Google, Yahoo!, Bing, and Ask.com are by and large effective search engines for helping lay users get health and medical information. Nevertheless, the current ranking methods have some pitfalls and there is room for improvement to help users get more accurate and useful information. We suggest that search engine users explore multiple search engines to search different types of health information and medical knowledge for their own needs and get a professional consultation if necessary.

Researchers searched for “breast cancer” using the four top search engines, combined the top 200 non-redundant results from each source into a list, and then gave that list to eight volunteers to evaluate, scoring there relevance to research on a scale of 0-10 (low to high). Volunteers were all highly educated, most of them with backgrounds in science. They were provided with six “gold standard” sites for information on this topic to compare against before making their determination:

1. U.S. National Cancer Institute
2. American Cancer Society
3. Mayo Clinic
4. MedicineNet
5. Wikipedia
6. Susan G. Komen for the Cure

The volunteers tended to score the popular science and personal websites the highest overall, while scoring corporation and advertising websites the lowest. Researchers conclude that search engines do provide good information overall, though their sample is small, both in number of participants and topics searched.

This study has a number of serious flaws in it, and begs the question: is a little bit of mediocre research better than no research at all? First, the high education levels of the volunteer evaluators, plus their choices to score popular science websites above commercial websites indicate high levels of information literacy. Yet other research shows that over 90 million adults in the U.S. (36% of the population) have poor health literacy. How would people like this evaluate and select the right sources using a search engine? As any librarian watching patrons search will tell you, most people never look beyond the first three search results, let alone the first page of results. And search engines like Google employ algorithms to customize search results based on your previous searches, which may or may not give you the best resources.

Next, the researchers note the shortcomings of search engines in “ranking the websites according to their usefulness,” and recommend that “users apply multiple search engines when looking for medical and health information online, instead of using only a single search engine.” As a librarian and past computer consultant, I’ve learned that many people cannot distinguish between “the Internet” and a web browser, let alone utilize and critically evaluate search engines and the search results they generate. Librarians and researchers are the professionals best suited to handle that task.

Finally, while the “gold standard” sites probably contain all the basic information on breast cancer from the view of their medical expert, how readable and understandable is their content across different groups and ability levels? Had the researchers chosen to include a librarian on their team, she or he could have provided important insight and evaluation of these sites in this area. And why was a site like MedicineNet included while MedlinePlus was excluded from the short list? MedlinePlus is advertisement-free, offers information in Spanish and other languages, and is written at a level that can be understood by a wider audience.

While search engines will, generally speaking, help end users find helpful health and medical information, the will inevitably lead some people to inaccurate or misleading information. And with so many people having low information and health literacy skills, it is imperative that they be directed to quality, evidence-based resources for answers to their questions. This study does nothing to assist in that endeavor.

References:

Kutner, M. (2007). Literacy in everyday life: Results from the 2003 National Assessment of Adult Literacy.

Wang, L., Wang, J., Wang, M., Li, Y., Liang, Y., & Xu, D. (2012). Using Internet Search Engines to Obtain Medical Information: A Comparative Study. Journal of medical Internet research, 14(3).

“there has also been criticism that this concept has been poorly defined, that it stretches the idea of “literacy” to an indefensible extent and more specifically, that it adds little to the existing concerns and intervention approaches of the better established discipline of health promotion.”

She goes on to select one definition of health literacy (Nutbeam, 2000) and using the concept of “critical health literacy” to determine its usefulness in improving the health of communities and individuals. This article concludes that the concept of critical health literacy connects ideas across multiple domains, yet retains “a key focus on the interaction between individuals and information about health” and how information can be used to improve health outcomes.

While much of the research around the topic of health literacy has be quantitative in measure, qualitative research is also needed to address the “socially situated nature of health literacy, involving interpersonal relationships, emotional involvement, and issues of power and resistance” (Chinn, 2011). Knowing how people utilize their personal networks to assemble an understanding of their health situation has the potential to increase the effectiveness of health literacy outreach efforts.

But we cannot stop there. It is also important to know what individuals and organizations benefit from poor health literacy, and what roadblocks and hurdles – legal, political, and more – are being put or kept in place to maintain the status quo.

What questions do you think researchers should be asking about critical health literacy? Where should academic institutions, libraries, non-profit organizations and others be focusing their resources to address this timely issue? Tell us about it!

References:

Chinn, D. (2011). Critical health literacy: a review and critical analysis. Soc Sci Med, 73(1), 60-67. doi: 10.1016/j.socscimed.2011.04.004

Nutbeam, D. (2000). Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. [Article]. Health Promotion International, 15(3), 259.

Recently, physicians at the University of Chicago published a research letter in the Archives of Internal Medicine detailing their experience with the routine use of iPads by internal medicine residents during their regular duties.

What they documented was that use of the mobile device was objectively associated with faster order entry after patient admission and the subjective assessment that it saves up to one hour per day for each resident.

Prior to initiating the program, investigators wisely met with hospital IT to determine their concerns and set up rules for usage of the devices. After initially having residents individually install apps via their own iTunes accounts, it was decided to work through a third-party vendor to standardize the devices — in this case, working with a company called Mobile Iron. Additional security protections included an eight-digit alphanumeric screen lock code (instead of the standard four-digit numeric code), and setting the iPads to automatically erase themselves after five unsuccessful attempts to log-in.

A great deal of interest has been generated since the research letter was published, and the authors plan to share what they’ve learned at conferences and workshops. In addition, the local ABC Television station did a segment on this event, which you can see below.

Have you used an iPad or other tablet computer in a medical setting? How did it work for you? Tell us about it!

The website template is available in two formats, one using simple HTML (MyRA 1.0) and one utilizing Alfresco and Drupal (MyRA 2.0). The simple HTML version contains links to resources available to University of Utah researchers. These links can be replaced and customized with the associated links relevant to each institution. The more dynamic version utilizes Drupal for front end display and Alfresco for enterprise content management. This version requires local instances of these two open source programs.

For more information and instructions on how to download the templates, please visit the MyRA Web Portal Project website.

This project has been funded in whole or in part with Federal funds from the Department of Health and Human Services, National Institutes of Health, National Library of Medicine, under Contract No. NO1-LM-6-3504 with the University of Utah Spencer S. Eccles Health Sciences Library.

This investigation was supported in part by the Public Health Services Grant number UL1-RR-25764 and C06-RR11234 from the National Center for Research Resources.

What does this mean for libraries in general and medical libraries specifically? Tell us what you think!

Some 35% of U.S. adults have software applications or “apps” on their phones, yet only 24% of adults use those apps. Many adults who have apps on their phones, particularly older adults, do not use them, and 11% of cell owners are not sure if their phone is equipped with apps.

The report goes on to note several additional observations about mobile app users:

• Apps users are younger, more educated, and more affluent than other cell phone users.
• App use ranks relatively low (9th) on a list of “non-voice cell phone use.”
• 29% of adult cell phone users have downloaded an app to their phone.
• One in eight adult cell phone users (13%) has paid to download an app.
• Data indicate that games are the most popular apps, followed by news/weather, maps/navigation, social networking, and music.

The authors of the blog post summarizing their findings call this “the Rise of Apps Culture” and call it a “pretty remarkable tech adoption story.” Yet games are the most popular items to download. Perhaps this is not a story of how one society adopted a new tech paradigm in record time. Rather it may just be people with “disposable” income acting like a kid who just got paid his/her allowance and raced to the corner drug store to buy a pack of sports trading cards for the new season.

What do you think?