descriptive analysis of strategies in Spain for internet biomedical
García S, Montesinos E, Baujard V, Boyer C.
Health On the Net Foundation, Geneva University Hospital, Switzerland
After this presentation participants should be able to understand the
following points. How the coexistence of several quality seals certifying
one website can influence internet users, health professionals as well
as general public. To determine if the existence of a growing number
of initiatives regarding health content quality is beneficial. And to
determine if a closer interaction amongst these initiatives is needed.
Introduction and goals:
The number of health related websites is rapidly growing, as well as
the number of internet users in search of health information. The number
of initiatives aimed at improving the quality of the health information
offered are growing as well. The health information offered is very
diverse, trusted medical information, reviewed by health professionals
can be found, as well as information with no scientific support or background.
This has lead to the development of control and evaluation tools.
The goal of these initiatives is to guide internet users in there search
of health information. This guidance is done by determining if a website
follows certain quality criteria regarding authorship, website funding
and the existence of conflict of interest.
Different Spanish speaking initiatives can be found. By means of a
health website certification process they guide the internet user.
We will study each one of them, comparing the methods they use and evaluate
the coexistence of the different quality seals in a website.
-First phase: Description and observation of Spanish projects for the
certification of health information websites, by independent research
in three generic search engines, five specialized search engines, Medline
database and Spanish Medical Index. Keywords used: "internet, quality,
information, ethic code, certification". The HON Foundation is
excluded as it is used as the "gold standard", this initiative
has the largest number of certified Spanish speaking websites. The initiatives
are selected after evaluating authorship, institutional support, existence
of a quality seal, how authorization is given to display the quality
seal, and a listing of the websites certified. Each initiative is compared
with the quality criteria established by the Health on the Net Foundation
and the European Commission.
-Second phase: Independent observation by two researchers of the homepage
of all the websites listed by each initiative. In each homepage the
presence of one or more quality seals has been evaluated. If the seal
was not found in the homepage, it was found in sections such as "credits,
certifications". For the HONcode quality seal, the certification
process status page was reviewed as well.
Regarding statistical analysis, a descriptive listing of the data was
From April to June 2003, besides HON, 9 health specific initiatives
were identified. Each one provided a description of the criteria used
for evaluation, certification and authorization to display there quality
seal. The list of the initiatives studied is:
1. http://wma.comb.es/cat/llistat.php (seal name: Web Médica
2. http://www.pwmc.org/pwmc.php3 (seal name: Web Médica de Calidad;
3. http://www.hipocampo.org/ (seal name: Web Recomendada; n=26).
4. http://www.webmastersanitarios.org/Asociadas/asociadas.asp (seal
name: SWS Calidad Biomedicina; n=98).
5. http://www.aurasalud.com/ (seal name: Web de Interés Divulgativo;
6. http://www.portalesmedicos.com/premio/medicina/ganadores.htm (seal
name: Premios Web; n=45).
7. http://www.seei.es/certificados/paginascertificadas.htm (seal name:
Certificado de calidad de páginas electrónicas; n=40).
8.http://aemir.org/ (seal name: Web de Utilidad en Formación
Médica Continuada n=52).
One initiative was disregarded (http://www.cristosalud.com) as it was
unavailable at the time of this study.
The number of websites reviewed by each initiative ranges from 26 to
233. The total number of websites reviewed by the 8 initiative is 600
(n=600). 174 websites (29%) were using more than one quality seal and
35 (6%) were websites not found by the server. The number of websites
displaying the HONcode (Health on the Net quality seal) was 215 (36%),
of which 72 are under revision process.
The variability found in the seal being displayed by the website was
high, only 53% (range 23%-96%) of the websites certified display the
quality seal. 60% of the sites display more than one quality seals.
In some cases 6 quality seals were found in the website.
The criteria used by each initiative is based on the quality Principles
established by the Health on the Net Foundation and the European Commission.
Some also include an evaluation of aspects related with the design,
the accessibility, the existence of a sitemap, the differentiation of
content for the general public and medical professionals, the use of
references to evidence based medicine and practice guidelines and the
use of plain language. All of the initiative are free of charge for
It has been noticed that most of the initiatives that guide the health
internet users, by certifying health websites with a quality seal do
not remain active for a long period of time.
The existence of multiples quality seals in one website does not indicate
a higher quality of the website, regarding the principles of the different
Users, and mostly patients, are not aware of all the quality initiatives
existing, and they are not aware of the importance of looking for quality
seals when doing there information search. A proposal to develop a platform,
sponsored by each country government, with the collaboration of public
institutions, professional associations, scientific societies and user
associations, unifying the experience of each quality initiative should
be taken into account, in order to improve the awareness of users and
patients and avoid the confusion that comes from the existence of multiple
quality seals. This awareness would keep the poor quality and fake medical
information from the user-patient, and would avoid the consequences
of misleading medical information. The European Union is studying the
development of a joint action among its members to establish a quality
seal for health websites. Initiatives such as MedCIRCLE have this objective.
Internet, quality, information, health, ethic code, certification.
Conflict of interests:
The authors have not received any external funding for this study. They
are consulters with the Health on the Net Foundation.
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