Purpose Online information can influence attitudes toward vaccination. The aim of the present study is to provide a systematic evaluation of the search engine ranking, quality, and content of webpages that are critical versus noncritical of HPV vaccination. Methods We identified HPV vaccine-related webpages with the Google search engine by entering 20 terms. We then assessed each webpage for critical versus noncritical bias as well as for the following quality indicators: authorship disclosure, source disclosure, attribution of at least one reference, currency, exclusion of testimonial accounts, and readability level less than 9th grade. We also determined webpage comprehensiveness in terms of mention of 14 HPV vaccine relevant topics. Results Twenty searches yielded 116 unique webpages. HPV vaccine-critical webpages comprised roughly a third of the top, top 5 and top 10-ranking webpages. The prevalence of HPV vaccine-critical webpages was higher for queries that included term modifiers in addition to root terms. Compared with noncritical webpages, webpages critical of HPV vaccine overall had a lower quality score than those with a noncritical bias (p<.01) and covered fewer important HPV-related topics (p<.001). Critical webpages required viewers to have higher reading skills, were less likely to include an author byline, and were more likely to include testimonial accounts. They also were more likely to raise unsubstantiated concerns about vaccination. Conclusion Webpages critical of HPV vaccine may be frequently returned and highly ranked by search engine queries despite being of lower quality and less comprehensive than noncritical webpages.
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