Health advice on the net

You can find lots of excellent information via the Internet. But there are potential pitfalls. Anyone can post anything at all on the Web – there is no review by experts, no editorial control. Sites may appear today and disappear tomorrow. Information can be inaccurate, misleading and, in some cases, dangerous. At the same time, clever presentation and innovative web design can make sites extremely seductive. This is particularly important when you are looking for information about health, illnesses and treatments. There are at least 100,000 health information web sites and it has been estimated that 98 million adults worldwide have used the Internet to access health information.

How can you be sure which information to trust? There are some simple steps you can take to find the best possible information available.

The BBC is not responsible for the content of external websites.

FINDING THE BEST INFORMATION

Use Gateways
One approach is to use Internet gateways to search for relevant sites. Search engines like Google and Alta Vista generally work by using robots (sometimes called spiders) to trawl the Web and find sites. This means that the sites they find are of variable quality. The sites you find using an Internet Gateway have been selected by professional librarians or information specialists, using quality criteria.

In health there are a number of specialist gateways which recommend good quality sites and information sources.

The US based Healthfinder site is probably the most comprehensive gateway site available at present

NHS Direct Online is a sister service to the NHS Direct telephone service, aims to become the UK equivalent of the Healthfinder site. It is an excellent starting point for UK health information. It includes an on-line encyclopaedia of conditions and treatments, links to thousands of high quality information leaflets and helpsheets, self-help groups and specialist organizations.

Organised Medical Networked Information (OMNI) is a specialist UK based gateway to resources in medicine, health and health services. It aims to provide comprehensive coverage of the UK resources in this area and access to the best resources worldwide.

Patient UK is a directory of UK health, disease and related websites. It is edited by two GPs.

MedlinePlus is a gateway produced in the United States by the National Library of Medicine and aimed at the general public.

SEARCH SYSTEMATICALLY
If you are going to search for information in more than one place you need to be organised and systematic. There are three steps you need to follow:

• Plan
• Search & Record
• Review & Evaluate

Plan
Be clear about what you want to know.
What is your question?
What are the keywords you are going to use to carry out the search?
Are there synonyms or equivalent words you might need to try?
Where are you going to search? (Which search engines or gateways are you going to use?)

 

Search & Record
Carry out your search systematically.
Keep a record of each source you search, the key words you use and what you find.
If you don’t find as much information as you need, try broadening the key words you are using.
If you find too much, try narrowing the key words.

Review & Evaluate
When you think you have found enough information to answer your question, stop.
Review what you have found and filter out anything which doesn’t address your question.
Then evaluate what you have left, using the PROMPT approach.

Judging the quality of information – the PROMPT approach

PROMPT is an easy way of remembering six dimensions of information quality. It offers you a simple framework for assessing all kinds of information – websites, articles, books or leaflets. We hope you will find it useful.

What does PROMPT stand for?

Presentation
Relevance
Objectivity
Method
Provenance
Timeliness

Presentation
The way in which information is presented has a profound effect on the way we receive and perceive it. There are many aspects of poor presentation – any of which can create a barrier between the message and the audience.
Look at this website – it is Jim Jacobson’s home page. Can you identify some of the aspects of poor presentation it demonstrates? You might have thought about colours, fonts, white on black, poor use of graphics, irritating animation, annoying pop-up boxes, music – you name it!

The same principles of course apply to printed information. Just to remind you of the importance of language in communication, look at the website of the Plain English Campaign and their ‘Golden Bull award’ winners.

Does presentation matter?
We think that presentation can have serious consequences. We might ignore and therefore miss out on information which has excellent content, but poor presentation. We might misinterpret information because of poor presentation. Someone might not be able to follow fire or safety instructions, for instance. If poorly presented information fails to get its message across it can waste the time of the recipients and the money spent on producing it.

Assessing presentation – what to look for:

• Language
• Writing style
• Structure
• Layout
• Font
• Colour

Relevance
This is an important aspect of information quality but it is not a property of the information you are looking at, but rather its relationship to the question you are trying to answer. There are a number of ways in which it may or may not be relevant to your needs. For example:

- level (it may be too detailed/specialised or too general/simple for your needs – e.g articles in medical books and journals tend to focus on unusual or extreme cases of an illness which won't be relevant to the majority of sufferers and could cause unnecessary alarm)

- differences between people (e.g. physiological differences between children and adults or ethnic/cultural differences in disease incidence) means that one piece of information may not ‘fit all’ and could be dangerously misleading

- emphasis (it may not contain the kind of information you are seeking
– this is often a question of emphasis, which may not be identifiable from the abstract)

Consider this scenario
Your twelve year old daughter is doing a school project on ‘the Brain and how it works ‘. As usual she has left herself very little time to do the research and, as you are visiting the Library for another purpose, you offer to see if they have any books or other resources which might be useful. You find the following three sources of information:

International Review of Neurobiology: Vol 45 Brain plasticity and epilepsy / edited by Jerome Engel 2001

The brain game - from the National Endowment for Science, Technology and the Arts (NESTA)
Which of these do you think are likely to be relevant for the s

chool project?

Does relevance matter?
Health information which is irrelevant in some of the ways listed above could at best waste your time and at worst be misleading and cause unnecessary anxiety or confusion.

Assessing relevance – what to look for

• Be clear about what you are looking for from the start – this will help you to be ruthless in discarding things which don’t fit the bill.
• Try and avoid having to read things in full – look at the abstract or summary, if there is one, for quick indications of ‘what it is about’.

Objectivity
In an ideal world, ‘objective’ or ‘balanced’ information would present all the evidence, all the arguments and leave you to weigh this up and draw conclusions. In the real world, this is probably unachievable – everything has some kind of position of interest.

This puts the onus on you to be aware of these positions and take account of them when you interpret the information.
In some cases, authors may be explicitly expressing a particular viewpoint – this is perfectly valid as long as they are explicit about the perspective they represent. Hidden bias, whether or not it is deliberate, can be misleading.

Consider this scenario:
A friend of yours is a heavy smoker and you have been trying to persuade her to give up. You read in the newspaper that the NHS are going to make Nicotine Replacement Therapy (NRT) available on prescription and you suggest this to your friend. She says that she would like some evidence that it really works. You offer to collect some information for her. This is what you find:

NHS Direct: Online

WhyQuit.com

Are both these sources giving the same message? If not, why not?

You have probably identified some vested interests. Here is a summary of some different kinds of vested interest:

Financial vested interests – protecting or selling a product or service
Media manipulation – a ‘good story’ (selling papers or pushing up ratings)
Political propaganda – influencing public opinion
Government ‘propaganda’ – influencing public behaviour
Academic self-interest - need to publish for career or financial rewards.

Assessing objectivity – what to look for:

• Perspectives – do the authors state clearly the viewpoint they are taking?
• Opinions: academic articles will often present unsubstantiated theories for debate. Look out for opinion presented as if it were fact.
• Language: can be a useful danger sign. Look out for language which is either emotionally charged or vague.
• Sponsorship: academic research may be sponsored by industry (e.g. pharmaceutical companies). This does not necessarily make the research less objective but it may make its interpretation selective. Make sure that all potential vested interests are clearly identified.

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