IntroductionThe explosive growth of the World Wide Web has made it more and more urgent to monitor and improve the quality of the information circulating through the Internet. But assessing medical and health information on the Web is a difficult challenge. In recent years, some organisations have been working on this issue. The Health On the Net Foundation (HON), for its part, administers an eight-point Code of Conduct called the HONcode, initiated in 1996. This solution is different from the others. The HONcode does not intend to rate or assess the quality of information provided by a Web site. This article gives a general presentation of the HONcode and its status in 1999, three years after it was launched.MethodsIt defines a set of voluntary rules designed to help a Web developer site practice responsible and to make sure a reader always knows the source and the purpose of the information he or she is reading. These guidelines encourage the authority, complimentarity, confidentiality, proper attribution, justifiability and validity of the medical advice and information provided. Furthermore, sites that subscribe to the HONcode commit themselves to providing transparent information on site sponsorship and clearly separating advertising and editorial content.ResultsIn 1998, the number of external links to the HONcode principles page grew by about 250% (e.g., from 2 to 5) . The rate of increase from January through April, 1999, suggests 300% this year. The growth in the number of links to the HONcode matches that of links to of the entire Web site, and is slightly higher than growth in links to HON's MedHunt search engine. Statistical analysis shows that approximately 50% of Web sites linked to the HONcode principles have a commercial domain name, 16% are from European countries, 15% are from non-profit organisations, and 7% are educational sites.DiscussionThis evolution shows a real need of guidelines for the developers of medical and health Web sites and their users. This conclusion is reinforced by the result of an international survey which HON conducted on the Internet in March and April 1999. The HONcode's scope of application is currently limited to publishing policy and ethical aspects. The HONcode does not address issues of quality and the relevance of the health and medical content of a Web page -- and this is a crucial issue for the further healthy development of the Internet in the medical domain. One way to assess and provide reliable medical and health content could be to review medical and health-related Web content by peers. Building on the system adopted by the scientific community decades ago for the paper medium, this Electronic peer review method could cover content as well as ethical and publishing aspects while retaining use of the HONcode display icon on registered sites as an additional reference.
IntroductionTo remain competitive, the providers of medical and health-related information must continually adapt their Web sites to new market demands and trends. Successful adaptation depends, among other things, on understanding users' needs. The Health on the Net Foundation (HON) has been conducting regular surveys of user-traffic since 1997. The fourth and latest in the series, conducted through the months of March and April, 1999, obtained 4,437 responses, compared to 1,863 responses obtained by the third survey in May and June, 1998. Thanks to these surveys, a broad user profile for Web-based medical and health-related information is emerging. The electronic questionnaire (in English, French, Italian and Portuguese) has remained largely the same since HON first posted it on its Web site in February-March, 1997. As in the past, results of the current survey are intended for use by all interested organisations. This article examines some major trends in user responses since then.MethodsThe survey uses non-probabilistic sampling, and cannot ensure that participants are representative of the total medical and health information user community on the Web. Additional links to the HON survey posted by "friendly" Web sites (e.g. eBMJ and Intelihealth, USA, DoctorMiner (Brazil) and others helped boost participation. The questionnaire is designed for completion within three to four minutes. It starts with some basic user-related questions (including age, gender, location and years on the Internet). Next come a number of statements and a multiple choice of relevant answers, from "Strongly agree" to "Strongly disagree", for simple clicking with the mouse. HON added two new questions to the March-April, 1999 questionnaire: "What type of site do you first go to?", offering six multiple-choice options, and "What are your three most preferred Web sites?". The latter is the only open question in the survey. It requires users to provide their three "favourite" URLs. Respondents are also given an opportunity to leave spontaneous messages: in the last survey, 782 left a wide variety of remarks.Results and Discussion:The survey suggests an important growth in Internet use for medical and health-related information by users in Europe. Only 18% cannot find information in their primary language. The May-June, 1998 HON survey showed 71% of respondents were North American and only 18% European, while the March-April, 1999, survey showed 48% North American users and 28% Europeans. Further, most European users (79%) were medical professionals and male (67%), an important difference to North American users (49% medical professionals and 63% female).The survey suggests that, generally speaking, users are mature to middle-aged, relatively content with the variety of medical and health-related information on the Internet, increasingly multi-national in terms of country of origin, and increasingly concerned about quality.
IntroductionUsers looking for medical and health information today can investigate a widening assortment of sources. A full package of information on a specific subject can include descriptions of a disease or a condition, relevant articles from scientific journals, articles from a variety of popular newsletters, pages from different Web sites, links to support groups, patient advocates, conferences, continuing medical education, still and moving images and much more. However, finding and collating all this material is time-consuming, for the user must first painstakingly compile it from disparate sources. In response to growing user demand, HON has developed a new integrated search tool, HONselect, that helps meet the evolving needs of all users and is now available on the HON Web siteMethodsThe HONselect tool integrates the Medical Subject Headings (MeSH) terminology thesaurus, MEDLINE for scientific publication abstracts, HON's own MedHunt search engine for Web resources, the Newspage service for daily news and HON's Media Gallery for medical images. HONselect not only integrates the user's search for Internet information types and databases, it also offers a selection of resources available in each database. The National Library of Medicine (NLM) pioneered the concept with MEDLINEPlus which consists of a complementary resources selection such as Web sites and bibliographical references dedicated to patientsResultsThe HONselect tool enables the user to search different databases and to centralise the results in one interface as well as assist in finding the appropriate medical terms or MeSH headings by browsing or searching the MeSH hierarchical structure. But HONselect does more than add value to MEDLINE Plus. It, is a new concept which gives users the possibility of learning more about a given condition or disease in a scientifically structured fashion. in French and English, HONselect permits searching for medical words in natural language and finding the related scientific term, synonyms and definitions as well as their position in the hierarchical MeSH structure with both broader and narrower concepts and terms .DiscussionThe Internet has always provided different types of information on a number of different subjects. This fact is particularly obvious in the medical domain. Until now, persons looking for details on a specific disease on the Web will first use a search engine that is either general or specialised in the medical domain. They will then select the Web site that appears best suited to their needs. But finding news, scientific papers or images usually means extending the search to further databases . HONselect is the solution (http://www.hon.ch/MeSH2/)
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