Prescription for Success: Consumer Health Information on the Web

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Prescription for SuccessConsumer Health
Information on the Web

• Bette Anton, MLS
• banton_at_library.berkeley.edu

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This Workshop Is Brought to You By

• National Network of Libraries of Medicine,
  Pacific Southwest Region, UCLA Louise M. Darling
  Biomedical Library.
• Funded by the National Library of Medicine
• Infopeople Project

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Introductions

• Name
• Library
• Position
• What brings you here?
• Are there health-related questions that you are
  frequently asked?

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Objectives

• Use MedlinePlus to aid health seekers to
• find reliable disease-specific information
• find reliable drug supplement information
• find hospitals and doctors
• find the latest health news

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• Be able to identify and use
• NLM and other government websites to find answers
  to commonly asked health questions
• Websites specifically designed for California and
  multi-cultural health seekers
• Develop strategies for finding and evaluating
  health information on the Internet

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Pre-Test

• MedlinePlus can help you find a local consumer
  health library. T F
• Reference librarians can provide advice about
  health information. T F
• Name three criteria for evaluating a health
  website.
• What is the name of the largest biomedical
  library in the world?

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The Patrons Path to You
Fibrocystic breast disease
Physician

Cystic Fibrosis
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What the Patron Says, What the
Patron Means

• Sick lick vomiting
• Rose acre
• Fireballs in the Eucharist
• Sweet smiling Jesus

• Cyclic vomiting
• Rosacea
• Fibroids in the uterus
• Spinal meningitis

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The Health Reference Interview

• Determine who the information is for.
• Use dictionary, anatomy book or medical
  encyclopedia first.
• Have patron contact health care provider if
  sufficient information is unavailable.
• Never provide interpretation of the information,
  or advice. Always suggest that patron contact
  her/his health care provider.

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• From NLM NIH
• Authoritative up-to-date information
• Encyclopedia dictionary
• Drug supplement information
• Clinical trial information
• Updated daily
• No advertising

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MedlinePlus en Español

• MedlinePlus is available in Spanish by clicking
  on the español link.
• All materials responsive to language, dietary,
  and cultural needs of Hispanic population.

http//medlineplus.gov/spanish/
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MedlinePlus Resources

• Encyclopedia includes 4,000 entries on diseases,
  tests, symptoms, injuries and surgeries, and an
  extensive library of photographs and
  illustrations.
• Medical Dictionary
• Health Topics
• http//medlineplus.gov/

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Bookmarks

• Go to bookmarks.infopeople.org
• Look for the class bookmark file.
  prescription_success_bk.html
• Click on it so it shows on the screen.
• With the class bookmark file showing in Internet
  Explorer, click the Favorites menu, choose Add to
  Favorites
• Notice the name in the Name box so that you can
  use the Favorites list to get back to the class
  bookmarks for the rest of the day.

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Other MedlinePlus Resources

• Drug supplement information
• News
• Doctor/hospital finder
• Interactive tutorials/surgery videos
• Local libraries

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NLM Resources Collaborations

• NIH Senior Health
• clinicaltrials.gov
• DIRLINE
• Genetics Home Reference
• American Indian Health
• Household Products Database
• Tox Town

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Reliable Resources for Common Consumer Health
Questions

• Complementary Alternative Medicine
• Cancer resources
• Lab Tests Online
• Drug Digest

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Complementary Alternative Medicine (CAM)

• Diverse medical health care systems,
  practices, and products not presently considered
  to be part of conventional medicine. Source
  http//nccam.nih.gov/health/whatiscam/
• Less evidence of efficacy of treatments and
  safety.
• 36 of adults over age 18 use some form of
  alternative medicine Source CDC 2002 Natl
  Health Interview Survey

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Integrative Medicine

• Combines mainstream medical therapies and CAM
  therapies for which there is some high-quality
  scientific evidence of safety and effectiveness.

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• National Center for Complementary Alternative
  Medicine
• http//nccam.nih.gov

My daughter, who is on Zoloft, is taking St.
Johns Wort for depression. Does it really work?
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Reliable Cancer Information

• National Cancer Institute
• http//www.cancer.gov/
• American Cancer Society
• http//www.cancer.org
• University of Pennsylvanias Oncolink
• http//www.oncolink.org

My mother was diagnosed with cervical cancer. I
think they called it stage IIA. What can you
tell me about it? Is she going to have chemo or
radiation?
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Drug Web Sites

• Many drug sites are commercial ones.
• Many are simply advertising for pharmaceutical
  companies or particular drugs.
• Direct-to-consumer advertising of prescription
  drugs can be misleading.

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Drug Digest

• Drug Library
• Interactions
• Comparisons
• Conditions Treatments
• Interactive Tools

Are there interactions between St. Johns Wort
and Zoloft?
http//www.drugdigest.org/
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Lab Tests Online
My doctor says my cholesterol is 210. What does
that mean?
http//www.labtestsonline.org/
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• Why is evaluation of health websites important?
• How is evaluation of health web sites different
  from evaluation on non-health websites?

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Evaluation Issues

• Increasing number of
• patients accessing information on the Internet
• health-related websites
• Patients believe that the web is a reliable
  source of information

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What Do We KnowAbout Consumer Behavior?

• Consumers use search engines rather than medical
  portals or sites of medical societies or
  libraries.
• When assessing the credibility, they claim to
  primarily look for the source, professional
  design, scientific or official touch, language,
  and ease of use.
• Under observation, none checked about us
  sections, disclaimers, or disclosure statements.

Source Eysenbach, G, Köhler, C. How do
consumers search for and appraise health
information on the world wide Web? BMJ. 2002
March 9 324 (7337) 573577.
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Five Criteria for Evaluation

• Accuracy
• Authority
• Bias
• Currency
• Coverage

Each of these alone is meaningless, but together
they create solid guidelines for evaluation.
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Read URL Carefully

• Is it someones personal page?
• or
• geocities or aol.com
• What type of domain does it come from?
• .gov or .edu or .org
• Who is the publisher?
• http//publisher/

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Evaluate, Evaluate, Evaluate!!

• Scan the perimeter of the page and think about
  these questions
• Why did the person create the page?
• Whats in it for them?
• Are they trying to sell something?
• Contact information
• About us

Now apply the five criteria
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Accuracy

• Is the information accurate? Remember
• Anyone can publish on the web
• Many web pages are not reviewed or verified by
  editors or peers
• Web standards to ensure accuracy do not exist

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Accuracy Example
http//www.malepregnancy.com/
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Authority

• Is the author an authority on the subject?
  Remember
• It is often difficult to determine the authorship
  of web pages
• If a name is listed, the authors qualifications
  are frequently absent
• Check if the web page has the backing of a
  well-established organization, institution, or
  agency

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Authority Example
http//members.tripod.com/tourette13/
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Bias

• Does the author bring any biases in posting the
  information? Remember
• Web pages often are soapboxes
• Check that the authors goals are clearly stated
• Watch out for the emotional kick photographs,
  exclamation points, huge fonts

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Bias Example
http//bseinfo.org/
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Currency

• Is the information current and timely? Remember
• Dates are not always included
• If dates are included it may not be clear if it
  is
• Date created
• Date revised
• Date page was placed on Web

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Currency Example
http//www.nytimes.com/specials/women/whome/hrt.ht
ml
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Coverage

• Many health sites are not comprehensive. The
  information may be accurate but important
  information may be left out. Remember
• How does the information compare with other
  sources on the same topic?
• Is a better source available?
• Does the site have a disclaimer?

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Coverage Example
http//www.medical-library.net/
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http//servers.medlib.hscbklyn.edu/ebm/2100.htm
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Evaluate, Evaluate, Evaluate!!

• Contributes to, is linked to, associated
  with is not the same as causes
• Doubles the risk is meaningful depending upon
  what risk was in the first place
• Significant is not the same as statistically
  significant

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More Evaluation Tips

• May v. will
• Proves - one study alone infrequently proves
  something.
• Breakthroughs rarely happen.
• Beware of miraculous cures.

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MedlinePlus Evaluation Resources

• Evaluating health Internet information a
  Tutorial
• http//www.nlm.nih.gov/medlineplus/webeval/webeval
  .html
• Health fraud resource
• http//www.nlm.nih.gov/medlineplus/healthfraud.htm
  l

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Health Literacy

• Health literacy is the ability
  to read, understand, and act
  on health care information.
• Source Center for Healthcare Strategies,
  http//www.chcs.org/usr_doc/FS1.pdf

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Who Has Health Literacy Problems?

• People of all backgrounds, especially those with
  chronic health problems
• Most adults in U.S. read at 6th grade level, 45
  below 6th grade level.
• Older people, immigrants those with low incomes
  are disproportionately more likely to have
  trouble reading understanding health-related
  information.

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• According to the latest U.S. census data, 41 of
  Californians over the age of 5 speak a language
  other than English at home.

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Multilingual Resources

• What language group(s) does your library serve?
• The NN/LM provides links to many multilingual
  resources
• http//nnlm.gov/train/chi/multi.html

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California-Specific Web Sites

• California Department of Health Services
• California Healthcare Foundation
• What Patients Think of California Hospitals
• California Nursing Home Search
• Online Enrollment for Public Health Insurance
• NN/LM/PSR http//nnlm.gov/psr/about/region/califor
  nia.html

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Action Plan Next Steps
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Post-Test

• MedlinePlus can help you find a local consumer
  health library. T F
• Reference librarians can provide advice about
  health information. T F
• Name three criteria for evaluating a health Web
  site.
• What is the name of the largest biomedical
  library in the world?

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In Summary

• The National Library of Medicine
  provides many important and reliable
  consumer health resources.
• Evaluation of unknown sites is essential.
• Health seekers frequently have difficulty
  finding, understanding and using health
  information.
• NEVER provide medical advice. Send patrons to
  their health care providers for advice and
  interpretation of health information.

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Wrap-Up

• How to reach NNLM/PSR
• http//nnlm.gov/psr/ or 1.800.338.7657
• Funding opportunities
• http//nnlm.gov/psr/funding/
• Other classes
• http//nnlm.gov/psr/training/
• Member Services
• http//nnlm.gov/psr/members/