Journal of General Internal Medicine

, Volume 34, Issue 9, pp 1884–1891 | Cite as

Can Patients Trust Online Health Information? A Meta-narrative Systematic Review Addressing the Quality of Health Information on the Internet

  • Lubna DarazEmail author
  • Allison S. Morrow
  • Oscar J. Ponce
  • Bradley Beuschel
  • Magdoleen H. Farah
  • Abdulrahman Katabi
  • Mouaz Alsawas
  • Abdul M. Majzoub
  • Raed Benkhadra
  • Mohamed O. Seisa
  • Jingyi (Francess) Ding
  • Larry Prokop
  • M. Hassan Murad
Review Paper



The Internet has become a leading source of health information accessed by patients and the general public. It is crucial that this information is reliable and accurate.


The purpose of this systematic review was to evaluate the overall quality of online health information targeting patients and the general public.


The systematic review is based on a pre-established protocol and is reported according to the PRISMA statement. Eleven databases and Internet searches were performed for relevant studies. Descriptive statistics were used to synthesize data. The NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess the methodological quality of the included studies.


Out of 3393 references, we included 153 cross-sectional studies evaluating 11,785 websites using 14 quality assessment tools. The quality level varied across scales. Using DISCERN, none of the websites received a category of excellent in quality, 37–79% were rated as good, and the rest were rated as poor quality. Only 18% of websites were HON Code certified. Quality varied by affiliation (governmental was higher than academic, which was higher than other media sources) and by health specialty (likely higher in internal medicine and anesthesiology).


This comprehensive systematic review demonstrated suboptimal quality of online health information. Therefore, the Internet at the present time does not provide reliable health information for laypersons. The quality of online health information requires significant improvement which should be a mandate for policymakers and private and public organizations.


quality online health information systematic review Internet patient education health literacy 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Supplementary material

11606_2019_5109_MOESM1_ESM.docx (447 kb)
ESM 1 (DOCX 447 kb)


  1. 1.
    Sylvain H, Talbot LR. Synergy towards health: a nursing intervention model for women living with fibromyalgia, and their spouses. J Adv Nurs 2002;38(3):264–273.CrossRefPubMedGoogle Scholar
  2. 2.
    Crooks VA. “I go on the Internet; I always, you know, check to see what’s new”: Chronically ill women’s use of online health information to shape and inform doctor-patient interactions in the space of care provision. ACME: An International E-Journal for Critical Geographies 2006;5(1):50–69.Google Scholar
  3. 3.
    Aranda S, Schofield P, Weih L, et al. Mapping the quality of life and unmet needs of urban women with metastatic breast cancer. Eur J Cancer Care 2005;14(3):211–222.CrossRefGoogle Scholar
  4. 4.
    Söderberg S, Lundman B, Norberg A. Struggling for dignity: The meaning of women’s experiences of living with fibromyalgia. Qual Health Res 1999;9(5):575–587.CrossRefPubMedGoogle Scholar
  5. 5.
    Alpay L, Verhoef J, Xie B, Te'eni D, Zwetsloot-Schonk J. Current challenge in consumer health informatics: Bridging the gap between access to information and information understanding. Biomed inform Insights 2009;2:BII. S2223.CrossRefGoogle Scholar
  6. 6.
    Fox S. The social life of health information. 2014. Accessed April 1, 2019.
  7. 7.
    Daraz L, MacDermid JC, Wilkins S, Gibson J, Shaw L. Information preferences of people living with fibromyalgia–a survey of their information needs and preferences. Rheumatol Rep 2011;3(1):7.CrossRefGoogle Scholar
  8. 8.
    Bishop FL, Bradbury K, Jeludin NNH, Massey Y, Lewith GT. How patients choose osteopaths: a mixed methods study. Compr Ther Med 2013;21(1):50–57.CrossRefGoogle Scholar
  9. 9.
    Eysenbach G, Köhler C. 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. Bmj. 2002;324(7337):573–577.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    The Medical Library Association. Find Good Health Information. Accessed April 1, 2019.
  11. 11.
    National Institute of Health. Health Information. Accessed Accessed April 1, 2019.
  12. 12.
    Mayo Clinic. Patient Care and Health Information. Accessed April 1, 2019.
  13. 13.
    Medline Plus. Accessed Accessed April 1, 2019.
  14. 14.
    Centers for Disease Control and Prevention. Accessed April 1, 2019.
  15. 15.
    Center for Addiction and Mental Health. Accessed April 1, 2019.
  16. 16.
    Cline RJ, Haynes KM. Consumer health information seeking on the Internet: the state of the art. Health Educ Res 2001;16(6):671–692.CrossRefPubMedGoogle Scholar
  17. 17.
    Eriksson-Backa K. Who uses the web as a health information source? Health Inform J 2003;9(2):93–101.CrossRefGoogle Scholar
  18. 18.
    Tao D, LeRouge C, Smith KJ, De Leo G. Defining information quality into health websites: a conceptual framework of health website information quality for educated young adults. JMIR Hum Factors 2017;4(4).Google Scholar
  19. 19.
    Suggs LS. A 10-year retrospective of research in new technologies for health communication. J Health Commun 2006;11(1):61–74.CrossRefPubMedGoogle Scholar
  20. 20.
    Daraz L, MacDermid JC, Wilkins S, Gibson J, Shaw L. The quality of websites addressing fibromyalgia: an assessment of quality and readability using standardised tools. BMJ Open 2011:bmjopen-2011-000152.Google Scholar
  21. 21.
    Wang J, Ashvetiya T, Quaye E, Parakh K, Martin SS. Online Health Searches and their Perceived Effects on Patients and Patient-Clinician Relationships: A Systematic Review,✯✯✯. Am J Med 2018.Google Scholar
  22. 22.
    Fox S. Online health search 2006: Pew Internet & American Life Project; 2006. Accessed April 1, 2019.
  23. 23.
    Daraz L, Morrow AS, Ponce OJ, et al. Readability of Online Health Information: A Meta-Narrative Systematic Review. Am J Med Qual 2018:1062860617751639.Google Scholar
  24. 24.
    Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 2010;8(5):336–341.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    National Institutes of Health. National Institutes of Health Quality Assessment tool for Observational Cohort and Cross-Sectional Studies. 2016. Accessed April 1, 2019.
  26. 26.
    Charnock D, Shepperd S. Learning to DISCERN online: applying an appraisal tool to health websites in a workshop setting. Health Educ Res 2004;19(4):440–446.CrossRefPubMedGoogle Scholar
  27. 27.
    University of Oxford. Institute of Health Sciences. Nuffield Department of Population Health and the Nuffield Department of Primary Care Health Sciences. discern online: quality criteria for consumer health information. Accessed Accessed April 1, 2019.
  28. 28.
    Charnock D, Shepperd S, Needham G, Gann R. DISCERN: an instrument for judging the quality of written consumer health information on treatment choices. J Epidemiol Community Health 1999;53(2):105–111.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Health on the net Foundation. The HON Code of Conduct for medical and health Web sites (HONcode). 1997. Accessed April 1, 2019.
  30. 30.
    Boyer C, Selby M, Scherrer J-R, Appel R. The health on the net code of conduct for medical and health websites. Comput Biol Med 1998;28(5):603–610.CrossRefPubMedGoogle Scholar
  31. 31.
    Mousiolis A, Michala L, Antsaklis A. Polycystic ovary syndrome: double click and right check. What do patients learn from the Internet about PCOS? Eur J Obstet Gynecol Reprod Biol 2012;163(1):43–46.CrossRefPubMedGoogle Scholar
  32. 32.
    Nason GJ, Byrne DP, Noel J, Moore D, Kiely PJ. Scoliosis-specific information on the internet: has the “information highway” led to better information provision? Spine. 2012;37(21):E1364-E1369.CrossRefPubMedGoogle Scholar
  33. 33.
    Commission FT. Remedies Targeted in International Health Claim Surf Day. 1998. Accessed April 1, 2019.
  34. 34.
    Statistics Canada. Canadian Internet Use Survey (CIUS). 2013. Accessed April 1, 2019.
  35. 35.
    Fox S. The social life of health information. Pew Internet & American Life Project 2009. Accessed April 1, 2019.
  36. 36.
    Daraz L, MacDermid J, Wilkins S, Shaw L. Tools to evaluate the quality of web health information: A structured review of content and usability. Int J Tech Knowl Soc 2009;5:3.Google Scholar

Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Lubna Daraz
    • 1
    Email author
  • Allison S. Morrow
    • 1
  • Oscar J. Ponce
    • 1
  • Bradley Beuschel
    • 1
  • Magdoleen H. Farah
    • 1
  • Abdulrahman Katabi
    • 1
  • Mouaz Alsawas
    • 1
  • Abdul M. Majzoub
    • 1
  • Raed Benkhadra
    • 2
  • Mohamed O. Seisa
    • 1
  • Jingyi (Francess) Ding
    • 1
  • Larry Prokop
    • 3
  • M. Hassan Murad
    • 1
  1. 1.Mayo Clinic Evidence-based Practice Research Program, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Division of Health Care Policy and Research, Department of Health Sciences Research Mayo ClinicRochesterUSA
  2. 2.Allegheny General HospitalPittsburghUSA
  3. 3.Mayo Clinic LibrariesMayo ClinicRochesterUSA

Personalised recommendations