1. Prescription for Success: Consumer Health Information on the Web Bette Anton, MLS banton@library.berkeley.edu

2. This Workshop Is Brought to You By National Network of Libraries of Medicine, Pacific Southwest Region, UCLA Louise M. Darling Biomedical Library. Funded by the National Library of Medicine Infopeople Project

3. Introductions Name Library Position What brings you here? Are there health-related questions that you are frequently asked?

4. Objectives Use MedlinePlus to aid health seekers to: find reliable disease-specific information find reliable drug & supplement information find hospitals and doctors find the latest health news

5. Be able to identify and use: NLM and other government websites to find answers to commonly asked health questions Websites specifically designed for California and multi-cultural health seekers Develop strategies for finding and evaluating health information on the Internet

6. Pre-Test MedlinePlus can help you find a local consumer health library. T F Reference librarians can provide advice about health information. T F Name three criteria for evaluating a health website. What is the name of the largest biomedical library in the world?

7. The Patron’s Path to You Physician PatientFriend/Relative Librarian Fibrocystic breast disease Cystic Fibrosis

8. What the Patron Says, What the Patron Means Sick lick vomiting Rose acre Fireballs in the Eucharist Sweet smiling Jesus Cyclic vomiting Rosacea Fibroids in the uterus Spinal meningitis

9. The Health Reference Interview Determine who the information is for. Use dictionary, anatomy book or medical encyclopedia first. Have patron contact health care provider if sufficient information is unavailable. Never provide interpretation of the information, or advice. Always suggest that patron contact her/his health care provider.

10. From NLM & NIH Authoritative & up-to-date information Encyclopedia & dictionary Drug & supplement information Clinical trial information Updated daily No advertising

11. MedlinePlus en Español MedlinePlus is available in Spanish by clicking on the “español” link. All materials responsive to language, dietary, and cultural needs of Hispanic population. http://medlineplus.gov/spanish/

12. MedlinePlus Resources Encyclopedia includes 4,000+ entries on diseases, tests, symptoms, injuries and surgeries, and an extensive library of photographs and illustrations. Medical Dictionary Health Topics http://medlineplus.gov/

13. Bookmarks Go to: bookmarks.infopeople.org Look for the class bookmark file. [prescription_success_bk.html] Click on it so it shows on the screen. With the class bookmark file showing in Internet Explorer, click the Favorites menu, choose Add to Favorites… Notice the name in the Name: box so that you can use the Favorites list to get back to the class bookmarks for the rest of the day.

14. Other MedlinePlus Resources Drug & supplement information News Doctor/hospital finder Interactive tutorials/surgery videos Local libraries

15. NLM Resources & Collaborations NIH Senior Health clinicaltrials.gov DIRLINE Genetics Home Reference American Indian Health Household Products Database Tox Town

16. Reliable Resources for Common Consumer Health Questions Complementary & Alternative Medicine Cancer resources Lab Tests Online Drug Digest

17. Complementary & Alternative Medicine (CAM) “Diverse medical & health care systems, practices, and products …not presently considered to be part of conventional medicine.” Source: http://nccam.nih.gov/health/whatiscam/ Less evidence of efficacy of treatments and safety. 36% of adults over age 18 use some form of alternative medicine Source: CDC 2002 Nat’l Health Interview Survey

18. Integrative Medicine Combines mainstream medical therapies and CAM therapies for which there is some high-quality scientific evidence of safety and effectiveness.

19. National Center for Complementary & Alternative Medicine http://nccam.nih.gov My daughter, who is on Zoloft, is taking St. John’s Wort for depression. Does it really work?

20. Reliable Cancer Information National Cancer Institute http://www.cancer.gov/ American Cancer Society http://www.cancer.org University of Pennsylvania’s Oncolink http://www.oncolink.org My mother was diagnosed with cervical cancer. I think they called it stage IIA. What can you tell me about it? Is she going to have chemo or radiation?”

21. Drug Web Sites Many drug sites are commercial ones. Many are simply advertising for pharmaceutical companies or particular drugs. Direct-to-consumer advertising of prescription drugs can be misleading.

22. Drug Digest Drug Library Interactions Comparisons Conditions & Treatments Interactive Tools http://www.drugdigest.org/ Are there interactions between St. John’s Wort and Zoloft?

23. Lab Tests Online My doctor says my cholesterol is 210. What does that mean? http://www.labtestsonline.org/

24. Why is evaluation of health websites important? How is evaluation of health web sites different from evaluation on non-health websites?

25. Evaluation Issues Increasing number of : patients accessing information on the Internet health-related websites Patients believe that the web is a reliable source of information

26. What Do We Know About Consumer Behavior? Consumers use search engines rather than medical portals or sites of medical societies or libraries. When assessing the credibility, they claim to primarily look for the source, professional design, scientific or official touch, language, and ease of use. Under observation, none checked “about us” sections, disclaimers, or disclosure statements. Source: Eysenbach, G, Köhler, C. How do consumers search for and appraise health information on the world wide Web? BMJ. 2002 March 9; 324 (7337): 573–577.

27. Five Criteria for Evaluation Accuracy Authority Bias Currency Coverage Each of these alone is meaningless, but together they create solid guidelines for evaluation.

28. Read URL Carefully Is it someone’s personal page? ~ or % geocities or aol.com What type of domain does it come from?.gov or.edu or.org Who is the “publisher”? http://publisher/

29. ¡¡Evaluate, Evaluate, Evaluate!! Scan the perimeter of the page and think about these questions: Why did the person create the page? What’s in it for them? Are they trying to sell something? Contact information About us Now apply the five criteria

30. Accuracy Is the information accurate? Remember: Anyone can publish on the web Many web pages are not reviewed or verified by editors or peers Web standards to ensure accuracy do not exist

31. Accuracy Example http://www.malepregnancy.com/

32. Authority Is the author an authority on the subject? Remember: It is often difficult to determine the authorship of web pages If a name is listed, the author’s qualifications are frequently absent Check if the web page has the backing of a well-established organization, institution, or agency

33. Authority Example http://members.tripod.com/~tourette13/

34. Bias Does the author bring any biases in posting the information? Remember: Web pages often are “soapboxes” Check that the author’s goals are clearly stated Watch out for the emotional “kick”… photographs, exclamation points, huge fonts

35. Bias Example http://bseinfo.org/

36. Currency Is the information current and timely? Remember: Dates are not always included If dates are included it may not be clear if it is: Date created Date revised Date page was placed on Web

37. Currency Example http://www.nytimes.com/specials/women/whome/hrt.html

38. Coverage Many health sites are not comprehensive. The information may be accurate but important information may be left out. Remember: How does the information compare with other sources on the same topic? Is a better source available? Does the site have a disclaimer?

39. Coverage Example http://www.medical-library.net/

40. http://servers.medlib.hscbklyn.edu/ebm/2100.htm

41. ¡¡Evaluate, Evaluate, Evaluate!! “Contributes to”, “is linked to”, “associated with” is not the same as “causes” “Doubles the risk” is meaningful depending upon what risk was in the first place “Significant” is not the same as “statistically significant”

42. More Evaluation Tips “May” v. “will” “Proves” - one study alone infrequently proves something. “Breakthroughs” rarely happen. Beware of miraculous cures.

43. MedlinePlus Evaluation Resources Evaluating health Internet information: a Tutorial http://www.nlm.nih.gov/medlineplus/webeval/webeval.html Health fraud resource http://www.nlm.nih.gov/medlineplus/healthfraud.html

44. Health Literacy Health literacy is the ability to read, understand, and act on health care information. Source: Center for Healthcare Strategies, http://www.chcs.org/usr_doc/FS1.pdf

45. Who Has Health Literacy Problems? People of all backgrounds, especially those with chronic health problems Most adults in U.S. read at 6 th grade level, 45% below 6 th grade level. Older people, immigrants & those with low incomes are disproportionately more likely to have trouble reading & understanding health-related information.

46. According to the latest U.S. census data, 41% of Californians over the age of 5 speak a language other than English at home.

47. Multilingual Resources What language group(s) does your library serve? The NN/LM provides links to many multilingual resources http://nnlm.gov/train/chi/multi.html

48. California-Specific Web Sites California Department of Health Services California Healthcare Foundation What Patients Think of California Hospitals California Nursing Home Search Online Enrollment for Public Health Insurance NN/LM/PSR http://nnlm.gov/psr/about/region/california.html http://nnlm.gov/psr/about/region/california.html

49. Action Plan: Next Steps

50. Post-Test MedlinePlus can help you find a local consumer health library. T F Reference librarians can provide advice about health information. T F Name three criteria for evaluating a health Web site. What is the name of the largest biomedical library in the world?

51. In Summary The National Library of Medicine provides many important and reliable consumer health resources. Evaluation of unknown sites is essential. Health seekers frequently have difficulty finding, understanding and using health information. NEVER provide medical advice. Send patrons to their health care providers for advice and interpretation of health information.

52. Wrap-Up How to reach NNLM/PSR: http://nnlm.gov/psr/ http://nnlm.gov/psr/ or 1.800.338.7657 Funding opportunities: http://nnlm.gov/psr/funding/ Other classes: http://nnlm.gov/psr/training/ Member Services http://nnlm.gov/psr/members/