How to rate health care sites on the Internet at their true value?

Chicago 25 February 1998 The search for valid health information on the Internet may not turn out to be all that easy as it looks. Health professionals as well as patients experience great difficulties to orient themselves, surfing the wide ocean of health care data, available on the Web. Dr. Alejandro R. Jadad and Anna Gagliardi, two researchers at McMaster University in Hamilton, Ontario, have tried to make a survey of Internet resources that review and rate Web sites, providing health information. They were able to identify forty seven rating instruments that are used for validation purposes but discovered that many of them were incompletely developed. This has led them to ask whether such instruments should exist in the first place, whether they measure exactly what they claim to measure, or whether they lead to more good than harm.

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The search for valid health information on the Internet may not turn out to be all that easy as it looks. Health professionals as well as patients experience great difficulties to orient themselves, surfing the wide ocean of health care data, available on the Web. Dr. Alejandro R. Jadad and Anna Gagliardi, two researchers at McMaster University in Hamilton, Ontario, have tried to make a survey of Internet resources that review and rate Web sites, providing health information. They were able to identify forty seven rating instruments that are used for validation purposes but discovered that many of them were incompletely developed. This has led them to ask whether such instruments should exist in the first place, whether they measure exactly what they claim to measure, or whether they lead to more good than harm.

In the Jadad/Gagliardi-study, the Internet constitutes both the focus of review and the main source of data. The research duo considers the Internet as a useful clinical tool for health care providers because it offers them a way to exchange information with colleagues and patients. For patients and their families, it undoubtedly has a beneficial influence for reasons of information and emotional support, particularly in the case of life-threatening diseases. For consumers, it forms an ideal way to actively participate in health care decisions, which may guarantee better psychological outcomes. However, how is one to judge the applicability and credibility of this confusing information overflow?

Jadad and Gagliardi have searched through various data sources in order to identify existing rating instruments, to trace their criteria, establish their degree of validation and possibly indicate future directions for research in this area. Their efforts have yielded forty seven different instruments, of which fourteen offered a description of the applied criteria and five provided specific instructions for their use. Eight out of fourteen were especially designed to rate health information. Some of them appeared as graphic analog scales in the shape of stars, apples, medals or thumbs; others as numerical scales. In six cases, however, the type of instrument was unclear. Only a few included requirements for authorship, source attribution and disclosure of ownership for the information displayed on the rated site.

Is it really necessary to dispose of a set of evaluation tools to track down relevant health information on the Internet? For people concerned about the rapid growth of uncontrolled data on the Web and its potential role in health care decisions, the answer should be an incontrovertible yes. Yet, others are reluctant to allow any controlling attempt by the academic community or regulatory agencies over the free generation of Internet expression and communication. The authors of the study are therefore pleading to start a formal scholarly discussion between as much divergent thinking groups of people as possible. If rating instruments indeed are desirable, what should the definition for a golden quality standard look like?

Internet information has a few typical characteristics which differ from articles in paper-based journals. A heterogeneous collection of people is producing and exchanging the data, presenting it in multiple formats like text, video and sound, modifying it at the speed of light and linking it within a complex network. Thus, the evaluation tool should cover more than just the contents alone but should also consider the structure, functions and possibly the impact of the concerned Web sites. The creation of such a powerful tool seems to be even harder than the rating itself. In addition, the research team insists that the evaluation performers furnish proof of the tool's beneficial influence on decisions, outcomes or resource utilisation in the health care sector, which of course, requires innovative methodological strategies.

The nature of health care information has taken on a challenging and revolutionary appearance with promising opportunities but also unexpected consequences. The authors assert that good communication and rigorous evaluations are more crucial than ever to optimise health care knowledge instead of turning it into a collapsing tower of Babel, full of confusion, anxiety and superfluous conflicts. For consultation of the complete version of the Jadad/Gagliardi-study, we refer to the review article in the February 25, 1998 issue of the Journal of the American Medical Association, which includes some interesting links to illustrative tables with regard to the existing rating instruments and their criteria.


Leslie Versweyveld

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