key: cord-326208-z49517nf authors: Lins Filho, P. C.; Macedo, T. S. d.; Ferreira, A. K. A.; Melo, M. C. F. d.; Araujo, M. M. S. d.; Freitas, J. L. d. M.; Caldas, T. U.; Caldas, A. d. F. title: Assessing the quality, readability and reliability of online information on COVID-19: aninfoveillance observational study date: 2020-05-30 journal: nan DOI: 10.1101/2020.05.30.20117614 sha: doc_id: 326208 cord_uid: z49517nf Objective: This study aimed to assess the quality, reliability and readability of internet-based information on COVID-19 available on Brazil most used search engines. Methods: A total of 68 websites were selected through Google, Bing, and Yahoo. The websites content quality and reliability were evaluated using the DISCERN questionnaire, the Journal of American Medical Association (JAMA) benchmark criteria, and the presence of the Health on Net (HON) certification. Readability was assessed by the Flesch Reading Ease adapted to Brazilian Portuguese (FRE-BP). Results: The web contents were considered moderate to low quality according to DISCERN and JAMA mean scores. Most of the sample presented very difficult reading levels and only 7.4% displayed HON certification. Websites of Governmental and health-related authorship nature showed lower JAMA mean scores and quality and readability measures did not correlate to the webpages content type. Conclusion: COVID-19 related contents available online were considered of low to moderate quality and not accessible. Health care is rapidly transitioning from a paternalistic approach to a person-centered model. This The internet offers a large amount of information, although the quality of health and sanitary 51 information offered is highly variable, ranging from scientific and evidence-based data to home remedies 52 or information of very questionable origin that can be dangerous to health (Eysenbach et al. 2002) . The Thus, monitoring the quality of information available to the population is of great importance to control the 66 spread of the disease itself and to mitigate its socioeconomic impacts (Hua and Shaw 2020). Therefore, the 67 WHO is dedicating tremendous efforts aimed at providing evidence-based information and advice to the 68 population through its social media channels and a new information platform called WHO Information 69 Network for Epidemics (Zarocostas 2020 Sites on the internet were identified using the three most accessed search engines by internet users 88 in Brazil: Google (www.google.com), Bing (www.bing.com) and Yahoo (www.yahoo.com), respectively, 89 97.59%, 1.2% and 1.04% of accesses in April 2020 (Statcounter 2020) . In April 2020, the searches were language. Duplicate sites were excluded, as were non-operative sites or sites with denied direct access 94 through password requirements, book review sites, or sites offering journal abstracts, and those sites that 95 did not offer information on COVID-19. Websites that could be modified by the general population were 96 also not considered in this investigation. The quality of website information was assessed by four evaluators, who were previously trained in 98 the analysis tools used. Concerning the scientific accuracy and reliability of websites information, WHO 99 official reports and technical guidelines were used as standards. The websites that were divergently 100 qualified by the examiners were reassessed to the achievement of a consensus score. As this was a study of 101 published information and involved no participants, no ethics approval was required. In order to avoid any 102 changes that may be made to the eligible websites during the period of analysis, the sites were assessed in 103 the same day by the evaluators. The sites were classified in terms of affiliation as commercial, news portal, non-profit organization, 105 university or health center and government. The type of content was classified as corresponding to medical 106 facts, human experiences of interest, questions and answers and socioeconomic related content. The quality of information of the selected websites was assessed using criteria of the Journal of the CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 30, 2020. . https://doi.org/10.1101/2020.05.30.20117614 doi: medRxiv preprint address the reliability of the publication and help users to decide whether it can be trusted as a source of 118 information relating to treatment choice. Questions 9-15 address specific details of the information relating 119 to treatment alternatives. In this context, questions 9-11 refer to the active treatments described in the 120 publication (possibly including self-care), while the options without treatment are addressed separately in 121 question 12. In turn, question 16 corresponds to the global quality assessment at the end of the instrument. Each question is scored on a scale of 1-5 (where 1, the publication is poor; and 5, the publication is of good 123 quality). In the present study, only the first section of the questionnaire was used for reliability assessment. The readability (RE) of the websites was assessed by the Flesch Reading Ease adapted to Brazilian Data were submitted to statistical analysis, all tests were applied considering an error of 5% and the 143 confidence interval of 95%, and the analyzes were carried out using SPSS software version 23.0 (SPSS Inc. fulfilled the inclusion and exclusion criteria. The search retrieval flow diagram is presented in Figure 1 . According to affiliation most websites were from news portals (51.5%), followed by government 158 (29.4%), commercial sites (13.2%), university or health center (4.4%) and non-profit organization (1.5%). Considering the type of content, the majority of the sites displayed medical facts (88.2%) followed by The correlation between distinct measures assessed through the instruments was analyzed. Besides the quality of information, the amount of it provided for an individual is also a concern. 208 Previous research suggests that the vast amount of available information can be confusing, potentially 209 resulting in over-concern and information overload (Farooq et al. 2020 In addition to ensure the quality and reliability of information, it is important that these quality quality. In the present study such correlation was not found possibly due the growing concern about the 228 quality of health-related information available online (Farooq et al. 2020 ), however, no positive correlation 229 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 30, 2020. . https://doi.org/10.1101/2020.05.30.20117614 doi: medRxiv preprint was found, which demonstrates the need for further efforts on improving the accessibility of high-quality 230 health related information available online. The internet and search engines are dynamic processes that constantly change. The sites evaluated 232 in this investigation may not necessarily reflect the information available to patients at another time. This 233 was a limitation for this investigation. However, the search engines used for the consultation represent 234 99.8% of the access of Brazilian internet users (Statcounter 2020 ). In addition, to cover a reasonable amount 235 of data, the first 100 consecutive websites of each search engine were accessed. Regarding the present sample of Brazilian websites, COVID-19 contents were considered of low to 237 moderate quality and low readability based on the parameters adopted. This pattern just reasonably . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 30, 2020. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 30, 2020. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 30, 2020. . https://doi.org/10.1101/2020.05.30.20117614 doi: medRxiv preprint . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 30, 2020. . https://doi.org/10.1101/2020.05.30.20117614 doi: medRxiv preprint CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 30, 2020. . https://doi.org/10.1101/2020.05.30.20117614 doi: medRxiv preprint During the COVID-19 Pandemic: Cross-Sectional Study Influence of peer support on HIV/STI 279 prevention and safety amongst international migrant sex workers: A qualitative study at the Mexico-280 Mental health problems and social media exposure during COVID-282 19 outbreak HON T Health on the Net (HON). HON Foundation Infodemic" and Emerging Issues through a Data 285 Lens: The Case of China Institute of Medicine (US) Committee on Assuring the Health of the Public in the 21st Century. The 288 Future of the Public's Health in the 21st Century Quality and readability of internet-based information on halitosis Coronavirus Goes Viral: Quantifying the COVID-19 Evaluating the Dental Caries-Related Information on 295 Brazilian Websites: Qualitative Study Person-centered care model in dentistry The quality of internet sites providing information relating 299 to oral cancer Relationship Between Internet Health Information and Patient 303 Compliance Based on Trust: Empirical Study Impact of Physician-Patient Communication in Online Health Communities on 306 Patient Compliance: Cross-Sectional Questionnaire Study Spanish in readability of online endodontic information for laypeople Quality of information about oral cancer in Brazilian 312 The quality and readability of online consumer information about 328 gynecologic cancer Search Engine Market Share Brazil Communicating risk in public health emergencies: a WHO 334 guideline for emergency risk communication (ERC) policy and practice Switzerland ISBN Combining Point-of-Care Diagnostics and Internet of 337 Medical Things (IoMT) to Combat the COVID-19 Pandemic. Diagnostics (Basel) How to fight an infodemic