Health which article was probably

Anon (1999) Health on the net. Health Which?, April, pp.8-11

Fiona

-----Original Message-----
From: Ray Jones <[log in to unmask]> at Internet
Sent: Thursday, November 30, 2000 10:35 AM
To: [log in to unmask] at Internet
Subject: global health info


Global Health Resources

On 10th November I mailed the list and a few others asking for views about
the suitability of sites developed in one country for people in other
countries..I said "Nevertheless the question arises how 'global' are these
ten sites? When constructed they will have had an American or even more
specific (New York eg?) audience in mind. So how applicable are they to my
Glasgow Granny, my Adelaide Aunty, or even my (English speaking) cousin in
Cordoba?"

I said I would 'report' back to the list with what I found. This is a
SELECTION (not all) of replies.


MICHAEL HARDY from University of Southampton said: "I  have found that for
example, people from minorities that might practice the  Muslim medical
system Unani will give greater credence to sites that  originate in Asia.
Other issues here include the different use of  proprietary drug names in
different countries. More broadly people do  recognise the different origin
of sites and may use this to challenge treatment, practice or policy locally."

DR MALPANI from India said "I guess a sophisticated reader ( " health
consumer" ) would be able to extract the relevant info and customise it for
his local situation, but most patients would much rather be "spoon-fed""

DIANE BARNET, Information Officer from 'Contact a Family' in England said
(in respect of her search of the MLA recommended sites for Syringomyelia)
"I think we have to accept that an American listing will look at American
sites! information officers working in the UK should recommend quality
sites whatever their source and these sites are ok. At the same time I
would be ensuring that an enquirer is informed of the UK support available.
Healthfinder was very good at listing the US support orgs so all that I
would then do would refer UK enquirers to UK Equivalents: ANTS (Anne's
Neurological Trust Society)c/o the Syringomyelia Service at the Queen
Elizabeth Hospital in Birmingham, ASBAH (covers the Chiari Malformation
aspects of Syringomyelia), Stroke Association and Pain orgs. Having said
all of this, I am an information officer and the 'man/woman in the street'
would have to have some knowledge to ferret all this out."

ANDREW STOREY AND MARILYN MARTIN, Researchers in Nutrition at Glasgow
University looked at two sites AMA Health Website and NOAH for information
on nutrition. They said Both sites lack immediate relevance to Glaswegians.
This may be  largely    due to the cultural differences between the US and
here. Health and nutritional recommendations and guidelines differ in
America, so for example recommended daily intakes of vitamins and minerals
as well as main dietary constituents have less relevance outwith the US. We
had not heard of some of the foodstuffs that were mentioned on both websites.

DIANE BENTAL from Heriot Watt University gave the following detailed reply.
She discusses this and personalised sites on her web site at
http://www.cee.hw.ac.uk/~diana/DIP/medical.html

She said
--------------------
I'm aware of four areas where national or even regional differences matter:
1. US assumptions about how healthcare is *delivered* can be very different
from eg the UK. For example, while pregnancy is pretty universal, the
medical *professionals* and *procedures* are different. A UK mother-to-be
needs to be clear that a midwife rather than an obstetrician could be
running her show (and a UK midwife is different from a US midwife), that
she shouldn't expect a glucose stress test, and so on. For a patient, who
and how the service is delivered, who to ask and what to expect, are often
as important as the more universal "raw" medical/scientific data, and on
consumer sites they are often closely mixed. These differences in medical
practice and delivery turned up in the AMA site
http://www.ama-assn.org/consumer.htm on your list of recommended sites. I
looked up 2-3 year olds: there were separate pages for communications,
medical care, fitness and growth. Most of the "communications" page was
universal, but one fifth of the information - i.e. the section on what to
do if your child has a problem - was specific to US practice and
terminology. The "medical care" page was the most highly US-specific, for
instance assuming that your child would have a "yearly well-child visit"
(as opposed to the irregular UK schedule), listing a US vaccination
schedule (which may not be quite the same as the UK one), and so on.
2. Another factor is that different issues are also "live" in different
places.  A few months ago, a relative asked me to look for info on a drug
and cancer - I think it was HRT and breast cancer. We found a brief, clear
and readable page on the CancerHelp UK site, but nothing about the issue on
the US sites including (at the time) Oncolink. UK sites highlight UK concerns.
3. Occasionally, even the recommendations vary.  Dietary restrictions in
pregnancy are different - in the US, alcohol is forbidden, while in the UK
it's pate, scrambled eggs and Brie :-)
4. Finally, the raw data can sometimes differ. The AMA children's page gave
growth charts which were not explicitly labelled as US data (although the
AMA heading on the pages should be a hint!). The AMA has a long page about
Web quality guidelines, but does not mention the fact that a US audience is
presupposed throughout, nor does it raise the issue of what their site
might mean to readers outside the US.
------------------------

IN CONCLUSION.
I agree with Diane's conclusion "Diversity is interesting but it can also
be confusing.  I'd like to see medical *World* Wide Web sites be much more
explicit about how local or diverse their different items of information
are, with explicit relevance information onscreen probably supported by
tagging of pages or paragraphs."

It is also an issue in the various 'rating scales' currently being used. It
is not sufficient that a site has (eg) an HON rating, we need to know for
which populations it is suitable.

Ray Jones

Ps (Ahmad Risk thought that Health Which had published a report on a
similar topic about 18 months ago, but as yet I have been unable to locate
it. If you know the article I would appreciate the title and date.)


Dr Ray Jones
Senior Lecturer in Health Informatics
Department of Public Health
1 Lilybank Gardens
Glasgow G12 8RZ
Email: [log in to unmask]
Fax: 0141-330-5018

Secretary
Rebecca Flanagan: [log in to unmask]
Tel: 0141-330-6110