A multilingual evaluation of current health information on the Internet for the treatments of benign prostatic hyperplasia

Does the urologist keep a central place in the medical information delivered to patients?

INTRODUCTION

Although urologists play an essential role in informing patients, with the ever-increasing use of modern media, a wealth of information sources is now available. The aim of this study was to identify the different sources of information available to urology patients, assess the scale of use of the internet and social networks in this group, and establish the profile of patients for whom a high level of information is crucial.

MATERIALS

A questionnaire was given to 500 patients consulting the urology department of a university hospital.

RESULTS

Out of the 500 questionnaires, 372 were analysable; the average age of respondents was 62.9years; 73% were men; 66.9% said they used the internet; 57% had received an explanatory document such as an French Urology Association information leaflet, 32.5% had received information from the paramedical team, 28.2% from their regular doctor, 28.2% from health-related websites and 5.9% from the website developed by the French Urology Association. Although 80.3% of patients thought that information received from the urologist was satisfactory, 53.2% of patients would like to receive more information. We did not identify any factors allowing us to determine the typical profile of patients seeking more information.

CONCLUSION

Urologists seem to retain their central role in informing patients, but almost half of patients were still seeking additional information after their urology consultation. The increasing use of the internet should encourage urologists to use these new media resources to optimise the information supplied to patients.

LEVEL OF EVIDENCE: 4

Online urological educational material for medical students: can search engines be trusted?

OBJECTIVES

To determine the credibility of online urological information that medical students are likely to encounter, determine possible discrepancies between the credibility of information pertaining to different areas within urology (especially those less relevant to patients), and assess trends in the sponsorship of online urological educational material.

MATERIALS AND METHODS

Health on the Net (HON) principles were used as a validated benchmark to assess the reliability of websites that appeared in the first 150 results of a search using the Google search engine. A variety of urological search terms were used, grouped into three broad categories with varying relevance to patients and medical students. Further analysis focussed on the sponsorship of assessed websites.

RESULTS

A total of 5400 websites were assessed for validation over a set of 36 search terms. Only 843/5400 (15.6%) of these were HONcode accredited, indicating a large proportion of unverified and potentially unreliable information. Search engine rankings usually favoured accredited websites (P = 0.009), and accreditation peaked at 51.1% (184/360) in the first page of results, but sorting became weaker outside the highest search results. The percentage of accredited websites varied significantly between different subcategories of search terms such as conditions (18.3% [329/1800], P = 0.003) and procedures (13.5% [243/1800], P = 0.043). Governmental/educational and commercial sources supported the majority of websites assessed for sponsorship (21% [31/150] and 33% [49/150], respectively), and the former were more likely to rank highly in search results.

CONCLUSION

Online urological information frequently lacks validation and is often of indeterminate credibility. There is a marked decrease in the proportion of accredited websites beyond the highest-ranked results and when considering search categories more relevant to students and less relevant to patients. Students cannot necessarily rely on free online sources for accurate information and could benefit from the development of more rigorous novel tools and platforms.

Assessing the Accuracy, Quality, and Readability of Information Related to the Surgical Management of Benign Prostatic Hyperplasia

Objectives: To assess the accuracy, quality, and readability of online educational health information in English related to the most common benign prostatic hyperplasia (BPH) guideline-approved surgical treatments. Methods: The terms "benign prostatic hyperplasia," "BPH," and all eight guideline-approved treatment modalities studied, were searched to retrieve the first five relevant websites and first two paid advertised websites related to the surgical treatment options for BPH. These modalities included transurethral resection of the prostate (TURP), GreenLight photovaporization, endoscopic enucleation of the prostate, Rezum, Urolift, Aquablation, open simple prostatectomy, and robotic simple prostatectomy (RSP). All relevant websites were assessed for their accuracy, quality, and readability using standardized scoring systems. Results: The mean accuracy score for each of the treatment modalities were all indicative of good accuracy, with 76%-99% of the information presented as being accurate. The median quality score was statistically different across the eight treatment modalities (p = 0.015). The median readability grade level was statistically different across the eight treatment modalities (p = 0.009). Websites that described TURP (median readability grade level, 9.00 [interquartile range (IQR) 8.00-10.80]) were significantly easier to read than those related to RSP (median readability grade level, 14.35 [IQR, 11.08-16.50]) (p = 0.011). No other statistically significant differences were found within the other treatment modality websites. Conclusions: The majority of websites retrieved were found to be of high accuracy, good quality, and poor readability. Additionally, it was found that none of the retrieved websites included descriptions for all the other included treatment modalities. Given these findings, the authors recommend the development of centralized resources with all guideline-approved treatment modalities and accurate, readable, and high-quality information related to the surgical treatment of BPH.

Evaluation of the quality of information available on the internet on vaginal meshes

OBJECTIVE

The objective of this study was to evaluate the quality of information on the internet about vaginal meshes available to the general population.

STUDY DESIGN

The terms "vaginal sling," "sling vagina," "vaginal mesh," "mesh vagina," "vaginal tape," and "tape vagina" were used every time on three major search engines, and the first 10 websites retrieved by each search engine were selected and evaluated using the DISCERN questionnaire. The websites were divided into four categories based on the type of agency that created the website. These included websites created by private health institutions, non-private health institutions, and non-health institutions and websites for encyclopedias, libraries, articles and scientific papers. They were compared in terms of the reliability, information quality, and total DISCERN score.

RESULTS

The survey yielded 98 different websites; after applying the exclusion criteria, 62 sites were selected. Websites for articles, magazines, libraries, and encyclopedias and those by non-private health services had significantly high scores for the reliability dimension of the DISCERN tool as compared to the other two website categories (p < 0.05). Regarding the quality of information, websites for non-specific health services and those for articles, magazines, libraries, and encyclopedias presented significantly lower scores as compared to the other two website categories. Websites for non-specific health services had significantly lower average total DISCERN points when compared to other website categories. The websites for private health services and those for articles, magazines, libraries, and encyclopedias had significantly lower DISCERN scores than the websites for non-private health services did.

CONCLUSION

Our findings showed that the quality of information regarding vaginal meshes on the first 10 websites on major search engines was moderate.

Adverse Effects of Radiotherapy and Chemotherapy for Common Malignancies: What Is the Quality of Information Patients Are Finding Online?

Little is known about the availability of high-quality online health information (OHI) for adverse effects (AEs) of radiotherapy (RT) and chemotherapy (CHT). Optimal search strategies for gaining access to high-quality OHI for these topics are not well-established. This study explores the quality of, potential disparities in, and possible search strategies for OHI pertaining to AEs of RT and CHT. One hundred twenty phrases on generalized and malignancy site-specific AEs of RT and CHT were searched on Google. The Health on the Net Foundation (HONcode) framework was applied to assess the quality of the first 100 websites for each search phrase. Comparisons of the availability of high-quality OHI were made between different languages, malignancy sites, and treatment modalities (RT vs CHT). Of the 12,000 RT and CHT AE websites analyzed, approximately half of the first 10 websites returned for each search were HONcode-accredited; approximately a fifth of the first 100 websites returned were HONcode-accredited. Such low availability of high-quality OHI persisted throughout different languages (English, French, Spanish) and common malignancy sites (breast, prostate, lung), with some variations between languages, malignancy sites, and RT vs CHT. Despite the important role of OHI in cancer patients' approach to health information gathering and decision-making, the availability of high-quality OHI for the AEs of common oncologic treatments, RT and CHT, is low across different languages and common malignancy sites. Our findings demonstrate the need for improvement in the availability of high-quality OHI. Therefore, providers should take an active stance in directing patients to high-quality OHI.

Radiation Oncology Online: Quality, Strategies, and Disparities

Although much is known about the quality of online health information (OHI) for many malignancies, the availability of high-quality OHI for oncologic treatments remains undefined. Furthermore, search strategies that improve quality of radiation oncology OHI, and disparities in availability of high-quality OHI, are not well-described. Forty phrases describing malignancies and their treatment modalities (radiation, chemotherapy, and surgery), and 57 phrases describing radiation oncology treatments, including abbreviations for some treatments and translations in different languages, were generated. The Health on the Net Foundation framework for assessing OHI quality was applied to the top 100 websites listed for each search phrase. The availability of high-quality OHI between malignancies and treatment modalities, and among treatment modalities, was compared. The roles of radiation oncology term abbreviation, search result order, patient gender, and language, on availability of high-quality OHI, were also assessed. Among the first 10, 20, and 50 websites for each search phrase, there were significantly more high-quality websites for phrases describing malignancies compared with respective treatment modalities (P < 0.02 for all). There were no differences among treatment modalities. Among radiation oncology treatment phrases, there were no significant differences between searches for full-name phrases and their respective abbreviations, though earlier results were more likely to be of high quality. Gender did not affect quality of OHI, though language did. Availability of high-quality OHI for cancer treatments lags behind that of cancer OHI. For radiation oncology treatment OHI, search strategies and patient disparities highlight potential areas for provider intervention and increased quality of OHI.

Arthroplasty information on the internet: quality or quantity?

AIMS

Total joint replacement (TJR) is a high-cost, high-volume procedure that impacts patients' quality of life. Informed decisions are important for patients facing TJR. The quality of information provided by websites regarding TJR is highly variable. We aimed to measure the quality of TJR information online.

METHODS

We identified 10,800 websites using 18 TJR-related keywords (conditions and procedures) across the Australian, French, German and Spanish Google search engines. We used the Health on the Net (HON) toolbar to evaluate the first 150 websites downloaded for every keyword in each language. The quality of information on websites was inspected, accounting for differences by language and tertiles. We also undertook an analysis of English websites to explore types of website providers.

RESULTS

'Total joint replacement' had the most results returned (150 million websites), and 9% of websites are HON-accredited. Differences in information quality were seen across search terms (p < 0.001) and tertiles (p < 0.001), but not between languages (p = 0.226). A larger proportion of HON-accredited websites were seen from keywords in the condition and arthroplasty categories. The first tertile contained the highest number of HON-accredited websites for the majority of search terms. Government/educational bodies sponsored the majority of websites.

CONCLUSION

Clinicians must consider the shortage of websites providing validated information, with disparities in both number and quality of websites for TJR conditions and procedures. As such, the challenge for clinicians is to lead the design of reliable, accurate and ethical orthopaedic websites online and direct patients to them. This stands to reward both parties greatly.

Disparity in online health information in pediatric vs. adult surgical conditions

BACKGROUND

Although the quality of online health information (OHI) for adult surgical conditions is well described, the availability of quality OHI for pediatric surgical conditions, and the comparison to that of adult surgical OHI, remains undefined.

METHODS

Medical and lay terms for 15 pediatric and 15 adult surgical conditions were searched using Google in English. The Health on the Net Foundation, a non-governmental OHI accreditation body, designates approval for quality websites. We compared the role of patient population while controlling for disease incidence (pediatric vs. adult), term complexity (medical vs. lay), and order (earlier vs. later listing of websites) on availability of quality OHI among the first 100 websites for each term.

RESULTS

Among the first 100 websites, the adjusted mean number of quality websites was 11.80 for pediatric vs. 17.92 for adult medical search terms, and 13.27 for pediatric vs. 18.20 for adult lay search terms (P < 0.05 for all). Term complexity did not affect quality, and earlier appearing results were more likely to be of high quality.

CONCLUSION

Availability of quality pediatric surgical OHI lags behind that of adult surgical OHI, even when controlling for disease incidence. These findings highlight the potential need for increased quality OHI in pediatric surgery.

Development of a Smartphone App for Informal Carers of People With Cancer: Processes and Learnings

Background

There are few support systems available to informal carers who provide care to cancer patients. Smartphone apps have the capacity to reach large audiences and can provide information and support at a time convenient to carers.

Objective

The aim of this study was to design a smartphone app prototype for carers of adults with cancer.

Methods

A multiple-method design was used to develop a smartphone app. Current and past carers of people with any type of cancer were recruited from a public hospital, a private hospital, and a carer organization, who participated in either a focus group or phone interview. Carers answered questions about items to include in an app to address supportive care needs identified. Using carers’ feedback, a smartphone app was designed and tested.

Beta testing was conducted using a convenience sample of participants who completed scenarios to inform the app’s design, functionality, and usability. Scenarios were timed and marked as complete or incomplete. Participants completed a questionnaire about the usability of the app. Beta testing occurred in 2 stages—a paper-based version of the app and an app-based test using the participants’ preferred device. Alpha testing was completed internally to ensure the functionality of the app. Data were collected between May 2016 and August 2017.

Results

A total of 33 carers participated in phone interviews and 12 in focus groups; their average age was 55 (SD 14) years, and 60% (27/45) were female. The majority of carers (76%, 25/33) had a positive attitude toward using smartphone apps. Carers noted that smartphone technology might improve their ability to seek information and support in managing their own health as well as the care needs of the person with cancer. Carers requested a variety of information and resources to be included in the app. Paper-based testing included the following: participants (N=10) were aged above 30 years (30%, 3/10), 30 to 49 years (30%, 3/10), and 50 years or above (40%, 4/10), and 60% (6/10) were male. Participants found the app user-friendly and pleasing in appearance.

App-based testing included the following: participants (N=10) were aged above 30 years (20%, 2/10), 30 to 49 years (30%, 3/10), and 50 years or above (50%, 5/10), and 50% (5/10) were male. Participants reported the app to be user-friendly and easy to navigate. The majority (60%, 6/10) of participants were unable to create a shortcut icon to add the app to the home screen of their phone.

Conclusions

Carers highlighted the needed information and support to assist them during the caring period; they also reported having a positive attitude toward smartphone apps. The Carer Guide App is currently undergoing a pilot study to further test usability among carers of people with 1 cancer type.

Quality of Health Information on the Internet for Prostate Cancer

Introduction

To compare (1) the quality of prostate cancer health information on the Internet, (2) the difference in quality between websites appearing earlier or later in the search, and (3) the sources of sponsorship for each of these websites.

Materials and methods

The top 150 listed websites on the Google search engine for each of the 11 search terms related to prostate cancer were analysed. Quality was assessed on whether the website conforms to the principles of the Health On the Net Foundation. Each of these websites was then reviewed to determine the main source of sponsorship. Statistical analysis was performed to determine if the proportion of HON accreditation varied among the different cohorts of listed websites and among the 11 search terms used.

Results

In total, 1650 websites were analysed. Among these, 10.5% websites were HON-accredited. The proportion of HON-accredited websites for individual search terms ranged from 3.3% to 19.3%. In comparison with the search term of "Prostate cancer," four search terms had statistically significant odds ratio of the rate of HON accreditation. Websites 51-150 were statistically less likely to have HON accreditation than websites 1-50. The top three website sponsors were journal/universities (28.8%), commercial (28.1%), and physician/surgeon (26.9%).

Conclusions

The lack of validated and unbiased websites for prostate cancer is concerning especially with increasing use of the Internet for health information. Websites sponsored or managed by the government and national departments were most likely to provide impartial health information for prostate cancer. We need to help our patients identify valid and unbiased online health resources.

International assessment on quality and content of internet information on osteoarthritis

OBJECTIVE

Osteoarthritis is one of the leading causes of global disability. Numerous studies have assessed the quality and content of online health information; however, how information content varies between multiple countries remains unknown. The primary objective of this study was to examine how the quality and content of online health information on osteoarthritis compares on an international scale.

METHODS

Internet searches for the equivalent of "knee osteoarthritis treatment" were performed in ten countries around the world. For each country, the first ten websites were evaluated using a custom scoring form examining: website type; quality and reliability using the DISCERN and Health-on-the-Net (HON) frameworks; and treatment content based on three international osteoarthritis treatment guidelines. Consistency of search results between countries speaking the same language was also assessed.

RESULTS

Significant differences in all scoring metrics existed between countries speaking different languages. Western countries scored higher than more eastern countries, there were no differences between the United States and Mexico in any of the scoring metrics, and HON certified websites were of higher quality and reliability. Searches in different countries speaking the same language had at least 70% overlap.

CONCLUSIONS

The quality of online health information on knee osteoarthritis varies significantly between countries speaking different languages. Differential access to quality, accurate, and safe health information online may represent a novel but important health inequality. Future efforts are needed to translate online health resources into additional languages. In the interim, patients may seek websites that display the HON seal.

Thoracic Surgery Information on the Internet: A Multilingual Quality Assessment

BACKGROUND

Previous data suggest that quality of Internet information regarding surgical conditions and their treatments is variable. However, no comprehensive analysis of website quality exists for thoracic surgery.

OBJECTIVE

The aim of this study was to quantify website quality in a multilingual setting using an international standard for assessment.

METHODS

Health On the Net (HON) principles may be applied to websites using an automated toolbar function. We used the English, French, Spanish, and German Google search engines to identify 12,000 websites using keywords related to thoracic conditions and procedures. The first 150 websites returned by each keyword in each language were examined. We compared website quality to assess for tertile (is the quality better in first, second, or third 50 websites returned) and language differences. A further analysis of the English site types was undertaken performing a comparative analysis of website provider types.

RESULTS

Overall, there are a considerable number of websites devoted to thoracic surgery: "lung cancer" returned over 150 million websites. About 7.85% (940/11,967) of websites are HON-accredited with differences by search term (P<.001) and tertiles (P<.001) of the first 150 websites, but not between languages. Oncological keywords regarding conditions and procedures were found to return a higher percentage of HON-accreditation. The percentage of HON-accredited sites was similar across all four languages (P=.77). In general, the first tertile contained a higher percentage of HON-accredited sites for every keyword.

CONCLUSIONS

Clinicians should appreciate the lack of validation of the majority of thoracic websites, with discrepancies in quality and number of websites across conditions and procedures. These differences appear similar regardless of language. An opportunity exists for clinicians to participate in the development of informative, ethical, and reliable health websites on the Internet and direct patients to them.

Health on the Net: Do Website Searches Return Reliable Health Information on Hemorrhoids and Their Treatment?

Objective:

To analyze the quality of health information on the Internet on hemorrhoids across 5 Western languages and perform a comparative analysis of website sponsors.

Summary of background data:

Hemorrhoids are a common condition affecting the hemorrhoid cushions of the anal canal. Many treatment options are available. Information on the Internet on hemorrhoids is considered variable, but there is little data analysis to support this. The World Health Organization's Health On the Net (HON) accredits medical and health websites based on a code of conduct and publishes a toolbar that aids identification of such accredited websites.

Methods:

Using the Google search engine (http://www.google.com, Google, Mountain View, California), searches were performed using 11 keywords related to hemorrhoids in English, French, German, Italian, and Spanish. Health On the Net accreditation was determined to assess quality website information. The first 150 websites in each language had their adherence to the HON principles analyzed, and English websites were analyzed to determine sponsorship source.

Results:

Of the 8250 websites analysed, 586 (7.1%) were found to HON-accredited. The rate of HON accreditation ranged from 2.0% (piles) to 10.0% (hemorrhoids), with higher-ranking results having higher rates of HON accreditation (P &lt; 0.001).

Conclusion:

There is a paucity of high-quality information on the Internet; however, the Google search algorithm prioritizes high-quality information in its web search results.

How Readable Is BPH Treatment Information on the Internet? Assessing Barriers to Literacy in Prostate Health

Information about benign prostatic hyperplasia (BPH) has become increasingly accessible on the Internet. Though the ability to find such material is encouraging, its readability and impact on informing patient decision making are not known. To evaluate the readability of Internet-based information about BPH in the context of website ownership and Health on the Net certification, three search engines were queried daily for 1 month with BPH-related keywords. Website ownership data and Health on the Net certification status were verified. Three readability analyses were performed: SMOG test, Dale-Chall readability formula, and Fry readability graph. An adjusted SMOG calculation was performed to reduce overestimation from medical jargon. After a total of 270 searches, 52 websites met inclusion criteria. Mean SMOG grade was 10.6 ( SD = 1.4) and 10.2 after adjustment. Mean Dale-Chall score was 9.1 ( SD = 0.6), or Grades 13 to 15. Mean Fry graph coordinates (173 syllables, 5.1 sentences) corresponded to Grade 15. Seven sites (13%) were at or below the average adult reading level based on SMOG; none of the sites qualified based on the other tests. Readability was significantly poorer for academic versus commercial sites and for Health on the Net-certified versus noncertified sites. In conclusion, online information about BPH treatment markedly exceeds the reading comprehension of most U.S. adults. Websites maintained by academic institutions and certified by the Health on the Net standard have more difficult readability. Efforts to improve literacy with respect to urological health should target content readability independent of reliability.

Transurethral enucleation of prostate with button electrode plasmakinetic vaporization for the treatment of Benign Prostatic Hyperplasia

Benign prostatic hyperplasia (BPH) is a common disease in aged men. In this study, we investigated the efficacy and safety of transurethral enucleation of prostate with button electrode plasmakinetic vaporization for the treatment of BPH. 60 patients diagnosed with BPH who were treated in our hospital from August to December, 2014 by enucleation with button electrode were retrospectively reviewed, and operation time, urinary catheter indwelling time, continuous bladder irrigation time, operation related complications, maximum urinary flow rate (Q_max), post-void residual urine volume (PVR), International Prostate Symptom Score (IPSS), quality of life assessment (QOL), perioperative hemoglobin and electrolytes were recorded. All the operations were completed successfully. The operation time and urinary catheter indwelling time were 45.3 ± 16.2 min and 1.72 ± 0.32 d, respectively. During the follow-up, urethral stricture (n = 1), and urinary incontinence (n = 2) were found with recovery after 1-month training. Postoperative PVR at 1, 3 and 6 months significantly decreased compared with preoperative ones (P < 0.05). IPSS, Q_max, QOL at 1, 3 and 6 months improved significantly (P < 0.05). There was no significant difference in serum hemoglobin, sodium and potassium before and after the operation. Thus, the study proved that enucleation of prostate with button electrode was efficient and safe, which was worth being recommended.

Quality of Health Information on the Internet for Urolithiasis on the Google Search Engine

Purpose. To compare the quality of health information on the Internet for keywords related to urolithiasis, to assess for difference in information quality across four main Western languages, and to compare the source of sponsorship in these websites. Methods. Health On the Net (HON) Foundation principles were utilised to determine quality information. Fifteen keywords related to urolithiasis were searched on the Google search engine. The first 150 websites were assessed against the HON principles and the source of sponsorship determined. Results. A total of 8986 websites were analysed. A proportion of HON-accredited websites for individual search terms range between 2.5% and 12.0%. The first 50 websites were more likely to be HON-positive compared to websites 51–100 and 101–150. French websites searched were more likely to be HON-positive whereas German websites were less likely to be HON-positive than English websites. There was no statistically significant difference between the rate of HON-positive English and Spanish websites. The three main website sponsors were from government/educational sources (40.2%), followed by commercial (29.9%) and physician/surgeon sources (18.6%). Conclusions. Health information on most urolithiasis websites was not validated. Nearly one-third of websites in this study have commercial sponsorship. Doctors should recognise the need for more reliable health websites for their patients.

Female urinary incontinence health information quality on the Internet: a multilingual evaluation

INTRODUCTION AND HYPOTHESIS

The quality of Internet information on female urinary incontinence is considered variable. No comprehensive analysis exists to support this. We compared the quality of current Internet information for common layperson terminology on female urinary incontinence across four Western languages and a comparative analysis of website sponsors.

METHODS

World Health Organization Health on the Net (HON) principles may be applied to websites using an automated toolbar function. We used the Google search engine; 10,200 websites were identified using keywords related to female urinary incontinence and treatments in English, French, German and Spanish. The first 150 websites in each language had HON principles examined, whilst a further analysis of site sponsorship was undertaken.

RESULTS

The total number of websites for each term is variable. "Female sling surgery" had the most websites with approximately 18 million, whereas "colposuspension" had the least with only 159,890 websites. Regardless of language, very few female urinary incontinence websites were HON accredited (p < 0.0001). Linguistically, French (18%) and English (16%) had the greatest percentage of HON-accredited sites. Tertiles (thirds) of the first 150 websites returned the higher percentage of HON-accredited websites (p < 0.0001). Websites were largely sponsored by physicians/surgeons.

CONCLUSIONS

The lack of validation of most female urinary incontinence websites should be appreciated by clinicians. Additionally, discrepancies exist in the quality and number of websites across conditions, languages and also between medical and alternative terms. Clinicians should participate in and encourage the development of informative, ethical and reliable health websites on the Internet and direct patients to them.