Efficacy of natural health products in treating osteoporosis: what is the quality of internet patient advice?

Quality appraisal of educational websites about osteoporosis and bone health

PURPOSE/INTRODUCTION

Bone health education publicly available through the Internet, if evidence-based and unbiased, could help patients deal with issues such as decision-making, maintaining healthy lifestyles, using medications correctly, and improving their communication with health professionals.

METHODS

We performed an environmental scan and quality assessment of the currently available osteoporosis and bone health patient education information on the World Wide Web. The sample websites were identified by using three separate search tools: Google Advanced, Bing, and Ask.com . Two independent investigators collected data and appraised the quality of selected websites.

RESULTS

We identified 48 websites. Most websites were focused on risks factors of osteoporosis, preventive measures, screening recommendations, and topics to discuss with the physician. All websites provided adequate information describing treatment options; however, only 36% had information addressing duration of treatment, what happens when treatment stops, and the benefits and risks of various treatments. A total of 55% of the websites had their content updated to 2019 and 68% cited their sources of information to support their content. Reading levels ranged from 7.5 to 15.2 (higher than the recommended 6-grade level).

CONCLUSIONS

Websites with information about bone health and osteoporosis commonly present information about initial treatment choices, but most fail to address risk-benefit issues, and common barriers than can occur throughout the course of the disease. In addition, many websites did not update their content, did not cite their sources of information, or were written at a 9-grade level or above (rendering them unsuitable for low-literacy populations).

Evaluating the Quality and Reliability of Online Information on Social Fertility Preservation

OBJECTIVE

With the rising trend of postponing motherhood, there has been an increasing rate of infertility. Social fertility preservation offers the potential to overcome this age-related infertility, and many women are turning to the Internet to seek medical information. The aim of this study was to evaluate online information on social fertility preservation.

METHODS

This study used five search terms-"egg freezing," "fertility preservation," "social egg freezing," "social fertility preservation," and "oocyte cryopreservation"-to identify the most popular sites as rated by Google. Accuracy of information and quality of websites were rated on the basis of four categories: Silberg's accountability criteria, Abbott's aesthetic criteria, Flesch-Kincaid readability score, and the Canadian Fertility and Andrology Society (CFAS) and the Society of Obstetricians and Gynaecologists of Canada (SOGC) recommendations (Canadian Task Force classification III).

RESULTS

Study investigators identified the 21 most used websites. The average Silberg score was 6.57, with 85.7% of websites meeting the criteria for adequate accountability. Only one website (4.8%) did not meet the criteria for appropriate aesthetic appeal. The average Flesch-Kincaid readability score was 11.39, equivalent to a grade 11 reading level, which is significantly higher than the reading level of the general population. A total of 57% of websites contained less than half of the evidence-based recommendations provided in CFAS and SOGC recommendations.

CONCLUSION

Online information on social fertility preservation is easily accessible and aesthetically pleasing, but information is not easily readable and does not reflect evidence-based recommendations. Hence, health care professionals must fill the knowledge gaps and adequately counsel their patients to optimize a woman's chance at a successful pregnancy.

The variation in quality and content of patient-focused health information on the Internet for otitis media

BACKGROUND

When symptoms of otitis media appear, parents and patients often access the Internet for health information. We study the content and quality of health information in parent-patient-focused websites for otitis media.

METHODS

We searched the 3 search engines (Google, Yahoo, and Bing) using "otitis media" and "middle ear infection" then reviewed the top 30 hits for each search. We included sites that were focused on providing patient-patient information about otitis media. A variety of instruments were used to assess website content and quality.

RESULTS

In 35 included websites, there was considerable variation in content, with the average site having 11 out of 15 informational items potentially useful to parents and patients on otitis media (range 4-15). Across included websites, the mean DISCERN score was 47 out of 80 (low to medium quality), 16 (46%) were HONcode certified, and 8 (23%) fulfilled all the JAMA benchmark criteria. The average website was written at a 9th/10th-grade reading level.

CONCLUSION

The content and quality of health information for otitis media in parent-and-patient-focused websites is highly variable. Although easy-to-read, high-quality websites with complete content are available, the average website sites is difficult to read without a high school education and is difficult to use. Consideration should be given to adopting a standard approach for presenting disease-specific information to parents and patients.

Identifying Complementary and Alternative Medicine Usage Information from Internet Resources. A Systematic Review

OBJECTIVES

Identify and highlight research issues and methods used in studying Complementary and Alternative Medicine (CAM) information needs, access, and exchange over the Internet.

METHODS

A literature search was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines from PubMed to identify articles that have studied Internet use in the CAM context. Additional searches were conducted at Nature.com and Google Scholar.

RESULTS

The Internet provides a major medium for attaining CAM information and can also serve as an avenue for conducting CAM related surveys. Based on the literature analyzed in this review, there seems to be significant interest in developing methodologies for identifying CAM treatments, including the analysis of search query data and social media platform discussions. Several studies have also underscored the challenges in developing approaches for identifying the reliability of CAM-related information on the Internet, which may not be supported with reliable sources. The overall findings of this review suggest that there are opportunities for developing approaches for making available accurate information and developing ways to restrict the spread and sale of potentially harmful CAM products and information.

CONCLUSIONS

Advances in Internet research are yet to be used in context of understanding CAM prevalence and perspectives. Such approaches may provide valuable insights into the current trends and needs in context of CAM use and spread.

Assessment and revision of clinical pharmacy practice internet web sites

BACKGROUND

Health care professionals, trainees, and patients use the Internet extensively. Editable Web sites may contain inaccurate, incomplete, and/or outdated information that may mislead the public's perception of the topic.

OBJECTIVE

To evaluate the editable, online descriptions of clinical pharmacy and pharmacist and attempt to improve their accuracy.

METHODS

The authors identified key areas within clinical pharmacy to evaluate for accuracy and appropriateness on the Internet. Current descriptions that were reviewed on public domain Web sites included: (1) clinical pharmacy and the clinical pharmacist, (2) pharmacy education, (3) clinical pharmacy and development and provision for reimbursement, (4) clinical pharmacists and advanced specialty certifications/training opportunities, (5) pharmacists and advocacy, and (6) clinical pharmacists and interdisciplinary/interprofessional content. The authors assessed each content area to determine accuracy and prioritized the need for updating, when applicable, to achieve consistency in descriptions and relevancy. The authors found that Wikipedia, a public domain that allows users to update, was consistently the most common Web site produced in search results.

RESULTS

The authors' evaluation resulted in the creation or revision of 14 Wikipedia Web pages. However, rejection of 3 proposed newly created Web pages affected the authors' ability to address identified content areas with deficiencies and/or inaccuracies.

CONCLUSIONS

Through assessing and updating editable Web sites, the authors strengthened the online representation of clinical pharmacy in a clear, cohesive, and accurate manner. However, ongoing assessments of the Internet are continually needed to ensure accuracy and appropriateness.

How evidence-based is the information on the internet about nausea and vomiting of pregnancy?

BACKGROUND

The Internet has become an important source of information about pregnancy and about health related concerns in general. This study assessed the quality of information available on the Internet for the common problem of nausea and vomiting of pregnancy (NVP).

METHOD

We used three search terms, "nausea and vomiting in pregnancy," "morning sickness," and "hyperemesis gravidarum," to identify the most popular sites as rated by Google. With modifications of previously described tools, the quality of the websites was rated in three categories: accountability using the Silberg criteria, presentation using a modified Abbott's score, and readability using the Flesch-Kincaid grade level score. Subsequently the information on the websites was compared with the SOGC guideline on management of NVP.

RESULTS

We identified 24 unique websites as most popular. The overall scores for accountability indicated poor quality, with only 25% of the websites meeting the required criteria and less than one half of the sites indicating authorship and credentials. Esthetic appeal criteria were met in over 75% of the websites. The readability score of the websites was significantly above the score recommended for the general population, with an average Flesch-Kincaid Grade level score of 10.7 (max = 12). Eighty-seven percent of the websites contained accurate, evidence-based recommendations according to the information provided in the SOGC clinical practice guideline on management of NVP.

CONCLUSION

Overall, the majority of information available online is accurate; however, the web pages demonstrated poor accountability and targeted an audience with a higher reading ability than the general population. Consideration of these findings would help create easy to navigate, credible web pages containing information to help women make informed decisions during pregnancy.

Comparing the use of an online expert health network against common information sources to answer health questions

Background

Many workers have questions about occupational safety and health (OSH). It is unknown whether workers are able to find correct, evidence-based answers to OSH questions when they use common information sources, such as websites, or whether they would benefit from using an easily accessible, free-of-charge online network of OSH experts providing advice.

Objective

To assess the rate of correct, evidence-based answers to OSH questions in a group of workers who used an online network of OSH experts (intervention group) compared with a group of workers who used common information sources (control group).

Methods

In a quasi-experimental study, workers in the intervention and control groups were randomly offered 2 questions from a pool of 16 standardized OSH questions. Both questions were sent by mail to all participants, who had 3 weeks to answer them. The intervention group was instructed to use only the online network ArboAntwoord, a network of about 80 OSH experts, to solve the questions. The control group was instructed that they could use all information sources available to them. To assess answer correctness as the main study outcome, 16 standardized correct model answers were constructed with the help of reviewers who performed literature searches. Subsequently, the answers provided by all participants in the intervention (n = 94 answers) and control groups (n = 124 answers) were blinded and compared with the correct model answers on the degree of correctness.

Results

Of the 94 answers given by participants in the intervention group, 58 were correct (62%), compared with 24 of the 124 answers (19%) in the control group, who mainly used informational websites found via Google. The difference between the 2 groups was significant (rate difference = 43%, 95% confidence interval [CI] 30%–54%). Additional analysis showed that the rate of correct main conclusions of the answers was 85 of 94 answers (90%) in the intervention group and 75 of 124 answers (61%) in the control group (rate difference = 29%, 95% CI 19%–40%). Remarkably, we could not identify differences between workers who provided correct answers and workers who did not on how they experienced the credibility, completeness, and applicability of the information found (P > .05).

Conclusions

Workers are often unable to find correct answers to OSH questions when using common information sources, generally informational websites. Because workers frequently misjudge the quality of the information they find, other strategies are required to assist workers in finding correct answers. Expert advice provided through an online expert network can be effective for this purpose. As many people experience difficulties in finding correct answers to their health questions, expert networks may be an attractive new source of information for health fields in general.

Quality of Internet information related to the Mediterranean diet

Objective

The present study aimed to evaluate the quality of Internet information on the Mediterranean diet and to determine the relationship between the quality of information and the website source.

Design

Website sources were categorized as institutional, pharmaceutical, non-pharmaceutical commercial, charitable, support and alternative medicine. Content quality was evaluated using the DISCERN rating instrument, the Health On the Net Foundation's (HON) code principles, andJournal of the American Medical Association(JAMA) benchmarks. Readability was graded by the Flesch Reading Ease score and Flesch–Kincaid Grade Level score.

Setting

The phrase ‘Mediterranean diet’ was entered as a search term into the six most commonly used English-language search engines.

Subjects

The first thirty websites forthcoming by each engine were examined.

Results

Of the 180 websites identified, thirty-two met our inclusion criteria. Distribution of the website sources was: institutional,n8 (25 %); non-pharmaceutical commercial,n12 (38 %); and support,n12 (38 %). As evaluated by the DISCERN, thirty-one of the thirty-two websites were rated as fair to very poor. Non-pharmaceutical commercial sites scored significantly lower than institutional and support sites (P= 0·002). The mean Flesch Reading Ease score and mean Flesch–Kincaid Grade Level were 55·9 (fairly difficult) and 7·2, respectively. The Flesch–Kincaid Grade Level score determines the difficulty of material by measuring the length of words and sentences and converting the results into a grade level ranging from 0 to 12 (US grade level).

Conclusions

Due to the poor quality of website information on the Mediterranean diet, patients or consumers who are interested in the Mediterranean diet should get advice from physicians or dietitians.

The International Collaboration on Complementary Therapy Resources (ICCR): working together to improve online CAM information

BACKGROUND

Use of the Internet to find health information is increasing dramatically but the quality of information, particularly on complementary and alternative medicine (CAM) is variable. The International Collaboration on Complementary Therapy Resources (ICCR) involves collaboration between the national CAM information centers in Australia, Denmark, Norway, the United Kingdom, and the United States, and a CAM information service in Germany.

OBJECTIVES

The study objectives were to compare the services and areas of expertise offered by each of the national CAM information services, to explore common challenges encountered in practice, and to establish specific objectives for the collaboration.

DESIGN

The workshop incorporated set templates for presentations, brainstorming, and analysis of notes to identify common themes.

RESULTS

Differences and similarities between the various services were revealed. Common challenges were identified under the main themes of overall context, users and needs, content and processes. Based on these themes, it was possible to agree on a number of specific objectives.

CONCLUSIONS

The member organizations of the ICCR serve a range of different audiences and have varied remits to fulfill. For the international collaboration to be effective, it was necessary to identify common challenges and to agree on specific objectives and potential ways of working together. Progress to date is also discussed together with plans for the future.

Surfing for mouth guards: assessing quality of online information

INTRODUCTION

The Internet is an easily accessible and commonly used source of health-related information, but evaluations of the quality of this information within the dental trauma field are still lacking.

AIM

The aims of this study are (i) to present the most current scientific knowledge regarding mouth guards used in sport activities, (ii) to suggest a scoring system to evaluate the quality of information pertaining to mouth guard protection related to World Wide Web sites and (iii) to employ this scoring system when seeking reliable mouth guard-related websites.

MATERIALS AND METHODS

First, an Internet search using the keywords 'athletic injuries/prevention and control' and 'mouth protector' or 'mouth guards' in English was performed on PubMed, Cochrane, SvedMed+ and Web of Science to identify scientific knowledge about mouth guards. Second, an Internet search using the keywords 'consumer health information Internet', 'Internet information public health' and 'web usage-seeking behaviour' was performed on PubMed and Web of Science to obtain scientific articles seeking to evaluate the quality of health information on the Web. Based on the articles found in the second search, two scoring systems were selected. Then, an Internet search using the keywords 'mouth protector', 'mouth guards' and 'gum shields' in English was performed on the search engines Google, MSN and Yahoo. The websites selected were evaluated for reliability and accuracy.

RESULTS

Of the 223 websites retrieved, 39 were designated valid and evaluated. Nine sites scored 22 or higher. The mean total score of the 39 websites was 14.2. Fourteen websites scored higher than the mean total score, and 25 websites scored less. The highest total score, presented by a Public Institution Web site (Health Canada), was 31 from a maximum possible score of 34, and the lowest score was 0.

CONCLUSION

This study shows that there is a high amount of information about mouth guards on the Internet but that the quality of this information varies. It should be the responsibility of health care professionals to suggest and provide reliable Internet URL addresses to patients. In addition, an appropriate search terminology and search strategy should be made available to persons who want to search beyond the recommended sites.