An evaluation of healthcare information on the Internet: the case of colorectal cancer prevention

Analysis of the quality, accuracy, and readability of patient information on polycystic ovarian syndrome (PCOS) on the internet available in English: a cross-sectional study

BACKGROUND

Online information about PCOS lacks reliability for patients seeking information about the disease. Thus, we aimed to perform an updated analysis of the quality, accuracy, and readability of patient information on PCOS available online.

METHODS

We conducted a cross-sectional study using the top five Google Trends search terms in English associated with PCOS, including "symptoms," "treatment," "test," "pregnancy," and "causes." Five separate searches in Bing, Yahoo, and Google were performed to obtain the first 10 unique webpages for each term that was categorized as commercial, non-profit organization, scientific resources, or private foundation. We used the 16-item DISCERN with Likert-responses (minimum 1, maximum 5) where the total is 80 and lowest is 16, clarity with the 32-item EQIP, where responses of no = 0 and yes = 1 (minimum 0, maximum 32), and accuracy scores with 1 denoting poor and 5 completely accurate information; low scores of each corresponded to poorly reported information. We assessed readability with Flesch-Kincaid reading ease index, where higher scores correspond to reading ease, and lower grades correspond to easier readability with Flesch-Kincaid grade level, Gunning-Fog, Coleman-Liau index, automated readability index, New Dale-Chall Readability, and simple measure of gobbledygook. We additionally assessed word and sentence characteristics. We used Kruskal-Wallis test to compare scores according to webpage categories.

RESULTS

Out of 150 webpages, most were commercial (n = 85, 57%), followed by non-profit organizations (n = 44, 29%), scientific resources (n = 13, 9%) and private foundations (n = 6, 4%). Google webpages had higher median DISCERN score ([Md] = 47.0) than Bing ([Md] = 42.0) and Yahoo ([Md] = 43.0) webpages; P = 0.023. No difference in EQIP scores according to search engine was found (P = 0.524). Predominantly, webpages from private foundations had higher DISCERN and EQIP scores, although comparisons were not statistically significant (P = 0.456) and P = 0.653.). Accuracy and readability were similar across search engines and webpage categories (P = 0.915, range 5.0-5.0) and (P = 0.208, range 4.0-5.0).

CONCLUSIONS

Quality and clarity of the data were fair according to search engine and category. Accuracy of information was high, showing that the public may encounter accurate information about PCOS. However, the readability of the information was high, reflecting a need for more readable resources about PCOS.

Modeling the Mediating and Moderating Roles of Risk Perceptions, Efficacy, Desired Uncertainty, and Worry in Information Seeking-Cancer Screening Relationship Using HINTS 2017 Data

Despite mixed findings in the literature, health information seeking is considered as a promising antecedent of health behavior and outcome. However, little research has been conducted to identify factors that explain the health information seeking-health behavior relationship. In the contexts of breast, cervical, and prostate cancer screening, this research utilized recently collected Health Information National Trends Survey data (HINTS 5 Cycle 1) to examine whether, among the population at risk of cancer, previous cancer information seeking influenced cancer screening via perceptions of risk and efficacy, desired uncertainty, and worry. The results indicated that previous cancer information seeking had a direct effect on cancer screening. Across the three cancer screening behaviors, desired uncertainty mediated the relationship between previous cancer information seeking and screening behavior. Worry about getting cancer moderated and mediated the relationship between cancer information seeking and cervical cancer screening. Moreover, desired uncertainty and perceived susceptibility respectively interacted with previous cancer information seeking to influence breast cancer screening. Perceptions of risk and efficacy had limited effects on cancer screening. Theoretical and practical implications are discussed.

Multiple approaches to enhancing cancer communication in the next decade: translating research into practice and policy

Communicating risk and other health information in a clear, understandable, and actionable manner is critical for the prevention and control of cancer, as well as the care of affected individuals and their family members. However, the swift pace of development in communication technologies has dramatically changed the health communication landscape. This digital era presents new opportunities and challenges for cancer communication research and its impact on practice and policy. In this article, we examine the science of health communication focused on cancer and highlight important areas of research for the coming decade. Specifically, we discuss three domains in which cancer communication may occur: (a) among patients and their healthcare providers; (b) within and among families and social networks; and (c) across communities, populations, and the public more broadly. We underscore findings from the prior decade of cancer communication research, provide illustrative examples of future directions for cancer communication science, and conclude with considerations for diverse populations. Health informatics studies will be necessary to fully understand the growing and complex communication settings related to cancer: such works have the potential to change the face of information exchanges about cancer and elevate our collective discourse about this area as newer clinical and public health priorities emerge. Researchers from a wide array of specialties are interested in examining and improving cancer communication. These interdisciplinary perspectives can rapidly advance and help translate findings of cancer communication in the field of behavioral medicine.

Decreased public pursuit of cancer-related information during the COVID-19 pandemic in the United States

Background

In response to the prioritization of healthcare resources towards the COVID-19 pandemic, routine cancer screening and diagnostic have been disrupted, potentially explaining the apparent COVID-era decline in cancer cases and mortality. In this study, we identified temporal trends in public interest in cancer-related health information using the nowcasting tool Google Trends.

Methods

We used Google Trends to query search terms related to cancer types for short-term (September 2019–September 2020) and long-term (September 2016–September 2020) trends in the US. We compared average relative search volumes (RSV) for specified time ranges to detect recent and seasonal variation.

Results

General search interest declined for all cancer types beginning in March 2020, with changes in search interest for “Breast cancer,” “Colorectal cancer,” and “Melanoma” of − 30.6%, − 28.2%, and − 26.7%, respectively, and compared with the mean RSV of the two previous months. In the same time range, search interest for “Telemedicine” has increased by + 907.1% and has reached a 4-year peak with a sustained increased level of search interest. Absolute cancer mortality has declined and is presently at a 4-year low; however, search interest in cancer has been recuperating since July 2020.

Conclusion

We observed a marked decline in searches for cancer-related health information that mirrors the reduction in new cancer diagnoses and cancer mortality during the COVID-19 pandemic. Health professions need to be prepared for the coming demand for cancer-related healthcare, foreshadowed by recovering interest in cancer-related information on Google Trends.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10552-021-01409-1.

Online health information seeking, medical care beliefs and timeliness of medical check-ups among African Americans

OBJECTIVE

This study aims to investigate the relationship among different types of internet sources for health, medical check-up beliefs and the timeliness of annual medical check-ups among African Americans, accounting for both health TV usage and health service use.

METHODS

Hierarchical linear regression analysis was conducted on data from 1734 African Americans surveyed in the 2013 Consumer Health Multimedia Audience Research Systems national pharmaceutical study of 19,420 U.S. adults.

RESULTS

The results indicate a positive association between seeking health information on medical websites (β = 0.052, p = 0.04) and consumer-driven health sites (β = 0.066, p < 0.01), and the timeliness of check-ups among African Americans, an association not found in relation to mainstream or news-related sites. Health TV program use was not associated with timeliness of medical check-ups. Medical check-up belief is positively associated with seeking health info on consumer-driven health sites (β = 0.072, p < 0.01) but not on medical sites or on TV.

CONCLUSION

Seeking information on health-specific websites was associated with more timely check-ups in African Americans and more positive preventative medical care belief, even after controlling for traditional barriers, such as poor provider relationship.

PRACTICE IMPLICATIONS

Health specific websites may provide an avenue for intervention to improve preventative care use in African Americans.

Evaluation of an online knowledge translation intervention to promote cancer risk reduction behaviours: findings from a randomized controlled trial

Background

Many cancers are preventable through lifestyle modification; however, few adults engage in behaviors that are in line with cancer prevention guidelines. This may be partly due to the mixed messages on effective cancer prevention strategies in popular media. The goal of the McMaster Optimal Aging Portal (the Portal) is to increase access to trustworthy health information. The purpose of this study was to explore if and how knowledge translation strategies to disseminate cancer prevention evidence using the Portal influence participants’ knowledge, intentions and health behaviors related to cancer risk.

Methods

Adults ≥40 years old, with no cancer history were randomized to a 12-week intervention (weekly emails and social media posts) or control group. Quantitative data on knowledge, intentions and behaviors (physical activity, diet, alcohol consumption and use of tobacco products) were collected at baseline, end of study and 3 months later. Participant engagement was assessed using Google Analytics, and participant satisfaction through open-ended survey questions and semi-structured interviews.

Results

Participants (n = 557, mean age 64.9) were predominantly retired (72%) females (81%). Knowledge of cancer prevention guidelines was higher in the intervention group at end of study only (+ 0.3, p = 0.01). Intentions to follow cancer prevention guidelines increased in both groups, with no between-group differences. Intervention participants reported greater light-intensity physical activity at end of study (+ 0.7 vs. 0.1, p = 0.03), and reduced alcohol intake at follow u (− 0.2 vs. + 0.3, p < 0.05), but no other between-group differences were found. Overall satisfaction with the Portal and intervention materials was high.

Conclusions

Dissemination of evidence-based cancer prevention information through the Portal results in small increases in knowledge of risk-reduction strategies and with little to no impact on self-reported health behaviours, except in particular groups. Further tailoring of knowledge translation strategies may be needed to see more meaningful change in knowledge and health behaviours.

Trial registration

ClinicalTrials.gov NCT03186703, June 14, 2017.

Patient decision aids: a content analysis based on a decision tree structure

INTRODUCTION

This paper presents the preliminary results of a decision-tree analysis of Patient Decision Aids (PDA). PDAs are online or offline tools used to structure health information, elicit relevant values and emphasize the decision as a process, in ways that help patients make more informed health decisions individually or with relevant others.

METHOD

Twenty PDAs are randomly selected from the International Patient Decision Aids Standards (IPDAS) ( https://decisionaid.ohri.ca/AZlist.html ) approved list. An evaluation tool is built bottom-up and top-down and results are described in terms of communicating uncertainty, completeness of the decision tree, ambiguous or misleading phrasing, overall strategies suggested within personal stories.

RESULTS

Twelve of the analyzed PDAs had branches of the decision tree which were not discussed in the tool and 6 had logically ambiguous phrasing. Many tools included dichotomous options, when the option range was wider. Several options were clustered within the "Do not take/Do not do" option and thus the PDA failed to provide all comparisons necessary to make a decision. Some tools employ expressions that do not differentiate between lack of information and known negative effects. Other tools provide unequal amounts or non-comparable bits of information about the options.

CONCLUSION

These results indicate a very loose range of interpretations of what constitutes an option, a treatment, and a treatment option. It thus emphasizes a gap between theory and practice in the evaluation of PDAs. Future developments of PDA evaluation tools should keep track of missing decision tree branches, accurate communication of uncertainty, ambiguity, and lack of knowledge and consider using measures for evaluating the completeness of the option spectrum at an agreed period in time.

Readability of information on colonoscopy preparation on the internet

Background: The incidence of colorectal cancer (CRC) has decreased in recent years, due in large part to increased screening, particularly through colonoscopy. This study aimed to examine the level of readability of information on colonoscopy preparation written on 100 websites that were found via an internet search.

Methods: In this cross-sectional study, the content of the first 100 websites in English found via an internet search were analyzed using established readability scales. Websites were compared based on whether they had a commercial or non-commercial URL extension.

Results: The majority of websites were found to have information of a difficult reading level. Less than 10% of websites had an easy reading level. Readability did not differ significantly based on URL extension.

Conclusion: The information currently posted on the internet regarding preparation for colonoscopy is written at a difficult reading level. If information presented was both accurate and easier to read, it could benefit a greater proportion of the general public and help inform decisions about preparing for a colonoscopy.

Variable Quality and Readability of Patient-oriented Websites on Colorectal Cancer Screening

BACKGROUND & AIMS

The efficacy of colorectal cancer (CRC) screening is dependent on participation and subsequent adherence to surveillance. The internet increasingly is used for health information and is important to support decision making. We evaluated the accuracy, quality, and readability of online information on CRC screening and surveillance.

METHODS

A Website Accuracy Score and Polyp Score were developed, which awarded points for various aspects of CRC screening and surveillance. Websites also were evaluated using validated internet quality instruments (Global Quality Score, LIDA, and DISCERN), and reading scores. Two raters independently assessed the top 30 websites appearing on Google.com. Portals, duplicates, and news articles were excluded.

RESULTS

Twenty websites were included. The mean website accuracy score was 26 of 44 (range, 9-41). Websites with the highest scores were www.cancer.org, www.bowelcanceraustralia.org, and www.uptodate.com. The median polyp score was 3 of 10. The median global quality score was 3 of 5 (range, 2-5). The median overall LIDA score was 74% and the median DISCERN score was 45, both indicating moderate quality. The mean Flesch-Kincaid grade level was 11th grade, rating the websites as difficult to read, 30% had a reading level acceptable for the general public (Flesch Reading Ease > 60). There was no correlation between the Google rank and the website accuracy score (r_s = -0.31; P = .18).

CONCLUSIONS

There is marked variation in quality and readability of websites on CRC screening. Most websites do not address polyp surveillance. The poor correlation between quality and Google ranking suggests that screenees will miss out on high-quality websites using standard search strategies.

Cancer Information Seeking and Cancer-Related Health Outcomes: A Scoping Review of the Health Information National Trends Survey Literature

Cancer is a leading cause of death among adults in the United States. Only 54% of U.S. adults reported seeking cancer information in 2014. Cancer information seeking has been positively associated with cancer-related health outcomes such as screening adherence. We conducted a scoping review of studies that used data from the Health Information National Trends Survey (HINTS) in order to examine cancer information seeking in depth and the relationship between cancer information seeking and cancer-related health outcomes. We searched five databases and the HINTS website. The search yielded a total of 274 article titles. After review of 114 de-duplicated titles, 66 abstracts, and 50 articles, 22 studies met inclusion criteria. Cancer information seeking was the outcome in only four studies. The other 18 studies focused on a cancer-related health outcome. Cancer beliefs, health knowledge, and information seeking experience were positive predictors of cancer information seeking. Cancer-related awareness, knowledge, beliefs, preventive behaviors, and screening adherence were higher among cancer information seekers. Results from this review can inform other research study designs and primary data collection focused on specific cancer sites or aimed at populations not represented or underrepresented in the HINTS data (e.g., minority populations, those with lower socioeconomic status).

Determinants of Consumer eHealth Information Seeking Behavior

Patients are increasingly using the Internet and other technologies to engage in their own healthcare, but little research has focused on the determinants of consumer eHealth behaviors related to Internet use. This study uses data from 115,089 respondents to four years of the National Health Interview Series to identify the associations between one consumer eHealth behavior (information seeking) and demographics, health measures, and Personal Health Information Management (PHIM) (messaging, scheduling, refills, and chat). Individuals who use PHIM are 7.5 times more likely to search the internet for health related information. Just as health has social determinants, the results of this study indicate there are potential social determinants of consumer eHealth behaviors including personal demographics, health status, and healthcare access.

The Internet as a new tool in the rehabilitation process of patients--education in focus

In the article we deal with the rehabilitation of patients using information technology, especially Internet support. We concentrate on two main areas in the IT support of rehabilitation: one of them is the support for individual therapy, the other one is providing patients with information, which is the basic step in emphasising individual responsibility. In the development of rehabilitation programmes, the knowledge of the IT professional and the therapist, in the IT support of web guidance, medical expertise plays the primary role. The degree of assistance involved in the rehabilitation process depends on the IT knowledge of medical (general practitioner, nursing staff) professionals as well. The necessary knowledge required in healing and development processes is imparted to professionals by a special (full-time) university training. It was a huge challenge for us to teach web-based information organisation skills to doctors and nurses, and it is also a complex task to put forward such an IT viewpoint to information specialists in order to create the foundations of the cooperation between IT and healthcare professionals.