The Quality of Internet Websites for People Experiencing Psychosis: Pilot Expert Assessment

Abstract

Background Clinicians need to be able to assess the quality of the available information to aid clinical decision-making. The internet has become an important source of health information for consumers and their families. Objective This study aimed to rate the quality of websites with psychosis-related information (to provide clinicians with a basis for recommending material to guide clinical decision-making with consumers and their families), using a validated instrument as well as a purpose-developed checklist, and consider improvement in quality over a 4-year period. Methods Two measures of website quality were used: the DISCERN scale and the Psychosis Website Quality Checklist (PWQC). Terms related to psychosis, including “psychotic,” “psychosis,” “schizophrenia,” “delusion,” and “hallucination,” were entered into Google, and the first 25 results were analyzed. In total, 6 raters with varying health professional backgrounds were used to evaluate the websites across two time points: January-March 2014 and January-March 2018. Results Of the 25 websites rated, only the 6 highest ranked websites achieved a DISCERN score, indicating that they were of “good” quality (51-62 out of a possible 75), while the mean score of the websites (mean 43.96, SD 12.08) indicated an overall “fair” quality. The PWQC revealed that websites scored highly on “availability and usability” (mean 16.82, SD 3.96) but poorly on “credibility” (mean 20.99, SD 6.68), “currency” (mean 5.16, SD 2.62), and “breadth and accuracy” (mean 77.87, SD 23.20). Most sites lacked information about early intervention, recreational drug use and suicide risk, with little change in content over time. Stating an editorial or review process on the website (found in 56% of websites) was significantly associated with a higher quality score on both scales (the DISCERN scale, P=.002; the PWQC, P=.006). Conclusions The information on the internet available for clinicians to recommend to people affected by psychosis tended to be of “fair” quality. While higher-quality websites exist, it is generally not easy way to assess this on face value. Evidence of an editorial or review process was one indicator of website quality. While sites generally provided basic clinical information, most lacked material addressing weighing up risks and benefits of medication and alternatives, the role of coercive treatment and other more contentious issues. Insufficient emphasis is placed on detailed information on early intervention and importance of lifestyle modifications or how families and friends can contribute. These are likely to be the very answers that consumers and carers are seeking and this gap contributes to unmet needs among this group. We suggest that clinicians should be aware of what is available and where there are gaps.