Dorothy J. Dunn, APRN, PhD, AHN-BC, FNP-BC, has more than 30 years of nursing experience, but patients regularly try to educate her about their conditions. Armed with reams of information from the Internet, they point out groundbreaking research, wonder drugs and miracle home remedies.

Dunn, a clinical instructor in the Christine E. Lynn College of Nursing at Florida Atlantic University, doesn’t mind that her patients turn to the World Wide Web to read up on their diagnoses. But she is concerned that much of what they’re reading is incomplete, inaccurate or inapplicable.

Which is why she makes a rule of sitting down with patients and going online together to find the most credible medical websites, says Dunn, who is a member of the Florida Nursing Association’s Health Literacy Committee.

“Patients need to take responsibility for their care, so they need that knowledge and the Internet is a wonderful tool for that,” says Dunn. “The Internet is not going away and I think we need to embrace technology, but just like a newspaper article, the Internet shows one viewpoint and opens a discussion.”

Differentiating between unbiased medical websites and those promoting particular products or viewpoints, therefore, becomes the biggest challenge in finding quality medical information online, says Edward Briggs, ARNP, MSN, FNP, director at large of the FNA and chair of its Health Literacy Committee.

“The most important thing I, as a nurse, need to do is go to the website and analyze it before referring the patient,” says Briggs, who practices at Largo Medical Center and Point Brittney Medical Center.”You need to look at the videos and look at the sources to see if it’s giving patients accurate and impartial information to help them make an informed decision or if it’s totally product-based.”

The more navigable the site and clearer the information, the better, says Aracely Rosales, chief content expert and multilingual director for the Bethesda, Md.-based Health Literacy Innovations, which, among other services, works with major health institutions to help them simplify online content.

“Staying on the site, reading the content, getting the message and remembering the information is what health literacy is all about,” Rosales says. “It’s empowering people with knowledge, so they can utilize that information and make smart health decisions.”

The Good

Oftentimes, the most accurate and accessible online sources are run by the government, Briggs says.

MedlinePlus (NLM.nih.gov/medlineplus/) is the National Institute of Health’s online consumer resource. With videos, online calculators, podcasts, drug information and an alphabetical listing of diseases that includes symptoms, prognosis, treatment and research, it’s full of reliable information, Briggs says. That it’s written at a 3rd-grade reading level, contains video tutorials and links to websites published in nearly 50 languages only amplifies it’s usability, he adds.

When highly-educated patients, who are offset by Medline’s plain language, complain about the site’s simplicity, Briggs explains to them that the site is designed for the masses and suggests more technical or academic literature.

WebMD.com is another site Briggs suggests to patients. Run by a team of healthcare and media professionals, the site features an extensive list of conditions with causes, symptoms and treatments; links to local specialists; healthcare news; interactive tools; blogs; message boards; medication reviews; and numerous other features.

Websites affiliated with national disease associations are among the first places she refers patients, says Dunn. These sites not only contain impartial information verified by the nonprofit, but offer patients a support network. Among such sites are The American Heart Association, The American Diabetes Association, The American Lung Association, The Alzheimer’s Association, American Cancer Institute, National Parkinson’s Foundation and the American Orthopedic Association.

For specific information on a product or vendor, Briggs suggests his patients turn to the U.S. Department of Health and Human Service’s Agency for Healthcare Quality at AHRQ.gov. In addition to having a search function that enables the user to locate government documents on myriad topics, the site contains links to news, clinical studies, research, and product-related information.

“The site also lists outcome data for local hospitals, so you could look at a hospital and see what are the outcomes for certain indicators, such as heart attack or stroke,” says Briggs.

The Bad

For every good medical website, there are dozens of bad ones, experts say.
Dunn explains that obtrusive advertisements should serve as a red flag that the site might have an ulterior motive and should be avoided.

Sites dedicated to the sale of a drug, product or service also present problems, says Briggs. “The first thing I educate patients about is to avoid any website dedicated to a product, such as pharmaceutical sites or homeopathic sites,” Briggs says. “The data they’re going to provide isn’t impartial, so it’s not going to give the patient an opportunity to make an informed decision.”

For example, says Briggs, the website for the diabetic medication Genuvia provides information about the drug, but not its particular indications. “So I have a lot of people who have diabetes, but don’t need medication, interested in the drug because they’ve been to the website,” Briggs adds.

Briggs is also wary of the Drugs.com, a comprehensive database of prescription and over-the-counter medications. The site pulls information from a variety of accredited medical sources, which are listed in the Drugs.com editorial policy, but it is unclear where particular information originates.

“If you can’t readily identify who’s composing the site, it’s a fairly good warning sign, Briggs says.

The online encyclopedia Wikipedia.org serves as an example of inconsistent and sometimes missing attribution, say the experts. According to Wikipedia, the site’s content, which is largely written by anonymous volunteers, must meet reliability requirements. Trustworthy sources include published materials with a reliable publication process or authors regarded as authoritative in relation to the subject.
“(Wikipedia) might be the future, but it’s just not evidence-based,” says Dunn. “You really want an evidence-based practice site that has credibility. Wikipedia is really not that stringent (on its sourcing) and anyone can modify it.”

Message boards, another way for anonymous sources to post information, can become havens for misinformation, says Rosales.

“A lot of people write and comment that their mother had this or brother had that and share their experiences, and that’s nice, but it doesn’t mean it’s accurate,” Rosales says. “People need to know who’s writing, who did the test or what was the process in order to verify the information — sites that state this information give people confidence and make the site more attractive.”

The Complicated

Even when sourcing information has been deemed credible and the facts verified, overly complicated design or language confuse patients.

Rosales says she regularly uses her firm’s literacy tool to process content from medical websites and finds that the majority of online content is written at the 8th-grade reading level, with some publishing text at the 11th, 12th, or post-secondary level.

Since roughly 43% of the U.S. population reads below a 6th-grade level, sites that present material in a highly-skilled manner are ineffective, says Rosales, adding “I myself sometimes get confused.”

Effective sites must also contain highly visible contact information, clear headings, and links that keep the reader on the site, Rosales says.

“It’s about not getting lost in the finding of information,” she adds.