This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Interactive Journal of Medical Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.i-jmr.org/, as well as this copyright and license information must be included.
Previous data suggest that quality of Internet information regarding surgical conditions and their treatments is variable. However, no comprehensive analysis of website quality exists for thoracic surgery.
The aim of this study was to quantify website quality in a multilingual setting using an international standard for assessment.
Health On the Net (HON) principles may be applied to websites using an automated toolbar function. We used the English, French, Spanish, and German Google search engines to identify 12,000 websites using keywords related to thoracic conditions and procedures. The first 150 websites returned by each keyword in each language were examined. We compared website quality to assess for tertile (is the quality better in first, second, or third 50 websites returned) and language differences. A further analysis of the English site types was undertaken performing a comparative analysis of website provider types.
Overall, there are a considerable number of websites devoted to thoracic surgery: “lung cancer” returned over 150 million websites. About 7.85% (940/11,967) of websites are HON-accredited with differences by search term (
Clinicians should appreciate the lack of validation of the majority of thoracic websites, with discrepancies in quality and number of websites across conditions and procedures. These differences appear similar regardless of language. An opportunity exists for clinicians to participate in the development of informative, ethical, and reliable health websites on the Internet and direct patients to them.
As patients are diagnosed with serious conditions and await complex procedures, it is accepted that they inherently will explore the Internet for answers. Over 80% of patients, health care professionals, and other invested groups utilize the Internet to seek medical information, seeing it as a reliable, trustworthy, and accessible source [
Thoracic surgery is a common mode of treatment for many patients with lung cancer. However, patients face a range of extensive and unregulated information regarding conditions and procedures on the Internet, often affecting their expectations and informed decision-making [
Clinicians also require tools both to identify quality information for themselves and also to direct their patients to reliable, high quality Internet resources [
A comprehensive literature search regarding website information within the sphere of thoracic surgery was undertaken, yielding no studies that evaluate the quality of thoracic surgery-related information on the Internet. In this study, we aimed to evaluate the quality of current Internet information on thoracic surgery websites based on HON principles, and to compare differences between English, French, German, and Spanish language sites. The effect of language relates to what websites appear on different Google search engines (English, French, German, and Spanish), and whether there are any differences in HON-accredited websites. Our secondary goal was to assess and compare information quality based on types of website sponsors.
Our methodology has been previously described and used [
International and independent, qualified accrediting bodies check HON status at regular times, ensuring that HON certification meets the strict internationally accepted requirements. Moreover, the HON function has been evaluated by many studies, and judged to be a high caliber tool [
Access beyond the first page of results by patients is rare [
A secondary analysis of the first 150 websites encountered for each search term was undertaken, as previously described [
For quality control, an English-language search of the control term, “lung cancer,” had nonaccredited sites within the first 150 discovered websites manually evaluated using the HON criteria to determine their HON status to ascertain if they fulfilled the criteria despite not being officially accredited.
This test was conducted using the three major variables of our study, namely a search term, language, and tertile, of the first 150 websites returned. The reference groups for each variable were excavatum, the first tertile, and English, respectively.
For all search terms, an analysis was undertaken from English-language websites to determine who the website sponsors were. Only English language websites were examined due to the authors’ lack of proficiency in the other languages. The site sponsors were organized into the following groups: (1) lawyers, (2) nonprofit organizations, (3) government organizations or educational institutions, (4) commercial, (5) thoracic specialists and their professional organizations, (6) Books, articles, and references, (7) other health care professionals, (8) other (social media, forums, personal websites, newspapers, and (9) unrelated.
Sponsorship was determined independently by information on the retrieved Web page regarding its origin; if sponsorship was not obviously apparent, the website was explored until sponsorship could be determined. The concept of sponsorship is not to be confused with the Google terminology of “sponsored links,” which either highlights pages at the start of retrieved search or lists links on the side of the page under a banner. As in a previous analysis, such pages were not included in this study [
Comparisons of proportions across types of cancer and language were performed by the chi-square test (or Fisher exact test when counts were <5). All statistical tests were two-sided. Odds ratio and 95% CI were also calculated from the logistic regression analysis. The data analysis for this study was generated by SAS software version 9.1. (SAS Institute Inc).
The total number of websites for each thoracic surgery-related search term is variable (
The total percentage of HON-accredited sites was notably low across all search terms (median 8%; see
Regarding linguistic differences (see
Tertiles were examined to ascertain where HON-accredited websites were more likely to appear. HON accreditation was seen statistically more commonly in the first tertile (0-50 sites) of websites (see
Number and percentage of HON-accredited websites.
Category | Search term | Total websites returned | HONa-accredited (600 per term) | Total | HONcode%d | ||
HONcode+b | HONcode−c | ||||||
Pectus carinatum | 1,069,000 | 49 | 551 | 600 | 8 | ||
Pectus excavatum | 2,120,000 | 68 | 532 | 600 | 11 | ||
Total | 1,594,500e | 117f | 1083f | 1200f | 10e | .06 | |
Thoracotomy | 2,596,000 | 46 | 554 | 600 | 8 | ||
Total | 2,596,000e | 46f | 554f | 600f | 8e | .55 | |
Lung cancer | 149,500,000 | 79 | 521 | 600 | 13 | ||
Nonsmall cell lung cancer | 67,600,000 | 96 | 504 | 600 | 16 | ||
Small cell lung cancer | 111,500,000 | 80 | 520 | 600 | 13 | ||
Total | 111,500,000e | 255f | 1545f | 1800f | 13e | .29 | |
VATS | 26,320,000 | 26 | 574 | 600 | 4 | ||
Video-assisted thoracic surgery | 1,934,000 | 40 | 560 | 600 | 7 | ||
Total | 14,127,000e | 66f | 1134f | 1200f | 6e | .08 | |
EBUS | 2,293,000 | 15 | 585 | 600 | 3 | ||
Endobronchial ultrasound | 793,000 | 24 | 576 | 600 | 4 | ||
Total | 1,543,000e | 39f | 1161f | 1200f | 4e | .29 | |
Lung lobectomy | 1,840,000 | 48 | 552 | 600 | 8 | ||
Lung resection | 22,310,000 | 32 | 568 | 600 | 5 | ||
Lung wedge resection | 928,000 | 44 | 556 | 600 | 7 | ||
Pneumonectomy | 3,889,000 | 44 | 523 | 567 | 8 | ||
Total | 2,864,500e | 168f | 2199f | 2367f | 8e | .26 | |
Lorenz bar repair | 1,529,000 | 12 | 588 | 600 | 2 | ||
Nuss procedure | 512,200 | 47 | 553 | 600 | 8 | ||
Ravitch procedure | 241,400 | 30 | 570 | 600 | 5 | ||
Total | 512,200e | 89f | 1711f | 1800f | 5e | <.001 | |
Bronchoscopy | 9,204,000 | 62 | 538 | 600 | 10 | ||
Mediastinoscopy | 764,000 | 52 | 548 | 600 | 9 | ||
Thoracoscopy | 1,576,000 | 46 | 554 | 600 | 8 | ||
Total | 1,576,000e | 160f | 1640f | 1800f | 9e | .26 | |
2,027,000e | 940f | 11027f | 11967f | 8e(2-16) | <.001 |
aHON: Health On the Net.
bHONcode+: HON-accredited website.
cHONcode−: not HON-accredited website.
dHONcode%: percentage of HON-accredited websites, calculated by ([HONcode+]/[total websites]); where, total websites=(HONcode+)+(HONcode−).
eMedian.
fSum.
Column graph of median percentage of Health On the Net (HON)–accredited sites for all keywords arranged according to language. Each keyword was searched on native Google search engine of respective countries. The graph indicates the median percentage of HON-accredited websites.
Clustered column graph of percentage of Health On the Net (HON)–accredited websites for keywords arranged by tertiles. The color “blue” indicates percentage HON-accredited websites in first tertile, “red” indicates percentage HON-accredited websites in second tertile, and “green” indicates percentage HON-accredited websites in third tertile.
Percentage of HON-accredited websites by language.
Category | Search terms | English | French | German | Spanish | ||||||||||||||
+a | −b | %c | + | − | % | + | − | % | + | − | % | ||||||||
Pectus carinatum | 13 | 137 | 9 | 14 | 136 | 9 | 12 | 138 | 8 | 10 | 140 | 7 | .80 | ||||||
Pectus excavatum | 17 | 133 | 11 | 19 | 131 | 13 | 16 | 140 | 7 | 16 | 134 | 11 | |||||||
Total | 30e | 270e | 10d | 33e | 267e | 11d | 28e | 278e | 8d | 26e | 274e | 9d | |||||||
Thoracotomy | 14 | 136 | 9 | 10 | 140 | 7 | 11 | 139 | 7 | 11 | 139 | 7 | |||||||
Total | 14e | 136e | 9d | 10e | 140e | 7d | 11e | 139e | 7d | 11e | 139e | 7d | .84 | ||||||
Lung cancer | 20 | 130 | 13 | 19 | 131 | 13 | 20 | 130 | 13 | 20 | 130 | 13 | |||||||
Nonsmall cell lung cancer | 32 | 118 | 21 | 24 | 126 | 16 | 18 | 132 | 12 | 22 | 128 | 15 | |||||||
Small cell lung cancer | 27 | 123 | 18 | 19 | 131 | 13 | 18 | 132 | 12 | 16 | 134 | 11 | |||||||
Total | 79e | 371e | 18d | 62e | 388e | 13d | 56e | 394e | 12d | 58e | 392e | 13d | .11 | ||||||
VATS | 4 | 146 | 2 | 7 | 143 | 5 | 7 | 143 | 5 | 7 | 143 | 5 | |||||||
Video-assisted thoracic surgery | 11 | 139 | 7 | 10 | 140 | 7 | 10 | 140 | 7 | 10 | 140 | 7 | |||||||
Total | 15e | 285e | 5d | 17e | 283e | 6d | 17e | 283e | 6d | 17e | 283e | 6d | .98 | ||||||
EBUS | 5 | 145 | 3 | 3 | 147 | 2 | 2 | 148 | 1 | 5 | 145 | 3 | |||||||
Endobronchial ultrasound | 6 | 144 | 4 | 6 | 144 | 4 | 6 | 144 | 4 | 6 | 144 | 4 | |||||||
Total | 11e | 289e | 4d | 9e | 291e | 3d | 8e | 292e | 5d | 11e | 289e | 4d | .87 | ||||||
Lung lobectomy | 11 | 139 | 7 | 13 | 137 | 9 | 11 | 139 | 7 | 13 | 137 | 9 | |||||||
Lung resection | 9 | 141 | 6 | 9 | 141 | 6 | 6 | 144 | 4 | 8 | 142 | 5 | |||||||
Lung wedge resection | 9 | 141 | 6 | 11 | 139 | 7 | 11 | 139 | 7 | 13 | 137 | 9 | |||||||
Pneumonectomy | 13 | 137 | 9 | 10 | 122 | 7 | 12 | 123 | 8 | 9 | 141 | 6 | |||||||
Total | 42e | 558e | 7d | 43e | 539e | 7d | 40e | 545e | 7d | 43e | 557e | 8d | .99 | ||||||
Lorenz bar repair | 3 | 147 | 2 | 3 | 147 | 2 | 3 | 147 | 2 | 3 | 147 | 2 | |||||||
Nuss procedure | 9 | 141 | 6 | 13 | 137 | 9 | 14 | 136 | 9 | 11 | 139 | 7 | |||||||
Ravitch procedure | 6 | 144 | 4 | 9 | 141 | 6 | 8 | 142 | 5 | 7 | 143 | 5 | |||||||
Total | 18e | 432e | 4d | 25e | 425e | 6d | 25e | 425e | 5d | 21e | 429e | 5d | .65 | ||||||
Bronchoscopy | 18 | 132 | 12 | 15 | 135 | 10 | 13 | 137 | 9 | 16 | 134 | 11 | |||||||
Mediastinoscopy | 14 | 136 | 9 | 12 | 138 | 8 | 13 | 137 | 9 | 13 | 137 | 9 | |||||||
Thoracoscopy | 12 | 138 | 8 | 11 | 139 | 7 | 12 | 138 | 8 | 11 | 139 | 7 | |||||||
Total | 44e | 406e | 9d | 38e | 412e | 8d | 38e | 412e | 9d | 40e | 410e | 9d | .88 | ||||||
253e | 2747e | 8d | 237e | 2745e | 7d | 223e | 2762e | 8d | 227e | 2773e | 7d | .76 |
a+: HON-accredited website.
b−: not HON-accredited website.
c%: percentage of HON-accredited websites, calculated by ([HONcode+]/[total websites]), where, total websites=(HONcode+)+(HONcode−).
dMedian.
eSum.
Percentage of HON-accredited websites by tertile.
Category | Search term | HONa-accredited | ||||||||||
Tertile 1 (sites 1-50) | Tertile 2 (sites 51-100) | Tertile 3 (sites 101-150) | ||||||||||
+b | −c | %d | + | − | % | + | − | % | ||||
Pectus carinatum | 23 | 177 | 12 | 11 | 189 | 6 | 15 | 185 | 8 | .08 | ||
Pectus excavatum | 33 | 167 | 17 | 22 | 178 | 11 | 13 | 187 | 7 | <.001 | ||
Thoracotomy | 28 | 172 | 14 | 18 | 182 | 9 | 0 | 200 | 0 | <.001 | ||
Lung cancer | 54 | 146 | 27 | 16 | 184 | 8 | 9 | 191 | 5 | <.001 | ||
Nonsmall cell lung cancer | 64 | 136 | 32 | 22 | 178 | 11 | 10 | 190 | 5 | <.001 | ||
Small cell lung cancer | 59 | 141 | 30 | 16 | 184 | 8 | 5 | 195 | 3 | <.001 | ||
VATS | 12 | 188 | 6 | 5 | 195 | 3 | 9 | 191 | 5 | .23 | ||
Video-assisted thoracic surgery | 30 | 170 | 15 | 6 | 194 | 3 | 4 | 196 | 2 | <.001 | ||
EBUS | 3 | 197 | 2 | 4 | 196 | 2 | 8 | 192 | 4 | .24 | ||
Endobronchial ultrasound | 19 | 181 | 10 | 4 | 196 | 2 | 1 | 199 | 1 | <.001 | ||
Lung lobectomy | 31 | 169 | 16 | 4 | 196 | 2 | 13 | 187 | 7 | <.001 | ||
Lung resection | 20 | 180 | 10 | 9 | 191 | 5 | 3 | 197 | 2 | <.001 | ||
Lung wedge resection | 21 | 179 | 11 | 16 | 184 | 8 | 7 | 193 | 4 | .02 | ||
Pneumonectomy | 43 | 157 | 22 | 1 | 199 | 1 | 0 | 167 | 0 | <.001 | ||
Lorenz bar repair | 12 | 188 | 6 | 0 | 200 | 0 | 0 | 200 | 0 | <.001 | ||
Nuss procedure | 28 | 172 | 14 | 9 | 191 | 5 | 10 | 190 | 5 | <.001 | ||
Ravitch procedure | 15 | 185 | 8 | 13 | 187 | 7 | 2 | 198 | 1 | <.001 | ||
Bronchoscopy | 35 | 165 | 18 | 13 | 187 | 7 | 14 | 186 | 7 | <.001 | ||
Mediastinoscopy | 41 | 159 | 21 | 9 | 191 | 5 | 2 | 198 | 1 | <.001 | ||
Thoracoscopy | 37 | 163 | 19 | 7 | 193 | 4 | 2 | 198 | 1 | <.001 | ||
608f | 3392f | 15e | 205f | 3795f | 5e | 127f | 3840f | 3e | <.001 |
aHON: Health On the Net.
b+: HON-accredited website.
c−: not HON-accredited website.
d(%): percentage of HON-accredited websites.
eMedian.
fSum.
For the first 150 “lung cancer” (English) results, we found that 20 sites were accredited by the HON toolbar and 130 were not. We found that 6.9% (9/130) of those nonaccredited sites met HON criteria when assessed manually and 13.2% (79/600) of cancer-related thoracic surgery websites are HON-accredited.
Odds ratios calculated by search term, language, tertile, and between groups, highlighted significant differences (
Odds ratio and 95% CI. Illustration of odds ratio of a search having HON-accreditation in relation to referent. The higher the ratio, the less likely a search term has HON-accreditation. The lower the ratio, the more likely a search term has HON-accreditation.
Effect on HONcode status | Odds ratio | 95% CI | |
Excavatum | 1.00 (referent) | ||
Bronchoscopy | 1.116 | 0.767-1.622 | |
EBUS | 5.239 | 2.940-9.334 | |
Endobronchial ultrasound | 3.197 | 1.964-5.207 | |
Lorenz bar repair | 6.598 | 3.512-12.394 | |
Lung cancer | 0.834 | 0.584-1.191 | |
Lung lobectomy | 1.498 | 1.007-2.229 | |
Lung resection | 2.347 | 1.505-3.662 | |
Lung wedge resection | 1.652 | 1.100-2.481 | |
Mediastinoscopy | 1.368 | 0.926-2.020 | |
Nonsmall cell lung cancer | 0.653 | 0.463-0.922 | |
Nuss procedure | 1.534 | 1.029-2.288 | |
Pneumonectomy | 1.612 | 1.073-2.422 | |
Ravitch procedure | 2.517 | 1.599-3.962 | |
Small cell lung cancer | 0.821 | 0.576-1.172 | |
Thoracoscopy | 1.572 | 1.052-2.349 | |
Thoracotomy | 1.572 | 1.052-2.349 | |
VATS | 2.936 | 1.826-4.720 | |
Video-assisted thoracic surgery | 1.838 | 1.211-2.788 | |
Carinatum | 1.464 | 0.985-3.960 | |
First tertile (0-50) | 1.00 (referent) | ||
Second tertile (51-100) | 3.354 | 2.840-3.960 | |
Third tertile (101-150) | 5.522 | 4.531-6.730 | |
English | 1.00 (referent) | ||
French | 1.076 | 0.889-1.303 | |
German | 1.155 | 0.951-1.402 | |
Spanish | 1.134 | 0.935-1.375 |
aSum.
Website sponsor analysis.
Search term | Lawyer, |
Non-profit, |
Government |
Commercial, |
Thoracic |
Books, |
Other health |
Others |
Unrelated, |
|
Carinatum | 0 (0) | 13 (9) | 48 (32) | 17 (11) | 10 (7) | 51 (34) | 3 (2) | 8 (5) | 0 (0) | .35 |
Excavatum | 0 (0) | 12 (8) | 61 (41) | 11 (7) | 7 (5) | 53 (35) | 0 (0) | 6 (4) | 0 (0) | |
Thoracotomy | 0 (0) | 7 (5) | 38 (25) | 4 (3) | 6 (4) | 83 (55) | 0 (0) | 12 (8) | 0 (0) | N/A |
Lung cancer | 0 (0) | 23 (15) | 48 (32) | 3 (2) | 3 (2) | 52 (35) | 0 (0) | 21 (14) | 0 (0) | <.001 |
Nonsmall cell |
0 (0) | 18 (12) | 40 (27) | 8 (5) | 1 (1) | 79 (53) | 0 (0) | 4 (3) | 0 (0) | |
Small cell lung |
1 (1) | 10 (7) | 49 (33) | 6 (4) | 2 (1) | 75 (50) | 0 (0) | 7 (5) | 0 (0) | |
VATS | 0 (0) | 4 (3) | 38 (25) | 5 (3) | 6 (4) | 23 (15) | 0 (0) | 2 (1) | 72 (48) | .001 |
Video-assisted |
0 (0) | 2 (1) | 79 (53) | 4 (3) | 7 (5) | 58 (39) | 0 (0) | 2 (1) | 0 (0) | |
EBUS | 0 (0) | 1 (1) | 30 (20) | 11 (7) | 5 (3) | 34 (23) | 0 (0) | 1 (1) | 68 (45) | <.001 |
Endobronchial |
0 (0) | 2 (1) | 53 (35) | 6 (4) | 6 (4) | 76 (51) | 0 (0) | 7 (5) | 0 (0) | |
Lung lobectomy | 1 (1) | 9 (6) | 44 (29) | 4 (3) | 5 (3) | 70 (47) | 0 (0) | 17 (11) | 0 (0) | .001 |
Lung resection | 0 (0) | 4 (3) | 35 (23) | 2 (1) | 5 (3) | 101 (67) | 0 (0) | 3 (2) | 0 (0) | |
Lung wedge |
0 (0) | 14 (9) | 33 (22) | 2 (1) | 5 (3) | 86 (57) | 0 (0) | 10 (7) | 0 (0) | |
Pneumonectomy | 1 (1) | 6 (4) | 17 (11) | 2 (1) | 4 (3) | 109 (73) | 0 (0) | 11 (7) | 0 (0) | |
Lorenz bar repair | 4 (3) | 3 (2) | 13 (9) | 5 (3) | 2 (1) | 72 (48) | 0 (0) | 3 (2) | 48 (32) | <.001 |
Nuss procedure | 0 (0) | 5 (3) | 29 (19) | 2 (1) | 5 (3) | 84 (56) | 0 (0) | 25 (17) | 0 (0) | |
Ravitch |
1 (1) | 4 (3) | 40 (27) | 9 (6) | 3 (2) | 66 (44) | 0 (0) | 27 (18) | 0 (0) | |
Bronchoscopy | 0 (0) | 4 (3) | 58 (39) | 12 (8) | 9 (6) | 62 (41) | 0 (0) | 5 (3) | 0 (0) | <.001 |
Mediastinoscopy | 0 (0) | 6 (4) | 38 (25) | 6 (4) | 4 (3) | 87 (58) | 0 (0)) | 9 (6) | 0 (0) | |
Thoracoscopy | 1 (1) | 2 (1) | 30 (20) | 15 (10) | 5 (3) | 78 (52) | 0 (0) | 19 (13) | 0 (0) | |
Total mean |
9 (<1) | 149 (5) | 821 (27) | 134 (4) | 100 (3) | 1399 (47) | 3 (<1) | 199 (7) | 188 (6) | <.001 |
The sponsor analysis of the 150 websites in English (
Search terms with a larger percentage of “government or education” or “books, articles, and references” were the terms with a larger percentage of HON-accredited websites: “lung cancer,” “nonsmall cell lung cancer,” “small cell lung cancer” with
The aim of this study was to quantify information quality on thoracic surgery-related websites on the Internet. Clinicians may become aware of the lack of quality information regarding thoracic surgery and help to educate patients about the pitfalls of information on the Internet, and direct them to better quality websites.
In summary, the total number of websites for keyword searches varies considerably. The total percentage of HON-accredited websites was markedly low across all search terms. There were minimal linguistic differences in HON-accredited websites, with HON-accredited websites most likely to appear in the first tertile. Nearly half of the websites were books, articles, or references, whereas nearly one-third were governmental or educational.
The Internet has developed into an accessible source of health information for everyone. Health websites are guides for patients wanting to better understand their conditions [
There is a stark discrepancy between reliable health information and quality resources that disseminate it. The number of websites providing accurate information for thoracic surgery is not ideal. Only 13% of cancer-related thoracic surgery websites overall were HON-accredited. This is less than in our previous studies, uro-oncology websites [
It has previously been acknowledged that website quality differs by language [
Websites also act as a conduit for advertising. Health information is increasingly being controlled by marketing and commercial interests, taking advantage of a significant proportion of the population searching for health information [
HONcode is a simple means by which a clinician or patient can objectively correlate a website with high quality information. Compared with other instruments for evaluating website quality, it appears to be a straightforward, valuable tool, and fulfills its goal of identifying reliable health websites [
It must be said that HONcode is a predictive indictor for high quality websites, which has its drawbacks. Thus, a proportion of websites with objectively high quality information may not fulfill HONcode criteria, and vice versa. As of 2015, HONcode certification is provided as a paid service. This can distort the validity of website information with HONcode criteria.
An inherent limitation of this study involves the search terms used. It cannot be guaranteed that patients would use these terms in their own research of their condition. It is in dispute whether informal search terms would yield websites with better quality information. Conversely, it may result in unrelated website results. However, given that the search terms used in this study are the most formal and objective, informal search terms would likely defer to pages with the formal terms by the Google search algorithm. One solution to this limitation is to encourage clinicians to use the formal medical terms for their patients, thereby empowering patients to research their condition better, ultimately resulting in greater patient education.
As with any Internet study, its dynamic and diverse character produces inherent limitations. In our study, we only performed searches in Melbourne, Australia. It would be interesting to perform multiple searches at various times and locations, analyzing any differences found. “Google” is the most popular search engine (http://searchenginewatch.com), having been used in other studies [
In conclusion, clinicians must appreciate the lack of validated information of most thoracic surgery websites. Discrepancies are apparent in quality and number of websites between search terms, tertiles, and language. Awareness of this lack of quality can facilitate clinicians in educating patients by using the formal medical term to empower patients to research their condition more comprehensively and thus gain a greater level of understanding. Clinicians must be proactive in identifying and directing patients to trustworthy and accurate information on websites. HONcode is an uncomplicated search tool and can serve as the vanguard to detect appropriate and trustworthy websites.
Health On the Net
toolbar function for website accreditation recognition by HON principles
Institutional Review Board
percentage of HON-accredited sites
World Health Organization
MD was involved in data collection, data analysis, and manuscript writing and editing. RA helped in data analysis. SB and NL were involved in manuscript writing and editing.
None declared.