Evaluate Online Health Information Research Articles

An integrative systematic review on interventions to improve layperson's ability to identify trustworthy digital health information.

Health information on the Internet has a ubiquitous influence on health consumers' behaviour. Searching and evaluating online health information poses a real challenge for many health consumers. To our knowledge, our systematic review paper is the first to explore the interventions targeting lay people to improve their e-health literacy skills. Our paper aims to explore interventions to improve laypeople ability to identify trustworthy online health information. The search was conducted on Ovid Medline, Embase, Cochrane database, Academic Search Complete, and APA psych info. Publications were selected by screening title, abstract, and full text, then manual review of reference lists of selected publications. Data was extracted from eligible studies on an excel sheet about the types of interventions, the outcomes of the interventions and whether they are effective, and the barriers and facilitators for using the interventions by consumers. A mixed-methods appraisal tool was used to appraise evidence from quantitative, qualitative, and mixed-methods studies. Whittemore and Knafl's integrative review approach was used as a guidance for narrative synthesis. The total number of included studies is twelve. Media literacy interventions are the most common type of interventions. Few studies measured the effect of the interventions on patient health outcomes. All the procedural and navigation/ evaluation skills-building interventions are significantly effective. Computer/internet illiteracy and the absence of guidance/facilitators are significant barriers to web-based intervention use. Few interventions are distinguished by its implementation in a context tailored to consumers, using a human-centred design approach, and delivery through multiple health stakeholders' partnership. There is potential for further research to understand how to improve consumers health information use focusing on collaborative learning, using human-centred approaches, and addressing the social determinants of health.

Digital Health Literacy Predictors and COVID-19 Online Information-Seeking Behaviors Among University Students from Romania

In addition to the infectious disease, the COVID-19 pandemic was accompanied by an infodemic that worsened the outbreak. Increased digital health literacy (DHL) skills and information-seeking behaviors are crucial for accessing, understanding, and evaluating online health information, especially during a pandemic, where misinformation imposes immediate health consequences. This study explores the predictors of DHL among Romanian students and their information-seeking behaviors during the COVID-19 pandemic. Data was collected through a cross-sectional study design over 3 months (December 2020–February 2021) and a self-reported web-based questionnaire from 1,381 university students from Romania assessing DHL and information-seeking behaviors. We used descriptive statistics, Cronbach Alpha coefficients, and univariate and multivariate binary logistic regressions to explore DHL’s predictors in the Romanian sample. Results showed that overall, the study sample had high levels of DHL. However, almost half of the respondents reported having problems assessing whether the information searched related to coronavirus is reliable or not, and 95% shared someone else’s private information online. Age, subjective social status, gender, and chronic diseases were identified as predictors for DHL. Students’ DHL skills need to be strengthened using tailored educational programs and interventions emphasizing the quality, accuracy, and timely provision of online information on official public health platforms. Additional actions include fostering collaborations between educational institutions and public health authorities, alongside developing smartphone applications for real-time guidance on health topics. It is of the utmost importance to address the spread of the infodemic through different strategies, to combat misinformation among university students.

Online Patient Education in Obstructive Sleep Apnea: ChatGPT versus Google Search.

The widespread implementation of artificial intelligence technologies provides an appealing alternative to traditional search engines for online patient healthcare education. This study assessed ChatGPT-3.5's capabilities as a source of obstructive sleep apnea (OSA) information, using Google Search as a comparison. Ten frequently searched questions related to OSA were entered into Google Search and ChatGPT-3.5. The responses were assessed by two independent researchers using the Global Quality Score (GQS), Patient Education Materials Assessment Tool (PEMAT), DISCERN instrument, CLEAR tool, and readability scores (Flesch Reading Ease and Flesch-Kincaid Grade Level). ChatGPT-3.5 significantly outperformed Google Search in terms of GQS (5.00 vs. 2.50, p < 0.0001), DISCERN reliability (35.00 vs. 29.50, p = 0.001), and quality (11.50 vs. 7.00, p = 0.02). The CLEAR tool scores indicated that ChatGPT-3.5 provided excellent content (25.00 vs. 15.50, p < 0.001). PEMAT scores showed higher understandability (60-91% vs. 44-80%) and actionability for ChatGPT-3.5 (0-40% vs. 0%). Readability analysis revealed that Google Search responses were easier to read (FRE: 56.05 vs. 22.00; FKGL: 9.00 vs. 14.00, p < 0.0001). ChatGPT-3.5 delivers higher quality and more comprehensive OSA information compared to Google Search, although its responses are less readable. This suggests that while ChatGPT-3.5 can be a valuable tool for patient education, efforts to improve readability are necessary to ensure accessibility and utility for all patients. Healthcare providers should be aware of the strengths and weaknesses of various healthcare information resources and emphasize the importance of critically evaluating online health information, advising patients on its reliability and relevance.

Why fall for misinformation? Role of information processing strategies, health consciousness, and overconfidence in health literacy.

Health misinformation, defined as false or misleading claims lacking scientific evidence, poses a significant threat to public health. This paper investigates factors associated with the failure to discern misinformation, including health consciousness, information processing strategies, and inaccurate self-assessments of health literacy. Through an online experiment involving 707 English-speaking U.S. participants (mean age = 43 years, 56.2% female), we found that misinformation beliefs about nutrition, vaccination, vaping, and cancer were significantly correlated, implying susceptibility across health topics. Greater susceptibility was associated with higher health consciousness, lower objective health literacy, more elaboration, and more selective scanning. Results provided evidence for the Dunning-Kruger effect and metacognitive monitoring errors, whereby confident individuals were unaware of inadequate health literacy and showed poor misinformation identification. Findings suggest that promoting both health literacy education and cognitive reflection skills among the general adult population could empower them to more critically evaluate online health information.

Developing a Tool for Assessing the Process of Seeking Health Information: Online Think-Aloud Method.

Nursing students can access massive amounts of online health data to drive cutting-edge evidence-based practice in clinical placement, to bridge the theory-practice gap. This activity requires investigation to identify the strategies nursing students apply to evaluate online health information. Online Think-Aloud sessions enabled 14 participants to express their cognitive processes in navigating various educational resources, including online journals and databases, and determining the reliability of sources, indicating their strategies for information-seeking, which helped to create this scoring system. Easy access and user convenience were clearly the instrumental factors in this behavior, which has troubling implications for the lack of use of higher-quality resources (e.g., from peer-reviewed academic journals). The identified challenges encountered during resource access included limited skills in the critical evaluation of information credibility and reliability, signaling a requirement for improved information literacy skills. Participants acknowledged the importance of evidence-based, high-quality information, but faced numerous barriers, such as restricted access to professional and specialty databases, and a lack of academic skills training. This paper develops and critiques a Performative Tool for assessing the process of seeking health information using an online Think-Aloud method, and explores factors and strategies contributing to evidence-based health information access and utilization in clinical practice, aiming to provide insight into individuals' information-seeking behaviors in online health contexts.

Evaluating online health information utilisation and its psychosocial implications among breast cancer survivors: Qualitative explorations.

This study investigated the online information-seeking behaviours of breast cancer patients at Jordan University Hospital, focusing on their dissatisfaction with available online health resources and its impact on their well-being and anxiety levels. Employing descriptive phenomenology and convenience sampling, we conducted five Skype-based focus groups with 4-6 breast cancer survivors each, from March to July 2020. Data analysis was performed using NVivo, following Braun and Clark's inductive thematic analysis framework. The thematic analysis revealed critical insights into survivors' interactions with online cancer resources, identifying key subthemes such as the quality of online information, cyberchondriasis, health literacy and search strategies, the distress caused by counterproductive searches, and the tendency to avoid internet searches. The study underscores the challenges breast cancer survivors face in accessing online health information, especially in Arabic. It highlights the need to improve the quality and accessibility of these resources. Enhancing the cultural relevance of online materials and educating patients on effective information evaluation are crucial. These measures can significantly boost health literacy, mitigate anxiety, and provide better support for breast cancer survivors.

The Influence of eHealth Literacy and Self-Efficacy on Online Health Information-Seeking Behaviour among University Students: Cyberchondria as a Mediator

COVID-19 has seen an increased reliance on online health information, raising concerns over cyberchondria, a condition characterised by excessive worry about health based on online information. This quantitative survey study examines the prevalence of cyberchondria and its correlation with eHealth literacy among 168 university students and their online health information-seeking behaviour. The results showed a significant negative correlation between eHealth literacy and cyberchondria, revealing that individuals with higher eHealth literacy were less likely to experience cyberchondria. This study also found that demographic factors such as age, gender, and education level were associated with cyberchondria. The findings suggest that eHealth literacy is an important protective factor against cyberchondria as individuals with higher eHealth literacy may be better able to critically evaluate online health information and avoid becoming overly anxious about their health. Thus, public health interventions should focus on improving eHealth literacy, especially for those with a heightened risk of cyberchondria, through online health information literacy courses and training healthcare providers on how to discuss cyberchondria with patients.

Assessing Credibility: Quality Criteria for Patients, Caregivers, and the Public in Online Health Information-A Qualitative Study.

The increasing reliance on the Internet for health information has raised concerns about patients using unreliable and potentially harmful content. This study aimed to establish quality criteria to assist patients, caregivers, and the public in evaluating the reliability of online health information. We conducted focus group workshops with 25 participants recruited across Canada, proficient in either English or French. The participants included 13 females and 12 males, with the majority having a college or higher level of education. Through an in-depth analysis comparing various aspects, the participants determined 6 quality criteria: authorship, reliability, usefulness, accessibility, readability, and privacy & confidentiality. The findings from this study present a comprehensive list of quality criteria that will contribute to developing evidence-based quality benchmarks and policy frameworks in multiple languages. These criteria are not only valid but also well-suited to the diverse needs and preferences of patients and the public, providing a reliable framework for evaluating online health information through an evidence-based approach.

How do patients with high cardiovascular risk evaluate online health information? A qualitative study

BackgroundPeople are exposed to variable health information from the Internet, potentially influencing their health decision-making and behaviour. It remains a challenge for people to discern between good- and poor-quality online health information (OHI). This study explored how patients evaluate and determine trust in statin-related OHI in patients with high cardiovascular risk.MethodsThis qualitative study used vignettes and think-aloud methods. We recruited patients from a primary care clinic who were at least 18 years old, had high cardiovascular risk and had previously sought OHI. Participants were given two statin-related vignettes: Vignette 1 (low-quality information) and Vignette 2 (high-quality information). Participants voiced their thoughts aloud when reading the vignettes and determined the trust level for each vignette using a 5-point Likert scale. This was followed by a semi-structured interview which was audio-recorded and transcribed verbatim. The transcripts were coded and analysed using thematic analysis.ResultsA total of 20 participants were recruited, with age ranging from 38–74 years. Among all the high cardiovascular-risk participants, eight had pre-existing cardiovascular diseases. For Vignette 1 (low-quality information), five participants trusted it while nine participants were unsure of their trust. 17 participants (85%) trusted Vignette 2 (high-quality information). Five themes emerged from the analysis of how patients evaluated OHI: (1) logical content, (2) neutral stance and tone of OHI content, (3) credibility of the information source, (4) consistent with prior knowledge and experience, and (5) corroboration with information from other sources.ConclusionPatients with high cardiovascular risks focused on the content, source credibility and information consistency when evaluating and determining their trust in statin-related OHI. Doctors should adopt a more personalised approach when discussing statin-related online misinformation with patients by considering their prior knowledge, beliefs and experience of statin use.

Assessing the Readability of Online Health Information for Colonoscopy - Analysis of Articles in 22 European Languages.

Patients often search on the Internet information about different medical conditions and procedures. This study aimed to evaluate online health information on colonoscopy, focusing on quantity and comprehensibility of internet resources dedicated to the colonoscopy. This information could be used by European Union (EU) colorectal cancer (CRC) screening providers to address patient's unfilled educational needs, fear of colonoscopy, and other barriers that deter from CRC screening. The term "colonoscopy" translated into 22 official EU languages was searched using the Google search engine. For each translation, generated list of websites was assessed with Google Translate. The first 50 websites in each language were assessed for suitability. Records in other languages were excluded. Included websites were free, focused on patient education, and did not have password. Readability assessments were performed with Lix score. A total of 588 websites in Bulgarian, Croatian, Czech, Danish, Dutch, English, Estonian, Finnish, French, German, Greek, Hungarian, Italian, Latvian, Lithuanian, Polish, Portuguese, Romanian, Slovak, Slovenian, Spanish, and Swedish were evaluated. The overall mean Lix score was 56 ± 8 and was classified as very hard to comprehend. There were significant differences in mean Lix scores across the included languages (P<.001). There was not significant correlation (R2 = 0.1, P = 0.142) between Lix score and number of search hits. Although there was a wealth of online patient information on colonoscopy, the comprehensibility of the available information is low. Physician guidance to reliable resources could increase patient's willingness to undergo a screening colonoscopy.

Evaluating online health information quality using machine learning and deep learning: A systematic literature review.

Due to the large volume of online health information, while quality remains dubious, understanding the usage of artificial intelligence to evaluate health information and surpass human-level performance is crucial. However, the existing studies still need a comprehensive review highlighting the vital machine, and Deep learning techniques for the automatic health information evaluation process. Therefore, this study outlines the most recent developments and the current state of the art regarding evaluating the quality of online health information on web pages and specifies the direction of future research. In this article, a systematic literature is conducted according to the PRISMA statement in eight online databases PubMed, Science Direct, Scopus, ACM, Springer Link, Wiley Online Library, Emerald Insight, and Web of Science to identify all empirical studies that use machine and deep learning models for evaluating the online health information quality. Furthermore, the selected techniques are compared based on their characteristics, such as health quality criteria, quality measurement tools, algorithm type, and achieved performance. The included papers evaluate health information on web pages using over 100 quality criteria. The results show no universal quality dimensions used by health professionals and machine or deep learning practitioners while evaluating health information quality. In addition, the metrics used to assess the model performance are not the same as those used to evaluate human performance. This systemic review offers a novel perspective in approaching the health information quality in web pages that can be used by machine and deep learning practitioners to tackle the problem more effectively.

EHealth literacy among online health consumers in Jordan

PurposeThis study aims to examine the eHealth literacy level among online health consumers (OHC) in Jordan and identified variables predicting their eHealth literacy level as well.Design/methodology/approachA quantitative study was conducted to achieve the study objectives. A purposeful sample of 262 OHC completed an electronic version of the eHealth literacy scale (eHEALS). eHEALS is the most cited scale in the literature, which includes eight items (measured on a 5-point Likert scale, ranging from strongly disagree to strongly agree).FindingsResults showed that OHC in Jordan had a moderate level of overall eHealth literacy. Specifically, the eHEALS formed two conceptually sound factors. Gender, occupation, perceived usefulness and perceived importance of the internet, and more frequent online health information seeking were significant positive predictors of overall eHealth literacy and/or its two identified dimensions.Research limitations/implicationsThis study represents a humble contribution to the field. Several recommendations were suggested to maintain and improve eHealth literacy among OHC in Jordan.Originality/valueThe internet has changed the landscape of health information. There is an increase in the provision and availability of health information to all users. OHC should be skillful in locating, using and evaluating online health information. Although many researchers have increasingly studied the concept of eHealth literacy among various groups in the past decade, little research has been devoted to focus on eHealth literacy among OHC, particularly in Jordan.

Online health information seeking and digital health literacy among information and learning resources undergraduate students

BackgroundDuring the COVID-19 pandemic, students have trouble coping with the available health information regarding the coronavirus in their daily lives because of misinformation. ObjectivesThe aim of this study was to evaluate online health information seeking and digital health literacy among information and learning resources undergraduate students at Taibah University during the COVID-19 pandemic. MethodsTo investigate the primary goal, this study used a simultaneous exploratory mixed methods design. Seventeen students participated in phone interviews, and 306 were invited to complete an online survey. AnalysisThe collected data was analyzed using both quantitative (SPSS) and qualitative (NVivo 10) methods. ResultsSearch engines, social media, and YouTube were most often used by the respondents as sources to search for COVID-19-related information. COVID-19 symptoms, restrictions, and the current spread of COVID-19 were the most searched topics by the respondents. Significant and relevant differences emerged for the digital health literacy subscales “information search” and “adding self-generated content”. However, there were no significant differences in the digital health literacy subscale “determining relevance”. ConclusionUsing the internet to provide health information tailored to the needs and interests of students to seek health information online and thereby improve their health literacy.

Age and neurocognition are associated with credibility evaluations of health websites

The internet has become a common means by which many older adults seek out health information. The prevalence of misinformation on the internet makes the search for accurate online health information a more complex and evaluative process. This study examined the role of age and neurocognition in credibility evaluations of credible and non-credible health websites. Forty-one older adults and fifty younger adults completed a structured credibility rating task in which they evaluated a series of webpages displaying health information about migraine treatments. Participants also completed measures of neurocognition, internet use, and health literacy. Results suggested that older adults rated non-credible health websites as more credible than younger adults, but the age groups did not differ in their ratings of credible sites. Within the full sample, neurocognition was associated with credibility ratings for non-credible health websites, whereas health literacy was related to the ratings of credible sites. Findings indicate that older adults may be more likely to trust non-credible health websites than younger adults, which may be related to differences in higher-order neurocognitive functions. Future work might examine whether cognitive-based supports for credibility training in older adults can be used to improve the accuracy with which they evaluate online health information.

Health Information Seeking Strategies among Individuals with Spinal Cord Injury

<h3>Research Objectives</h3> To explore and identify how individuals with spinal cord injury (SCI) seek and critically evaluate online health information. <h3>Design</h3> Qualitative descriptive study. <h3>Setting</h3> This study was conducted in the general community setting. <h3>Participants</h3> Community-dwelling individuals with SCI were recruited across Canada. Participants had a mean age of 48 years; 12 participants were female, 8 participants experienced non-traumatic SCI. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> Data were collected via one-on-one, semi-structured interviews with a sub-sample of 20 participants enrolled in a larger, clinical trial. Analysis of the transcripts was undertaken using a five-step process of thematic analysis. <h3>Results</h3> Our analysis identified four main themes that described how individuals with SCI seek and critically evaluate online health information. Themes included (1) using Google's search engine, (2) using health organization websites, (3) cross-referencing information found online, and (4) matching key words. <h3>Conclusions</h3> By identifying health information seeking strategies among individuals with SCI, these findings can inform researchers and clinicians on the existing ways with which this population utilizes internet-based resources for their health information seeking needs. Long-term, these findings can help guide future health literacy and eHealth literacy programs and interventions. <h3>Author(s) Disclosures</h3> We report no real or perceived conflicts of interest.

Improving Teen Girls' Skills for Using Electronic Health Information.

Background:In a world increasingly dependent on the Internet for information, it is not surprising that people use the internet to find answers to their health-related questions. Research has shown that teen girls are more likely to search for health information online than boys, but that they do not feel confident in using the information they find.Objective:To address this disparity, teen girls were engaged in the process of developing a teen-friendly, internet-based tool that explains the best way to find, evaluate, and use online health information.Methods:Focus groups were held with girls and their parents to inform the design of the tool. After collaborating with information technology, marketing, and video production teams, a tool was developed consisting of a webpage, videos, and an interactive game. The efficacy and acceptability of the tool were tested among our target demographic through a usability trial.Key Results:Parent and teen focus groups informed the three-step design of the tool. Teen girls reported significantly higher levels of eHealth literacy after using the tool. Dissemination of the tool through a national targeted ad campaign generated web traffic to the tool.Conclusions:An internet-based training tool has been shown to improve teen girls' eHealth literacy. Findings from this developmental study can be used to inform efforts to improve eHealth literacy in adolescent girls. [HLRP: Health Literacy Research and Practice. 2021;5(1):e26–e34.]Plain Language Summary:This research study used teen and parent input to help design an internet-based training tool to teach teen girls the best way to use the internet to find health information. Teen girls' ability to find, understand, and evaluate online health information significantly improved after using the tool. The tool was advertised throughout the United States on various social media platforms.

The effects of information source and eHealth literacy on consumer health information credibility evaluation behavior

Health consumers can easily access information on the Internet. The quality of online health information varies and overall is concerning. The definition of eHealth literacy implies that consumers' ability to evaluate online health information varies with their eHealth literacy. A lab-based experiment was conducted to investigate how information source and consumers’ eHealth literacy affect their use of different types of indicators and criteria in evaluating the credibility of online health information. Credibility evaluation was viewed as a process of utilizing criteria to interpret webpage indicators. Twenty-five participants each viewed a total of 15 webpages from government, commercial, and online forum sources (five from each). Gaze-cued retrospective think-aloud was employed to elicit the indicators and criteria that participants used to evaluate the webpages. The findings showed that content-related indicators and criteria were used the most in credibility evaluation across different information sources. Participants used source indicators more often than design indicators in evaluating government websites and used design criteria more often than individual factors in evaluating commercial websites. eHealth literacy did not significantly affect credibility evaluation but showed a marginally significant interaction effect with information sources on the number of indicators used. The results enhance our understanding of factors influencing consumer online health information evaluation behavior.

Evaluating online health information in terms of readability, understandability and actionability

Improving the population health literacy is one of the main objectives of 21st century medicine. Poor health literacy is associated with an inappropriate use of healthcare resources, a higher rate of unnecessary services and hospitalizations. The Internet could play an important role in increasing the level of the population health literacy. To this end, in addition to being of high quality, it is important that information provided to citizens has to be readable. Furthermore, it should be understandable and actionable, indicating clearly which actions should be taken to maintain good health. These features can be measured in online health information using validated tools such as readability formulas and the Patient Education Materials Assessment Tool, which are dealt with in this personal review. Studies that have applied these tools on online health information in english and italian language are discussed. Valutare l’informazione sanitaria online in termini di readability, understandability e actionability Il miglioramento della health literacy della popolazione e uno degli obiettivi prioritari della Medicina del XXI secolo. Una scarsa health literacy e responsabile di una inappropriata utilizzazione dei servizi sanitari per un tasso piu alto di prestazioni e di ospedalizzazioni non necessarie. Internet potrebbe svolgere un ruolo importante per aumentare il livello di health literacy nella popolazione. A tal fine e fondamentale che le informazioni sanitarie fornite ai cittadini, oltre ad essere di elevata qualita, siano comprensibili. Inoltre dovrebbero essere interpretabili (understandable) e indicare chiaramente quali azioni occorre intraprendere (actionable) per mantenere un buono stato di salute. Queste caratteristiche possono essere misurate nei materiali informativi sanitari in rete mediante strumenti validati come le formule per la readability e il Patient Education Materials Assessment Tool, oggetto di trattazione in questa revisione personale. Vengono inoltre discusse ricerche che hanno applicato questi strumenti sul materiale informativo sanitario online in lingua inglese e in lingua italiana.

Evaluating online health information sources using a mixed methods approach. Part 3

Evaluating online health information sources using a mixed methods approach. Part 3

Consumer Evaluation of the Quality of Online Health Information: Systematic Literature Review of Relevant Criteria and Indicators.

BackgroundAs the quality of online health information remains questionable, there is a pressing need to understand how consumers evaluate this information. Past reviews identified content-, source-, and individual-related factors that influence consumer judgment in this area. However, systematic knowledge concerning the evaluation process, that is, why and how these factors influence the evaluation behavior, is lacking.ObjectiveThis review aims (1) to identify criteria (rules that reflect notions of value and worth) that consumers use to evaluate the quality of online health information and the indicators (properties of information objects to which criteria are applied to form judgments) they use to support the evaluation in order to achieve a better understanding of the process of information quality evaluation and (2) to explicate the relationship between indicators and criteria to provide clear guidelines for designers of consumer health information systems.MethodsA systematic literature search was performed in seven digital reference databases including Medicine, Psychology, Communication, and Library and Information Science to identify empirical studies that report how consumers directly and explicitly describe their evaluation of online health information quality. Thirty-seven articles met the inclusion criteria. A qualitative content analysis was performed to identify quality evaluation criteria, indicators, and their relationships.ResultsWe identified 25 criteria and 165 indicators. The most widely reported criteria used by consumers were trustworthiness, expertise, and objectivity. The indicators were related to source, content, and design. Among them, 114 were positive indicators (entailing positive quality judgments), 35 were negative indicators (entailing negative judgments), and 16 indicators had both positive and negative quality influence, depending on contextual factors (eg, source and individual differences) and criteria applied. The most widely reported indicators were site owners/sponsors; consensus among multiple sources; characteristics of writing and language; advertisements; content authorship; and interface design.ConclusionsConsumer evaluation of online health information is a complex cost-benefit analysis process that involves the use of a wide range of criteria and a much wider range of quality indicators. There are commonalities in the use of criteria across user groups and source types, but the differences are hard to ignore. Evidently, consumers’ health information evaluation can be characterized as highly subjective and contextualized, and sometimes, misinformed. These findings invite more research into how different user groups evaluate different types of online sources and a personalized approach to educate users about evaluating online health information quality.