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Informing, advising, or persuading? An assessment of bone mineral density testing information from consumer health websites

Published online by Cambridge University Press:  28 May 2004

Carolyn J. Green ,
Arminée Kazanjian  and
Diane Helmer
Carolyn J. Green
Affiliation:
BC Office of Health Technology Assessment University of British Columbia
Arminée Kazanjian
Affiliation:
BC Office of Health Technology Assessment University of British Columbia
Diane Helmer
Affiliation:
BC Office of Health Technology Assessment University of British Columbia
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Abstract

Greater access to web-based information on health-care interventions might result in greater participation by patients in care and self-care decisions, but only improve health outcomes if the indicated actions produce the intended benefits. Unbiased research on benefits and harms of health information can provide a basis for evidence-based patient information systems.

Objectives: To evaluate the quality of the information content on bone-mineral density (BMD) testing posted on consumer health websites (CHWS).

Methods: Five popular engines (Yahoo, MSN, AOL, Lycos, and Go.com) were used to search for patient information on bone densitometry. The fifteen websites that supplied relevant content and were identified by three of the five search engines were selected in order of popularity of the search engine and primacy of placement. Six BMD reports from health technology assessment (HTA) organizations were used as a standard of scientific quality. These were identified from the HTA Database at York University United Kingdom and published between 1996 and 2001. Content was extracted from both document types, and these sets were compared independently by two reviewers.

Results: The majority of CHWS identified by popular search engines do not disclose the limited capacity of BMD to discriminate between low-risk individuals and those who will suffer future fractures. CHWS generally present BMD testing as quick, painless, noninvasive, and as being recommended, based on risk factors that are widespread among the general public. BMD testing information is prominently paired on CHWS sites with information on osteoporosis, with an emphasis on “silent disease” and the devastating consequences of advanced disease. Sponsors of CHWS sites are frequently either providers of BMD testing or companion drugs, and consequently in a position of conflict of interest with regard to decisions to undergo BMD testing. HTA organizations have no documented conflict of interest, nor do they invoke emotional arguments. Their approach is to emphasize the effects of testing on populations, on the basis of referenced research findings.

Conclusions: Content analysis demonstrates the omissions and divergence of information on BMD testing available to consumers on the Internet, as compared with HTA reports. The content of HTA reports has undergone rigorous systematic and peer review; therefore, their findings may be useful to consumers. This information is not generally accessible to patients using the most popular Internet search engines. Inaccurate and incomplete information may cause harm by deflecting patients from optimal decisions.

Keywords

Content analysisConsumer health informationBone densitometry
Type
Research Article
Information
International Journal of Technology Assessment in Health Care , Volume 20 , Issue 2 , April 2004 , pp. 156 - 166
Copyright
© 2004 Cambridge University Press

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References

Brown JP, Josse RG, 2002; for the Scientific Advisory Council of the Osteoporosis Society of Canada. 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. CMAJ. 167 (Suppl): S1– S34. Available at: www.osteoporosis.ca. Accessed: July 23, 2003.Google Scholar
Chestnut CH. 2001; Osteoporosis, the underdiagnosed disease. JAMA. 286: 2865– 2866.Google Scholar
Commercial Alert. 2001. Commercial alert files complaint against search engines for deceptive ads. News release: Monday, July 16, Available at: www.commercialalert.org. Accessed: December 31, 2002.
Craigie M, Loader B, Burrows R, Muncer S. 2002; Reliability of health information on the Internet: An examination of experts' ratings. J Med Internet Res. 4: e2.Google Scholar
Diaz JA, Griffith RA, Ng JJ, Reinert SE, Friedmann PD, Moulton AW. 2002; Patients' use of the Internet for medical information. J Gen Intern Med. 17: 180– 185.Google Scholar
Eaton L. 2002; A third of Europeans and almost half of Americans use internet for health information. BMJ. 325: 989b.Google Scholar
Eiskjaer S, Ostgard SE, Jakobsen BW, Jensen J, Lucht U. 1992; Years of potential life lost after hip fracture among postmenopausal women. Acta Orthop Scand. 63: 293– 296.Google Scholar
Espallargues M, Estrada MD, Sola M, Sampietro-Colom L. 1999: Guidelines for the indication of bone densitometry in the assessment of fracture risk. Barcelona: Catalan Agency for Health Technology Assessment; 20.
Evidence-Based Medicine Working Group, Guyatt GH, Sackett DL, Sinclair JC, Hayward R, Cook DJ, Cook RJ. 1995; Users' guides to the medical literature: IX. A method for grading health care recommendations. JAMA. 274: 1800– 1804.Google Scholar
Eysenbach G, et al. Collaboration for Internet rating, certification, labeling and evaluation of health information (Med- CIRCLE). 11th World-Wide-Web Conference WWW2002, Hawaii, May 7-11, 2002 URL: http://www2002.org/CDROM/alternate/T4/.
Fitt NS, Mitchell SL, Cranney A, Gulenchyn K, Huang M, Tugwell P. 2001; Influence of bone densitometry results on the treatment of osteoporosis. CMAJ. 164: 777– 781.Google Scholar
Gagliardi A, Jadad AR. 2002; Examination of instruments used to rate quality of health information on the internet: Chronicle of a voyage with an unclear destination. BMJ. 324: 569– 573.Google Scholar
Green CJ, Bassett K, Foerster V, Kazanjian A. 1997. Bone mineral density testing: Does the evidence support its selective use in well women? Vancouver: British Columbia Office of Health Technology Assessment, The University of British Columbia;
Griffiths KM, Christensen H. 2000; Quality of web based information on treatment of depression: Cross sectional survey. BMJ. 321: 1511– 1515.Google Scholar
Hailey D, Sampietro-Colom l, Marshall D, et al. 1996: The INAHTA project on the effectiveness of bone density measurement and associated treatments for prevention of fractures: Statement of findings. Edmonton: Alberta Heritage Foundation for Medical Research; 34.
Homik J, Hailey D. 1999: Selective testing with bone density measurement. Alberta, Canada: Alberta Heritage Foundation for Medical Research (AHFMR); HTB4.
Impicciatore P, Pandolfini C, Casella N, Bonati M. 1997; Reliability of health information for the public on the world wide web: Systematic survey of advice on managing fever in children at home.BMJ. 314: 1875.Google Scholar
Jadad A, Gagliardi A. 1998; Rating health information on the Internet: Navigating to knowledge or to Babel? JAMA. 279: 611– 614.Google Scholar
Jadad AR, Cook DJ, Browman GP. 1997; A guide to interpreting discordant systematic reviews. CMAJ. 156: 1411– 1416.Google Scholar
Kazanjian A, Green CJ, Bassett K, Brunger F. 1999; Bone mineral density testing in social context. Int J Technol Assess Health Care. 15: 679– 685.Google Scholar
Martin S. 2000; Nearly a quarter of Canadians head online for health info. CMAJ. 163: 1328a.Google Scholar
Moynihan R, Heath I, Henry D, Gotzsche PC. 2002; Selling sickness: The pharmaceutical industry and disease mongering. Commentary: Medicalisation of risk factors. BMJ. 324: 886– 891.Google Scholar
Pandey SK Hart JJ, Tiwary S. 2003; Women's health and the internet: Understanding emerging trends and implications. Soc Sci Med. 56: 179– 191.Google Scholar
Pandolfini C, Bonati M. 2002; Follow up of quality of public oriented health information on the world wide web: Systematic re-evaluation. BMJ. 324: 582– 583.Google Scholar
Peto R, Collins R, Gray R. 1995; Large-scale randomized evidence: Large, simple trials and overviews of trials. J Clin Epidemiol. 48: 23– 40.Google Scholar
Purcell GP, Wilson P, Delamothe T. 2002; The quality of health information on the internet. BMJ. 324: 557– 558.Google Scholar
Quality Health Council. Bone mineral density testing services in Saskatchewan. Summary Report. Saskatoon, Saskatchewan, April 2003. Available at: www.hqc.sk.ca. Accessed: July 23, 2003.
Rossouw JE, Anderson GL, Prentice RL, et al. 2002; Risks and benefits of estrogen plus progestin in healthy postmenopausal women: Principal results from the women's health initiative randomized controlled trial. JAMA. 288: 321– 333.Google Scholar
Sackett DL, Haynes RB, Tugwell P, Guyatt GH. 1991. Clinical epidemiology: A basic science for clinical medicine. 2nd ed. Boston: Little, Brown;
Sanson G. 2001. The osteoporosis “epidemic”: Well women and the marketing of fear. Auckland: Penguin Books (NZ) Ltd;
Sculpher M, Torgerson D, Georee R, O'Brien B. 1999. A critical structured review of economic evaluations of interventions for the prevention and treatment of osteoporosis. (University of York. Centre for Health Economics. Discussion paper; 169.) York, England: Centre for Health Economics, University of York
Siris ES, Miller PD, Barrett-Connor E, et al. 2001; identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausal women. JAMA. 286: 2815– 2822.Google Scholar
Tantono W, Selby S, Bagner J, Sonu C. 2002; FTC advises search engines to disclose paid placements. Intellect Property Technol Law J. 14: 21– 22.Google Scholar
The Swedish Council on Technology Assessment in Health Care (SBU). 1996. Effectiveness of bone density measurement and associated terms for prevention of fractures. Statement of finding (INAHTA Joint Project). Sweden: The Swedish Council on Technology Assessment in Health Care (SBU);
Yin RK. 1994. Case study research: Design and methods. 2nd ed. Applied social research methods series, vol. 5. London, Thousand Oaks: Sage Publications;