T HE INTERNET HAS BECOME AN IMportant mass medium for consumers seeking health information and health care services online.1 A recent concern and public health issue has been the quality of health information on the World Wide Web. However, the scale of the problem and the "epidemiology" (distribution and determinants) of poor health information on the Web are still unclear, as is their impact on public health and the question of whether poor health information on the Web is a problem at all. 2 Many studies have been conducted to describe, critically appraise, and analyze consumer health information on the Web. These typically report proportions of inaccurate or imperfect information as estimates of the prevalence of flawed information or the risk of encountering misinformation on the Web.However, to date no systematic and comprehensive synthesis of the methodology and evidence has been attempted. Two previous systematic reviews focused on compiling quality criteria and rating instruments, but did not synthesize evaluation results. Jadad and Gagliari 3 reviewed nonresearch-based rating systems (eg, criAuthor Affiliations: Unit for Cybermedicine and EHealth, Department of Clinical Social Medicine, University of Heidelberg, Heidelberg, Germany (Dr Eysenbach); Health Services Research Unit, London School of Hygiene and Tropical Medicine, London, England (Dr Powell); Department of Medical Epidemiology, Biometry and Informatics, University of Halle-Wittenberg, Halle/Saale, Germany (Dr Kuss); and Global Health Network Group, Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pa (Ms Sa). Dr Eysenbach is now with the Centre for Global eHealth Innovation, Toronto General Hospital, Toronto, Ontario. Corresponding Author and Reprints: Gunther Eysenbach, MD, Centre for Global eHealth Innovation, Toronto General Hospital, 190 Elizabeth St, Toronto, Ontario,. ContextThe quality of consumer health information on the World Wide Web is an important issue for medicine, but to date no systematic and comprehensive synthesis of the methods and evidence has been performed. ObjectivesTo establish a methodological framework on how quality on the Web is evaluated in practice, to determine the heterogeneity of the results and conclusions, and to compare the methodological rigor of these studies, to determine to what extent the conclusions depend on the methodology used, and to suggest future directions for research. . We also conducted hand searches, general Internet searches, and a personal bibliographic database search. Data Sources We searched MEDLINE and PREMEDLINE (1966 throughSeptem Study SelectionWe included published and unpublished empirical studies in any language in which investigators searched the Web systematically for specific health information, evaluated the quality of Web sites or pages, and reported quantitative results. We screened 7830 citations and retrieved 170 potentially eligible full articles. A total of 79 distinct studies met the inclusion criteria, evaluating 5941 health Web sites and 1329 Web...

Objective To compile and evaluate the evidence on the effects on health and social outcomes of computer based peer to peer communities and electronic self support groups, used by people to discuss health related issues remotely.

Background As Internet use grows, health interventions are increasingly being delivered online. Pioneering researchers are using the networking potential of the Internet, and several of them have evaluated these interventions.Objective The objective was to review the reasons why health interventions have been delivered on the Internet and to reflect on the work of the pioneers in this field in order to inform future research.Methods We conducted a qualitative systematic review of peer-reviewed evaluations of health interventions delivered to a known client/patient group using networked features of the Internet. Papers were reviewed for the reasons given for using the Internet, and these reasons were categorized.Results We included studies evaluating 28 interventions plus 9 interventions that were evaluated in pilot studies. The interventions were aimed at a range of health conditions. Reasons for Internet delivery included low cost and resource implications due to the nature of the technology; reducing cost and increasing convenience for users; reduction of health service costs; overcoming isolation of users; the need for timely information; stigma reduction; and increased user and supplier control of the intervention. A small number of studies gave the existence of Internet interventions as the only reason for undertaking an evaluation of this mode of delivery.Conclusions One must remain alert for the unintended effects of Internet delivery of health interventions due to the potential for reinforcing the problems that the intervention was designed to help. Internet delivery overcomes isolation of time, mobility, and geography, but it may not be a substitute for face-to-face contact. Future evaluations need to incorporate the evaluation of cost, not only to the health service but also to users and their social networks. When researchers report the outcomes of Internet-delivered health care interventions, it is important that they clearly state why they chose to use the Internet, preferably backing up their decision with theoretical models and exploratory work. Evaluation of the effectiveness of a health care intervention delivered by the Internet needs to include comparison with more traditional modes of delivery to answer the following question: What are the added benefits or disadvantages of Internet use that are particular to this mode of delivery?

BackgroundMost households in the United Kingdom have Internet access, and health-related Internet use is increasing. The National Health Service (NHS) Direct website is the major UK provider of online health information.ObjectiveOur objective was to identify the characteristics and motivations of online health information seekers accessing the NHS Direct website, and to examine the benefits and challenges of the health Internet.Methods We undertook an online questionnaire survey, offered to users of the NHS Direct website. A subsample of survey respondents participated in in-depth, semistructured, qualitative interviews by telephone or instant messaging/email. Questionnaire results were analyzed using chi-square statistics. Thematic coding with constant comparison was used for interview transcript analysis.ResultsIn total 792 respondents completed some or all of the survey: 71.2% (534/750 with data available) were aged under 45 years, 67.4% (511/758) were female, and 37.7% (286/759) had university-level qualifications. They sought information for themselves (545/781, 69.8%), someone else (172/781, 22.0%), or both (64/781, 8.2%). Women were more likely than men to seek help for someone else or both themselves and someone else (168/509 vs 61/242, χ2 2 = 6.35, P = .04). Prior consultation with a health professional was reported by 44.9% (346/770), although this was less common in younger age groups (<36 years) (χ2 1 = 24.22, P < .001). Participants aged 16 to 75 years (n = 26, 20 female, 6 male) were recruited for interview by telephone (n = 23) and instant messaging/email (n = 3). Four major interview themes were identified: motivations for seeking help online; benefits of seeking help in this way and some of the challenges faced; strategies employed in navigating online health information provision and determining what information to use and to trust; and specific comments regarding the NHS Direct website service. Within the motivation category, four concepts emerged: the desire for reassurance; the desire for a second opinion to challenge other information; the desire for greater understanding to supplement other information; and perceived external barriers to accessing information through traditional sources. The benefits clustered around three theme areas: convenience, coverage, and anonymity. Various challenges were discussed but no prominent theme emerged. Navigating online health information and determining what to trust was regarded as a “common sense” activity, and brand recognition was important. Specific comments about NHS Direct included the perception that the online service was integrated with traditional service provision.ConclusionsThis study supports a model of evolutionary rather than revolutionary change in online health information use. Given increasing resource constraints, the health care community needs to seek ways of promoting efficient and appropriate health service use, and should aim to harness the potential benefits of the Internet, informed by an understanding of how and why people go ...