Deficiencies in information could have a negative influence on consumer health decisions, including whether to seek care

CHICAGO - Accessing health information using Internet search engines and simple search terms is not efficient, and coverage of key information on English- and Spanish-language Web sites is poor and inconsistent, although the accuracy of the information provided is generally good, according to an article in the May 23/30 issue of The Journal of the American Medical Association (JAMA).

Gretchen K. Berland, M.D., of RAND Health, Santa Monica, Calif., and colleagues evaluated health information on the Internet on breast cancer, depression, obesity, and childhood asthma available through English- and Spanish-language search engines and Web sites. The authors performed three studies from July 2000 through December 2000 to assess the accessibility of relevant content, the quality of health information, and the reading grade level of text.

According to background information cited in the article, one recent survey estimated that more than 60 million U.S. residents went online in search of health information in the past year. Among those who use the Internet, more than 70 percent report the health information they find influences a decision about treatment.

To assess the accessibility of 10 English- and 4 Spanish-language search engines, trained searchers entered the four search terms ("breast cancer," "childhood asthma," "depression," and "obesity") into each of the 14 search engines. All links to the first electronic page for each search engine were then counted and classified, and searchers followed a sample of relevant links to determine whether they led to relevant content. "Less than one quarter of the search engines' first pages of links led to relevant content (20 percent of English and 12 percent of Spanish)," the authors write.

A total of 34 physicians evaluated the quality of 25 health Web sites (18 English- and 7 Spanish-language) and content provided by one search engine. "On average, 45 percent of the clinical elements on English- and 22 percent on Spanish-language Web sites were more than minimally covered and completely accurate and 24 percent of the clinical elements on English- and 53 percent on Spanish-language Web sites were not covered at all," the authors write.

"Although we found thousands of pages of material related to key questions, there were substantial gaps in the availability of key information," they report. "Only half of the topics that the expert panels thought were important for consumers were covered more than minimally. This deficiency was particularly striking across Spanish-language sites, where more than half of the condition-related topics were not addressed."

The authors selected three sample passages of text from the beginning, middle, and end of the material abstracted from each Web site. The Fry Readability Graph, which has been validated in both English and Spanish, was used to determine reading grade level. "All English and 86 percent of Spanish Web sites required high school level or greater reading ability," the authors report.

"Our results suggest that consumers using the Internet may have a difficult time finding complete and accurate information on a health problem," they write. "If people are relying on the Internet to make treatment decisions, including whether to seek care, deficiencies in information could negatively influence consumer decisions."

"The Internet has the potential to be a powerful resource for meeting some of the public's health information needs. Ideally, consumers would be able to learn much of what they need to know from high-quality Web sites, so that the limited time they have with their physicians could be used more efficiently," the authors suggest. "However, this requires that Web sites present well-organized and accurate information in a way that is understandable."

"Research is needed on how the public's use of the Internet facilitates, complements, or complicates patient-physician communication and on how patients and health professionals can make better use of this resource," they conclude. (JAMA. 2001; 285:2612-2621)

Editor's Note: Support for this research was received from the California HealthCare Foundation (http://www.chcf.org) to Rand (Dr. Berland), and the Robert Wood Johnson Foundation Clinical Scholars Program (Dr. Berland and co-author Jeffrey I. Algazy, M.D., M.P.H.). Supplementary tables from this study will be available post-embargo on the JAMA Web site at www.jama.ama-assn.org/issues/v285n20/abs/joc02274.html

For more information: contact the JAMA/Archives Media Relations Department at 312/464-5374.

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