Researchers from Harvard University wanted to get a handle on the quality of online osteoarthritis (OA) information available around the world. While the researchers found some fascinating patterns in global OA information, probably the most unexpected outcome was how poorly physician websites communicate evidence-based medical information on their websites.
Their study, “International assessment on quality and content of internet information on osteoarthritis,” appears in the August 2018 edition of Osteoarthritis and Cartilage.
First author Nathan Varady, a third year M.D./M.B.A. candidate at Harvard University, told OTW, “The first and most obvious result was the drastic differences in quality of online health information among countries with large populations. In order to be applicable to as many people as possible, we selected the top ten countries based on total internet users, excluding countries where the primary language of the country overlapped with that of an already included country.”
“The fact we found such large differences in these countries hints at how large the gap likely is in countries with even fewer common languages. Patients who do not speak one of the most common languages may be left with essentially no reliable health information online.”
“The next interesting result was that performing the same searches in the same language with the same search engine yielded different results between countries, but not to a massive degree. A search for ‘knee osteoarthritis treatment’ in Boston, Massachusetts, yielded slightly different results than the same search in Hamilton, Bermuda, for example, but in general at least 70% of the websites were the same. Next, and perhaps the most intriguing result, was the exceptional quality of health information in Mexico—no different than that of the United States.”
“In reviewing the results, we realized these websites were often formal translations of English-based websites. This is a critical finding because it suggests that primary texts do not necessarily have to be created in every language immediately for us to better serve the international community; rather, professional translation services can be employed to translate high quality websites such as https://orthoinfo.aaos.org/ or https://www.oarsi.org/ to additional languages. However, this is only a temporizing measure until healthcare providers from the native country can revise (or create new) materials to be culturally appropriate for the given population they’re created to serve.”
“Though not a primary focus of our study, the relatively lower score for physician websites was also surprising. In general, we found physicians relied heavily on their own expertise and did not frequently cite sources, which could be improved. In contrast, while we expected commercial websites to be of lower quality, they actually scored the second highest. Part of this was related to the separation of websites that rely on advertising revenue (‘commercial’) and those that actually sell products (‘selling products’); the former needs high quality content to drive use, while the latter was expectedly much more prone to bias.”
“Ultimately, it is important to realize that online health information plays a large role in our patients’ understanding of their conditions. Our study was inspired by work by others that shows that indeed this is the case. We would speculate that even for conditions less common than knee osteoarthritis, online health information plays a large role in patient understanding and decision making. Our work demonstrates that not only is it imperative to be aware of what patients are accessing in English, but to be cognizant of the fact that speakers of different languages may face unique disparities in access to health information. Our study shows that this is the case over the world but can theoretically be extrapolated to non-English speakers locally in the United States, as well. Nonetheless it is key that surgeons point their patients in the right direction with regard to online health information. Similarly, as a scientific and medical community, where possible, we must strive to create resources useful for all patients.”
