• Martin Hirsch, Shivani Aggarwal, Claire Barker, Colin J Davis, and DuffyJames M NJMNNuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Oxford, United Kingdom; Balliol College, University of Oxford, Oxford, United Kingdom. Electronic address: james.duffy@balliol.ox.ac.
• Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Yvonne Carter Building, London, United Kingdom.
• Am. J. Obstet. Gynecol. 2017 May 1; 216 (5): 451-458.e1.

BackgroundThe demand for health information online is increasing rapidly without clear governance.ObjectiveWe aim to evaluate the credibility, quality, readability, and accuracy of online patient information concerning endometriosis.Study DesignWe searched 5 popular Internet search engines: aol.com, ask.com, bing.com, google.com, and yahoo.com. We developed a search strategy in consultation with patients with endometriosis, to identify relevant World Wide Web pages. Pages containing information related to endometriosis for women with endometriosis or the public were eligible. Two independent authors screened the search results. World Wide Web pages were evaluated using validated instruments across 3 of the 4 following domains: (1) credibility (White Paper instrument; range 0-10); (2) quality (DISCERN instrument; range 0-85); and (3) readability (Flesch-Kincaid instrument; range 0-100); and (4) accuracy (assessed by a prioritized criteria developed in consultation with health care professionals, researchers, and women with endometriosis based on the European Society of Human Reproduction and Embryology guidelines [range 0-30]). We summarized these data in diagrams, tables, and narratively.ResultsWe identified 750 World Wide Web pages, of which 54 were included. Over a third of Web pages did not attribute authorship and almost half the included pages did not report the sources of information or academic references. No World Wide Web page provided information assessed as being written in plain English. A minority of web pages were assessed as high quality. A single World Wide Web page provided accurate information: evidentlycochrane.net. Available information was, in general, skewed toward the diagnosis of endometriosis. There were 16 credible World Wide Web pages, however the content limitations were infrequently discussed. No World Wide Web page scored highly across all 4 domains.ConclusionIn the unlikely event that a World Wide Web page reports high-quality, accurate, and credible health information it is typically challenging for a lay audience to comprehend. Health care professionals, and the wider community, should inform women with endometriosis of the risk of outdated, inaccurate, or even dangerous information online. The implementation of an information standard will incentivize providers of online information to establish and adhere to codes of conduct.Copyright © 2016 Elsevier Inc. All rights reserved.

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