Part 3. Eroding Attention to the Details of Information Quality

Three-quarters of health seekers do not consistently check the source and date of the health information they find online.

In 2001, the Pew Internet & American Life Project collaborated with the Medical Library Association¹⁸ to devise a series of questions about how internet users conduct health information inquiries. At that time, using a somewhat different methodology to identify health seekers and ask in-depth questions of health seekers, we found that only one-quarter were vigilant about following the research protocol recommended by medical librarians, that is, to always check the source and date of the information found online.¹⁹ Another quarter of health seekers checked the source and date of health information online “most of the time.” About half of health seekers reported they “only sometimes, hardly ever, or never” check the source and date of health information online.

We now find that the percentage of “vigilant” health seekers who always check the source and date of health information found online has dropped to about 15%. An additional 10% of health seekers fall into the “concerned” category by reporting that they check these two essential information quality indicators most of the time. Approximately three-quarters of health seekers say they check the source and date only sometimes, hardly ever, or never and therefore fall into the “unconcerned” category. That last group translates to about 85 million Americans who are gathering health advice online without consistently examining two key information quality indicators, as identified by the Medical Library Association.

Few health sites display the source and date, along with other information quality indicators.

Health seekers might be forgiven if they give up what at times is a search for a needle in a haystack. A recent study commissioned by the U.S. Department of Health and Human Services (HHS) finds that a tiny percentage of health sites display the source and date of the information on their pages.²⁰

The study is part of Healthy People 2010, an initiative led by HHS to improve the health of all Americans. One goal within Healthy People 2010 is to increase the proportion of health-related websites that disclose information that can be used to assess the quality of the site. HHS’s Office of Disease Prevention and Health Promotion, working with industry experts, identified six types of information that should be publicly disclosed to health seekers: the identity of the site’s sponsors, the site’s purpose, the source of the information provided, privacy policies to protect users’ personal information, how users can provide feedback, and how the content is updated. Of the 102 websites reviewed for the report, none met all six of the disclosure criteria and only six complied with more than three criteria. Just 4% of “frequently visited” health websites disclosed the source of the information on their pages and 2% disclosed how the content is updated. Less-popular health sites fared even worse: 0.3% of these sites listed their content’s source and only 0.1% disclosed how the content is updated.

Consumers check food labels more often than they check the source and date of health information online.

It is interesting to note that American adults are likely to pay attention to informative labels when they are more readily available. A September 2006 Wall Street Journal/Harris Interactive online survey found that 17% of American adults “always” read food labels that provide nutritional information in order to make informed food choices for themselves or for their family. An additional 34% of adults say they “very often” read labels. Forty-four percent of adults say they read food labels “sometimes” or “hardly ever.” Five percent of adults say they “never” read food labels.²¹

Demographic shifts are one factor in the erosion of concern about information quality.

One aspect of the landscape that has changed since 2001 is the broadening base of the internet population. In 2001, 46% of high school graduates had access to the internet. In 2006, 60% of high school graduates have access. By contrast, college graduates only modestly increased their numbers online during the same time period (going from 89% to 91%).

While less-educated Americans are increasing their numbers online, they are less likely than college-educated internet users to look online for health information and less likely to check the two information quality indicators included in our survey. Seventy percent of internet users with a high school diploma have looked online for information about at least one of seventeen health topics, compared with 89% of internet users with a college degree. Fully 80% of health seekers with a high school diploma fall into the “unconcerned” category, compared with 64% of health seekers with a college degree. On the other end of the spectrum of vigilance, 9% of health seekers with a high school diploma say they “always” check the source and date of health information they find online, compared with 20% of health seekers with a college degree.

This gap between Americans with more and less education dovetails with the data laid out in the September 2006 report by the National Center for Education Statistics, “The Health Literacy of America’s Adults.” It found that Americans with less education often lack the skills required to read and understand written health information encountered in daily life.²² Fully 49% of Americans who had not attended or completed high school have “below basic” health literacy. Fifteen percent of high school graduates have “below basic” health literacy and just 3% of college graduates have such low levels of health literacy. On the other end of the scale, 4% of high school graduates are “proficient” (able to handle more complex health information), compared with 27% of college graduates and 33% of Americans who have done graduate work. In addition, the report found that 80% of people with below basic health literacy do not use the internet for health information, nor do about one-half of people with basic health literacy. 

Health seekers’ success may bolster their sense of confidence about what they find online.

Another factor in the eroding attention to information quality indicators is the sense of confidence and efficacy prevalent among most internet users. Recall that only one in five health seekers say they felt “frustrated by a lack of information or an inability to find what they were looking for online” during their last search for health information online. And only 3% of health seekers say they or someone they know has been seriously harmed by following the advice or information they found online.

This echoes what the Digital Future Report found in 2004: Fewer than 20% of health seekers said they wanted more health information, but did not know where to find it online or did not have time to get it. The same study found that about only one in five health seekers said they were concerned about the quality of the health information they encountered online.²³

Many health seekers would likely agree with a September 2005 article in PLoS Medicine which reported that “for many clinical scenarios, Google and other search engines can provide, quickly enough, an answer that is good enough.”²⁴