title: Urologists in cyberspace: A review of the quality of health information from American urologists' websites using three validated tools.
abstract: OBJECTIVE
  In this paper, we evaluate a sample of urologists' web-sites, based in the United States, using three validated instruments: the Health on the Net Foundation code of conduct (HONcode), DISCERN and LIDA tools. We also discuss how medical websites can be improved.
  
  
  METHODS
  We used the 10 most populous cities in America, identified from the US Census Bureau, and searched using www.google. com to find the first 10 websites using the terms "urologist + city." Each website was scored using the HONcode, DISCERN and LIDA instruments. The median score for each tool was used to dichotomize the cohort and multivariable logistic regression was used to identify independent predictors of higher scores.
  
  
  RESULTS
  Of the 100 websites found, 78 were analyzed. There were 18 academic institutions, 43 group and 17 solo practices. A medical website design service had been used by 18 websites. The HONcode badge was seen on 3 websites (4%). Social media was used by 16 websites. Multivariable logistic regression showed predictors of higher scores for each tool. For HONcode, academic centres (OR 6.8, CI 1.2-37.3, p = 0.028) and the use of a medical website design service (OR 17.2, CI 3.8-78.1, p = 0.001) predicted a higher score. With DISCERN, academic centres (OR 23.13, p = 0.002, CI 3.15-169.9 and group practices (OR 7.19, p = 0.022, CI 1.33-38.93) were predictors of higher scores. Finally, with the LIDA tool, there were no predictors of higher scores. Pearson correlation did not show any correlation between the three scores.
  
  
  CONCLUSIONS
  Using 3 validated tools for appraising online health information, we found a wide variation in the quality of urologists' websites in the United States. Increased awareness of standards and available resources, coupled with guidance from health professional regulatory bodies, would improve the quality urological health information on medical websites.
authors.affiliation: Division of Uro-oncology, Department of Surgical Oncology, Princess Margaret Hospital, University of Toronto, Toronto, ON.
authors.forename: Lih-Ming
authors.initials: LM
authors.lastname: Wong
authors.forename: Hanmu
authors.initials: H
authors.lastname: Yan
authors.forename: David
authors.initials: D
authors.lastname: Margel
authors.forename: Neil E
authors.initials: NE
authors.lastname: Fleshner