Wednesday, January 11, 2012

Traveling the Information Superhighway

It is estimated that 50-80% of the American public uses the Internet to obtain medical and health information. A single Google search using the term “soccer” returns nearly 850 million sites. Combining soccer with terms like nutrition, training or injury returns more than 10-20 million sites. While many of these sites are duplicates and news articles, it is clear that there is a tremendous amount of information about soccer available on the Internet. This raises a number of important questions. How accurate, reliable and complete is information posted on websites? Are some sites more reliable than others? Given the emergence of the information age, studies of website content are now being published. In general, these studies examine the quality and completeness of information found on various sites. The results are troubling. For the most part, traveling the information superhighway is littered with potholes. However, there are some bright spots along the way.

A 2010 survey asked more than 300 registered fitness professionals about where they obtain information on obesity (1). A large percentage these individuals utilize textbooks, class notes, journals and workshops. However, a significant portion also use the Internet and mass media. Those professionals without degrees in exercise science were more likely to utilize the Internet than those with formal education.

Unfortunately the information that these trainers find is relatively poor. A survey of physical activity sites found that less than 2% are considered accurate and 78% are characterized as having low accuracy (2). The researchers conclude that the quality of physical activity information found on the Internet is “dismal”. As a result, many fitness professionals may be utilizing and promoting inaccurate information about exercise training.

The same can be said for nutritional information found on the Internet. Commercial and sponsored sites could account for 80% of the visits and time spent seeking nutritional information (3). That is, Internet users are more likely to use websites that have a commercial investment and promote their product or service. Of these, only 31% have purely correct information. The worst sites are commercial site that contain articles written by “expert” journalists, professionals who write “scientific” articles but have little or no formal training in the medical or health field (3). Articles are often written in an attempt to entice readers to purchase a product rather that to educate them. News sites or sites featuring “news” articles about nutrition also provide questionable information. The investigators specifically mention sites such as Yahoo and MSN as publishing inaccurate or misleading articles.

While accuracy is a key problem, omission also raises concern. That is, the information is often incomplete and unable to answer the questions raised by readers. An example of this is found in a recent survey of sites focused on asthma (4). Researchers found that while many sites contain accurate information, less than 9% provide comprehensive information on the educational concepts provided by the National Heart, Lung and Blood Institute. That is, critical information was omitted. A second potential problem found is the owner of the website. Sponsored sites (those with a commercial interest) or those owned by a single individual are the least accurate and least comprehensive. Sites sponsored by governmental organizations (such as the National Institutes of Health) and professional organizations (like the American Lung Association) provide the most accurate and most complete information.

The problems obtaining accurate and complete information from the Internet are highlighted in a 2010 study (5). The investigators performed Google searches to answer five common child-health related questions. These questions ranged from MMR vaccines to infant sleeping positions. They entered search terms for each question then analyzed the first 500 sites that appeared on the search results.

Of the websites surveyed, 39% gave correct information, 11% gave incorrect information and 49% did not answer the question at all. Governmental sites (those ending in .gov) tended to be the most accurate. Educational sites (.edu) were the second most reliable. News sites provide correct information slightly more than half of the time and none of the sponsored sites surveyed provide accurate information. In particular, sponsored sites suffer from glaring conflicts of interest with many offering products or services that did not conform to sound medical advice.

From these studies, four trends emerge regarding health, nutrition and exercise information posted on the World Wide Web. First, be wary - many websites do not provide complete or accurate information about health conditions or treatments. Many are inaccurate and most suffer from a problem of omission. That is, the lack of information is as problematic as accuracy. Second, articles authored media experts can be unreliable in terms of accuracy and completeness. Most lay authors are not trained in exercise science, nutrition or injury management biology. Complex health issues such as these should be addressed by someone who is an expert in the field rather than someone who is an expert writer. Third, commercial and sponsored websites are rife with conflicts of interest. The problem here is that it is very difficult to determine if the information provided is accurate or if it is designed to entice the reader to purchase a product or service. Many times, misleading information can appear to be sound advice. Sponsored sites should not be used for advice on training because their primary goal is commerce, not necessarily improving performance.

Is there hope? How can one go about finding credible and complete information about issues like soccer, diet, training and injury prevention? The most reliable sites are governmental and educational (typically ending in .gov or .edu). A number of universities have sports science centers that regularly post well-researched information about improving performance and avoiding injury. For example, the Soccer and Health Research Project at the University of Copenhagen has an excellent site that presents soccer-specific information. Professional organizations (not advocacy groups) are also provide sound web-based information. The American College of Sports Medicine’s Access Public Information website provides a number of excellent resources that coaches and players can use. Their sites provide accurate information and the information provided is thorough and complete. The articles are either written by or thoroughly reviewed by experts in the field rather than a copy editor. Likewise, FIFA and the FIFA FMARC group provide excellent information. The advantage of these sites is that they do not suffer from conflicts of interest. Their goal is to provide unbiased, educational information, not to sell a product or sway an opinion.

It is also important be skeptical and look for multiple points of view. It is also important to ask some simple questions when reading information posted online. First, what is the goal of the article? Is the objective to promote a product or to educate the reader? Second, ask who is writing the article? Is the author trained is the topic? Expert coaches are excellent resources for coaching information such as tactical formations, motivating players, etc. However, they may not be the best experts on issues such as supplement use or injury prevention. Likewise, scientists can explain what research says about diet, training and injuries but they may lack context or a sense of how research findings fit into the game. Often considering both a coach’s and researcher’s points of view give the best answer. Lastly, consider what the information is based on. Is the article simply the author’s opinion or is the info based on credible research? Opinions can be biased and sometimes wrong. Look for articles that provide references or list additional resources.

The bottom line, surfing the web for information about soccer, diet and exercise is a case of “reader beware”. The search for accurate information can be difficult. It is a process that must be carried out with care. However, by looking in the right places and asking a few questions, information that is accurate and complete as well as useful to the player and coach can be found in the World Wide Web.

REFERENCES

Stacey D, Hopkins M, Adamo KB, Schorr R, Prud’homme D (2010) Knowledge translation to fitness trainers: A systematic review. Implementation Science, 5: 28.

Bonnar-Kidd KK, Black DR, Mattson M, Coster D (2009) Online physical activity information: Will typical users find quality information. Health Communication, 24: 165-175.

Ostry A, Young ML, Hughes M (2007) The quality of nutritional information available on popular websites: a content analysis. Health Education Research, 23: 648-655.

Meadows-Oliver M, Banasiak NC (2010) Accuracy of asthma information on the world wide web. Journal for Specialists in Pediatric Nursing, 15: 211-216.

Scullard P, Peacock C, Davies P (2010) Googling children’s health: reliability of medical advice on the internet. Archives of Disease in Childhood. 95: 580-582.

NOTE

This article was extracted and modified from the new book, Questioning Research, recently published by Jay Williams.