The quality of online health information for consumers has been a critical issue that concerns all stakeholders in healthcare. To gain an understanding of how quality is evaluated, this systematic review examined 165 articles in which researchers evaluated the quality of consumeroriented health information on the web against predefined criteria. It was found that studies typically evaluated quality in relation to the substance and formality of content, as well as to the design of technological platforms. Attention to design, particularly interactivity, privacy, and social and cultural appropriateness is on the rise, which suggests the permeation of a user-centered perspective into the evaluation of health information systems, and a growing recognition of the need to study these systems from a social-technical perspective. Researchers used many preexisting instruments to facilitate evaluation of the formality of content; however, only a few were used in multiple studies, and their validity was questioned. The quality of content (i.e., accuracy and completeness) was always evaluated using proprietary instruments constructed based on medical guidelines or textbooks. The evaluation results revealed that the quality of health information varied across medical domains and across websites, and that the overall quality remained problematic. Future research is needed to examine the quality of user-generated content and to explore opportunities offered by emerging new media that can facilitate the consumer evaluation of health information.
IntroductionThe web is now the single largest source of health information for consumers. However, unlike traditional media, it is unregulated territory. Anyone with basic web programming skills can quickly launch a serviceable website. Thus, while embracing the enhanced accessibility to health information, almost all parties involved in healthcare have expressed concerns about the quality of health information online, despite few cases of harm having been documented and reported in the literature (Crocco, Villasis-Keever, & Jadad, 2002). Nevertheless, due to the potential detrimental consequences that poor-quality health information could cause, attention to the quality issue has not subsided. In past decades, numerous reviews synthesizing the literature on this subject have been published. Among them, Jadad and Gagliardi (1998) and Gagliardi and Jadad (2002) focused on identifying quality-rating instruments that were used to produce awards or seals of approval for websites; Bernstam, Shelton, Walji, and Meric-Bernstam (2005) focused on instruments that could be used by consumers; whereas Kim, Eng, Deering, and Maxfield (1999) surveyed criteria proposed to evaluate health-related websites. A commonality of these reviews is that they included academic publications, but mainly emphasized instruments or criteria that could be easily accessed through the open web. As a result, they shed limited light on how quality was defined and evaluated in evidence-based research publications. Eysenbach...