Health information on the web

Abstract
Increasingly, consumers engage in health information seeking via the Internet, Taking a communication perspective, this review argues why public health professionals should be concerned about the topic, considers 70 000 websites disseminate health information; in excess of 50 million people seek health information online, with likely consequences for the health care system. Websites and forums are full of health information and advertising for medicinal products and herbal and other health products. Some contains information which is not sporadic any consistency, or contain outdated information. And others by the fallacies or information copied from forums or other sites. The sudden massive increase on the amount of health information that is available via the Internet and the growing locks of specialists in the field of medical care on the use of the Internet for information, led to a dramatic increase in cases of doubt in matters of health on the Internet. Although there is a great deal of health information and medical value through the Internet unless it refers to both the specialist health care and receive all of them at risk from the widespread use of the information is accurate and misleading, but the expected harm, so it has become to be cautious when dealing with Internet must be to identify the credibility and accuracy of the information. A lot of people or patients derive health information and the use of drugs or products of various types of these sites. Some drugs that are marketed in these locations do not have any significant medical impact, however we believe that there is panic on these drugs only because it was the publication of information reported in several locations. We must not forget that the use of drugs and seize his laws should be used according to the knowledge of medical or pharmacy. So before we use any drug or product depends not we use him to declare his praise of a friend or use it, what benefit to the patient or someone who is not necessarily give the same effect for others. Therefore it is essential to consult health professionals, led by the treating physician to our health on any product we want to benefit if we use to support the treatment that we use, or may harm our situation, or does not work at all or react badly with our medicines. Future research needs to address the Internet as part of the larger health communication system and take advantage of incorporating extant communication concepts. Not only should research focus on the `net-gap' and information quality, it also should address the inherently communicative and transactional quality of Internet use. Both interpersonal and mass communication concepts open avenues for investigation and understanding the influence of the Internet on health beliefs and behaviors, health care, medical outcomes, and the health care system.

The Internets powerful influence on health seekers

Fifty-two million American adults, or 55% of those with Internet access, have used the Web to get health or medical information. We call them health seekers and a majority of them go online at least once a month for health information. A great many health seekers say the resources they find on the Web have a direct effect on the decisions they make about their health care and on their interactions with doctors. 48% of these health seekers say the advice they found on the Web has improved the way they take care of themselves; and 55% say access to the Internet has improved the way they get medical and health information. 92% of health seekers say the information they found during their last online search was useful; 81% said they learned something new. 47% of those who sought health information for themselves during their last online search say the material affected their decisions about treatments and care. Half of these health seekers say the information influenced the way they eat and exercise.

9% of health seekers have communicated with a doctor online. 10% have purchased medicine or vitamins online. 10% have described a medical condition or problem in order to get advice from an online doctor. 21% have provided their email address to a health Web site; 17% have provided their name or other personal information.

The reasons people like to go online for health information

Internet users say that one of the most important aspects of online health advice is the fact that its available at any hour of the day or night, from wherever they are able to log on. Fully 93% of those who have gotten health information say that convenience is important. Internet users also like to search a diverse menu of resources from commercial sites like Drkoop.com to government sites like the federal National Institutes of Health (www.nih.gov). Eighty-three percent of those who have sought health information say it is important that Internet users can get more health information online than from other sources.

36% of those who sought health information for someone else during their last online search say the material affected their decisions on behalf of that loved one.
Most users go to health sites for research and reference purposes. Few use it to communicate with their caregivers or to buy medicine. Most health seekers have been able to get the information they need without making any significant trade-offs by giving up personal information. Thus, it is not clear whether most Internet users will embrace a full range of health-care activities online, such as filling prescriptions, filing claims, participating in support groups, and emailing doctors.

How to see for Quality Content

Millions of consumers get health information from magazines, TV or the Internet. Some of the information is reliable and up to date; some is not. How can you tell the good from the bad? First, consider the source. If you use the Web, look for an "about us" page. Check to see who runs the site: Is it a branch of the government, a university, a health organization, a hospital or a business? Focus on quality. Does the site have an editorial board? Is the information reviewed before it is posted? Be skeptical. Things that sound too good to be true often are. You want

current, unbiased information based on sound scientific research and proven techniques. Dont believe everything you read. Its an old warning that is especially true for health-related information you find on the World Wide Web. The Web can be a great resource when you want to learn about a specific disease or health condition. You can also find tips on staying healthy. But among the millions of websites that offer health-related information, there are many that present myths and half-truths as if they are facts. To avoid unreliable health information when youre surfing the Web, ask yourself the following questions:

Is the purpose of the site to inform? Is it to sell a product? Is it to raise money? If you can tell who runs and pays for the site, this will help you evaluate its purpose. Be cautious about sites trying to sell a product or service. Quackery abounds on the Web. Look for these warning signs and remember the adage "If it sounds too good to be true, it probably is." Does the site promise quick, dramatic, miraculous results? Is this the only site making these claims? Beware of claims that one remedy will cure a variety of illnesses, that it is a "breakthrough," or that it relies on a "secret ingredient." Use caution if the site uses a sensational writing style (lots of exclamation points, for example.) A health Web site for consumers should use simple language, not technical jargon. Get a second opinion. Check more than one site.

Where did this information come from?

Any website that provides health-related information should tell you the information's source. See if you can find answers to the following questions: Who wrote this information? Keep in mind that many health-related websites post information that comes from other sources. If the person or organization that runs the website didn't write the information, the original source should be clearly stated. If a health care professional didn't write the information, was it reviewed by a doctor or another medical expert? If the information contains any statistics, do the numbers come from a reliable source? Does something on the website appear to be someone's opinion rather than a fact? If so, is the opinion from a qualified person or organization (such as a doctor or medical organization)?

Who pays for the Web site?

It costs money to run a Web site. The source of a Web site's funding should be clearly stated or readily apparent. For example, the U.S. government funds Web sites with addresses ending in ".gov," educational institutes maintain ".edu" sites, noncommercial organizations' addresses often use ".org," and ".com" denotes a commercial organization. A Web site's source of funding can affect the content it presents, how it presents that content, and what the owner wants to accomplish on the site.

What is the original source of the information on the Web site?

Always pay close attention to where the information on the site comes from. Many health and medical Web sites post information collected from other Web sites or sources. If the person or organization in charge of the site did

What is the purpose of the Web site?

not write the material, the original source should be clearly identified. Be careful of sites that don't say where the information comes from. Good sources of health information include sites that end in ".gov" sponsored by the federal government. .edu sites, which are run by universities or medical schools, such as Johns Hopkins University School of Medicine and the University of California at Berkeley Hospital, health system, and other health care facility sites, like the Mayo Clinic and Cleveland Clinic .org sites maintained by not-for-profit groups whose focus is research and teaching the public about specific diseases or conditions, such as the American Diabetes Association, the American Cancer Society, and the American Heart Association Medical and scientific journals, such as The New England Journal of Medicine and the Journal of the American Medical Association, although these aren't written for consumers and could be hard to understand. Sites whose addresses end in .com are usually commercial sites and are often selling products.

hasn't been reviewed in the past year, look for more recently updated information.

Who is responsible for the content of the website?

Before you believe any health-related information you find on the Web, find out who is responsible for information on the site. The easiest way to do this is to look at the site's home page. If the home page doesn't tell you who publishes the site, look for a link that says About us or About this site. Often, this link will be at the bottom of the home page. Clicking on this link will usually take you to a page that explains what person or organization is responsible for the information on the site.

Websites published by an organization.

Health-related websites may be published by the U.S. government (.gov), a nonprofit organization (.org) or a college or university (.edu). These sites may be the most reliable sources of health information because they're usually not supported by for-profit companies, such as drug or insurance companies. However, you still need to find out where these sites get their information. Sites with .com Web addresses may represent a specific company or be published by a company that uses the Web to sell products or services. These are called commercial sites. Commercial sites can offer useful and accurate information. You may want to be more careful about believing the information you read on these sites, though. The information may not be fair and accurate if the company that pays for the site has something to gain from it. It's a good idea to double-check information you read on commercial websites.

How current is this information?

Health information is constantly changing. For example, researchers continue to learn new things about various diseases and their treatments. You should know whether the health-related information you're reading is upto-date. Many Web pages will post the date on which the page was last reviewed or updated. You can usually find this date at the very bottom of the page. If this date isn't included, check to see whether the page has a copyright line. This tells you when the information was originally written. If the page you're reading

Can the accuracy of information received in an e-mail be verified?

Carefully evaluate e-mail messages. Consider the origin of the message and its purpose. Some companies or organizations use e-mail to advertise products or attract people to their Web sites. The accuracy of health information may be influenced by the desire to promote a product or service.

anyone moderates the discussions and, if so, who provides the moderation and what criteria the moderator uses to determine which comments to accept and which to reject. Always read online discussions before participating to make sure that you are comfortable with the discussion and with what participants say to one another.

Websites published by an individual.

Websites published by individuals may offer support and advice about coping with certain conditions and their treatments. These sites can contain reliable and useful information. However, it's very important to double-check health information you see on a website published by an individual. While many of these sites contain good information, some may contain myths or rumors. Without experience, it can be difficult to structure a search to find exactly the information you want. And, even when you do an effective search, you may be confused about the nature of different health web sites. For example, there are health web sites created by government agencies (.gov suffix), commercial entities (.com suffix), educational institutions (.edu suffix), and non-profit organizations (.org suffix). With all this variety, how can you find accurate, timely, understandable information on a specific topic without spending hours online? Also, how can you feel confident about the quality of the information once you arrive at a promising site?

What information about users does the Web site collect, and why?
Web sites routinely track the path users take through their sites to determine what pages people are viewing. However, many healthrelated Web sites also ask users to "subscribe" to or "become a member" of the site. Sites sometimes do this to collect a user fee or select relevant information for the user. The subscription or membership might allow the Web site owner to collect personal information about the user. Any Web site asking you for personal information should explain exactly what the site will and will not do with the information. Many commercial sites sell "aggregate" datasuch as what percent of their users take dietary supplementsabout their users to other companies. In some cases, sites collect and reuse information that is "personally identifiable," such as your ZIP code, gender, and birth date. Be certain to read and understand any privacy policy or similar language on the site and do not sign up for anything that you do not fully understand.

How does the Web site manage interactions with users?

Web sites should always offer a way for users to contact the Web site owner with problems, feedback, and questions. If the site hosts a chat room or some other form of online discussion, it should explain the terms of using the service. For example, the site should explain whether

Privacy policy issues

Despite these public sentiments, the healthinformation privacy regulations soon to be released by the Clinton Administration will probably not cover the majority of the nations more than 17,000 health-related Web sites. Analysis by the Health Privacy Project suggests that many Web sites do not clearly fall into the three categories of organizations that are

covered by the regulations health care providers, insurance companies, and health data clearinghouses (the organizations that process and transmit insurance-claim data). Many of the most common features of health Web sites will not be covered: health assessments, applications for clinical trials, chat rooms and bulletin boards, and personal management tools such as online disease management and patient-generated medical records. In the future, health seekers want protection and the right to punish companies that violate their privacy policies. Look on the Home page of health web sites for a link to their privacy statement. If the site is collecting personal information from you, you need to know how that information will be used. The incidence of fraud on commercial web sites (not just health web sites) is widespread. As a general rule, do not give out bank card number to any web site. If you are buying a product online, you must have assurances that the web site is using a secure server before you give out credit card information. Even then, you may be at risk.

There is little legal protection now for health information online or offline. Unlike financial records, credit reports, and even video rental records, there is no comprehensive federal law that protects the privacy of medical records. State laws are generally considered inadequate for the rapidly changing health care delivery system. That is why Congress specified in the 1996 Health Insurance Portability and Accountability Act that federal rules should be written by HHS in 1999 if Congress itself had not written such rules. The department released draft regulations in November 1999, and received more than 55,000 comments on the draft. It appears unlikely that the new rules will have a major impact on health Web sites or give significant privacy protections to those who use those Web sites. The regulations may impose some confidentiality standards on certain Web sites and provide new protections for the consumers who frequent such sites. But the regulation will only cover three kinds of health care entities, all of which are related to insurance activities. They will cover providers who electronically transmit insurance claims information, insurers, and the clearinghouses that process information for providers and insurers. The draft regulation only covers a select universe of information held by these three entities. Given the wide range of activities that take place on the more than 17,000 health-related Web sites, and the relatively narrow scope of the regulation, it is likely that a great deal of health information collected on health Web sites will not be covered by the new regulation. Many of those Web sites do not fall into any of the categories of organizations covered by the new rules. Still, the Web sites that will be covered by the new regulation may have to change their practices in significant ways. Among its many provisions, the draft regulation give consumers a right to inspect and copy their own health information; requires that consumers receive

Privacy concerns about using the Web for health information

Hospitals, pharmacists, insurance companies, and patients are struggling with the murky issues of medical privacy. Internet users have made it clear that privacy is one of their primary concerns whether its their name and address being sold to a marketer or their medical records being handed over to researchers or broken into by crackers (that is, hackers with destructive or illegal intent). Everyone involved with online health care is waiting for new privacy rules that are expected to be released in the next few weeks by the Clinton administrations Department of Health and Human Services (HHS).

notice about the use and disclosure of their health information; and gives consumers the right to limit disclosures in many circumstances. Health privacy

Interestingly, this question elicited the highest level of not at all concerned responses in the overall Internet population 35% possibly because not all respondents are employed, possibly because these Internet users do not believe their employers will track their online health research.

Remember:
Information that you find on a website does not replace your doctor's advice. Your doctor is the best person to answer questions about your personal health. If you read something on the Web that doesn't agree with what your doctor has told you, ask him or her about it. Visit more than one website and compare what you find. In general, information is more trustworthy when you find the same type of information on more than one website. Talk with your doctor about health information you find on your own. Consider bringing the information with you to a medical visit. You may want to ask questions about it, especially if it disagrees with something youve been told.

Most Internet users are anxious about their privacy online and this general feeling becomes quite acute when it comes to medical and health information. An overwhelming majority of Internet users and an even greater 89% of health seekers are concerned that a health Web site might sell or give away information about what they did online. Most health seekers fear reprisals might occur if others knew the kind of information they were examining at health Web sites. Eighty-five percent of health seekers are concerned that an insurance company might raise their rates or deny coverage because of the health sites they have gone to online. In a similar vein, Internet users are afraid that their online health research could have an impact on their job status. More than half of health seekers (52%) are concerned that their employer might find out what health sites they have gone to online.

Discussion
The results of this study indicate that consumers search for and appraise information in a different way than is implicitly assumed in many studies in which investigators assessed the quality of information on the web by entering a single search phrase and systematically evaluating the quality of all hits. This study is, to our knowledge, the first observational study carried out in a usability laboratory to investigate the retrieval strategies of people searching for health information on the web. Participants were very successful in finding answers to health questions by trying various search terms, exploring the first few hits by cursory examination of the content of the page, and iteratively refining their search

strategy. However, few participants took notice and later remembered from which websites they retrieved information or who stood behind the sites. The study has several important limitations. Firstly, we observed only a small number of participants in a somewhat artificial environment under experimental conditions. We cannot rule out the possibility that participants may have felt time pressure and thus put less emphasis on checking the quality and source. We tried to minimise this by explicitly instructing them to take their time and try to retrieve the correct answer rather than a quick answer. Secondly, as answering the questions did not have any direct impact on the participants, people in a real setting with a greater stake in the outcome of the search might care more about quality and therefore more actively look for markers of quality. Thirdly, we do not know to what degree the sample we tested was representative, but it is likely that we had a relatively experienced sample as people volunteered to participate in this study, we had three nurses in the sample, and some of our participants had taken part in the preceding focus groups. Although the nurses in our sample did not perform notably better than other participants, future studies with more participants and greater statistical power could explore whether health professionals use different strategies for search and appraisal than do consumers, are more successful than consumers, and if so why. More observational studies are needed to design and evaluate educational and technological innovations for guiding consumers to high quality health information on the web. This is one of the important challenges in the age of consumer health informatics.

Conclusion
The Internet has become a major source of health information. It can improve patients understanding of their medical condition and their self-efficacy. Additionally, it can empower them to make health decisions and to talk to their physician, resulting in a more patientcentred interaction between patient and health professional. It has also contributed to a shift in the role of patients from passive recipients to more active consumers of health information. In response to the Internet informed patient, the patienthealth professional relationship can develop in one or more of three ways: (1) the relationship can become health professionalcentred with the health professional exerting his or her expert opinion. (2) The relationship can become patient-centred where patient and health professional collaborate in obtaining and analysing the Internet information and (3) the health professional acknowledges the patient's search for knowledge and guides the patient to reliable and accurate information.

Practice implications
However, for this shift to happen towards patient-centred interaction, it is important that health professionals acknowledge patients search for knowledge, that they discuss the information offered by patients and guide them to reliable and accurate health websites. To adequately prepare health professionals to be able to do this, it is recommended that courses, such as health informatics or patient informatics (i.e. the use of technology mediated information for patients) are integrated in the health professional's education. For further research, it would be interesting to determine how the relationship will develop between newly qualified Internet informed health professionals and their patients and how these health professionals will respond to the more Internet informed patient.

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