Quality Control of Information on Health-Related Content Websites Goes Further on the Internet. Response

To the Editor,

Health professionals have been concerned about the quality of information on the Internet since the technology was first introduced. In 1998, JAMA published a review of instruments to assess the quality of information on the Internet.¹ The article concluded by questioning both the aims of and need for such instruments, given that the most important aspect is the way people use the available information. In that context, it is important to note that there is little scientific evidence on the relationship between health-related information on the Internet and its negative impact on the health of users.²

Subsequent systematic reviews of these instruments have noted both their proliferation and the lack of agreement on how the concept of quality should be defined and measured.^{3, 4} In addition to these formal difficulties, Adams et al.⁵ set out a further series of criticisms. First, they questioned whether Internet users are aware of this type of quality control initiative. Second, even if users are aware of such initiatives there is no guarantee that they understand the information provided. Third, they note how easy it is to reproduce or acquire such instruments without the approval of the developers. Fourth, the process of acquiring such instruments has sometimes been criticized for a lack of transparency and for the interests of those involved. Critics suggest that although this type of instrument has made it easier to identify and highlight problems related to the quality of information online, they have not solved the problem because there is no clear evidence that they are effective in that regard.^{6, 7}

There is then a need to develop strategies for quality control which will help healthcare organizations, professionals, and citizens optimize the potential of the Internet as a source of health information.⁸ These new strategies must take into account the technological and social nature of the Internet⁹ and focus on the way information is used rather than only focusing on formal aspects.^{10, 11} The experience gained in developing and applying strategies based on “control” will be very useful in shaping new strategies centered on “use”.

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