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This article explores evaluation issues in online consumer health information within the context of librarians as educators and intermediaries. Literature on Internet and health information seekers reveals that health information returned by search engines is generally accepted without critical appraisal. Reported and observational studies of users show a disconnect between what users say they know and their actions in finding and assessing the appropriateness of health information. A growing body of literature assessing the accuracy, comprehensiveness, and attribution reporting of health information finds these areas lacking and contributing to the poor assessment of quality. Several quality initiatives representative of available criteria sets, accreditation bodies, and teaching aids are discussed. A rationale for providing some type of evaluative or critical appraisal component is offered.
The number of Internet or online health information seekers continues to grow. The common methods new and experienced users employ in finding health information has remained constant. Health information seekers continue to use search engines to search and browse for usable health information resources. Search engines may be one of the most important tools developed for any information seeker. The unorganized and vast resources of the Internet are, as users suspect, readily and instantly organized. It is assumed that the most relevant and necessary links are displayed on the first page of results.
Librarians know that as much as search engines may be important tools, it is also important to help users develop a critical approach to assessing the information resources that are so readily available. Librarians have had key roles in bringing the Internet to newer audiences. As libraries become access points to the previously unconnected, librarians become intermediaries not just to the information users see but also to the analytical process users are not currently employing.
Consumer health information brings a different dimension to user education of online information seekers. The need for privacy, the ordeal of a new and heuristic experience, and the often fragile emotional states medical conditions can place users in are issues that affect the uninitiated health information seeker. Medical librarians are familiar with this type of patron. The growing number of new Internet searchers has meant that public librarians have also been acquainted with this type of user. The convergence of the new and perhaps unsavvy user, a health information need, the promise of instant information from the Internet, and the reality of hard-to-discern information resources has made the need for teaching evaluation skills apparent.
This article will explore issues related to the need for teaching users analytical evaluation skills in the context of online consumer health information. The studies discussed will reinforce the notions alluded to above. Studies examining Internet health information seekers will be discussed, specifically, articles that shed light on the number and behaviors of health information seekers. Several studies attempting to measure the quality of Internet content will be reviewed in order to examine whether there is a "quality problem" on the Internet. The literature examining quality initiatives and their use of criteria sets will also be reviewed. Studies of consumer health information-seeking behavior support the need for continued educational reinforcement of critical analysis of health information Web sites.
HEALTH INFORMATION SEEKING: PREVALENCE AND BEHAVIOR
The studies mentioned in this section are drawn from surveys of users of Internet health information. Most searches for health information are reported by users as taking place at home. Nevertheless it is important to consider the library user's predisposition to the same behaviors uncovered in the research. Findings reveal the need for libraries to consider appropriate interventions for preparing the online health information user.
Several studies attempt to gauge the popularity and use of online health information throughout the United States. In the larger context of information seeking on the Internet, users turn to online resources to gather information on new or unfamiliar topics. The abundance of information sources makes the Internet helpful in researching topics when the ability to compare information is most important. (Fox & Rainie, 2002).
Licciardone, Smith-Barbaro, and Coleridge (2001) attempted to measure the use of online health information against other media. The study found that print media (newspapers and magazines) and television are the two major sources of health information. Thirty-two percent of the respondents in the study indicated using the Internet as their primary source for health information. There was no distinction made as to whether the information gleaned from these sources was the result of the user's active research into a particular topic or came across through casual or recreational reading and viewing. In the Licciardone et al. (2001) study, 50 percent of the respondents indicated they "felt comfortable using the Internet as a health information resource." The study's methodology did not establish any criteria for self-assessment of the user's comfort level.
The findings in Licciardone et al. are largely consistent with Fox, Rainie, and Horrigan et al. (2000). The Fox study estimates that, of 104 million American adults that are Internet users, 55 percent use the Internet to acquire health information. The Fox study did not attempt to measure the user's comfort or skill level for finding online health information, but it did provide findings on how users search for health information. Users are likely to search for information related to a physical or mental illness (91 percent and 26 percent respectively) but are less likely to take part in online transactions like getting advice from an online doctor (10 percent) or purchasing medications and supplements (10 percent).
Users surveyed in Fox, Raine, and Horrigan et al. (2000) reported a reliance on search engines to conduct their health information searches. Users are likely to save or bookmark a …