Antonia Lombardi: Website Evaluation, Essay Example

The Implications of Internet Use Amongst Pregnant Women

Pregnancy occupies a unique place on the Internet, merging health care issues and concerns of both the well consumer, the recently diagnosed, and those suffering from chronic illness.  Although pregnancy is a natural occurrence in which complications are the exception rather than the rule, the medicalization of pregnancy plays a crucial role in determining whether a woman’s experience of pregnancy is positive or negative (Rudolfsdottir, 2000). While the Internet is a treasure trove of helpful information concerning the changes facing both mother and fetus during pregnancy, the consumer must be cautioned to sift through this information carefully, as some pregnancy websites may over emphasize the risk of complications in healthy pregnant women (Roman, 2007).  This is especially true given that the Internet use of this population tends to mirror the trend of consumer empowerment discussed by McGonigle and Mastrian (2009) in which individuals “demand news and information and […] want immediate results and unlimited access” (p.240).

As well online health consumers whose Internet use becomes “intense and targeted” (Cain, 2000, p. 26), especially in the first-trimester when fetal viability is most at-risk, the behavior of these consumers is similar to that of the newly-diagnosed.  Indeed, in Health e-People: The Online Consumer Experience (2000), Cain et. Al suggest that the largest source of Newly Diagnosed online health consumers is members of the Well category who experience a seminal health event (p. 30), resulting in a mindset where “urgency drives behavior, and speed is key” (p. 30).  Because of the Internet’s constant availability and wealth of information, the desire for immediate answers and reassurance may result in some consumers encountering information that is less than accurate and may actually amplify any existing fears of pregnancy complications.  Thus health care professionals, especially those who work primarily with pregnant women, are encouraged to educate consumers about the mixed messages they will encounter online, given that many pregnancy websites tout pregnancy as a happy and exciting event while simultaneously warning pregnant women about the myriad of behaviors and lifestyle choices that can result in pregnancy complications.

Romanov (2007) suggests that “women should be encouraged to notice their emotional and intellectual responses to what they ?nd online. Childbirth educators should guide women to ignore or reject content that increases their anxiety, decreases their con?dence, or contradicts common sense” (p. 23).  It is unrealistic to expect that pregnant women will avoid Internet use altogether; indeed, there is a great deal of positive and productive information available that can reassure pregnant women and their partners while lessening the burden on the health care system by minimizing the need for multiple appointments.  However, by identifying that the Internet can also be a source of anxiety, health care professionals will become better able to meet the needs of pregnant consumers by guiding them towards reliable websites that provide practical and non-inflammatory information without any hidden commercial agenda (Romanov, 2007).

The Hypothetical Consumer

Nancy is a healthy twenty-six year-old woman who has been trying for six months to get pregnant.  After administering a home pregnancy test and calculating all relevant dates, she determines that she is eight weeks pregnant.  She has an appointment scheduled with her family doctor in one week and is anxious for official confirmation of her pregnancy.  In order to determine that her nausea and fatigue may indeed be symptoms of pregnancy, Nancy turns to the Internet for advice and reassurance.  However, Nancy is already worrying about worse case scenarios, and wants to ensure that she avoids doing anything that might compromise the success of this much-desired pregnancy.

Nancy’s initial search involves typing “pregnancy complications” into the Google toolbar on her laptop, a term that yields twenty million hits in under one second.  She chooses to first visit Wikipedia, looking for a general overview of the types of problems that she might encounter in her pregnancy.  The site lists over three dozen potential problems ranging from the routine to those that can “cause both maternal death and fetal death if left untreated” (Wikipedia, 2011).

Looking for further information, Nancy follows an external link on the Wikipedia site and is sent to a generic search engine loaded with banner ads and extraneous information with no relevance to her concerns.  She then visits the Baby Center website and About.com, where she again encounters a great deal of information about issues such as pre-eclampsia, gestational diabetes, and placenta previa.  Nancy is less than reassured, a reaction that mirrors Romanov’s assertion that almost 25% of newly-pregnant women may feel “overwhelmed by the amount of information they found online […] or frustrated by a lack of information […] or confused by what they found” (2007, p. 21).

Undeterred, she shifts her search strategy away from broad-based search engines and instead seeks out two medical websites she had used in the past:  the Health Canada site and the Mayo Clinic.  Although she still uses the search term “pregnancy complications,” both sites direct her to pages that discuss healthy pregnancies with an emphasis on nutrition, healthy eating, and overall wellness rather than the problematizing of pregnancy.  Nancy’s choice to return to familiar medical websites after her unsuccessful search marks the best-case scenario for Web sites who seek to build enduring consumer loyalty but find that Well consumers, who make up more than 60% of Internet traffic, demonstrate little loyalty to specific medical Web sites (Cain, 2000).  According to Cain, et. al., the best these sites can expect is “to have gained enough loyalty and brand recognition during episodic encounters to keep these consumers when they get pregnant” (2000, p. 28) or find themselves facing chronic illness.

Website Evaluations

The Health on the Net Foundation (HON) exists to ensure that high-quality health information is available on the Internet to both health care professionals and the general public (McGonigle & Mastrian, 2009).  Through their certification process and code of ethics, HON provides guidelines to website publishers that stresses transparency, accountability, and objectivity  The HonCode certification process is a voluntary measure used by websites to demonstrate their willingness to comply with safe Internet practices in the dispersal of medical information.  Websites that have received the HON seal of approval are regularly monitored for compliance and may be subject to review should HON receive complaints about the accuracy of information on a particular website (HON, 2010).

The five websites evaluated were Wikipedia, Babycenter, About.com, The Mayo Clinic, and Health Canada.  Generally, all of the websites had some form of author and source attribution and clearly made available contact information to reach the site creator or webmaster.  Both the Babycenter (2011) site and The Mayo Clinic (2011) carry the HON seal of certification demonstrating that they have been verified as safe sources of health information on the Internet.  The Mayo Center also has increased trustworthiness and accountability due to its reputation as an established medical authority.

Unsurprisingly, the Wikipedia (2011) entry failed to meet many of the safety parameters encouraged by HON, including information about the author of the entry, his or her accreditations, and a full list of sources.  Although the Wikipedia entry used a bibliography, it was very brief and left some information without clear citations.  Additionally, the links to external resources delivered users to an advertising-based search engine that had nothing to do with the original topic of pregnancy complications and there was no disclaimer provided regarding the complementary nature of the medical information displayed on the site.  To its credit, however, the Wikipedia site uses no advertising and is funded primarily by user donations, a community-based approach that may lessen any commercial conflicts of interest.

The About.com (2009) site was the only one of the five that provided clear information about authorship.  Additionally, a disclaimer was provided stating that “disease and condition content is reviewed by the Medical Review Board” (Cornforth, 2009).  A link took users to the Medical Review Board page which provided photographs, names, and affiliation information about the doctors, nurses, and other health care practitioners who provide content for the website.  The site is financially supported through advertising revenue, and although content is clearly separated from advertisements and banners, the overall effect is cluttered and difficult to visually navigate.  As well, the prominent placement of an advertisement dealing with weight loss, specifically unwanted belly fat, sends a mixed message about body image to the pregnant women who may utilize the site.

The Health Canada (2011) website provides the aura of trustworthiness because it is a government-funded and supported website.  However, the site lacked clear attribution of authorship and full citations.  Some of this information was available by following links to further articles; however, the main site itself did not provide any information about the medical authorities who contributed to the site or any disclaimer about the manner in which the medical information was intended for use.  The site does also not have HONcode certification, although this may be because it is funded by the Canadian government and may not feel that it requires such a seal of approval.

Recommendations

From the perspective of a health care provider, rather than a consumer, there are clear distinctions in quality to be made between these five web sites.  While the Wikipedia (2011) entry does provide a comprehensive overview of some of the complications a woman might encounter during pregnancy, the lack of attribution, citation, and context is troubling.  Often, Wikipedia entries provide a starting off point for further web searches; however, in this case, the bibliography and external references are unhelpful in pointing consumers to further sources of information.  Both Romanov (2007) and Cain et. al (2000) mention Babycenter.com (2011) as a website that is immensely popular amongst new and expectant mothers.  It provides a great deal of information that is difficult to source and its connection with its advertisers raises some questions about the intentions of the website creators; for example, the site discusses breastfeeding as an option but is also sponsored, in part, by Nestle, a company which makes baby formula.  Although About.com (2009) sources its information about contributors and carries the seal of approval from HON, it remains difficult to navigate due to the high level of advertising, some of which carries contradictory implications regarding female health, nutrition, and body image.

Romanov (2007) suggests that searches for medical information in regards to pregnancy are most successful when facilitated by health care practitioners who help to contextualize potentially-frightening information.  The Mayo Clinic website (2011) and the Health Canada website (2011) both provide ample opportunity for constructive discussions about the steps women can take to help ensure a healthy and happy pregnancy.  Although Health Canada does not have HONcode certification, its support from the Federal government demonstrates a commitment to providing quality health care information that will benefit both the individual and society as a whole.  The Mayo Clinic’s commitment to transparency and advertising-free content ensures that consumers need not worry about a hidden agenda that might complicate their search for unbiased information.

Conclusion

The educational opportunities provided by the Internet have the potential to outweigh the risk of encountering misinformation or bias when visiting various health-related websites.  As new technologies becomes more deeply rooted in North American society, consumers are becoming increasingly Internet-savvy and able to critically appraise the content that they encounter (McGonigle & Mastrian, 2009).  Romanov’s (2007) assertion that a majority of women are empowered by their ability to navigate pregnancy websites, and feel “reassured that they could make appropriate health-care decisions and […] con?dent to raise new questions or concerns with their health-care providers” (p. 21) suggests that websites providing medical information will increasingly become a viable and supportive resource for both the Well and the Newly-diagnosed.  Organizations such as the Health on the Net Foundation (2010) play a vital role in helping consumers choose websites that contain practical, unbiased, and accurate information, further ensuring that consumers can play an active and participatory role in improving their health status and overall wellness.

Appendix 

Evaluation Criteria

In accordance with the Health on the Net (2010) principles for accreditation of websites providing trustworthy information, the following eight principles were used to determine the quality of websites used in this paper:

1. Authoritative; wherein websites clearly state the qualifications of the authors.
2. Complementarity; wherein information is clearly given stating that the website is meant to support rather than replace the doctor-patient relationship.
3. Privacy; wherein the visitor’s personal data is respected to the utmost degree.
4. Attribution; wherein the sources of published information is provided.
5. Justifiability; wherein the website can back up any and all medical claims.
6. Transparency; wherein accurate email contact information is clearly provided.
7. Financial disclosure; wherein all funding sources are identified.
8. Advertising; wherein every effort is made to separate editorial content from advertising.

Individual Website Assessments

1. Wikipedia (2011)

The information on this site is not authoritative as it doesn’t provide general information about the author(s) responsible for providing medical content.  The site also does not attribute all of the content in the entry, and uses external links that lead consumers to websites with dubious credentials and intentions.  There is no disclaimer about the complementary relationship between health care practitioner and patient in relation to the information contained on the site, which may lead users to value information found in the Wikipedia entry over that which they receive from qualified medical personnel.  The site also breaches the HONcode (2010) principles by not mentioning a specific audience for the information contained therein.

2. Health Canada (2011)

Although the information on this website is authoritative in the sense that it is provided by the Federal government, there is no clear attribution about the authorship of the web content or the qualifications of the content editors/writers.  The site lacks a statement declaring that the information provided by the Health Canada site is meant to complement rather than replace medical advice received from qualified health care practitioners.  The site does also not clarify how it deals with privacy issues concerning consumer emails and the sharing of confidential information.

3. The Mayo Clinic (2011).

As this site is already HON certified, it meets the eight principles of the HONcode (2010).  The site is authoritative because the qualifications of its health practitioners and advisory board are clearly stated.  A disclaimer is provided in regards to complementarity and information regarding privacy issues is readily available.  The information published on the site is attributed to valid medical sources and all claims made within the site are justifiable.  The advertising is clearly separated from medical content, and the funding sources of the organization are identified.  Additionally, contact information for the organization and the webmaster are both provided.

References

Baby Center. (2011). Pregnancy complications. Retrieved from www.babycenter.ca/pregnancy/complications

Cain, M.M., Sarasohn-Kahn, J. & Wayne, J.C. (2000). Health e-People: The online consumer experience. Menlo Park, CA: Institute for the Future. Retrieved from http://www.chcf.org/publications/2000/08/health-epeople-the-online-consumer-experience

Cornforth, Tracee. (2009 July 17). Pregnancy complications: Symptoms, problems, diagnosis, treatment. About.com. Retrieved from womenshealth.about.com/cs/pregnancy/a/pregnancycompli.htm

Health Canada. (2011). Healthy pregnancy. Retrieved from http://www.hc-sc.gc.ca/hl-vs/preg-grosindex-eng.php

Health on the Net Foundation. (2010). HON code and guidelines. Retrieved from https://www.hon.ch/

Mayo Clinic. (2011). Healthy pregnancy. Retrieved from http://www.mayoclinic.com/health/pregnancy-week-by-week/MY00331

McGonigle, D. & Mastrian, K. (2009). Nursing informatics and the foundation of knowledge. Boston: Jones and Bartlett Publishers.

Roman, A.M. (2007). A changing landscape: Implications of internet use for childbirth educators. The Journal of Perinatal Education, 16(4), 18-24. doi: 10.1624/105812407X244903

Rudolfsdottir, A. (2000). ‘I am not a patient, and I am not a child’: The institutionalization and experience of pregnancy. Feminism & Psychology, 10 (3), 337-350. doi: 10.1177/09593500010003004

Wikipedia. (2011). Complications of pregnancy. Retrieved from http://en.wikipedia.org/wiki/Complications_of_pregnancy