How do consumers search for and appraise health information on the world wide web? Qualitative study using focus groups, usability tests, and in-depth interviews

doi:10.1136/bmj.324.7337.573

BMJ 2002;324:573-577 ( 9 March )

Papers

How do consumers search for and appraise health information on the world wide web? Qualitative study using focus groups, usability tests, and in-depth interviews

Gunther Eysenbach, senior researcher, Christian Köhler, researcher.

Unit for Cybermedicine and eHealth, Department of Clinical Social Medicine, University of Heidelberg, Bergheimer Str 58, 69115 Heidelberg, Germany

Correspondence to: G Eysenbach ey{at}yi.com

Objectives: To describe techniques for retrieval and appraisalused by consumers when they search for health information on theinternet.
Design: Qualitative study using focus groups, naturalisticobservation of consumers searching the world wide web in a usabilitylaboratory, and in-depthinterviews.
Participants: A total of 21 users of the internet participatedin three focus group sessions. 17 participants were given a seriesof health questions and observed in a usability laboratory settingwhile retrieving health information from the web; this was followedby in-depthinterviews.
Setting: Heidelberg,Germany.
Results: Although their search technique was oftensuboptimal, internet users successfully found health informationto answer questions in an average of 5 minutes 42 seconds (median4 minutes 18 seconds) per question. Participants in focus groupssaid that when assessing the credibility of a website they primarilylooked for the source, a professional design, a scientific orofficial touch, language, and ease of use. However, in the observationalstudy, no participants checked any "about us" sections of websites,disclaimers, or disclosure statements. In the post-search interviews,it emerged that very few participants had noticed and rememberedwhich websites they had retrieved informationfrom.
Conclusions: Further observational studies are needed todesign and evaluate educational and technological innovationsfor guiding consumers to high quality health information on theweb.

What is already known on this topic
Little is known about how consumers retrieve and assess the quality of health information on the internet

Qualitative data are needed to design educational and technological innovations to guide consumers to high quality health information

What this study adds
Users of the internet explore only the first few links on general search engines when seeking health information

Consumers say that when assessing the credibility of a site they primarily look for the source, a professional design, and a variety of other criteria

In practice, internet users do not check the "about us" sections of websites, try to find out who authors or owners of the site are, or read disclaimers or disclosure statements

Very few internet users later remember from which websites they retrieved information or who stood behind the sites

© BMJ 2002

CiteULike

Complore

Connotea

Del.icio.us Add to Digg

Digg

StumbleUpon Add to Technorati

Technorati What's this?

Relevant Articles

Suicide and the internet: Lucy Biddle, Jenny Donovan, Keith Hawton, Navneet Kapur, and David Gunnell
BMJ 2008 336: 800-802. [Extract] [Full Text] [PDF]

Googling your treatment for analgesia in labour: James Holding and Michael V Holmes
BMJ 2006 332: 795. [Extract] [Full Text]

Websites on screening for breast cancer: "Infodemiology" studies have surely had their day: Gunther Eysenbach
BMJ 2004 328: 769. [Extract] [Full Text]

Internet users say and do different things about quality
BMJ 2002 324: 0. [Full Text]

The invention of talk
BMJ 2002 324: 0. [Full Text] [PDF]

The quality of health information on the internet: Gretchen P Purcell, Petra Wilson, and Tony Delamothe
BMJ 2002 324: 557-558. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

Mager, A. (2009). Mediated health: sociotechnical practices of providing and using online health information. New Media Society 11: 1123-1142 [Abstract]
Lowe, P., Powell, J., Griffiths, F., Thorogood, M., Locock, L. (2009). "Making it All Normal": The Role of the Internet in Problematic Pregnancy. Qual Health Res 19: 1476-1484 [Abstract]
Barber, M. N., Staples, M., Osborne, R. H., Clerehan, R., Elder, C., Buchbinder, R. (2009). Up to a quarter of the Australian population may have suboptimal health literacy depending upon the measurement tool: results from a population-based survey. HEALTH PROMOT INT 24: 252-261 [Abstract] [Full text]
STINSON, J. N., TUCKER, L., HUBER, A., HARRIS, H., LIN, C., COHEN, L., GILL, N., LUKAS-BRETZLER, J., PROULX, L., PROWTEN, D. (2009). Surfing for Juvenile Idiopathic Arthritis: Perspectives on Quality and Content of Information on the Internet. The Journal of Rheumatology 36: 1755-1762 [Abstract] [Full text]
Laurent, M. R., Vickers, T. J. (2009). Seeking Health Information Online: Does Wikipedia Matter?. J. Am. Med. Inform. Assoc. 16: 471-479 [Abstract] [Full text]
Newman, M. A., Ziebland, S., Barker, K. L. (2009). Patients' views of a multimedia resource featuring experiences of rheumatoid arthritis: pilot evaluation of www.healthtalkonline.org. Health Informatics Journal 15: 147-159 [Abstract]
Whelan, A. M., Jurgens, T. M, Bowles, S. K, Doyle, H. (2009). Efficacy of Natural Health Products in Treating Osteoporosis: What is the Quality of Internet Patient Advice?. The Annals of Pharmacotherapy 43: 899-907 [Abstract] [Full text]
Mackert, M., Love, B., Whitten, P. (2009). Patient education on mobile devices: an e-health intervention for low health literate audiences. Journal of Information Science 35: 82-93 [Abstract]
Clauson, K. A, Polen, H. H, Boulos, M. N K., Dzenowagis, J. H (2008). Scope, Completeness, and Accuracy of Drug Information in Wikipedia. The Annals of Pharmacotherapy 42: 1814-1821 [Abstract] [Full text]
Bath, P. A. (2008). Health informatics: current issues and challenges. Journal of Information Science 34: 501-518 [Abstract]
Akram, G, Thomson, A H, Boyter, A C, Morton, M J S (2008). Characterisation and evaluation of UK websites on attention deficit hyperactivity disorder. Arch. Dis. Child. 93: 695-700 [Abstract] [Full text]
Keselman, A., Browne, A. C., Kaufman, D. R. (2008). Consumer Health Information Seeking as Hypothesis Testing. J. Am. Med. Inform. Assoc. 15: 484-495 [Abstract] [Full text]
Lintonen, T. P., Konu, A. I., Seedhouse, D. (2008). Information technology in health promotion. Health Educ Res 23: 560-566 [Abstract] [Full text]
Crutzen, R., de Nooijer, J., Brouwer, W., Oenema, A., Brug, J., de Vries, N. K. (2008). Internet-delivered interventions aimed at adolescents: a Delphi study on dissemination and exposure. Health Educ Res 23: 427-439 [Abstract] [Full text]
Biddle, L., Donovan, J., Hawton, K., Kapur, N., Gunnell, D. (2008). Suicide and the internet. BMJ 336: 800-802 [Full text]
Datta, A. K, Selman, T. J, Kwok, T., Tang, T., Khan, K. S (2008). Quality of information accompanying on-line marketing of home diagnostic tests. JRSM 101: 34-38 [Abstract] [Full text]
Drummond, G. B., Dozier, M. F. (2007). Just give me the facts. Br J Anaesth 99: 608-610 [Full text]
Harland, J., Bath, P. (2007). Assessing the quality of websites providing information on multiple sclerosis: evaluating tools and comparing sites. Health Informatics Journal 13: 207-221 [Abstract]
Toms, E. G., Latter, C. (2007). How consumers search for health information. Health Informatics Journal 13: 223-235 [Abstract]
Caron, S., Berton, J., Beydon, L. (2007). Quality of anaesthesia-related information accessed via Internet searches. Br J Anaesth 99: 195-201 [Abstract] [Full text]
Flanagin, A. J., Metzger, M. J. (2007). The role of site features, user attributes, and information verification behaviors on the perceived credibility of web-based information. New Media Society 9: 319-342 [Abstract]
Suter, E., Verhoef, M. J., Bockmuehl, C., Forest, N., Bobey, M., Armitage, G. D. (2007). Inquiring minds: Women's approaches to evaluating complementary and alternative therapies for menopausal symptoms. cfp 53: 84-90 [Abstract] [Full text]
Marshall, L. A., Williams, D. (2006). Health information: does quality count for the consumer?: How consumers evaluate the quality of health information materials across a variety of media. Journal of Librarianship and Information Science 38: 141-156 [Abstract]
Carlson, B. A., Neal, D., Magwood, G., Jenkins, C., King, M. G., Hossler, C. L. (2006). A Community-Based Participatory Health Information Needs Assessment to Help Eliminate Diabetes Information Disparities. Health Promot Pract 7: 213S-222S [Abstract]
Holding, J., Holmes, M. V (2006). Googling your treatment for analgesia in labour.. BMJ 332: 795-795 [Full text]
Kivits, J. (2006). Informed Patients and the Internet: A Mediated Context for Consultations with Health Professionals. J Health Psychol 11: 269-282 [Abstract]
Schwartz, K. L., Roe, T., Northrup, J., Meza, J., Seifeldin, R., Neale, A. V. (2006). Family Medicine Patients' Use of the Internet for Health Information: A MetroNet Study. J Am Board Fam Med 19: 39-45 [Abstract] [Full text]
Zeng, Q. T., Crowell, J., Plovnick, R. M., Kim, E., Ngo, L., Dibble, E. (2006). Assisting Consumer Health Information Retrieval with Query Recommendations. J. Am. Med. Inform. Assoc. 13: 80-90 [Abstract] [Full text]
Ansani, N. T., Vogt, M., Henderson, B. A. F., Mckaveney, T. P., Weber, R. J., Smith, R. B., Burda, M., Kwoh, C. K., Osial, T. A., Starz, T. (2005). Quality of arthritis information on the Internet. Am J Health Syst Pharm 62: 1184-1189 [Abstract] [Full text]
Purvis, J. M., Alexander, A. H., Einhorn, T. A., Griffin, L. Y. (2005). Symposium Evaluating the Flood of Orthopaedic Media and Marketing Information. JBJS 87: 1392-1398 [Full text]
McCray, A. T. (2005). Promoting Health Literacy. J. Am. Med. Inform. Assoc. 12: 152-163 [Abstract] [Full text]
Maloney, S., Ilic, D., Green, S. (2005). Accessibility, nature and quality of health information on the Internet: a survey on osteoarthritis. Rheumatology (Oxford) 44: 382-385 [Abstract] [Full text]
Chang, B. L., Bakken, S., Brown, S. S., Houston, T. K., Kreps, G. L., Kukafka, R., Safran, C., Stavri, P. Z. (2004). Bridging the Digital Divide: Reaching Vulnerable Populations. J. Am. Med. Inform. Assoc. 11: 448-457 [Abstract] [Full text]
SPALLEK, H. (2004). A resource guide for practice development through technology. Journal of the American Dental Association 135: 38S-44S [Full text]
Charnock, D., Shepperd, S. (2004). Learning to DISCERN online: applying an appraisal tool to health websites in a workshop setting. Health Educ Res 19: 440-446 [Abstract] [Full text]
Eysenbach, G., Kohler, C. (2004). Health-Related Searches on the Internet. JAMA 291: 2946-2946 [Full text]
Anderson, J. G. (2004). Consumers of e-Health: Patterns of Use and Barriers. Social Science Computer Review 22: 242-248 [Abstract]
Eysenbach, G. (2004). Websites on screening for breast cancer: "Infodemiology" studies have surely had their day. BMJ 328: 769-769 [Full text]
Eysenbach, G. (2003). The Impact of the Internet on Cancer Outcomes. CA Cancer J Clin 53: 356-371 [Abstract] [Full text]
de Lusignan, S. (2003). The National Health Service and the internet. JRSM 96: 490-493 [Full text]
Slater, M. D., Zimmerman, D. E. (2003). Descriptions of Web Sites in Search Listings: A Potential Obstacle to Informed Choice of Health Information. AJPH 93: 1281-1282 [Full text]
Christensen, H., Griffiths, K. (2003). The internet and mental health practice. Evid. Based Ment. Health 6: 66-69 [Full text]
Murray, E., Lo, B., Pollack, L., Donelan, K., Catania, J., White, M., Zapert, K., Turner, R. (2003). The Impact of Health Information on the Internet on the Physician-Patient Relationship: Patient Perceptions. Arch Intern Med 163: 1727-1734 [Abstract] [Full text]
Ilic, D., Bessell, T.L., Silagy, C.A., Green, S. (2003). Specialized medical search-engines are no better than general search-engines in sourcing consumer information about androgen deficiency. Hum Reprod 18: 557-561 [Abstract] [Full text]
Powell, J A, Darvell, M, Gray, J A M (2003). The doctor, the patient and the world-wide web: how the internet is changing healthcare. JRSM 96: 74-76 [Full text]
Bauerle Bass, S. (2003). How will Internet Use Affect the Patient? A Review of Computer Network and Closed Internet-based System Studies and the Implications in Understanding How the Use of the Internet Affects Patient Populations. J Health Psychol 8: 25-38 [Abstract]
Slater, M. D., Zimmerman, D. E. (2002). Characteristics of Health-Related Web Sites Identified by Common Internet Portals. JAMA 288: 316-317 [Full text]
Eysenbach, G., Powell, J., Kuss, O., Sa, E.-R. (2002). Empirical Studies Assessing the Quality of Health Information for Consumers on the World Wide Web: A Systematic Review. JAMA 287: 2691-2700 [Abstract] [Full text]
Purcell, G. P, Wilson, P., Delamothe, T. (2002). The quality of health information on the internet. BMJ 324: 557-558 [Full text]

Rapid Responses:

Read all Rapid Responses

Focus on quality of website information neglects issue of internet usage: John R Petrie, et al.
bmj.com, 12 Apr 2002 [Full text]
A more democratic approach to information: Robert C Hsiung
bmj.com, 30 May 2002 [Full text]
Re: A more democratic approach to information: Gunther Eysenbach
bmj.com, 1 Jun 2002 [Full text]
Re: A more democratic approach to information: Robert C Hsiung
bmj.com, 11 Jun 2002 [Full text]
starting from basics: Vinod Scaria
bmj.com, 26 Jun 2002 [Full text]
An Expertise Not Utilized: Elizabeth M. La Rue
bmj.com, 31 Jan 2003 [Full text]