10/7/2015: Quality of medical information on the internet

-Dr. Sean Reyes, Las Vegas Podiatrist 24/7 Foot Doctor

Do you get medical information from the internet? Is Dr. Google your family physician? The truth is most people get on google or yahoo to obtain medical information. However, is what you are reading legit? I set out to find out the answers and did a research study exactly on this subject matter. This was presented at the annual Mallory Coleman Research Day in Columbus, Ohio. Below are the pictures and actual study.

Analysis of Plantar Fasciitis Websites using the DISCERN Instrument
Sean Reyes, DPM, Christy Ortigas
Ohio State University, University of Nevada


     Patients and healthcare providers have become increasingly dependent on using the internet as the primary source of information.  Eighty percent of internet users look up medical information online, making it the third most searched topic on the internet 1. The information on the internet, however, varies in quality, accuracy, readability, and remains uncontrolled. There are numerous websites on nearly every health topic and many have no rules overseeing the quality of information that is provided2. One of the most common foot complaints is plantar fasciitis. The objective of this study is to determine the quality of plantar fasciitis websites using the DISCERN instrument. Furthermore, it seeks to assess readability of these websites through the Flesch-Kincaid Algorithm, the factors that affect variability in DISCERN Scores and grade levels, and the relationship between quality and readability.



                                                                                                                                                                      Figure 1

      Two key terms (“plantar fasciitis” and “heel pain”) were used in Google and Yahoo search engines. The DISCERN instrument was utilized to evaluate these websites. DISCERN is an instrument or tool used to measure the quality of health information based on its content, and helps consumers decide what treatment choices are good for them3. Readability ratings were assessed using the Flesch-Kincaid Readability Algorithm. The two-sample t-test (using alpha = 0.05) assuming equal variances (if f > f critical) and unequal variances (if f < f critical) were used to explain the variability in DISCERN scores and grade level readability. The independent variables for testing these variability were potential for commercial gain, health related seals of approval, language(s) and multimedia features. Lastly, Pearson r was used to test the correlation between the DISCERN Scores and grades.   


       A total of 100 websites were assessed. 10 were eliminated in accordance with the exclusion criteria and 55 duplicate websites were excluded, leaving 35 unique websites (see Fig. 1). In assessing the quality of the unique websites, of a maximum score of 80, the overall average DISCERN Score was 51.0 (SD=15.5) and readability (grade level) of 58.1 (9.4)  (SD=2.0). The t-tests demonstrated that websites seal of approval (p =0.002) and potential for commercial gain (p = 0.017) were contributing factors to higher and lower DISCERN scores, respectively, while none of the independent variables made a significant difference on grade level readability, as indicated by their p values (p > 0.05). Pearson r showed no correlation between DISCERN Scores and grades (r = 0.264).


     The mean DISCERN Score for the 35 unique websites was 51.0, which suggests information of moderate quality with potentially important but not serious shortcomings. The mean grade level readability was 9.4, indicating a fairly difficult reading level which would require some high school degree. The potential implications of this study for clinical practice are limited to treatment because DISCERN was designed for that purpose. Websites with a seal of approval contributed to higher DISCERN scores. This suggests that websites should strive to get a health-related seal of approval. However, websites that aim to sell commercial products contributed to lower DISCERN scores. Since these websites are more focused on commercial gain, this means that patients should be educated to avoid them because of the poorer quality of health information.


1 Buck, S. (2012, June 15). Mashable. Retrieved Nov 24, 2014, from What Doctors Think About Your Online Health http://mashable.com/2012/06/15/online-medical-searches/

2 NHS Executive Research and Development Programme. (1997). DISCERN Online. Retrieved May 19, 2014, from DISCERN Instrument and Handbook: http://www.discern.org.uk/background_to_discern.php#what_is_discern_for

3 U.S. Department of Health and Human Services. (2014, Dec). National Institute on Aging. Retrieved January 8, 2015, from Online Health Information: Can You Trust It?: www.nia.nih.gov/health/publication/online-health-information