Health Information Websites Research Articles

Developing an Automatic Diagnostic System Driven by Consumer-Generated Health Care Data

In order to develop an accurate automatic differential diagnostic system with statistical methods, a large amount of data from patient interviews is required. On the other hand, many Internet users often supply their own information to the public.Our hypothesis is that the medical data collected from general Internet users is useful to develop an automatic statistical diagnostic system. The purpose of this study is to assess this hypothesis.We installed a simple health information website on the Internet. On this website, we hosted a Web application that can infer diseases compatible with the information entered by the users. On this site, if its users had visited a medical institution after using this Web application, we requested them to inform us about doctors’ diagnoses. We developed an automatic diagnostic system based on the Naive-Bayes algorithm with only these data. For evaluation, we used as test data the cases from clinical case questions in a Japanese National Medical Practitioners Qualifying Examination, which medical students must pass to become medical doctors in Japan. We evaluated the correctanswer rate to prove whether this new application makes the minimum satisfactory judgment demanded of doctors. We collected 8812 cases from our website and developed an automatic diagnostic system based on the Naive-Bayes algorithm with these data. The correct-answer rate of this new application was 69.4% (95% CI, 58.8-80.1%). This rate is higher than the borderline (66%) of the examination.This result suggests that medical data collected from general Internet users is valuable in developing an automatic differential diagnostic system and that an online automatic diagnostic system can be developed that improves its own accuracy with user log data.

Consumer health information on the Web: The relationship of visual design and perceptions of credibility

AbstractConsumer health information has proliferated on the Web. However, because virtually anyone can publish this type of information on the Web, consumers cannot always rely on traditional credibility cues such as reputation of a journal. Instead, they must rely on a variety of cues, including visual presentation, to determine the veracity of information. This study is an examination of the relationship of people's visual design preferences to judgments of credibility of information on consumer health information sites. Subjects were asked to rate their preferences for visual designs of 31 health information sites after a very brief viewing. The sites were then reordered and subjects rated them according to the extent to which they thought the information on the sites was credible. Visual design judgments bore a statistically significant similarity to credibility ratings. Sites with known brands were also highly rated for both credibility and visual design. Theoretical implications are discussed.

The role of quality tools in assessing reliability of the Internet for health information

The Internet has made it possible for patients and their families to access vast quantities of information that previously would have been difficult for anyone but a physician or librarian to obtain. Health information websites, however, are recognised to differ widely in quality and reliability of their content. This has led to the development of various codes of conduct or quality rating tools to assess the quality of health websites. However, the validity and reliability of these quality tools and their applicability to different health websites also varies. In principle, rating tools should be available to consumers, require a limited number of elements to be assessed, be assessable in all elements, be readable and be able to gauge the readability and consistency of information provided from a patient's view point. This article reviews the literature on the trends of the Internet use for health and analyses various codes of conduct/ethics or ‘quality tools’ available to monitor the quality of health websites from a patient perspective.

Age-Sensitive Design of Online Health Information: Comparative Usability Study

BackgroundOlder adults’ health maintenance may be enhanced by having access to online health information. However, usability issues may prevent older adults from easily accessing such information. Prior research has shown that aging is associated with a unique pattern of cognitive changes, and knowledge of these changes may be used in the design of health websites for older adults.ObjectiveThe goal of the current study was to examine whether older adults use of a health information website was affected by an alternative information architecture and access interface (hierarchical versus tag-based).MethodsFifty younger adults (aged 18-23) and 50 older adults (aged 60-80) navigated a health information website, which was organized hierarchically or used tags/keywords, to find answers to health-related questions while their performance was tracked. We hypothesized that older adults would perform better in the tag-based health information website because it placed greater demands on abilities that remain intact with aging (verbal ability and vocabulary).ResultsThe pattern of age-related differences in computer use was consistent with prior research with older adults. We found that older adults had been using computers for less time (F 1,98= 10.6, P= .002) and used them less often (F 1,98= 11.3, P= .001) than younger adults. Also consistent with the cognitive aging literature, younger adults had greater spatial visualization and orientation abilities (F 1,98= 34.6, P< .001 and F 1,98= 6.8, P= .01) and a larger memory span (F 1,98= 5.7, P= .02) than older adults, but older adults had greater vocabulary (F 1,98= 11.4, P= .001). Older adults also took significantly more medications than younger adults (F 1,98= 57.7, P< .001). In the information search task, older adults performed worse than younger adults (F 1,96= 18.0, P< .001). However, there was a significant age × condition interaction indicating that while younger adults outperformed older adults in the hierarchical condition (F 1,96= 25.2, P< .001), there were no significant age-related differences in the tag-based condition, indicating that older adults performed as well as younger adults in this condition.ConclusionsAccess to online health information is increasing in popularity and can lead to a more informed health consumer. However, usability barriers may differentially affect older adults. The results of the current study suggest that the design of health information websites that take into account age-related changes in cognition can enhance older adults’ access to such information.

Does outcome feedback make you a better emergency physician? A systematic review and research framework proposal

The organization of emergency medical care limits the ability of emergency physicians to know the outcomes of most of their patients after the patients leave the emergency department. This lack of outcome feedback may hinder the practice of emergency medicine (EM) by preventing "calibration" of the decision tools of practitioners. We sought to determine what is currently known about outcome feedback in EM, including its incidence, impact and modifiers. We searched the following databases: PreMEDLINE, MEDLINE, EMBASE, CINAHL, CENTRAL, PsycINFO, DARE, Health Technology Assessment Database and AMED. We performed manual searches on abstract databases, reference lists, various health information and research websites, and nonindexed journals. Selection entailed a 2-step screening pro cess to exclude articles not pertaining to outcome feedback in EM. Our search yielded 1128 bibliographic records, from which screening identified 7 relevant reports: 5 surveys, 1 system level evaluation and 1 intervention trial. All studies were found to have "inadequate" or "unable to assess" reporting and study quality. Systems for outcome feedback to EM residents have been increasingly available since 1984, though they are perceived to be inadequate. Commonly used mechanisms for outcome feedback include automatic routing of discharge summaries, case conferences for admitted patients and telephone calls to patients or families for discharged patients. With respect to attending emergency physicians, no conclusions or clinical recommendations can be made given the level of available evidence. The potential importance of outcome feedback remains, at this time, underevaluated. We propose a research framework, and hypothesize that increasing outcome feedback would increase emergency physician diagnostic accuracy, therapeutic outcomes, clinical efficiency and job satisfaction. Future research in this area should include surveys and focus groups, as well as simulated or real-world intervention trials.

Up for sale: consumer medical information

PurposeThis paper aims to examine privacy breaches in personal health record information that expose consumers to unsolicited marketing.Design/methodology/approachExamples of: data theft by healthcare workers; sale of consumer health data by entities not covered by the Health Insurance Portability and Accountability Act (HIPAA); and piracy of health data through sophisticated internet targeted marketing.FindingsThis paper finds that HIPAA's strict safeguards to medical privacy are not extended to database companies that aggregate data for electronic medical records, a source of highly profitable information that is purchased by advertisers. Similar health information is obtained by marketers through consumer “health surveys” completed on web‐based health information sites or at community health screenings.Practical implicationsConsumer education is warranted to ensure awareness of privacy breaches and vigilance against loss of personal and protected health information to marketers.Originality/valueThe paper highlights the areas for protecting consumers via identifying loopholes in HIPAA, as well as pointing out consumer behavior that can lead to subtle, yet systematic exploitation of their health information for profit via marketing.

Use of and Satisfaction With Sources of Health Information Among Older Internet Users and Nonusers

Older adults generally have an increased need for health care information. Whereas some use the Internet to look for this information, others use more traditional sources. This study gathered data from older adults to determine their health information needs, the perceived usefulness of sources of health information, and if there are differences in perceptions and use of health information between Internet users and nonusers. We conducted 9 focus groups-4 groups of Internet users (n = 27) and 5 groups of non-Internet users (n = 26)-to determine reasons for seeking health information, satisfaction with information, and use of the Internet to fulfill information needs. Data from focus groups were supplemented with questionnaire data. Those who do not use the Internet were found to be just as satisfied with the health information they find as those who search for information online. We also found that nonusers are more likely to make health care decisions based upon information found offline than Internet users who have access to more information. Nonusers may find it quicker to look for information through traditional media sources and stay offline, thus limiting their information options. Strategies for encouraging Internet use and programs to teach effective searching skills are needed. Physicians could also direct older patients toward credible health information Web sites.

The “Big Three” Consumer Health Sites and Web Technology Trends: MedlinePlus®, Healthfinder®, and CAPHIS

The increasing application of the newest Web technologies to health information sites such as Revolution Health and IndivoHealth as well as patient-focused blogs and wikis brings greater patient participation into the traditionally static equation of health information-seeking on the Internet. Health-related Web sites are currently offering features that allow consumers to interact with each other and medical professionals, display and store their medical data, and obtain current biomedical research. What do all these new developments portend for those long-standing dependable Web sites such as MedlinePlus®? This article examines the history, current status, and potential for three sites, the National Library of Medicine's MedlinePlus, the Medical Library Association's Consumer and Patient Health Information Section's CAPHIS site, and Healthfinder®, in the context of the emerging importance of the newer social networking tools for consumer health information-seeking and decision making. The focus is on the inquiries produced at this transitional period of online health information. The purpose is to stimulate thought and debate.

Effects of Information and Communication Technology on Youth’s Health Knowledge

Information technology (IT) has produced a deep impact on human lives, and the most important aspect of its effect is on education and learning. This study was done for the purpose of evaluating the effectiveness of electronic health information on our Web site http://www.teen.hbi.ir in the promotion of health education and in increasing the capabilities of the students in the use of the Internet. This study was performed on the basis of the information obtained from the questionnaires on selected health issues from 649 students from 3 high schools. Information was collected in 2 steps (pretest and posttest). The t test and Leven's test were used in the statistical analysis of data. Results of the t test showed that educating students through health information Web sites has increased their knowledge by at least 14.5% on environmental health and 48.9% on nutrition and was statistically meaningful in all fields (P=.000) with the exception of mental health. The fact is that the use of IT has become a part of our society and is perhaps the most promising medium for achieving health promotion initiatives.

Web Portals and Patient Information-Seeking Behaviors

Web Portals and Patient Information-Seeking Behaviors

The Italian Horizon Scanning Project

Keywords Emergingtechnology .Healthtechnologyassessment .Horizonscanning .WarningsystemIntroductionDemographic changes, increased life expectancy and theaccelerated development of new health technologies have aconsiderable impact on National Health Systems (NHSs)worldwide [ 1].According to the Pharmaceutical Research and Manufac-turers of America (PhRMA) more than 2700 new moleculesfor 4600 indications are currently under development [ 2].Why an early assessment of emerging drugs?The often modest therapeutic value, the great uncertainty interms of level of innovation, and the high cost of newmedicines [ 3–5] suggest a pressing need for an earlyevaluation of emerging pharmaceuticals.Health Technology Assessment (HTA) is a form of policyresearch that studies the short- and long-term consequencesof introducing health technologies in a healthcare system interms of safety, clinical benefit, and social-economic aspects,thereby providing decision-makers with important informa-tion [ 6]. However, this kind of evaluation is carried out onlyafter the launch of new technologies, which prevents theimplementation of management strategies. Thus, methods foridentifying and timely assessing new technologies arenecessary to help decision-makers plan their appropriateuse and optimize resources [ 7, 8].On the basis of these considerations an early warningsystem for identification and assessment of emergingtechnologies could provide decision-makers with timelyinformation on the potential clinical impact and costeffectiveness of new health technologies.The Italian Horizon Scanning Project (IHSP) predictswhich new drugs are likely to have a significant impacton the Italian NHS, issuing periodical evaluations ofemerging medicines for which a European MarketingAuthorization (M.A.) is expected within 12 –36 months.The IHSP is a member of the EuroScan, an internationalcollaborative network of Early Warning Units estab-lished in 1999 for the identification and assessment ofemerging new technologies [ 9].How does IHSP work?The IHSP collects information on emerging medicines fromwebsites (pharmaceutical companies, financial analysiscompanies, international scientific societies, internationalregulatory authorities, health information websites, etc.),medical –scientific literature, pharmaceutical companies ’press releases, and other early warning systems. A scientificcommittee, a database team, and an evaluation team foremerging pharmaceuticals, with a technological infrastruc-ture for data collection, checking, monitoring, and analysis

Healthlink BC: British Columbians Have Trusted Health Information at Their Fingertips

HealthLink BC, a multitopic consumer health information Web site from British Columbia, Canada, is a single point of access to nonemergency health information about diseases and conditions, healthy lifestyles, medication, and local health services. This column discusses the site's audience, its features, and how to navigate and search the site.

Online Trust and Health Information Websites

Health care websites are important to people managing their health. But the quality of the information on health care websites varies, so it’s hard for users to decide whether to trust their information. This study develops and tests a model of the factors influencing users’ initial trust of a health care website. The factors are perceived credibility, risk, and ease of use. A survey instrument was developed to test the model with 176 participants who interacted with a health care website. It had strong statistical reliability and validity, and the model showed a statistically strong fit to the data. Users’ website trust was significantly explained by users’ perceptions of website credibility, ease of use, and risk. Ease of use directly predicted trust, and affected trust indirectly through credibility. Credibility was a direct predictor of trust and an indirect predictor of trust through risk. Variance explained by the model was high, 0.73.

Use of Urban Adolescent Natural Language to Access Sexual Health Information and Education

Sexual health information could be more accessible to urban adolescents. Many of the sexual health information Web sites are indexed using medical terms instead of slang terms that are typically used by teenagers. Many Americans have poor health literacy; sexually transmitted diseases, including HIV/AIDS, are affecting more and more young people. Actively indexing and mapping natural language terms to the more commonly used terms, by using a database, might enhance access to sexual health information and education. With easier access to this information, young people can learn more and protect themselves.

A Guide to Safe Use of Pain Medicine for Consumers

Editor's Note: The following bulletin was published by the Food and Drug Administration (FDA) and posted on its Consumer Health Information Web site at http://www.fda.gov/consumer/updates/painmeds022309.html on February 23, 2009. We present it here because it is important for clinicians to know what their patients are being told by other authoritative sources.

Health literacy and patient information: Developing the methodology for a national evidence-based health website

Objective To define evidence-based health information and the conceptual framework and methodology of Germany’s national health information website. Methods Description of the political and methodological processes in the development of the website Gesundheitsinformation.de/Informed Health Online developed by the Institute of Quality and Efficiency in Health Care (IQWiG). Results Autonomy, empowerment and health literacy were useful theoretical concepts to guide the definition of evidence-based health information and the objectives and methodologies used for developing this website. These choices had direct practical consequences for the patient information. Conclusion Evidence-based patient information involves the use of evidence and systematic methodologies in several facets of information provision. These include a process of information development that minimises bias, evidence as the information basis for the content, and the use of evidence-based communication techniques. To be empowering and support patient autonomy, information should be patient-centred and non-directive. Practice implications Health websites are communication interventions which can have very different objectives and methods. A conceptual framework can help guide these choices and provide a basis for subsequent evaluation.

Philip Morris's Health Information Web Site Appears Responsible but Undermines Public Health

Many people may search for information about tobacco use, the largest cause of preventable mortality in the United States, on the Internet. In 1999, Philip Morris U.S.A. (PM), the country's biggest cigarette manufacturer, posted a Web site and launched a campaign to encourage people to obtain information about tobacco and health issues there. The company asserted that its goal was to deliver the messages of the public health community about tobacco. However, internal tobacco company documents reveal that the site was a public relations effort intended to help the company avoid punishment and regulation. Examination of the language on the Web site reveals many contradictions and omissions that may undermine public health messages. Among these are vague and confusing information about addiction, tar, and nicotine, a lack of motivators to quit smoking, and silence about tobacco-related mortality. By appearing to join with public health organizations in disseminating "responsible" messages about tobacco, PM may improve its image, thus facilitating its ability to continue to sell its lethal products. Public health nurses should be prepared to examine health information on the Internet for subtle biases, to counter PM's specific language about smoking to patients, and to challenge PM's larger corporate goals.

“Usability + usefulness = trust”: an exploratory study of Australian health web sites

PurposeThe aim is to explore users' reactions to health information web sites from the perspective of trust, retrieval of relevant information and ease‐of‐use, and to establish the link between perceived quality, trust, and usability.Design/methodology/approachAn analysis of three Australian health web sites was undertaken. A usability test was conducted on those three web sites resulting in 207 completed user evaluations. The evaluations included both quantitative and qualitative data.FindingsThe three investigated health information web sites do not meet the needs of health consumers. More details such as how information is selected to engender greater trust need to be provided. The retrieval of relevant information could be improved through the implementation of functionality such as spell checking and information differentiation. Finally, ensuring web sites are easy to use contributes to the level of trust users have in a web site.Research limitations/implicationsThis was a relatively small study investigating only three generic Australian health web sites, the results however suggest that a larger study looking at other health web sites is needed.Practical implicationsFor government agencies developing health information web sites more attention needs to be paid to the design of these web sites if users are to be encouraged to use the web site and return. The research suggests that effective health information web sites must be perceived to be of reliable quality, be trustworthy, have some level of intelligence to assist in the retrieval of relevant information, and be easy to use.Originality/valueAlthough there is much research relating to the relationship between web site design and trust for e‐commerce transactional web sites this work has not been undertaken for web sites designed for information retrieval, in particular little work has been done of health information web sites. This paper fills in some of the gaps.

Perceived helpfulness of websites for mental health information

Despite the high risk of developing a mental disorder during adolescence, many young people fail to receive appropriate treatment from mental health professionals. Recent studies have found certain mental health information websites have improved mental health literacy and reduced symptoms of depression. However, studies exploring young people's perceptions of such resources still remain scarce. The current paper compared young people's preference for a website with self-help books and two face-to-face services-counselling and mental health services. The factors associated with believing in the perceived helpfulness of each intervention were also explored. A national telephone survey was carried out with 3,746 people aged 12-25 years and 2005 co-resident parents. Perceived helpfulness of each intervention was assessed in relation to four vignettes (depression, social phobia, psychosis and depression with alcohol misuse). Approximately 71% of respondents rated websites and books as likely to be helpful, which was less than for counselling, but more than for mental health services. Predictors of rating a website as likely to be helpful were older age (18-25 years), belief in seeking help, less social distance from peers like the one in the vignette, and being presented with the vignettes depicting either social phobia or depression with alcohol misuse. Predictors of rating a book as helpful included belief in seeking help, awareness of the national depression initiative beyondblue, less social distance, being presented with the social phobia vignette, and the belief that the person in the vignette is 'weak not sick'. Most young people are open to the idea of accessing mental health information online, especially for disorders that are often perceived as behavioural problems. These young people also believe in help-seeking in general and are more willing to associate with peers who have mental health problems.

Ethical Challenges of Telemedicine and Telehealth

As healthcare institutions expand and vertically integrate, healthcare delivery is less constrained by geography, nationality, or even by institutional boundaries. As part of this trend, some aspects of the healthcare process are shifted from medical centers back into the home and communities. Telehealth applications intended for health promotion, social services, and other activities—for the healthy as well as for the ill—provide services outside clinical settings in homes, schools, libraries, and other governmental and community sites. Such developments include health information web sites, on-line support groups, automated telephone counseling, interactive health promotion programs, and electronic mail exchanges. Concomitant with these developments is the growth of consumer health informatics, in which individuals seeking medical care or information are able to find various health information resources that take advantage of new information technologies.