1. Separating Fact from Fiction
Consumer Health
Separating Fact from Fiction
This is not related to the course specifically but
At home, work, school or play, policies determine the nature of our surroundings and our actions within them. For this reason, policy is a meaningful way to protect and improve health. Developed in conjunction with national experts, Health Policy Coach equips you with the tools, strategies and information necessary to create policy change in your community.

2. Issues Misleading Information Quackery and Health Fraud
Problems with Products
Problems with Services
Problems with Costs
The Need for Consumer Protection
Intelligent Consumer Behavior
Consumer health encompasses all aspects of the marketplace related to the purchase of health products and services. Although health care in America is potentially the world's best, many problems exist.
Health information is voluminous and complex. Many practitioners fall short of the ideal, and some are completely unqualified. Quackery is widespread. The marketplace is overcrowded with products, many of which are questionable. Rising costs and lack of adequate insurance coverage have reached crisis levels. Consumer protection is limited.
Only well-informed individuals can master the complexity of the health marketplace. Intelligent consumers maintain a healthy lifestyle, seek reliable sources of information and care, and avoid products and practices that lack scientific substantiation.

3. Issue1 Misleading Information
High volume and complex
Media influence
Radio & TV
Magazines & newspapers
Functions
Entertain, inform, carry advertisements and make money
News, commentary & talk shows
Issues and Trends
The environment for communicating about health has changed significantly. These changes include dramatic increases in the number of communication channels and the number of health issues vying for public attention as well as consumer demands for more and better quality health information, and the increased sophistication of marketing and sales techniques, such as direct-to-consumer advertising of prescription drugs and sales of medical devices and medications over the Internet. The expansion of communication channels and health issues on the public agenda increases competition for people’s time and attention; at the same time, people have more opportunities to select information based on their personal interests and preferences. The trend toward commercialization of the Internet suggests that the marketing model of other mass media will be applied to emerging media, which has important consequences for the ability of noncommercial and public health-oriented health communications to stand out in a cluttered health information environment.

4. Issue 7 Intelligent Consumer Behavior
Seek reliable sources of information
Maintain a healthy lifestyle
Select practitioners with care
Assess own health
Active health & illness management
Use scientifically substantiated health products and services
Understand costs of health and illness
Report fraud

5. Key Points How facts are determined Selecting internet sites
Magazines and periodicals
Consumer health encompasses all aspects of the marketplace related to the purchase of health products and services. Although health care in America is potentially the world's best, many problems exist.
Health information is voluminous and complex. Many practitioners fall short of the ideal, and some are completely unqualified. Quackery is widespread. The marketplace is overcrowded with products, many of which are questionable. Rising costs and lack of adequate insurance coverage have reached crisis levels. Consumer protection is limited.
Only well-informed individuals can master the complexity of the health marketplace. Intelligent consumers maintain a healthy lifestyle, seek reliable sources of information and care, and avoid products and practices that lack scientific substantiation.

6. Healthy People 2010 Effective Health Communication
Accuracy
Availability
Balance
Consistency
Cultural competence
Evidence base
Reach
Reliability
Repetition
Timeliness
Understandability

7. How Facts are Determined
Research Basics
Survey Research
Experimental and Observational Research
Secondary Research
Examine popular approaches used in collecting statistical data.
National Public Health Week The observance of National Public Health Week (NPHW) will be April 5-11, The tagline is, "Eliminating Health Disparities: Communities Moving from Statistics to Solutions." Last year's NPHW was a great success with events in every state including the District of Columbia. Our message on obesity was heard in 7.4 million households. With the sponsorship of The Robert Wood Johnson Foundation, the Commonwealth Fund, and the Josiah Macy Jr., Foundation, we anticipate this year to be the most successful yet. To find out more about National Public Health Week 2004, please visit

8. Research Basics Types of Studies The Research Process
Exploratory
Descriptive
Causal
Predictive
The Research Process
Primary vs Secondary Data
Statistics used as a descriptive tool for expressing information relevant to our needs and an inferential device for using sample findings to draw conclusions about a population.
Types of Studies
Exploratory – initial step, helps us become familiar with the problem situation, identify important variables and use the variables to form hypotheses. Hypothesis will be statement about a variable or relationship between variables i.e., health care costs will decrease if we get more people using evidence based health information. Hypothesis may be not be true but is useful as an assertion that can be examined by collecting sample data
Factor analysis = set of techniques for studying interrelationships among variables. A very large set of variables can be reduced to a small set of new variables (factors) that are more basic in meaning but contain most of the information in the original set.
Cluster analysis = When each of a great many individuals or objects is represented by a set of measurements or variables, cluster analysis categorizes the individuals or objects into groups where the member tend to be similar. In marketing, one application of cluster analysis is to categorize consumers into groups, a procedure associated with what is referred to as market segmentation.
Discriminant analysis = A technique which identifies the variables that best separate members of two or more groups. It can also be used to predict group membership on the basis of variables that have been measured or observed.
Multidimensional scaling (MS) = Based on a ranking that reflects the extent to which various pairs of objects are similar or dissimilar, multidimensional scaling is a procedure which maps the location of objects in a perceptual space according to dimensions that represent important attributes of the objects. In this approach to MS, one of the biggest challenges is the interpretation of exactly what these dimensions mean.
Conjoint analysis = based on a ranking of preferenes for varous combinations of product featrues, conjoint analysis proceeds to determine underlying utility curves for these features. From these utility curves, it is then possible to travel in the reverses direction, estimating the attractiveness of a new product (health behavior, health product, health service) on the basis of the particular combination of features it will possess.
Exploratory research can also be of a qualitative nature. One method for this is the focus groups in which a moderator leads a small group discussion about a group and the client observes videos and audio of the discussion.
Descriptive Studies = has the goal of describing something, i.e., describe the average age, income of those who are members of health clubs or buy from health food stores.
Causal Studies = tries to determine if one variable has an effect on another. Example is the borken utility poles decrease after stricter drunk driving laws go into place.
Predictive = tries to forecast some situation or value that will occur in the future.
See next slide for research process
Primary data are those gerenated by a researcher for a specific problem.
Secondary data are gathered by someone else for some other purpose.

9. Research Process 1. Define the problem
2. Deciding on the type of data to collect
3. Determining through what means
the data will be obtained
4. Planning for the collection of data (selection of a sample)
5. Collecting and analyzing the data
6. Drawing conclusions and reporting the findings

10. Survey Research Types of Surveys Questionnaire Design Types of surveys
Mail or internet– usually accompanied by a cover letter and postage-paid envelope. Letter should be, brief, readable, explain who is doing the study. Should contain information on how information will be kept confidential and informed consent process.
Personal Interview – personal getting information in a “purposeful conversation.” This is an expensive process compared to mail or internet surveys.
Telephone interview – good for getting information about what a person is doing at the time of the call. Like product using or food eating.
Questionnaire design – 3 types: multiple choice, dichotomous (2 choices) with sometime “don’t know” or no opinion), open ended where respondent can expand on the subject of the question.
Vocabulary in questionnaire – level appropriate for type of person being surveyed, avoids leading words the influence response, avoids sensitive topics or phrases the topic in a way making it less sensitive (condom use vs barrier use in sexual activity).
Example sensitive q’s from a preventive health assessment at
use of intravenous drugs
Have you ever used intravenous (injected) drugs, shared needles for injection, or been exposed to needles in a potentially unsafe or unsterile environment, such as a less-developed nation or a tattoo parlor? Yes, no, prefer not to answer
Estimate your lifetime number of sexual partners.
0, 1, 2 or 3, 4 or more
Which birth control method/STD protection do you or your partner use? (Check all that apply.)
birth control pill, condom, Deprovera (shots), diaphragm, IUD, Norplant (implant) rhythm method (fertility awareness) spermicide tubal ligation/vasectomy other none
sexual activity
Are you concerned about your sexual health? (Check all that apply.)
yes, erectile dysfunction yes, sexually transmitted diseases (STDs) yes, reproductive health yes, other concern no prefer not to answer
blood transfusions
Did you receive any blood transfusions before 1985?
Yes, no, not sure
Have you ever had sexual relations with another male?
Yes, no, prefer not to answer

11. Survey Research The Sampling Process Errors in Survey Research
Sampling Process – is a process used to study a response to an intervention in a small population that can be applied to a larger population. Some terms to become familiar with are listed and explained below.
Element - An element is the most basic unit on which information will be collected - individuals, chart records, etc.. For example: In a study of nursing delivery system in hospital that has three different units using 3 different delivery systems, the elements are the first floor case method, the second floor team method, and the third floor partnership model.
Population - population is a set of individuals that meet sampling criteria. The target population is the entire set of population that the researcher would like to make generalizations about . The accessible population is the one that meets the criteria established and is also accessible, considering constraints of time, money, researcher availability.
Generalizability - is extending findings from the sample to the larger population
Sampling Criteria - A well defined set that meets very specific criteria: criteria must be very well defined, must have limiting factors so that persons not meeting the criteria will be excluded, must be able to control for homogeneity by excluding from the desired population anyone who would bring in a confounding variable
Representativeness - The extent to which the sample and the population are alike. Sampling Unit The selection of a portion of the target population that will represent the entire population
Types of Sampling
NONPROBABILITY SAMPLING Uses a non random method to select the sample - you cannot be assured that every element available is fairly represented in the sample
CONVENIENCE SAMPLING Uses the most readily available subjects and is the easy method to obtain subjects Example:  all students enrolled in a nursing program; first 200 patients admitted to a nursing unitProblem:  risk of bias is very great sample tends to be self selecting:
what motivated people to volunteer? what sample of the population is missed because they were not available?
QUOTA SAMPLING Knowledge about the population is used to build some design into the sample. Each stratum of the population is represented proportionally Must base sampling on previous knowledge :from a literature review Example:  you want to study attitudes of nurses about use of nursing diagnosis what type of samples would you think would be important to include? level of education ; years in practice as a nurseProblem:  Even these techniques do not assure that no bias may be present - in the above example, what variable could affect a nurse's willingness to participate in the study?
PURPOSIVE SAMPLING Researcher handpicks subjects to participate in the study based on identified variables under consideration. Used when the population for study is highly unique
Example:  Parents of children with Tay Sach's diseaseProblems:  Must assume that errors of judgment in ranges of the sample will tend to even out - as many subjects who are at the far ends of the population will cancel each other out. Uses for purposive sampling: validation of a test or instrument with a known population, collection of exploratory data from an unusual population, use in qualitative studies to study the lived experience of a specific population
How does purposive and quota sampling differ?
Purposive restrict the sample population to a very specific population and then tends to use all of the subjects available
PROBABILITY TESTING Random selection of subjects from a specific population
SIMPLE RANDOM SAMPLING
population if defined listing all of the descriptors identify all populations that meet the descriptors and give each a number use a table of random numbers to select population for study, read off numbers in any fixed direction
Advantages:  researcher bias cannot operate representation of the desired population is maximized probability of selecting a nonrepresentative sample is decreased as the sample size is increased
Disadvantages:  very time consuming it may be impossible to obtain a list of every person eligible to be part of the population under study
STRATIFIED RANDOM SAMPLING
uses a quota for subsets to ensure that all subgroups are fairly represented similar to proportional quota sampling except that a random approach is used to select the sub populations
Example:see diagram of study on registered nursesQuestions to be addressed
what is the logical basis for selecting the subsets?
do you have sufficient information available to divide population into subsets
should each subset be equal in size or should the size be based on the frequency in the population?
are there enough subjects to get meaningful groups into each subset?
have random procedures ben used to select subjects for each of the subsets?
Problems:  similar to a simple random design in terms of stability to identify appropriate subjects greater because of the need for greater numbers of subjects to fill each of the subsets
CLUSTER SAMPLING used to break up large groups into smaller workable models Example:The researcher wants to examine nursing practices in county health departmentsStage 1:identify all states - each will be a sampling group - randomly select a certain percentage of statesStage 2:select a random sample of subjects from the first sample: a random sample of county health departments within the states selected Stratified random sampling technique could be used by looking at counties based on rural vs urban, etc.
Advantages:more economical of time and moneyDisadvantage:  sampling error can creep in
SYSTEMATIC SAMPLING select every nth subject from a list of all possible subjects - example: every 5th patient admitted to the hospital
the population listing must be random - example a list of nurses by alphabetical order
the sample selection of the population must start at a random point - if you had an alphabetical listing of all subjects, you would not start with the "A" - but rather with a random point in the list and then go by the nth interval
Sampling interval - determined by the size of the group
n = total population = size of the desired sample Problems:be sure geographic or cyclic events are not introducedExample:use of 7 as an interval size when looking at use of a facility Geographic regions that happen to vary with the interval size: every 3rd room being a private room as compared to double rooms
MATCHED SAMPLING used to obtain equivalent comparison groups: match on characteristics such as age, sex, schooling, etc.
SAMPLE SIZE
Power Analysis
In quantitative studies, the larger the sample the greater likelihood will it be non biased
In qualitative studies, the sample size is generally very small
The sample size will be indicated by the type of statistical tools that will be used
The degree of precision needed will help to determine sample size
The smaller the expected differences in subject response to the intervention, the large the sample size needed to demonstrate a significantly different response
If the study has been well designed, a smaller sample size can produce good results
Errors in Sampling
Sampling error is a random error described as nondirectional or nonsystemaitc because error is as likely to be low are high.
Response error/non-response errors are directional or systematic. Respondents may distort the truth

12. Experimental and Observational Research
Experimentation
Identify cause and effect relationships
Internal validity
External validity
Observational Research
Experimental Research ('true scientific research') is that which tests causal relationships by observing the behaviour of the subject under conditions where some variables are controlled and others manipulated. Strictly speaking, the term experiment should be confined to those actions or series of actions where it is possible to do all of the following:
Randomly assign the subjects of the experiment to either an experimental group (to which something is done) or a control group (to which the thing done to the experimental group is not done).
Manipulate (do something to) the experimental group.
Ensure that in all other important aspects, the factors affecting the experimental and control groups remains the same.
In the technical jargon, one would say that a true experiment must be distinguished by the three characteristics of 'random assignment', 'manipulation' and 'control'. The classic format for an experiment is, according to LoBiondo-Wood and Haber (1994 p 217): Random Assignment to groups:
Experimental Group » Pre-test » Experimental Treatment »Post-test
Control Group » Pre-test » » » Post-test
By definition, experimental research is always quantitative.
Internal Validity is the approximate truth about inferences regarding cause-effect or causal relationships. Thus, internal validity is only relevant in studies that try to establish a causal relationship. It's not relevant in most observational or descriptive studies, for instance. But for studies that assess the effects of social programs or interventions, internal validity is perhaps the primary consideration. In those contexts, you would like to be able to conclude that your program or treatment made a difference -- it improved test scores or reduced symptomology. But there may be lots of reasons, other than your program, why test scores may improve or symptoms may reduce. The key question in internal validity is whether observed changes can be attributed to your program or intervention (i.e., the cause) and not to other possible causes (sometimes described as "alternative explanations" for the outcome).
External Validity
The extent to which research results may be generalized to other populations and settings. Example: would reduction in smoking from 54% to 42% in Norway from 1974 to 1984 results of a tobacco ad ban be similar in the US or Britain as those found in Norway
Observational research – relies on watching or listening, then counting or measuring. There are no respondents

13. Secondary Data Internal Sources External Sources
Evaluating Secondary Data
2ndry = data collected by someone other thena the researcher for purposes other than your own problem or decision at hand.
Internal = usually accounting or financial information. But could be on participation, quality, sales.
External sources = Federal, state and local gov’t such as Census of Population, Housing; Statistical Abstract of the US. From Bureau of the Census and US Dept of Commerce, Centers for Disease Control, commercial suppliers
Select, evaluate and use with caution since information may be irrelevant to your needs, out of date, not in units or levels of aggregation compatible with your informational requirements or may not have been collected or reported objectively.

14. Healthy People 2010 Objective 11-4 (Developmental)
Increase the proportion of health-related Web sites that disclose information that can be used to assess the quality of the site.
Developers & sponsors
Purpose of site
Original sources of content
Privacy & confidentiality of personal information collected
How content is updated
How site is evaluated
11-4. (Developmental) Increase the proportion of health-related World Wide Web sites that disclose information that can be used to assess the quality of the site.
Potential data sources: Health on the Net Foundation; Health Internet Ethics (Hi-Ethics); Internet Healthcare Coalition.
With the rapidly growing volume of health information, advertising, products, and services available on World Wide Web sites, serious concerns arise regarding the accuracy, appropriateness, and potential health impact of these sites.4, 21 People are using the Internet to look up information, purchase medications, consult remotely with providers, and maintain their personal health records. Approximately 70 million persons in the United States use the Internet for health-related reasons,[45] and the potential for harm from inaccurate information, inferior quality goods, and inappropriate services is significant. Many initiatives are under way to identify appropriate and feasible approaches to evaluate online health sites.26 Professional associations are issuing guidelines and recommendations,[46], [47], [48] Federal agencies such as the Federal Trade Commission are actively monitoring and sanctioning owners of Web sites that are false or misleading,[49] and developers and purchasers of online health resources are being urged to adopt standards for quality assurance.4
To allow users to evaluate the quality and appropriateness of Internet health resources, health-related Web sites should publicly disclose the following essential information about their site:4 (1) the identity of the developers and sponsors of the site (and how to contact them) and information about any potential conflicts of interest or biases, (2) the explicit purpose of the site, including any commercial purposes and advertising, (3) the original sources of the content on the site, (4) how the privacy and confidentiality of any personal information collected from users is protected, (5) how the site is evaluated, (6) and how the content is updated. An additional mark of quality which should be present in a Web site relates to the site’s accessibility by all users. Contents of the site should be presented in a way that it can be used by people with disabilities and with low-end technology.

15. Where the information comes from Whether the information checks out
Rating Media AARP
Where the information comes from
Whether the information checks out
How old the information is
Whether the information sounds "too good to be true."
Whether the site is telling you to do something.
Where the information comes from.
Always pay close attention to where the information on the site you're looking at comes from. Good sources of health information include:
"Dot govs," or government sites like the National Institutes of Health and the U.S. Centers for Disease Control and Prevention
University or medical school sites, such as Johns Hopkins University Medicine and the University of California at Berkeley
Hospital, health system, and other health care facility sites like the Mayo Clinic and Cleveland Clinic
"Dot orgs," or not-for-profit groups whose focus is research and teaching the public about specific diseases or conditions, such as the American Diabetes Association, the American Cancer Society, and the American Heart Association
Medical and science journals, such as the "New England Journal of Medicine" and the "Journal of the American Medical Association," although these aren't written for consumers and could be hard to understand
Check to see if the information you're reading refers to experts in the field or to medical studies, reports, or articles. Be careful of sites that don't say where the information comes from. Ask yourself the purpose of the site. Is it to inform? To sell a product? To raise money? Be on the lookout for sites trying to sell a product, service, or opinion.
Whether the information checks out.
Compare the information you find on a site with other sites, news accounts, or library resources to see if it says the same thing. You also can get your doctor's opinion by asking whether he or she is familiar with the information you uncovered.
How old the information is.
Because health information changes quickly and often, a good health site needs to be up-to-date. Check when the information was posted on the site. Usually the date will appear at the bottom, or sometimes at the top, of the Web page. How old is the information? Does the site mention how often it is updated? Does the information before you reflect the most current thinking and medical findings available? You might have to research other Web sites or go to other information sources to find out.
Whether the information sounds "too good to be true."
If the information sounds unbelievable, it probably is. Some Web sites push miracle cures for cancer and other diseases without enough evidence or studies to show they work. Be on guard for misleading reports of medical information. Sometimes reporters misrepresent study findings because they don't understand them or because they're trying to make a story more interesting or "newsy." Shop around to see if other sources support the information you have. Check for links. Reliable sites are more likely to link to others with similar information. Beware of sites that link only to a search engine.
Whether the site is telling you to do something.
Be careful of any site that wants you to take action right now (buy something, send personal information or money). No matter how good a plan or remedy might seem, check the information out or talk to a doctor before acting on it.
Because health care issues can be complex, even medically reliable consumer information can be hard to understand at times. Look for sites that explain things clearly and completely. If you're not sure you understand something you read, look for more information or ask your doctor or someone with health care training to explain it to you. Misunderstanding health information can be dangerous.
A Word About Chats
Health sites with discussion boards and chat rooms allow Internet users to support one another and share health information and experiences. Some chats feature medical experts who answer consumer questions online. While information you get from these sources can be helpful, they shouldn't be the basis for making decisions about your care. In fact, no health information you find on the Internet should replace a doctor's medical advice. Instead, it should help you learn about your problem and treatment options so you can work better with your doctor to get the best care possible.
If you're looking for information online because you don't like or believe what your doctor has told you, get a second opinion or share what you learned with your doctor. If your doctor won't discuss information you gathered, you might need to find a new one who will.
AARP Resources
How To Talk To Your Doctor Knowing how to talk to your doctor is critical to getting good care.
Basic Browsing Learn everything you need to know about surfing the Web, whether you're a beginner or more seasoned "surfer."
Additional Resources
Tips For Understanding Popular Medical Information The University of Connecticut Health Center has tips to help you size up medical information online and off.
Guidelines For Good Health Sites The Health On the Net Foundation developed eight principles that good health Web sites should follow.
Health Care Products And Services Scams The U.S. Federal Trade Commission shows you how to avoid getting "taken" online.
National Library Of Medicine Medline Plus gives you online access to the world's largest medical library, the National Library of Medicine. Find meanings of medical terms, lists of doctors and hospitals, information on prescription and over-the-counter drugs, and health news from magazines, journals, newsletters, and other sources.
Books
Find these books online at
"How to Find Health Information On The Internet", Bruce Maxwell, Congressional Quarterly, Inc., 1998
"Health Care Resources on The Internet: A Guide for Librarians and Health Care Consumers", M. Sandra Wood, Haworth Press, Inc., 2000
"The Complete Idiot's Guide to Online Medical Resources", Joan Price, Que, 2000

16. Rating Media Health on the Net (HONcode)
Authority
Complementarity
Confidentiality
Attribution
Justifiable
Authorship
Honesty in advertising policy
Authorship
Authority 1. Any medical or health advice provided and hosted on this site will only be given by medically trained and qualified professionals unless a clear statement is made that a piece of advice offered is from a non-medically qualified individual or organisation. Principle 1 guidelines Complementarity2. The information provided on this site is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her existing physician. Principle 2 guidelines Confidentiality3. Confidentiality of data relating to individual patients and visitors to a medical/health Web site, including their identity, is respected by this Web site. The Web site owners undertake to honour or exceed the legal requirements of medical/health information privacy that apply in the country and state where the Web site and mirror sites are located. Principle 3 guidelines Attribution4. Where appropriate, information contained on this site will be supported by clear references to source data and, where possible, have specific HTML links to that data. The date when a clinical page was last modified will be clearly displayed (e.g. at the bottom of the page). Principle 4 guidelines  Justifiability5. Any claims relating to the benefits/performance of a specific treatment, commercial product or service will be supported by appropriate, balanced evidence in the manner outlined above in Principle 4.. Principle 5 guidelines  Transparency of authorship6. The designers of this Web site will seek to provide information in the clearest possible manner and provide contact addresses for visitors that seek further information or support. The Webmaster will display his/her address clearly throughout the Web site. Principle 6 guidelines  Transparency of sponsorship7. Support for this Web site will be clearly identified, including the identities of commercial and non-commercial organisations that have contributed funding, services or material for the site. Principle 7 guidelines  Honesty in advertising & editorial policy8. If advertising is a source of funding it will be clearly stated. A brief description of the advertising policy adopted by the Web site owners will be displayed on the site. Advertising and other promotional material will be presented to viewers in a manner and context that facilitates differentiation between it and the original material created by the institution operating the site. Principle 8 guidelines

17. Rating Media QUality Information ChecKlist
Is it clear who has written the information?
Are the aims of the site clear?
Does the site achieve its aims?
Is the site relevant to me?
Can the information be checked?
When was the site produced?
Is the information biased in any way?
Does the site tell you about choices open to you?
1. Is it clear who has written the information?
Who is the author? Is it an organisation or an individual person. Is there a way to contact them? 2. Are the aims of the site clear?
What are the aims of the site? What is it for? Who is it for? 3. Does the site achieve its aims?
Does the site do what it says it will? 4. Is the site relevant to me?
List five things to find out from the site.
5. Can the information be checked?
Is the author qualified to write the site? Has anyone else said the same things anywhere else? Is there any way of checking this out? If the information is new, is there any proof?
6. When was the site produced?
Is it up to date? Can you check to see if the information is up to date and not just the site?
7. Is the information biased in any way?
Has the site got a particular reason for wanting you to think in a particular way? Is it a balanced view or does it only give one opinion?
8. Does the site tell you about choices open to you?
Does the site give you advice? Does it tell you about other ideas?

18. Rating Media Science Panel on Interactive Communication and Health
Background of Sponsors
Purpose
Content
Confidentiality
Design
Evaluation Results & Effectiveness
An Evidence-Based Approach to Interactive Health Communication: A Challenge to Medicine in the Information Age
Authors: Thomas N. Robinson, MD, MPH; Kevin Patrick, MD, MS; Thomas R. Eng, VMD, MPH; and David Gustafson, PhD; for the Science Panel on Interactive Communication and Health
Citation:  JAMA. 1998; 280: ,
Background of Developers/Sponsors
Is the identity of the developers and sponsors clearly stated?    
Do the developers have expertise (or use experts) in the content area?   
Is there a mechanism to contact the developers?  
Does the application disclose any potential conflicts of interest or biases of the developers and sponsors?   
Purpose
Does the application state its specific purpose?   
Does the application state the intended audience(s) and specific health issue(s) it addresses?  
Do the application’s purpose and objectives match the likely needs of its intended users?   
Content
Is the original source(s) of the content identified?    
Is the original source(s) of the content likely to be reliable and without bias?  
Is the content sufficiently current to ensure that it is accurate and up-to-date?   
Is the application’s method of ensuring the validity of its content reasonable?   
Confidentiality
If relevant, does the application specify whether and how users' personal information and anonymity are protected?   
If relevant, does the application specify who has access to information about its users?  
Design
Is the application easy to use?   
Are the reading/comprehension level, graphics, audio, and other multimedia features appropriate for the intended user?   
Does it require special and/or high level technology?
Evaluation Results and Effectiveness
Do the developers provide any evaluation results about the effectiveness or impact of the application in the following areas?
If yes, please identify:
__ usability of application  __ user satisfaction    __ changes in user knowledge or attitudes   __ changes in health behaviors   __ changes in health status (morbidity or mortality)   __ changes in costs or use of resources
If evaluation results are available:
Did the application specify the funding source for the evaluation and potential conflicts of interest of the evaluators?  
Was the evaluation conducted with people similar to the intended target group of the application?
Did the evaluation compare users to non-users? If yes, were evaluation participants randomly assigned to being users or non-users? If no, did the evaluation results include a rationale for caution and other possible explanations for the results?

19. Rating Media Tufts University Nutrition Navigator
Content
Nutrition Accuracy (1-10)
Depth of Nutrition information (1-7)
Site last updated (1-3)
Usability
User experience (1-5)
Content: Nutrition Accuracy (1-10) has two parts: evaluates the scientific accuracy of empirical data, how well the information is referenced and if the information is current (1-5)
assesses how information is placed in the context of generally accepted dietary advice, looking closely at any conclusions the site may draw and any guidance it may provide. Also evaluates how well the site provides a balanced coverage of nutrition issues, particularly those that are complex and multifaceted. (1-5)
Because accuracy is so important:
if a site receives an accuracy score of 6 points or less, the site is automatically rated "Not Recommended"
if the site receives an accuracy score of 7, it cannot receive an overall rating higher than "Average"
Depth of Nutrition information (1-7) evaluates the depth (amount) of nutrition information provided relative to entire site content, and how well the site's objectives are met
Site last updated (1-3) rates whether the site has been updated within past month (3), within past 4 months (2) or longer than 4 months or no information is given on updates (1)
Usability: User experience (1-5) assesses the site's use of effective and clear navigation tools, accessibility of information, download time and timeliness of information

20. Popular Magazines and Health & Nutrition Periodicals
American Council on Science and Health
Provision of factual information
Objective presentation of information
Presentation of sound nutritional recommendations
Three magazines, Cooking Light, Parents, and Ladies' Home Journal, had scores just below the "excellent" category.
Thirteen others, Better Homes and Gardens, Good Housekeeping, Consumer Reports, Reader's Digest, Redbook, Woman's Day, Glamour, Self, Health, Runner's World, Prevention, Shape, and Fitness all earned lower scores in the "good" range.
Cosmopolitan and Men's Health were rated as "fair" sources of nutrition information.
Men's Fitness and Muscle and Fitness earned only a "poor" evaluation.

21. Popular Magazines and Health & Nutrition Periodicals
Excellent
Cooking Light
Parents
Ladies’ Home Journal
Three magazines, Cooking Light, Parents, and Ladies' Home Journal, had scores just below the "excellent" category.
Thirteen others, Better Homes and Gardens, Good Housekeeping, Consumer Reports, Reader's Digest, Redbook, Woman's Day, Glamour, Self, Health, Runner's World, Prevention, Shape, and Fitness all earned lower scores in the "good" range.
Cosmopolitan and Men's Health were rated as "fair" sources of nutrition information.
Men's Fitness and Muscle and Fitness earned only a "poor" evaluation.

22. Popular Magazines and Health & Nutrition Periodicals
Good
Better Homes and Gardens
Good Housekeeping
Consumer Reports
Reader's Digest
Redbook
Woman's Day, Glamour, Self, Health, Runner's World, Prevention, Shape, and Fitness
Three magazines, Cooking Light, Parents, and Ladies' Home Journal, had scores just below the "excellent" category.
Thirteen others, Better Homes and Gardens, Good Housekeeping, Consumer Reports, Reader's Digest, Redbook, Woman's Day, Glamour, Self, Health, Runner's World, Prevention, Shape, and Fitness all earned lower scores in the "good" range.
Cosmopolitan and Men's Health were rated as "fair" sources of nutrition information.
Men's Fitness and Muscle and Fitness earned only a "poor" evaluation.

23. Popular Magazines and Health & Nutrition Periodicals
Fair
Cosmopolitan
Men’s Health
Poor
Men’s Fitness
Muscle and Fitness
Three magazines, Cooking Light, Parents, and Ladies' Home Journal, had scores just below the "excellent" category.
Thirteen others, Better Homes and Gardens, Good Housekeeping, Consumer Reports, Reader's Digest, Redbook, Woman's Day, Glamour, Self, Health, Runner's World, Prevention, Shape, and Fitness all earned lower scores in the "good" range.
Cosmopolitan and Men's Health were rated as "fair" sources of nutrition information.
Men's Fitness and Muscle and Fitness earned only a "poor" evaluation.

24. Dr. Barrett’s Not Recommended (see slide notes for URL)
Untrustworthy because
Promote misinformation
Espouse unscientific theories
Contain unsubstantiated advice, and/or fail to distinguish between reliable and unreliable sources of advice
Additional information
(*) also carry ads for questionable products, services, and/or publications
(**) have been accompanied by questionable solicitations.
Magazines
Advances, Alive*, All Natural Muscular Development*, Alternative Medicine Digest*, Arthritis Today*, Better Nutrition*, Body and Soul* (formerly New Age Journal), Body, Mind & Spirit* (ceased publication in 1998), Bridges (published by ISSSEEM), The Choice, Choices, Counselor*, Delicious!*, Doctors' Prescription for Healthy Living*, Dr. William Campbell Douglass' Real Health, Energy Times*, Explore More!, Flex*, Food & Water Journal, Forefront, Good Medicine, Great Life*, Health & Healing (Journal of Complementary Medicine), Health and Healing Wisdom Journal,
Health & Nutrition Breakthroughs*, Health Consciousness*, Health Counselor*, Health Products Business (trade publication, formerly called Health Foods Business)*, Health Freedom News*, Health Naturally* (ceased publication in 1999), Health Science, Health World*, Healthier Times, HealthKeepers*, Healthy & Natural*, Herbs for Health*, Holistic Health Journal, Holistic Medicine*, Holistic Times, The Human Ecologist*, Innovation*, Journal of Longevity, Journal of Longevity Research*, Let's Live*, Life Enhancement*, Life Extension*, Lifestyle and Wellness*, Living Nutrition, Longevity (discontinued in 1996)*, MAMM*, Massage & Bodywork*, Muscle & Fitness*, Natural Foods Merchandiser (trade ublication)*,
Natural Health*, Natural Pharmacy (trade publication)*, Natural Remedies* (discontinued 6/98), The Natural Way , Nature's Impact*, New Body*,
NEWLIFE*, Noetic Sciences Review, Nutrition & Fitness, Nutrition Bites, Nutrition Science News Nutritional Perspectives, Positive Health, Prevention*, Prime Health & Fitness, Psychology Today*, Search for Health, Self, Senior Health*, Spectrum, To Your Health, Total Health*,
Townsend Letter for Doctors and Patients*, Vegetarian Times*, Veggie Life*, VitaJournal* Vital Living (online), Vitamin Retailer (trade publication)*, Well Being Journal, Whole Foods (trade publication)*, Your Health*
Journals
Advances: The Journal of Mind-Body Health, Alternative & Complementary Therapies*, Alternative Medicine Review, Alternative Therapies in Clinical Practice, American Journal of Natural Medicine*, Biomedical Therapy (formerly Biological Therapy), British Journal of Medicine (articles on "complementary therapies"), Chiropractic Research Journal, Clinical Practice of Alternative Medicine (formerly Journal of Advancement in Medicine), Ethical Human Sciences and Services, Fluoride: Journal of the International Society for Fluoride Research, Integrative Medicine, International Journal of Auricular Medicine (IJAM), International Journal of Biosocial Research, Journal of Alternative and Complementary Medicine,
Journal of American Physicians and Surgeons (formerly Medical Sentinel), Journal of the American Neutraceutical Association, Journal of Applied Nutrition*, Journal of Energetic Medicine, Journal of Holistic Nursing, Journal of Naturopathic Medicine*, Journal of Nutritional and Environmental Medicine, Journal of Optimal Nutrition, Journal of Orthomolecular Medicine, Journal of Subluxation Research, Massage Therapy Journal*, Nutritional Perspectives, Patient Care (articles on alternative/complementary therapies), Subtle Energies & Energy Medicine
Newsletters
After Everything Else FAILS Health Report, Allergy Hotline, Alternative & Natural Medicine Newsletter (discontinued in 1999), Alternative Health Issues, Alternative Medicine Advisor, Alternatives (David Williams, D.C.)**, Antha, Bio-Probe Newsletter, Bob Livingston Newsletter, Bottom Line Health, Cancer Chronicles, Complementary Medicine for the Physician, Dr. Atkins' Health Revelations (Robert C. Atkins, M.D.)**, FDA Hotline (not an FDA publication; discontinued in 1997), Forefront, Fountain, The Fungazatte Newsletter, Gerson Healing Newsletter, Healing Arts Report,
Health & Healing (Julian Whitaker, M.D.)**, Health Alert (Bruce West, D.C.)**, Health and Happiness , Health & Longevity, HealthBeat, HealthNotes, Health Resource Newsletter,Health Sciences Institute Members Alert**, Health Wisdom for Women , HealthFacts, HealthSense, HealthxFiles, Healthy Edge Newsletter, Healthy Talk, Health Victory Bulletin, Health Watch, Healthwise Digest (Zoltan Rona, M.D.), Infinite Possibilities (Deepak Chopra, M.D.), The International DAMS Newsletter, The Lark Letter**, John R. Lee, M.D., Medical Letter, The McDougall Newsletter, Men's Health Newslette,r McAlvany Health Alert, The Mindell Report**, Natural Healing & Alternative Medicine, Naturally Well,
Nutrition & Healing, Nutrition Bites, Nutrition in Complementary Care, Nutrition Insights (discontinued in 1998), Nutrition News (Siri Khalsa), The Nutrition Reporter, Options (People Against Cancer) (posted 2/14/00), Organic Food Business, People's Medical Society Newsletter (updated 12/19/98), The Perlmutter Letter, Prescriptions for Healthy Living, Price-Pottenger Nutrition Foundation Health Journal, Pure Facts (Feingold Association of the United States), Second Opinion (William C. Douglass, M.D.), Secrets of Robust Health, Self Healing (Andrew Weil, M.D.), The Doctors' Prescription for Healthy Living, To Your Health (Alan N. Spreen, M.D.), Total Health in Today's World, The Vaccine Reaction, Vita-Health (People's Medical Society), Vital Communications, What Doctors Don't Tell You**, Whole Health, Women's Health Advocate**,
Newspapers
Family Health News*, Health Matters (HealthNet Newspapers), Health News & Review, Health Store News, Health Watch (HealthNet Newspapers), Healthy Cell News*, Nutrition Health Review
Online Newsletters
Spirit of Health, The Toxicity Newsletter

25. Dr. Barrett’s Recommended (see slide notes for URL)
Consumer Reports on Health
FDA Consumer
Focus on Alternative and Complementary Therapies (FACT)
National Council Against Health Fraud News
The Scientific Review of Alternative Medicine
The Scientific Review of Mental Health Practice
Skeptical Briefs
Tufts University Health & Nutrition Letter

26. Summary How facts are determined Selecting internet sites
Magazines and periodicals