JMIR Publications

ABSTRACT

Background:

The internet has become a major source of health information, yet the quality of online health information varies considerably. Users’ ability to evaluate the trustworthiness of online health information is limited, as around half of Europeans have limited health literacy. Existing checklists and tools are either prepared for research purpose use or use by health care professionals, have not been developed by considering the lay user perspective, are too long and complicated to be used by laypersons, or were developed for written health information.

Objective:

To develop and validate a checklist that enables laypersons to evaluate the trustworthiness of online health information without prior training.

Methods:

We employed a multistage mixed-methods approach including: (1) a comprehensive literature review to identify existing tools and quality criteria; (2) an expert Delphi study with six specialists in patient communication and health information; (3) cognitive interviews with 19 lay users in two rounds; (4) application testing on 15 selected health information webpages with 20 additional lay users; (5) a determination of the factual correctness of 100 health information webpages by assessing the difference between the claimed and factual strength of evidence on a health information webpage; and (6) validation testing by research team members on 100 health information webpages using a Bayesian logistic regression model to analyze the predictive validity. In the final step, we integrated all quantitative and qualitative results to select final checklist items.

Results:

From an initial pool of 1,740 items extracted from 73 documents, we systematically condensed the list through multiple evaluation and testing rounds. To ensure the checklist is user-friendly, we involved a diverse group of potential users. The final product, named the Info without Side Effects (iWISE) checklist, contains seven items that assess key aspects of health information trustworthiness, including the absence of advertising, balanced presentation of information, limited use of professional jargon, origination from an independent organization, citation of sources, mention of scientific validation, and presence of a publication date. The checklist demonstrated the ability to distinguish between evidence-based and non-evidence-based online health information during validation testing with a nearly 100% probability that the health information is correct if all items were marked with yes.

Conclusions:

The iWISE checklist represents a user-friendly, validated tool for evaluating online health information trustworthiness. With only seven items, it is easy to remember and could significantly improve critical health literacy. Future research should test its reliability for social media posts and health information videos.