Internet Health Resources: from Quality to Trust

Summary

Objectives: Quality of online health resources remains a much debated topic, despite considerable international efforts. The lack of a systematic and comprehensive conceptual analysis is hindering further progress. Therefore we aim at clarifying the origins, nature and interrelations of pertinent concepts. Further, we claim that quality is neither a necessary nor a sufficient condition for Internet health resources to produce an effect offline. As users’ trust is also required, we examine the relation of quality aspects to trust building online.

Methods: We reviewed and analyzed the key documentation and deliverables of quality initiatives, as well as relevant scientific publications. Using the insights of philosophy, we identified the elementary dimensions which underlie the key concepts and theories presented so far in the context of online health information quality. We examined the interrelations of various perspectives and explored how trust as a phenomenon relates to these dimensions of quality.

Results: Various aspects associated with the quality of online health resources originate from four conceptual dimensions: epistemic, ethical, economic and technological. We propose a conceptual framework that incorporates all these perspectives. We argue that total quality exists only if all four dimensions have been addressed adequately and that high total quality is conducive to warranted trust.

Conclusions: Quality and trust are intertwined, but distinct concepts, and their relation is not always straightforward. Ideally, trust should track quality. Apprehending the composition of these concepts will help to understand and guide the behavior of both users and providers of online information, as well as to foster warranted trust in online resources. The framework we propose provides a conceptual starting point for further deliberations and empirical work.

Keywords

Internet - world wide web - quality of information - ethics - trust

• References

• 1 Available at: http://public.web.cern.ch/Public/ACHIEVEMENTS/WEB/history.html
• 2 Internet Domain Survey, The Internet Software Consortium. Available at: www.isc.org.ds/.
• 3 California Health Care Foundation. Proceed with caution: A report on the quality of health information on the Internet. May 2001. Available at: www.chcf.org/documents/ihealth/ProceedWithCautionCompleteStudy.pdf Accessed: May 28 2002
• 4 Ferguson T. From patients to end users. BMJ 2002; 324: 555-6.
• 5 Harris Interactive. New data show Internet, Website and e-mail usage by physicians all increasing. Health Care News. 1 (8), February 26 2001 Available at: www.harrisinteractive.com/about/healthnews/HI_HealthCareNews 2001Vol1_iss8.pdf.
• 6 Health On the Net Foundation. Healthcare professionals’ experience of the medical Net. Survey May-July 2000. Available at: www.hon.ch/Survey/ResPoll/Total.html
• 7 Eng TR. The e-Health landscape – A terrain map of emerging information and communication technologies in Health and Health Care. Report. The Robert Woods Johnson Foundation 2001. Available at: www.rwjf.org/apprw_publications_and_links/publicationsPdfs/eHealth.pdf.
• 8 Wyatt JC. Measuring quality and impact of the World Wide Web. BMJ 1997; 314: 1879-81.
• 9 Sonnenberg FA. Health information on the Internet. Opportunities and pitfalls. Arch Intern Med 1997; 157: 151-2.
• 10 Jadad AR, Gagliardi A. Rating health information on the Internet: navigating to knowledge or to Babel?. JAMA 1998; 279: 611-4.
• 11 McLeod S. The quality of medical information on the Internet. A new public health concern. Arch Ophthalmol 1998; 116: 1663-5.
• 12 Robinson TN, Patrick K, Eng TR, Gustafson D. An evidence-based approach to interactive health communication. A challenge to medicine in the information age. JAMA 1998; 280: 1264-9.
• 13 Kim P, Eng TR, Deering MJ, Maxfield A. Published criteria for evaluating health related web sites: review. BMJ 1999; 318: 647-9.
• 14 Forsstrom JJ, Rigby M. Considerations on the quality of medical software and information services. Int J Med Inf 1999; 56: 169-76.
• 15 Baur C, Deering MJ. Proposed Frameworks to Improve the Quality of Health Web Sites. Review, Med Gen Med (journal online) September 2000. Available at: www.medscape.com/viewarticle/418842. Accessed: May 27 2002
• 16 Delamothe T. Quality of websites: kitemarking the west wind. BMJ 2000; 321: 843-4.
• 17 Purcell GP, Wilson P, Delamothe T. The quality of health information on the internet. BMJ 2002; 324: 557-8.
• 18 Wilson P. How to find the good and avoid the bad or ugly: a short guide to tools for rating quality of health information on the internet. BMJ 2002; 324: 598-600.
• 19 Stanberry BA. Commentary: Legal aspects of health on the Internet: a European perspective. BMJ 2002; 324: 605-6.
• 20 Eysenbach G, Köhler C. How do consumers search for and appraise health information on the world wide web? Qualitative study using focus groups, usability tests, and in-depth interviews. BMJ 2002; 324: 573-7.
• 21 Meric F, Bernstam EV, Mirza NQ. et al. Breast cancer on the world wide web: cross sectional survey of quality of information and popularity of websites. BMJ 2002; 324: 577-81.
• 22 Nissenbaum H. Securing trust online: wisdom or oxymoron?. Boston University Law Review 2000; 81 (Suppl. 03) 635-64. Available at: www.princeton.edu/~helen/BU-final-trust.pdf.
• 23 Introna L, Nissenbaum H. Shaping the Web: why the politics of search engines matters. The Information Society 2000; 16: 1-17.
• 24 Nissenbaum H. How computer systems embody values. IEEE Computer 2001; 118-20.
• 25 van den Hoven MJ. Internet, health information and values in design. In: Berg M, van der Lei J. eds. Proceedings of IT in Healthcare: Socio-technical approaches. International Conference Rotterdam; The Netherlands: September 2001
• 26 van den Hoven MJ. Ethics, social epistemics, electronic communication and scientific research. European Review 1998; 7: 341-9.
• 27 Goldman A. Knowledge in a Social World. Oxford: Oxford University Press; 1999
• 28 Thagard P. Internet epistemology: contributions of new information technologies to scientific research. Available at: cogsci.uwaterloo.ca/articles/pages/epistemology.html
• 29 Wachbroit R. Reliance and reliability: the problem of information on the Internet. Information Magazine 2001 (online journal). Available at: www.cisp.org/imp/may_2001/05_01/wachbroit.htm Accessed: May 27, 2002.
• 30 Bower H. Internet sees growth of unverified health claims. BMJ 1996; 313: 381.
• 31 McLeod SD. The quality of medical information on the Internet. A new public health concern. Arch Ophthalmol 1998; 116 (Suppl. 12) 1663-5.
• 32 van den Hoven MJ. The varieties of informational wrongdoing”. in Internet Ethics. Langford Duncan. editors. London: MacMillan; 2000
• 33 Terry N. Regulating health information: a US perspective. BMJ 2002; 324: 602-5.
• 34 Coiera E. Information Economics and the Internet. JAMIA 2000; 7: 215-21.
• 35 Varian HR. Markets for information goods. 1998 Available at: www.sims.berkeley.edu/~hal/people/hal/papers.html
• 36 Risk A, Dzenowagis J. Review of internet health information quality initiatives. J Med Internet Res 2001; 3 (Suppl. 04) e28.
• 37 Eysenbach G, Powell J, Kuss O, Sa ER. Empirical studies assessing the quality of health information for consumers on the world wide web: a systematic review. JAMA 2002; 287 (Suppl. 20) 2691-700.
• 38 Hardwig J. Epistemic dependence. J Philosophy 1995; 82: 335-49.
• 39 Coiera E. Information epidemics, economics and immunity on the Internet. BMJ 1998; 317: 1496-502.
• 40 Seligman AB. Role complexity, risk, and the emergence of trust. Boston University Law Review 2000; Vol 81 (Suppl. 03) 619-34.
• 41 Goldman A. Social epistemology. Online Stanford Encyclopedia of Philosophy. 2001 Available at: http://plato.stanford.edu/entries/epistemology-social/
• 42 Goldman A. Pathways to knowledge. Private and Public. Oxford University Press; 2002
• 43 Pew Internet Project. Vital decisions. How Internet users decide what information to trust when they or their loved ones are sick Report. May 2002 Available at: www.pewinter.net.org/reports/index.asp
• 44 Spence M. Job market signalling. Quarterly J Economics 1973; 87: 355-74.