With Canadians increasing their use of the Internet to find health-related information, especially regarding natural health products (NHPs), there is a need for high-quality, evidence-based information on Web sites to aid consumers in making informed decisions regarding the appropriate and safe use of NHPs.
Objective
To determine the quality of Web sites that target consumers and advocate the use of NHPs in the management of osteoporosis in postmenopausal women.
Methods
Web sites were identified via the Google search engine using the key words “natural treatment osteoporosis.” The first pages of the first 91 Web sites identified were assessed for relevance based on the following criteria: (1) written in English, (2) contained consumer information, and (3) claimed a benefit of a single NHP in the management of osteoporosis. This task was completed by 2 investigators; differences were resolved by consensus after discussion with the third investigator. Quality of relevant sites was assessed using an expanded DISCERN instrument that also examined the evidence supporting the claim of benefit. Additionally, readability of the sites was assessed.
Results
Thirty-eight Web sites met the inclusion criteria. Using the DISCERN instrument, we found that many of the sites scored low, suggesting serious or extensive shortcomings. On many Web sites, benefit claims regarding calcium, vitamin D, phytoestrogens, dehydroepiandrosterone and vitamin K were consistent with empirical evidence. However, for other NHPs, many of these same sites made effectiveness claims that were not supported by current evidence from randomized controlled trials. Twenty-five sites did not provide information as to what resources were used to support their claims. The average reading grade score was grade 11.9 (based on US school grades) and the mean Flesch Reading Ease Score was 41.7. (A higher score out of 100 indicates ease of reading.)
Conclusions
Due to the poor quality and content from unknown sources found on some Web sites, consumers who access Web sites for information regarding the use of NHPs in osteoporosis should do so cautiously and discuss results with their healthcare providers.
BrownJPFortierM. Canadian consensus conference on osteoporosis, 2006 update. J Obstet Gynaecol Can2006;28: S95–112.
2.
BrownJPJoseeRJ, for the Scientific Advisory Council of Osteoporosis Society of Canada. 2002 Clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. CMAJ2002;167:S1–34.
3.
CheungAMFeigDSKapralMDiaz-GranadosNDodinS. Prevention of osteoporosis and osteoporotic fractures in postmenopausal women: recommendation statement from the Canadian Task Force on Preventive Health Care. CMAJ2004;170:1665–7.
MorrisCAAvonJ. Internet marketing of herbal products. JAMA2003;290:1505–9. DOI 10.1001/jama.290.11.1505
8.
ThurairajaRBarrassBPersadR. Internet websites selling herbal treatments for erectile dysfunction. Int J Impot Res2005;17:196–200. Epub 28 Oct 2004. DOI 10.1038/sj.ljir.3901282
9.
WhelanAMJurgensTMBowlesSK. Natural health products in the prevention and treatment of osteoporosis: systematic review of randomized controlled trials. Ann Pharmacother2006;40:836–49. Epub 2 May 2006. DOI 10.1345/aph.1G226
10.
MolassiotisAXuM. Quality and safety issues of web-based information about herbal medicines in the treatment of cancer. Complement Ther Med2004;12:217–27. DOI 10.1016/j.ctim.2004.09.00
11.
CroftDRPetersonMW. An evaluation of the quality and contents of asthma education on the world wide web. Chest2002;121:1301–7. DOI 10.1378/chest. 121.41301
12.
BernardALangilleMHugesSRoseCLeddinDvan ZantenSV. A systematic review of patient inflammatory bowel disease information resources on the world wide web. Am J Gastroenterol2007;102:2070–9. DOI 10.1111/j.1572-0241.2007.01325.x
13.
Perez-LopezFRPerez RonceroGR. Assessing the content and quality of information on the treatment of postmenopausal osteoporosis on the world wide web. Gynecol Endocrinol2006;22:669–75. DOI 10.1080/09513950601012603
14.
LuevoraskirikulKGrayNJAndersonCW. Developing a consumer evaluation tool of weight control strategy advertisements on the Internet. Health Educ Res2008;23:567–75. Epub 7 Sept 2007. DOI 10.1093/her/cym044
15.
WallaceLSTurnerLWBallardJEKeenumAJWeissBD. Evaluation of web-based osteoporosis educational material. J Womens Health2005;14:936–45. DOI 10.1089/jwh.2005.14.936
16.
CharnockD. The DISCERN handbook: quality criteria for consumer health information on treatment choices. Abingdon, Oxon, UK: Radcliffe Medical Press Ltd., 1998.
WrightJV. Fight—even prevent—osteoporosis with the hidden secrets of this bone-building miracle mineral. www.tahoma-clinic.com/strontium.shtml (accessed 2007 Jun 20).
LewieckiEMRudolphLAKiebzakGMChavezJRThorpeBM. Assessment of osteoporosis-website quality. Osteoporos Int2006;17:741–52. DOI 10.1007/s00198-005-0042-5
60.
Statistics Canada and the Organization for Economic Co-operation and Development. Adult literacy and life skills (ALL) survey. www.abc-canada.org/Literacy_facts (accessed 2008 Aug 19).
61.
FriedmanDBHoffman-GoetzLArochaJF. Health literacy and the World Wide Web: comparing the readability of leading incident cancers on the Internet. Med Inform Internet Med2006;31:67–87. DOI 10.1080/14639230600628427
62.
MeadeCDMcKinneyWPBamasGP. Educating patients with limited literacy skills: the effectiveness of printed and videotaped materials about colon cancer. Am J Pub Health1994;84:119–21.
EysenbackGKohlerC. How do consumers search for and appraise health information on the world wide web? Qualitative study using focus groups, usability tests, and in-depth interviews. BMJ2002;324:573–7. DOI 10.1136/bmj324.7337.573
65.
PetersonGAslaniPWilliamsPA. How do consumers search for and appraise information on medicines on the Internet? A qualitative study using focus groups. J Med Internet Res2003;5: e33. DOI 10.2196/jmir.5.4.e33.
66.
SilversteinCMaraisHHenzingerMMoriczM. Analysis of a very large web search engine query log. ACM SIGIR Forum1999;33:6–12.
