeks to recast these themes in a way that will facilitate pragmatic and applied means of employing data in prescriptive and interdisciplinary ways. This issue includes 14 papers that exemplify applications for the research framework recommended in this paper. This framework includes an expanded focus on the development and design of online cancer services, online consumer behavior/communication, behavior change, and living with cancer.

Use of an interactive web-based questionnaire to evaluate a breast cancer website

OBJECTIVES

Health-related information should be tailored to patients' needs and requirements. Interactive features are required to allow refinement of information and feedback.

METHODS

A voluntary questionnaire was set up at to allow feedback from patients and website visitors.

RESULTS

A total of 1089 questionnaires were completed between Aug 2000 and Oct 2001. 77% (n = 799) had used the Internet previously to look up health-related information. With regard to the reasons visiting the site, 51% (n = 351) women indicated a recent breast problem while 26% (n = 267) had recently been diagnosed with breast cancer. The most popular information types were benign disease (64%), malignant disease (62%) information on the current research field (67%), a discussion group (57%), operation details (53%), online consultations (62%), and the location of local clinics (57%).

CONCLUSIONS

An interactive feedback questionnaire is a useful way to ensure that health-related internet sites are tailored to their users' needs.

An exploratory study of cancer patients' views on doctor-provided and independent written prognostic information

This is the first study to systematically compare cancer patients' views on prognostic information provided by their doctor and written prognostic information obtained from a major cancer organisation (The Cancer Council New South Wales). Twenty-six adult patients who were recruited from a cancer clinic and an oncologist's private rooms completed a questionnaire and an interview. Participants varied in their views about the relative accuracy of doctor-provided and independent written information and responses to contradictory information. Participants' need for certainty, trust in their doctor and concerns about the effect of undermining that trust, appear to influence whether they would discuss independent information with their doctor, and how they would deal with conflicting information. Although preliminary, this study has identified a number of issues that may need to be taken into account both by people developing written prognostic information and by doctors, who may need to address patient concerns about trust to assist patients to deal with conflicting information.

Quality of fertility clinic websites

OBJECTIVE

To evaluate the overall quality of the Society for Assisted Reproductive Technology (SART)-affiliated fertility clinic websites, according to American Medical Association (AMA) Internet health information guidelines.

DESIGN

Cross-sectional evaluation.

SETTING

Two hundred sixty-six websites drawn from the SART directory and the World Wide Web.

INTERVENTION(S)

Three objective scoring scales (ownership, content, and navigation) adapted from AMA guidelines.

MAIN OUTCOME MEASURES

Seven objective criteria for ownership, 8 for content, and 11 for website navigation.

RESULT(S)

Two thirds of SART-affiliated fertility clinics have functional websites. Of the 236 sites evaluated, 58 belong to hospital centers. Overall, the scores for the three scoring scales were low. Compared with the websites of non-hospital clinics, those of hospital centers were more likely to include information about site ownership and affiliations (89.7% vs. 60.7%) and patient privacy (34.5% vs. 20.8%). Also, contents of hospital center websites were significantly easier to distinguish from advertisements (70.7% vs. 47.7%), and reference sources for specific contents were easier to identify (27.6% vs. 8.4%). Hospital center websites were more likely to indicate affiliations and financial disclosures of authors (25.9% vs. 10.7%), to feature a site map (25.9% vs. 12.3%), and to have a search function (31.0% vs. 5.6%).

CONCLUSION(S)

Websites of SART-affiliated clinics fail to meet most of the AMA health information guidelines. The quality of the hospital centers' websites is better than that of private clinics.

Quality and safety issues of web-based information about herbal medicines in the treatment of cancer

A number of studies have been carried out to assess health information on the internet and they all have demonstrated that, whereas the internet can be the third opinion for many patients, often contains inaccurate and misleading information. Furthermore, as herbal medicines are increasingly used by patients, it is imperative to assess the quality of information presented on the internet. Hence, the aim of this study was to assess the quality and safety of the information presented on the internet about medicinal herbs specifically in the field of cancer. Two hundred relevant websites were initially selected from a process using 10 search engines and the keywords 'herbs' and 'cancer', and 43 sites actually met all inclusion criteria. Assessment of both quality and safety indicators was carried out using the DISCERN instrument, which has been developed to enable consumers and information providers to judge the quality of health information. Readability scores of the sites were also obtained (Flesch formula). It was shown that most sites had low quality in a number of indicators, including accuracy of information, revealing sources of information, biased presentation of information or regularity of updates. The mean score for quality was 22.12 (S.D.=4.18) out of a maximum score of 50. The mean safety score was 13.26 (S.D.=2.14) out of a maximum score of 30. Commercial sites had the most inaccurate or misleading information, emphasizing only the positive aspects of the use of herbs, with little or no evidence. The only biomedical sites assessed achieved the highest score in both quality and safety. Readability of the information was equal to the school level of college (mean=44.63). Seven percent of the sites discouraged the use of conventional medicine. Results suggest that health professionals should talk about use of alternative therapies with their patients and help them find the best available information when using the internet.

Women's Approaches to the Use of New Technology for Cancer Risk Information

BACKGROUND

Women are currently offered multiple sources of breast cancer risk information, and the Internet is the most rapidly growing health information source. The objectives of this study were to identify women's preferences for receiving online breast cancer risk information, to identify barriers to accessing this information, and to identify differences in these factors between Internet users and non-users.

METHODS

Eight focus groups were conducted with women aged 18 to 74 (n = 65) living in King County, Washington.

RESULTS

Participants were interested in accessing online health information with the support of a real person to assist with information searches and in accessing personalized information online. Participants emphasized the importance of trust, both in the content provider and in the organization collecting their personal data.

CONCLUSIONS

Web sites should provide personalized information and personal searching assistance. They should also include disclosures of content sources and a privacy policy that details how personal data is handled.

Breast cancer on the Internet: the quality of Swedish breast cancer websites

The aim of this study was to investigate the quality of Swedish-language breast cancer information available on the Internet. The questions explored were the extent and type of breast cancer information available, the coverage and correctness of that information, and whether the websites fulfilled the European Commission quality criteria for health-related websites. Three search engines were used to find websites containing medical information on breast cancer. An oncologist then evaluated the 29 relevant sites. Only seven of these were judged suitable for breast cancer patients. The coverage and correctness of the medical information varied considerably. None of the websites fulfilled the European Commission quality criteria. Therefore, considerable effort will be required before the Internet can serve as a valuable and up-to-date source of information on breast cancer for both professionals and laypersons. Our findings broadly match the results of earlier studies of English-language websites.

What do we mean by Internet access? A framework for health researchers

Much is written about Internet access, Web access, Web site accessibility, and access to online health information. The term access has, however, a variety of meanings to authors in different contexts when applied to the Internet, the Web, and interactive health communication. We have summarized those varied uses and definitions and consolidated them into a framework that defines Internet and Web access issues for health researchers. We group issues into two categories: connectivity and human interface. Our focus is to conceptualize access as a multicomponent issue that can either reduce or enhance the public health utility of electronic communications.

Internet and information on breast cancer: an overview

In the past few years, many Internet breast cancer resources have appeared, including medical journals and clinical trial registries. Examples of online breast cancer journals are the The Breast, The Breast Journal, and the Breast Cancer Research and Treatment. These have replicated the experience of general medical and cancer journals such as the British Medical Journal and the Journal of Clinical Oncology. One of the most important cancer registries is the Physician Data Query, which provides information on the National Cancer Institute's clinical trials, most of which are related to breast cancer. Medical guideline databases, institutional websites, medical associations, and non-profit breast cancer organizations provide users with information including news, calendars of international breast cancer events, clinical guidelines and abstracts presented at cancer and breast cancer meetings. Finding high-quality breast cancer literature and websites is relatively easy using appropriate indexes such as Cancerlit, MedlinePlus, and Cancerlinks.

Improving Web searches: case study of quit-smoking Web sites for teenagers

Background

The Web has become an important and influential source of health information. With the vast number of Web sites on the Internet, users often resort to popular search sites when searching for information. However, little is known about the characteristics of Web sites returned by simple Web searches for information about smoking cessation for teenagers.

Objective

To determine the characteristics of Web sites retrieved by search engines about smoking cessation for teenagers and how information quality correlates with the search ranking.

Methods

The top 30 sites returned by 4 popular search sites in response to the search terms "teen quit smoking" were examined. The information relevance and quality characteristics of these sites were evaluated by 2 raters. Objective site characteristics were obtained using a page-analysis Web site.

Results

Only 14 of the 30 Web sites are of direct relevance to smoking cessation for teenagers. The readability of about two-thirds of the 14 sites is below an eighth-grade school level and they ranked significantly higher (Kendall rank correlation, tau = -0.39, P= .05) in search-site results than sites with readability above or equal to that grade level. Sites that ranked higher were significantly associated with the presence of e-mail address for contact (tau = -0.46, P= .01), annotated hyperlinks to external sites (tau = -0.39, P= .04), and the presence of meta description tag (tau = -0.48, P= .002). The median link density (number of external sites that have a link to that site) of the Web pages was 6 and the maximum was 735. A higher link density was significantly associated with a higher rank (tau = -0.58, P= .02).

Conclusions

Using simple search terms on popular search sites to look for information on smoking cessation for teenagers resulted in less than half of the sites being of direct relevance. To improve search efficiency, users could supplement results obtained from simple Web searches with human-maintained Web directories and learn to refine their searches with more advanced search syntax.

[Do we need a chart of quality for websites related to cosmetic surgery?]

Convergence of medicine and Internet may be one of the most remarkable transformations in the health care business. Following the path led by the United States, the number of French websites related to cosmetic surgery is growing rapidly. In this study, we intend to assess the quality of French websites dedicated to cosmetic surgery regarding good quality criteria currently available and recommendations suggested by the French Medical Association.

MATERIALS AND METHODS

We browsed the main French search engines on the Web that initially answering the following question: how many webpages are available regarding cosmetic surgery and what are the best referenced websites. For each website, we surveyed the following data: author's name and qualification, date of creation and last update, sources of information, level of interactivity, and adherence to a chart of quality such as HON.

RESULTS

Eighty-five websites were surveyed and assessed. Forty-five French websites were active websites dedicated to cosmetic surgery. Websites are mainly hosted by private clinics (18 sites = 40%), with informative content. We found that no website adheres to any chart of quality, and the French Society for Plastic Surgery (SOF.C.P.R.E.) is never mentioned. Intrinsic quality criteria for websites (author's identification, last update, sources of information, confidentiality) are only partially present.

DISCUSSION

We recall the key statistics regarding e-health business in the world, the various charts of quality available for medical websites, and recommendations provided by the French Medical Association. We suggest that websites should be available as a service (for information to the patient, for managing the office, for setting up medical records) rather than a poor personal webpage or a showcase.

CONCLUSION

The quality of websites for cosmetic surgery is poor; however, as in the USA, the number of web surfers on medical sites is growing. Online presence of our speciality should evolve. To improve medical websites, collective awareness is required. We recommend using a specific chart of quality, with recommendations rather than constraints.

Female urinary incontinence health education on the Internet: pitfalls and opportunities

The prevalence and demographics of urinary incontinence (UI) in Canada demand new initiatives to provide both health education and care to the growing number of incontinent women. The Internet, and the Web sites on it, offer an opportunity to provide information on female UI health to patients, health-care professionals, and other caregivers in a time and location convenient to them. Internet usage in Canada is increasing, and women are more likely than men to access Web health information. However, problems such as access to reliable health information do exist, as the quality of Web sites and the information on them varies from excellent to poor. Potential quality control mechanisms include codes of conduct, quality labels, user guides, and filtering systems, but there is uncertainty about which method is best. As the Internet precipitates a shift in care toward prevention of disease, and enhancement of health, a new role for health professionals emerges: to educate patients about and guide them to wise use of the Internet.

Information and communication technology (ICT) in oncology. Patients' and relatives' experiences and suggestions

Cancer patients and relatives worldwide are turning more and more to the internet to obtain health information. The goal of this survey was to clarify their experiences and suggestions on the implementation of information and communication technology (ICT) in oncology. A total of 127 patients and 60 relatives visiting the outpatient clinic at the Department of Oncology, University of North Norway (UNN), the regional office of the Norwegian Cancer Union (NCU) and the Montebello Centre were included in a questionnaire-based study. Participants were recruited during the period September 2001 to February 2002. There were 92 women and 95 men. We revealed that hospital doctors, followed by nurses and friends, were the most important informants. Two-thirds of patients and relatives had access to the internet, but fewer than one-third had searched the internet for medical information and only one-fifth had discussed information accessed with their doctor. Only one-tenth had visited a hospital website. Internet access was correlated with young age. Almost two-thirds suggested that e-mail and/or WAP (wireless application protocol) communication should be included in hospital-patient communication. Concerning hospital websites, waiting time, treatment offer and addresses were considered the top three topics of interest. In conclusion, the majority of cancer patients and relatives have access to the internet. They recommend ICT employed in patient-hospital communication and suggest waiting time, treatment offers and addresses the three most important topics on hospital websites.

Sources of cancer information for seniors: a focus group pilot study report

BACKGROUND

Limited research has been conducted on older adults' sources of cancer information. Seniors require accurate and credible cancer information given that increased age is a major risk factor for most common, adult-onset cancers.

METHODS

To examine older women's sources of cancer information and their views on cancer as portrayed in mass print publications, three pilot focus groups were conducted in Toronto, Canada with community-dwelling senior women aged 50 and over (n = 18).

RESULTS

Results showed that the majority of participants obtained their cancer facts from two primary sources: physicians and the print media, although both sources were perceived to provide inadequate and unclear information. Medical journalists were rated as scientifically untrained members of the media who provided conflicting health information to the public. Cancer information was regarded as credible by participants if it came from authoritative sources including notable journals, government agencies, or health organizations.

CONCLUSIONS

These findings reflect senior women's concerns with cancer research information being disseminated through the media. To facilitate cancer prevention and early detection behaviors, it is important that the media impart accurate and understandable cancer information to our aging population.

Users of Internet health information: differences by health status

BACKGROUND

Millions of consumers have accessed health information online. However, little is known about their health status.

OBJECTIVE

To explore use of Internet health information among those who were sicker (fair/poor general health status) compared with those reported being healthier.

METHODS

A national, random-digit telephone survey by the Pew Internet & American Life Project identified 521 Internet users who go online for health care information. Our primary independent variable was general health status rated as excellent, good, fair, or poor. Patterns of Internet use, and types of information searched were assessed.

RESULTS

Among the 521 users, 64% were female, most (87%) were white, and median age was 42 years. Most individuals indicated that they learned something new online (81%) and indicated that they believe most information on the Internet (52%). Compared with those with excellent/good health, those with fair/poor health (N = 59) were relative newcomers to the Internet but tended to use the Internet more frequently, were more likely to use online chats, were less likely to search for someone other than themselves, and were more likely to talk about the new information with their physician (odds ratio 3.3 [95% confidence interval 1.8-6.3]), after adjustment for age, education and income.

CONCLUSIONS

Health care professionals should be aware that their sicker patients are more likely to ask them about information they found online. Physicians, public health professionals, and eHealth developers should work together to educate patients about searching for health information online and to provide tools for them to navigate to the highest quality information.

Assessing the quality of infertility resources on the World Wide Web: tools to guide clients through the maze of fact and fiction

The Internet has become a major source of health information for women, but information placed on the World Wide Web does not routinely undergo a peer review process before dissemination. In this study, we present an analysis of 197 infertility-related Web sites for quality and accountability, using JAMA's minimal core standards for responsible print. Only 2% of the web sites analyzed met all four recommended standards, and 50.8% failed to report any of the four. Commercial web sites were more likely to fail to meet minimum standards (71.2%) than those with educational (46.8%) or supportive (29.8%) elements. Web sites with educational and informational components were most common (70.6%), followed by commercial sites (52.8%) and sites that offered a forum for infertility support and activism (28.9%). Internet resources available to infertile patients are at best variable. The current state of infertility-related materials on the World Wide Web offers unprecedented opportunities to improve services to a growing number of e-health users. Because of variations in quality of site content, women's health clinicians must assume responsibility for a new role as information monitor. This study provides assessment tools clinicians can apply and share with clients.

Evaluation of Norwegian cancer hospitals web sites and explorative survey among cancer patients on their use of the internet

BACKGROUND

Hospital homepages should provide comprehensive information on the hospital's services, such as departments and treatments available, prices, waiting time, leisure facilities, and other information important for patients and their relatives. Norway, with its population of approximately 4.3 million, ranks among the top countries globally for its ability to absorb and use technology. It is unclear to what degree Norwegian hospitals and patients use the Internet for information about health services.

OBJECTIVES

This study was undertaken to evaluate the quality of the biggest Norwegian cancer hospitals Web sites and to gather some preliminary data on patients use of the Internet.

METHODS

In January 2001, we analyzed Web sites of 5 of the 7 biggest Norwegian hospitals treating cancer patients using a scoring system. The scoring instrument was based on recommendations developed by the Norwegian Central Information Service for Web sites and reflects the scope and depth of service information offered on hospital Web pages. In addition, 31 cancer patients visiting one hospital-based medical oncologist were surveyed about their use of the Internet.

RESULTS

Of the 7 hospitals, 5 had a Web site. The Web sites differed markedly in quality. Types of information included - and number of Web sites that included each type of information - were, for example: search option, 1; interpreter service, 2; date of last update, 2; postal address, phone number, and e-mail service, 3; information in English, 2. None of the Web sites included information on waiting time or prices. Of the 31 patients surveyed, 12 had personal experience using the Internet and 4 had searched for medical information. The Internet users were significantly younger (mean age 47.8 years, range 28.4-66.8 years) than the nonusers (mean age 61.8 years, range 33.1-90.0 years) (P = 0.007).

CONCLUSIONS

The hospitals Web sites offer cancer patients and relatives useful information, but the Web sites were not impressive.

Impact of the media and the internet on oncology: survey of cancer patients and oncologists in Canada

PURPOSE

To evaluate the use of the news media and the Internet as sources of medical information by patients and oncologists in Canada and to investigate the impact on patients' treatment decisions and the patient-doctor relationship.

PATIENTS AND METHODS

During a 2-week period, 191 ambulatory patients participated in the survey. Questionnaires were also mailed to Canadian oncologists: 410 of 686 questionnaires were returned (response rate = 60%).

RESULTS

Of the 191 patients, 86% wanted as much information as possible about their illness, 54% reported receiving insufficient information, 83% cited physicians as their primary information source, and 7% cited the Internet. Seventy-one percent of patients actively searched for information, and 50% used the Internet. Patients' opinions about the balance, accuracy, and relevance of news media reports were evenly split. English as the first language, access to the Internet, and use of alternative treatments predicted a higher rate of information seeking. Most oncologists routinely pay some attention to medical news and believe that it is difficult for patients to interpret medical information in the media and on the Internet accurately. Both patients and oncologists agree that information seeking does not affect the patient-physician relationship.

CONCLUSION

Information searching is common among cancer patients in Canada. It does not affect the patient-doctor relationship. The media and the Internet are powerful means of medical information dissemination. Strategic efforts are needed to improve the quality of medical news reporting by the media, and to provide guidance for patients to understand their disease and interpret such information better.