site to another. Many web sites track and publish back linkages for the purpose of enhancing their credibility and marketability.The best way to evaluate back linkages is to examine the context in which they are used, that is, their purpose, relevance, credibility, and authority, as well as any associated bias.

Design

The design or layout of the web site, including graphics and text, as well as links is important to the effective delivery and use of any web-based information, even though it does not affect the quality of the information per se. For example, do essential instructions appear before links and interactive portions? Do all parts work? Is using the site intuitive, or are parts likely to be misunderstood? Can you find your way around and easily locate a particular page from any other page? Is the structure stable or do features disappear between visits? Does it look friendly?The design of web sites can be evaluated in terms of accessibility, logical organization (navigability), and internal search capability.

Access:

Is the web site written in standard html (hyper text markup language), or have proprietary extensions been used? Must you download software to use it? Do part of it take too long to be load? Is it usually possible to reach the site, or is it overloaded?Is it stable or the URL (Uniform Resources locator) keep changing? Does the site use words the average person would try in a search engine? Is it open to everyone on the Internet, or do parts require membership and/or fees?Are there rules for use stated up front? Web sites should be accessible by the lowest level available browser technology. Other features to improve access include option for assessing the information when multimedia browsers are not available, as well as options for enabling use by the people with disability (hearing and seeing impaired……).

Logical organization (navigability):

The best web sites are clearly focused on their purpose and target audience.They are simple, internally consistent, and easy to use. Cross-references are provided to aid the user in comprehending the overall structure of the information.The composition of the information reflects an awareness of reading level, language, and the need for a balance of text and graphics, color and sound.

Internal search capability:

An internal search engine is a highly desirable component for most web sites with depth and breadth of content.The scope and function of the search engine-what it covers and how it works- should be clearly described.The search engine should be capable of searching specified content by keyword or search string and retrieving only relevant materials.It should also have a user interface that is easy to understand and use.

Interactivity 

Interactivity includes three criteria: Mechanism for feed back, chat rooms, and tailoring

Mechanism for feedback:

Reputable journals provide a feedback mechanism for their readers, and so, too, should web sites.The capability for interaction is unique benefit of the Internet.For example, a link to send criticism and comments to the site’s resource should always be included with the original information.Users should be able to comment on the validity and value of the information, and possibly point out areas of omission or obvious bias.A professionally operated web site will endeavor to respond to user feed back within a reasonable amount of time.

Chat rooms:

Chat rooms allow information to be exchange among many individuals, often anonymously.Whether a moderator is present should be posted, along with a warning that the information may not be accurate.If a moderator is present, the individual should be identified, together with his /her expertise and affiliations, and the source of his/her compensation

Tailoring:

In cases where web site provides an interactive service, such as tailoring information to the user based on clinical algorithms, the algorithm should be stated, including its developer and the site’s affiliation with the developer.

Caveats

Consumers should recognize that while use of the Internet for health information can be wonderful and educational experience, it can also have potential drawbacks. In particular, personal information may be easily given, stored, and shared for purpose that users may bot be aware of or agree to those uses.

Additionally, information may be inaccurate; thus, the consumers must be alerted to potential quack medical claims.

Alert:

The consumer must be wary of sound-a-like names or names that seem prestigous.Impressive names, conceived by shrewd marketing strategies, can be quite misleading, the American institute of Drug Analysis may sound like a well-equipped facility with academically credential staff, but it may in fact be a poorly instrumented and staffs laboratory in a garage.There is no legal restriction on the naming of business.

Products and services:

Site that sells products and services in health may be regulated by the FDA as to what they can clam.

Consumers must be highly skeptical of claims of “amazing results”, “earthshaking breakthroughs”, or miracles, as well as “secret cures” knows only to purveyor.Likewise, they should be wary if basic science widely accepted medical principle, or sound public health policies are attacked.

Health on the net foundation HON code: 5

The health on the net foundation code of conduct (HON code) for medical and health Web sites addresses one of the Internet’s main health care issues: the reliability and credibility of information.

The HON code is not an award system, nor does it intend to rate the quality of the information provided by a Web site.It only defines a set of rules and principles to hold web site developers to basic ethical standards in the presentation of information; and help make sure readers always know the source and the purpose of the data they are reading.

How it works?

You can use the HON code to verify a medical or a health site by entering the relevant URL and click GO. And HON’s MedHunt search will display results from its data –base, but you should be aware that if a given web site does not bear the HON code seal and is not listed on MedHunt, is NOT necessarily and indication of poor quality.

This is a very short interactive questionnaire that will help you assess if a Web site follows the ethical principles highlighted by HON code.

·The site provides and/or hosts medical /health information and advice

·The information and advice Is given by medical /health professionals

·A clear statement is made that the information or advice is offered bynon- medical or professionals or organization

·There is no statement readapting authorship.

·The site and its mirrors respect the legal requirements for medical information privacy that apply in the country and state of their location

·yes

·No

·I have no knowledge of these law

·The last modification date of the web site is clearly displays

·Yes

·No

·The site contains information from other resources

·An HTML link is provided to the source data

·A bibliographic reference to the source data is provided

·No reference to the source is made

·The site makes claims relating to thebenefit or performance of a specific medical treatment , commercial product or service

·The claims are supported by clear references to scientific research results and/or published articles

·The claims are based on the personal research or opinion of the site developer.

·All the pages of the web site display the contact e-mail address of the webmaster or a link to it

·Yes

·No, only some of the pages

·No, none of the pages

·No, the site only offers a feedback form.

·The source of the funding of the site is

·Clearly described

·No funding explanation is provided

·The site displays banner advertising, which is a source of income:

·Clearly described

·No funding explanation is provided

And the results of these questionnaires will help you to identify which ethical aspects of the HON code principles your chosen Web site does not respect.

Comparison of health information Megasites, and search engines

Here is a listing of the major search engines and directory services on the world-wide web and their features6:


 
Search engine/ directory
URL
Feature
AltaVista
http://www.altavista.com//
One of the biggest and most powerful search engines on the web. It has a partnership with looksmart who provides it with its directory listing. It also features a directory and online shopping
HotBot
http://www.hotbot.com//
Comprehensive; intuitive; user friendly and fast search engine
Excite
http://www.excite.com//
Useful ability to list result by web sites as well as search for documents that are similar to any given in the results. All results are given a relevancy rating. 
Infoseek
http://www.infoseek.com//
Runs search engine and separate directory. Results are automatically given as both web pages and as reviewed sites from its directory listing. 
Lycos
http://www.lycos.com//
Features ‘top 5%’, which are sites, that reviewers have picked as being the best on the web.Can also search for pictures and sounds using keyword search.
Yahoo
http://www.yahoo.com//
The most popular directory on the web, listing more than 800 000 web sites. It has links to all the major search engines
LookSmart
http://www.looksmart.com//
Contains a directory of 20000 subjects covering 300 000 web sites. Also features smart shopper and Classified advertisement

Comparisons here are made across many famous health information sites (As of April 2000)with specific focus on Target audience, who selects, and last modified, availability of search engine, and availability of help. 7


 
Site name
Site address
Target Audience
Who selects
Last modified
Search engine
Help
Achoo
www.achoo.com
medical community
Team
not stated
available
available
Biosites
www.library.UCSF.edu
Not stated
Librarians
not stated
available
available
Clinic Web
www.web-clinic.com
students and practitioners
not stated
not stated
available
Einet Galaxy
http://galaxy.einet.net
not stated
Information specialists
not stated
available
available
GHN

Global health network

www.astralcom.com/ghn
public health and prevention
Various professionals
within 2 months
HON

Health on the net foundation

www.HON.com
health care professionals and providers
not stated
within 2 weeks
available
Health AtoZ
www.healthAtoZ.com
comprehensive: health and medicine
Medical professionals
not stated
available
Healthfinder
www.healthfinder.com
public
not stated
within one month
available
Healthlinks
www.healthlinks.com
health sciences faculty, student, and staff
Librarians
within 2 weeks
available
HealthWeb
www.healthweb.org
health care professionals
Librarians, information professionals, and health professionals
every 3 months
HSLS, U.

Pittsburgh

Health Science library system

www.hsls.pitt.edu
not stated
not stated
within one month
Martindale
www-sci.lib.uci.edu/ ~ Martindale
not stated
not stated
within one week
MedExplorer
www.MedExplorer.org
not stated
not stated
not stated
available
MDchoice
www.mdchoice.com
Physician and patients
Physician
Daily
Medical matrix
www. Medical matrix.org
USA physicians and health care professionals
Practicing clinicians
Daily
available
Medical world search
www.mwsearch.com
clinical practitioners or consumers
Editorial board
not stated
available
available
MedWeb
www.medweb.emory.edu
not stated
Software(search engine/spider)
not stated
available
MMRLS*
www.MMRLS.org
not stated
not stated
not stated
available
NOAH
www.NOAH.cuny.edu
public, consumers
Librarians and content committee
within one week
available
available
OMNI
www.OMNI.ac.UK
UK and world
Volunteers, information specialists
within one week
available
available
Virtual naval Hospital
www.vnh.com
patients and health care providers
Editorial board
continuously
available
WebDoctor
www.gretmar.com/webdoctor
physicians
Physicians
11/27/97
available
Yahoo
www.yahoo.com
not stated
not stated
not stated
available
available

* Metrowest Massachusetts Regional Library System

Summary

The Internet presents a powerful mechanism for helping users improve their health-care decision making by providing easy and rapid access, exchange, and dissemination of enormous amounts of health information.Yet users must be aware of the potential for misinformation and recognize the critical need to assess the quality of the information provided. Content provider must be encouraged to develop and post high-quality information, and policy makers and health care professionals must be educated on this important health issue.

References:

1.Gang Wu, Jie Li., Comparing web search engine performance in searching consumer health information. Bull. Medical Library Association. 1999:87(4)

2.Finding and judging advice online. The New York Times. March, 6, 2000

3.Paul Kim et al., Published Criteria for evaluating health related web sites: Review. BMJ 1999;318:647-649

4.Helga E. Rippent et al. For assessing the quality of health information on the internet, http://hitiweb.mitretek.org/hswg/

5.Health on The Net Foundation, http://www.hon.com//

6.Downes Pk.Successful Web Searching. British Dental Journal.1998:Oct 24; 185:393-399.

7.http://www.lib.umich.edu/megasites/abstract.htlm