This article was written on 12 Nov 2011, and is filled under Volume 15 Number 3.

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TRUTHFUL: A Method to Assist Patients with Evaluating Health Information on the Internet

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by Mary O’Sullivan, CRNA, DNP
& Marge Benham-Hutchins, PhD, RN


O’Sullivan, M. & Benham-Hutchins, M. (October 2011). TRUTHFUL: A Method to Assist Patients with Evaluating Health Information on the Internet. Online Journal of Nursing Informatics (OJNI), 15, (3). Available at http://ojni.org/issues/?p=893


The World Wide Web has fast become a primary repository for health information for the medically naïve yet technically savvy healthcare consumer.  Nurses can and should acknowledge the genuine value of the Web as a teaching tool by providing responsible guidance through the overwhelming maze of information it presents.   This article embraces the theme of delivering quality health information on the internet by using the truthful website evaluation method and demonstrates the use of this acronym to evaluate a popular health information website from the American Association of Sleep Apnea.  In the role of health care advocate, nurses can responsibly inspire the consumer to seek personal answers and empowerment as well as capitalize on the opportunities for interpersonal conversations that questions from these queries may generate.


The image of ‘patient education’ as a one on one, question and answer conversation between provider and patient is fast becoming a thing of the past.  Knowledge of health and wellness within the lay population has become more of an independent study.  Regardless of the setting, a living room sofa, an office examination table or a hospital bed, when or if a nurse is lucky enough to secure thirty minutes to interact with a client or his/her family, the encounter becomes more of a fact finding mission than an educational enterprise.  It comes as no surprise to any health care provider that the computer literacy of our clientele is transforming as well.  The ‘right here, right now’ culture of today no longer expects more than just education; it demands empowerment.   One solution is to maximizing every health care educational opportunity is to incorporate instantaneous educational opportunities of the World Wide Web.

In a matter of seconds, any Web query produces easily thousands of websites which may or may not encompass the intent of the original search.  The nurse’s challenge is twofold:  first, to be able to responsibly review and recommend specialty websites to the client and second,  to engage the hi-tech yet commonly health illiterate consumer to safely explore the Web for their personal health issues at their own pace.  To this end, this article embraces the theme of delivering education via an acronym.  This evaluation method is easy for the nurse to deliver and easy for the client to engage because it is succinct and direct.   The acronym chosen is truthful.

T – Technical characteristics of the webpage (Fox, 2009)

  • Is the website’s technology easy to use – links work, multimedia easily engaged?
  • Is the information updated regularly?
  • Is the instruction written in an understandable manner, logically organized and free of typographical errors?

R – Rated and reviewed website?

  • Has the website been reviewed by a reputable resource such as Health on the Network (http://www.hon.ch/), Medical Matrix  (http://www.medmatrix.org/index.asp) (Fox), MEDLINEPLUS

(http://www.medlineplus.gov) produced by the National Library of Medicine, or            Healthfinder ® (http://www.healthfinder.gov) from the US Department of Health     and Human Services. (Medical Library Association, 2009)


U – What is your understanding of page’s purpose? (Agency For Health Care Policy And Research, 1999)

  • Look for the disclosure statement which should describe the purpose of the site as well as any profiling or collection of information associated with using the site.


TTreatments recommended

  • Does the treatment or intervention proposed include a review of associated pros and cons and a disclaimer statement?


HHave you seen this information before? (Medical Library Association)

  • Have similar recommendations or advice come from another source or can you authenticate this information from a “primary information source such as the professional literature, abstracts, or links to other web pages.”?


FFunding origins

  • Based on information found within the domain name (the three letters at the end of the web address), the page header and the footer or more subtly through labeled or unlabeled advertisements, who is sponsoring and/or funding the page? (Fox), (National Library of Medicine & National Institutes of Health, 2009)


U All about YOU (National Library of Medicine & National Institutes of Health)

  • If your personal information is requested, do you know how it will be used and is this use acceptable?


L Legitimacy of the sources (Fox, 2009)

  • What qualifications does the webpage author or its editorial/review board have to be distributing the information, advice, or treatment and can you contact them in any form?
  • What is the source of the medical advice dispensed on this website?  Published research trials, peer reviewed practice guidelines, or personal stories?


As an example, the website www.sleepapnea.org has been chosen to review using the “TRUTHFUL” medical information website evaluation method.  This website originates from the American Association of Sleep Apnea (AASA), founded in 1990, “a non-profit organization dedicated to educating the public about sleep apnea and to serving people with this common disorder.”  (American Association of Sleep Apnea, 2008, About the ASAA, para. 1).   The website is intended for multiple audiences:  patients, parents, practitioners and the media.  This intention of this exercise is to represent the website as being evaluated from a patient’s perspective.

T – Technical:  The webpage is organized, easy to read and use.  All links work from the blogs to chat rooms to the YouTube videos to research.  Most of the basic obstructive sleep apnea (OSA) information is dated 1999-2007; however, all of the research, blogs, chat rooms, surgical options, and video/book resources are extremely current.  The general information presented has no posting date on it.

R – Reviewed:  This site has been reviewed by the Health on the Network (HON), Medical Matrix and Healthfinder® networks.  The site is not HON certified and has received a one out of five stars rating from the Medical Matrix website.

U – Purpose:  The following statement was identified within the “about the ASAA” tab:  “The ASAA promotes education and awareness… voluntary mutual support groups, research, and continuous improvement in care.” (American Association of Sleep Apnea, 2008, About the ASAA, para. 2).

T – Treatments:  Multiple non-invasive and surgical options are presented; all with clear disclaimers to the effect of seek medical direction before proceeding.

H – Authentication:  Much of the basic literature presented on this website is identical to the American Sleep Association (ASA – HON accredited) and National Heart, Lung and Blood Institute’s (NHLBI – government run) sites the primary sources used within the text presented on the ASAA website are not specifically referenced.  This domain’s name is .org which means formed by an organization versus a government or educational institution.

F– Funding:  Sponsorship ranges from corporations to individuals to sleep medicine clinics.  The site provides links to supporting shopping websites, the Combined Federal Campaign and vehicle donation opportunities.  It also solicits for membership and individual donations.  Unless the clearly marked product links are engaged, one does not see advertisements littered throughout the site.

U – Personal information:  The site’s privacy policy states it neither shares nor sells the email addresses or personal information.

L– legitimacy:  Sixteen people make up the association’s board of directors, six of which are physicians, one is a PhD.  It is unclear if these are the authors of the information posted.  No board member can be contacted directly but a site email system, the association’s physical address (with map service) and phone number are readily apparent.  The medical advice provided on this site is varied – from personal recommendations within the chat rooms to peer reviewed research links.  There are multiple disclaimers all over the site that the ASAA does not endorse or support any specific of therapeutic intervention.

In general, it is prudent to refer and/or recommend this website for clients to review for a variety of reasons.  First, the site is user friendly.  Navigation is simple and it does not assault the eyes with advertisements.  Second, the medical information is written in straightforward English within the parent, patient and media tabs.  While not a source for cutting edge research studies, it does provide established information that does not require an advanced degree in physiology to interpret. Third, the site is conservative with frequent reminders to seek the professional advice before engaging any suggested treatments.   Fourth, the blogs and chat rooms are very active which speaks volumes as to the very real, but perhaps unintended, role of this website in filling a needed gap in managing this disorder.  Experiential sharing between those with OSA is important to the mission of the ASA.  This forum allows for detailed discussion, for example, what kind of masks work best, common frustrations in accessing care, and what life can be like with a normal sleep pattern.   Advocacy, however, is about advising as well as acclaiming a website.   Though the site is beneficial, this is an ‘. Org’ website (an organization versus a governmental (.gov) or educational (.edu) institution) and not well recommended by medical reviewing websites such as Health on the Network (HON) or Medical Matrix.    Therefore, readers should be cautioned to examine alternative resources, those with a ‘.gov or.edu’ ending or their personal health care providers, to corroborate the medical accuracy of any health care conclusions they draw from this site.   Final points of note, the primary sponsors are medical supplying companies and less than half of the site’s Board of Directors has advanced degrees in a healthcare related field.

The “TRUTHFUL” medical information website evaluation method is intended to guide anyone from the nursing professional to the medically naïve healthcare consumer through the seemingly limitless knowledge bank that is the World Wide Web.  It is meant to be flexible, convenient and easily applied to any website conveying health care information. The ASAA website reviewed here is intended to educate the general public about obstructive sleep apnea.  Upon applying the “TRUTHFUL” evaluation method, the reader can promptly determine that it has genuine merit as a generally information/socializing outlet but perhaps is not the most rigorous evidence based medical authority on the subject of sleep apnea.

Nurses can and should acknowledge the value of the Web as a source of information, education and support.  Granted, one website cannot possibly be all things to all people and education is not always just about the facts.  Just getting someone to seek answers to personal care needs and generating interpersonal discussions with their health care providers has its own intrinsic value.


(Agency For Health Care Policy And Research 1999 Assessing the Quality of Internet Health Information)Agency for Health Care Policy and Research. (1999). Assessing the Quality of Internet Health Information. Retrieved from http://www.ahrq.gov/data/infoqual.htm

(American Association Of Sleep Apnea 2008 Home Page)American Association of Sleep Apnea. (2008). Home Page. Retrieved on October 25, 2009, from http://www.sleepapnea.org/info/index.html

(American Sleep Association 2007 Home page)American Sleep Association. (2007). Home page. Retrieved October 25, 2009, from http://www.sleepassociation.org/

(Fox L M 2009 Evaluating Medical Information on the World Wide Web)Fox, L. M. (2009). Evaluating Medical Information on the World Wide Web. Retrieved October 15, 2009, from http://hsclibrary.uchsc.edu/education/evaluating.php

(Medical Library Association 09820 User’s Guide to Finding and Evaluating Health Information on the Web)Medical Library Association. (09, August 20). A User’s Guide to Finding and Evaluating Health Information on the Web. Retrieved from http://www.mlanet.org/resources/userguide/html

(National Heart Lung And Blood Institute 2009 Sleep Apnea)National Heart Lung and Blood Institute. (2009). Sleep Apnea. Retrieved October 25, 2009, from http://www.nhlbi.nih.gov/health/dci/Diseases/SleepApnea/

(National Library Of Medicine National Institutes Of Health 0922)National Library of Medicine, & National Institutes of Health. (09, February 2). Retrieved from http://www.nlm.nih.gov/medlineplus/webeval/webeval_start.html


Author’s Bio

Dr. Mary O’Sullivan 

Nursing school – University of WA, Seattle 1987. Master’s degree – University of New England, Biddeford, ME – MSNA (nurse anesthesia) 1992. Doctoral degree – Northeastern University, Boston. 2010. Presently employed at the Audie L. Murphy Veterans Administration Hospital, San Antonio, TX as a staff nurse anesthetist.  Previous nursing experiences include medical-surgical, medical/surgical/cardiac intensive care, anesthesia, adjunct/assistant professor of nursing and nurse anesthesia, hospital education and utilization management.

Marge Benham-Hutchins, PhD, RN

Marge is an Assistant Professor at Texas Woman’s University, College of Nursing, Denton in Denton, Texas.

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