{"paper_id":"3a97564f-eedc-4791-aca5-afa6d33a831a","body_text":"Evaluation of the quality of online colon cancer patient information in the Arabic language | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Evaluation of the quality of online colon cancer patient information in the Arabic language lamya alnaim This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1446709/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 25 Oct, 2022 Read the published version in Asian Journal of Pharmaceutical Research and Health Care → Version 1 posted You are reading this latest preprint version Abstract Background and Study Aims With the ever-expanding reach of Internet information, more people than ever are using online searches to obtain medical information, often before consulting a medical professional. This study aims to assess the quality of available Internet information on colon cancer in the Arabic language. Patients and Methods A cross-sectional study was performed to assess the quality of Arabic language websites on colon cancer in Arabic using the DISCERN instrument, a validated 16-item questionnaire, and our assessment of the correctness, completeness, and transparency of each website. Results A total of 24 websites were identified, of which 12 (50%) were commercial, 9 (37.5%) were university-sponsored, 2 (8.3%) were governmental, and 1 (4.2%) was from a non-profit organization. The DISCERN instrument had an overall mean score of 42.5 (fair) out of a maximum score of 80, with 50% of commercial websites scoring 41 or below (poor) and only 11% scoring in the good range. Two-thirds (66.7%) of the university-sponsored sites were rated poor, the single non-profit website scored fair, and the two governmental sites were rated poor. The most accurate topics covered by the websites were surgical treatment, screening, and colonoscopy. Regarding correctness, 94.6% of the websites were accurate in the information provided, while only 55% scored high in Completeness, meaning that they provided comprehensive information. Transparency was poor for most websites, with only two providing sufficient information to verify their sources. Conclusion This study demonstrated that while people use the Internet to access medical information about colon cancer, much of this information is incomplete in the Arabic language. This raises the question of how much benefit versus harm individuals receive from using websites to learn about colon cancer, and what can be done to improve the information available. colon cancer DISCERN instrument website quality Arabic Strengths And Limitations Of This Study No previous study has evaluated Arabic language information on colon cancer found on the Internet. A validated tool to assess website quality was used (DISCERN instrument). Three pharmacists independently evaluated each website and compared the results. Only a few websites were found on colon cancer in the Arabic language, limiting the power of the study. The fact that Internet content and quality can change rapidly and regularly limits the generalizability of any study using websites. Introduction Retrieving information on medical topics is now simpler than ever. Since the use of contemporary Internet search engines, social networks, and universal access via devices like smartphones, tablets, and computers is increasingly widespread, health-related information is now accessible at any moment right at people’s fingertips. 1 Health information on the Internet varies from personal blogs and accounts of illness, discussion, and support groups to published research and formal guidelines produced by medical and health-related organizations. 2 However, like all information on the Internet, health information is unregulated; data could be incorrect or false, while other information could be confusing or harmful to vulnerable patients by endorsing harmful products and treatments or by providing inaccurate advice. 3 Many individuals seek information from the Internet before speaking to their physicians. 1 It is much easier to search for an ailment or a set of symptoms on a search engine at home than to schedule, wait for, and attend an appointment in the doctor’s clinic. 1 We live in a world where people are used to getting immediate answers to their questions and concerns. Why wait a week or two for a doctor to diagnose and educate you when a simple online search can seemingly give you the same information right now? Based on statistics from June 2019, 4.42 billion people, 57.3% of the total world population, were active Internet users. The largest number of users were reported to be in Asia and North America. 4 The countries with the most internet users were China, India, and the United States. 5 Also, about 3.5 billion people were regular social media users. According to the latest health statistics, 17 million new cases of cancer were diagnosed worldwide in 2018, with the most common being lung, breast, colon, and prostate cancer. 6 In Saudi Arabia, colon cancer is the most prevalent cancer in males and the third most common in females. 7 Additionally, the percentage of patients diagnosed with colon cancer and the mortality rates from this disease have increased significantly in the last 10 years. Today, the median age at diagnosis for colon cancer is 60 years for men and 56 years for women. 7,8 Notably, access to appropriate and accurate information not only promotes better health results for colon cancer patients, but it also helps patients and caregivers to deal with the effects of colon cancer from initial diagnosis through disease management. 9 It has been demonstrated to have a positive effect on patients’ emotions, attitudes, and coping skills. It also helps to reduce anxiety and mood disorders while preparing the patient for future management and potential long-term outcomes. 10 The specific information needs of patients with cancer pertain to many domains. Early in the disease, information regarding staging, treatment options, and treatment side effects is most important. After treatment, recovery and long-term prognosis are the details that most patients seek information about. 9,10 This information helps patients gain a sense of control, reduce anxiety, and encourage self-care while improving their abilities to make informed decisions about their care. 11 Patients will use the Internet, their doctors, cancer organizations, family and friends, and the library to obtain information. 12–14 The Arabic language is the official language in 22 countries, with 423 million speakers. Although Arabic is the 7 th most widely spoken language, its online content accounts for only 0.7–1.5% of the total across the Internet. 17,18 Although the number of Arabic websites and speakers continues to grow, research by Al Huziah et al. (2009) has demonstrated that health-related online contact is weak. It has been characterized as overly simplistic and as lacking specificity and accuracy. This is especially true of websites that purport to be specialized in dispensing medical information originating from Saudi Arabia, Egypt, and Syria. The data, however, are usually posted in English. 19 Currently, Egyptian health websites are considered the best in authoritativeness and transparency. 17,19 There have been some recent initiatives aimed at providing more trustworthy health information in Arabic on the Internet. One such initiative is being undertaken by the King Abdullah Bin Abdul-Aziz Arabic Health Encyclopedia (KAAHE) in Saudi Arabia, which specializes in health information for consumers and healthcare professionals. 20 Other examples in Saudi Arabia include the Saudi Ministry of Health (MOH), King Faisal Specialist Hospital & Research Centre, 20 the Ministry of Health Portal in the Hashemite Kingdom of Jordan, and the Ministry of Health Portal, United Arab Emirates. These government-run websites provide Arabic and English health information. Nevertheless, there remains a large gap between the needs of Arabic-speaking individuals for accurate and timely health-related information and what is found on the Internet. Moreover, there has been very limited research published on the quality of Arabic information related to health in general and colon cancer in particular. Many studies have attempted to draw attention to the prevalence of inadequate health information using different quality criteria. 15 However, there is no consensus on which is the best method to ensure quality for consumers. Five approaches and tools to evaluate website quality have been described: codes of behavior, quality labels, user guides, filters, and accreditation by third parties. 16 Codes of conduct are standards applied during the development of websites to help ensure quality. Quality labels are marks displayed on websites to show their assurance to abide by a code of conduct. These labels may be assigned by a third party, which certifies websites against codes of conduct. Filters are entries that may be used to show only websites that satisfy a certain set of quality criteria. Finally, user guides are tools that may be published by organizations to assist users in judging website quality. 16 The aims of this study are to: 1. evaluate the quality of the colon-cancer related information available in Arabic on the Internet; 2. determine which website(s) provide the best (i.e., most accurate and complete) information in Arabic for individuals seeking information on colon cancer; and 3. in the poorer quality websites focused on colon cancer in Arabic, determine how much and which specific information is missing and inaccurate. Material And Methods We conducted a cross-sectional study using three search engines (Bing, Google, and Yahoo), as these were the most popular search engines during our study in 2019. The Arabic word(s) for colon cancer were used as search terms ( سرطان القولون ). These search terms were chosen based on the input from a convenience sample of medical patients without a personal history of colon cancer. The search terms were kept short yet broad to reflect the typical practice of Internet users of all abilities seeking information about colon cancer. The searches resulted in more than 122,000 hits on Bing, 94,900 on Yahoo, and 5,390,000 from Google. Published marketing data show that when people search the Internet, they typically do not go beyond the first two pages of search output. 21 We expanded our search to the first 10 pages because there are few Arabic websites and we wanted to ensure the collection of nearly all Internet sources. ***** We identified all websites that contained health information on colon cancer in the Arabic language. In total, we found 24 relevant websites, all of which were accessible when the study was conducted in November 2019. We excluded websites provided by private individuals, those containing links to other websites, and those containing only chat rooms or discussion groups. Additionally, websites were excluded if they were not provided in the Arabic language, provided information irrelevant to colon cancer or its treatments, or required payment or registration to access. Blogs and posts addressing specific questions were excluded, as were commercial websites selling or promoting a product and online news articles referring to a specific treatment or medical study. Every website that met the inclusion criteria was independently reviewed by two research assistants (Table 1). Evaluation of the websites To assess each website, we adopted an evaluation method previously developed and published. 22 Two junior pharmacists, in addition to a clinical pharmacist with medical oncology experience, used the evaluation forms to assess the websites. The criteria evaluated for each website were divided into two principal categories: quality and transparency. Quality is the sum of the scores for each website in three subsections: breadth of topics, depth of topics, and correctness of information. Adding the scores for the breadth and depth of the website’s topics provided a score for the completeness of the information. 23 The transparency score was the sum of scores for five subsections: authorship, attribution, currency, disclosure, and kitemarks. 24 The completeness of each website (sum of breadth and depth) looked at 10 themes: risk factors, staging and prognosis, screening and colonoscopy, surgical treatment, chemotherapy, radiotherapy, biological treatment, other pharmaceutical treatments, complementary medicine, and emotional/psychological support 23 (Table 1). Five criteria were used to calculate transparency: authorship, attribution, currency, disclosure, and kitemarks. Organizations use the first four transparency criteria to award kitemarks that identify trusted sites. 24 Each criterion is scored as listed in Table 1. Appropriate references were chosen by a practicing oncologist to verify the accuracy of the website information. The National Comprehensive Cancer Network (NCCN) guidelines for colon cancer were used for this assessment. 25 The transparency criteria are based on the criteria described by Silberg et al. in 1997. 26 DISCERN Instrument The DISCERN instrument was used as an additional tool to assess the quality of the websites. 28 This validated 16-item instrument is a Likert-style questionnaire used for scoring the quality of printed health information. The first eight questions evaluate the reliability of the information. The next seven questions rate the quality of the information regarding treatment options. The final question assesses the overall rating of the publication 29 (Table 1). The maximum score for the DISCERN instrument was 80, with a minimum score of 16. Each score was rated from very poor to excellent (Table 2). Each evaluator was provided with the instrument and the DISCERN Handbook, which includes comprehensive details about DISCERN element scoring. 30 Statistical analysis Data were analyzed using SPSS version 25.0 statistical package (SPSS Inc., Chicago, IL, USA). A descriptive study was conducted for each variable. The associations between the DISCERN scores for each website and the type of website were analyzed using the chi-square test. The Kruskal–Wallis test was applied between different websites using type and quality as variables. Interrater reliability The interrater reliability of the information was assessed by three independent investigators using the same rating form and instructions. Intercorrelations between the first evaluator and the two other evaluators were calculated separately using a two-tailed Spearman’s rho with a range of ρ = 0.82–0.95 ( p < 0.0001). The interrater reliability showed an agreement of 88%. Where initial agreement was lacking, a consensus was reached after discussion.. Results The different types of 24 websites that provide information about colon cancer in the Arabic language are presented in Table 1. Most of the websites that provided information about colon cancer were commercial (50%), 37.5% were academic, 8.3% were governmental, and 4.2% from non-profit organizations. Regarding quality as assessed by the DISCERN instrument, the mean score for all websites was 42.5% (95% CI 39.6–45.5). Fifty percent of commercial websites scored “poor” and another 50% were “fair.” Two-thirds (66.7%) of university websites were “poor,” with only 11.1% “good.” All non-profit websites were “fair,” and all government websites were “poor” ( p > .05). None of the websites had a high rating (Table 3). [Insert Table 3 about here] The mean and standard deviation of each attribute under the categories of breadth and transparency of the websites are presented in Table 4. [Insert Table 4 about here] Breadth of information In terms of completeness, only one website included information about complementary medicine, while all websites included information about screening, colonoscopy, and surgical treatment. Most websites mentioned risk factors and chemotherapy and radiotherapy as forms of treatment. Only about one-third of websites covered staging and prognosis, biological treatments, and other pharmaceutical treatments. Emotional and psychological support was covered by 20% of the assessed websites. A Kruskal-Wallis H test showed a non-significant difference in completeness score among the different website categories, χ 2 (3) = 1.833, p = 0.608, with a mean rank t -total score of 13.88 for commercial websites, 12.11 for university websites, 6.00 for non-profit websites, and 9.25 for government websites. For depth, 55% of the information provided was complete and comprehensive. The remainder included information that might have been accurate but did not cover the details thoroughly. There was no clear pattern in which websites provided complete information or themes. A Kruskal-Wallis H test showed a non-significant difference in depth score among the website categories, χ 2 (3) = 2.331, p = 0.507, with a mean rank t -total score of 13.96 for commercial websites, 11.83 for university websites, 3.5 for non-profit websites, and 11.25 for government websites. Regarding correctness, 94.6% of the websites provided completely correct information regarding the themes covered. The information that was not completely accurate was primarily related to treatment modalities, specifically surgical treatments, chemotherapies, and radiotherapy. A Kruskal-Wallis H test showed a non-significant difference in correctness score among the website categories, χ 2 (3) = 1.923, p = 0.588, with a mean rank t -total score of 13.5 for commercial websites, 12.89 for university websites, 7.00 for non-profit websites, and 7.5 for government websites. Transparency Only two of the websites had health-related and verifiable kitemarks. None of the websites scored 10 on authorship, and 50% had a score of 0. Almost 67% scored 0 for attribution, while three websites received a full score of 8. A quarter of the websites scored a perfect 6 on currency, while 12.5% scored 0. The websites scored best on disclosure, with 67% achieving a perfect score of 12 and none receiving a score of 0. A Kruskal-Wallis H test showed a non-significant difference in t -total scores among the different website categories, χ 2 (3) = 2.658, p = 0.447, with a mean rank t -total score of 13.42 for commercial websites, 10.22 for university websites, 21.00 for non-profit websites, and 13.00 for government websites. Discussion The primary aim of this study was to evaluate the quality of Arabic language knowledge and information related to colon cancer available online on different websites. Patients need accessible and high-quality information to assist them in making decisions about their health. Given the high prevalence of colon cancer worldwide, combined with the finding that more than half of the population turns to the Internet as a major source of health information, 31 it is vital that the information provided on websites be as complete and accurate as possible. This study showed that the information available in Arabic regarding colon cancer is limited and of low quality. The completeness, depth, and correctness of the 24 websites showed varied results for the topics assessed. Surgical treatment of colon cancer and screening and colonoscopy were the two main topics covered, with most of the information being correct (50–70% of the websites examined). The topic of “complementary medicine for the treatment of colon cancer” was the topic that was least covered (only 4% of the websites alluded to it). Users looking for information about colon cancer in Arabic will find only a little more than half of the information considered necessary for a thorough understanding of the topic. This leaves a large gap in the knowledge available to the Arabic-speaking population, who are just as likely to turn to the Internet as to physicians for medical-related information. The transparency of the websites was calculated using attributes such as authorship, attribution, currency, disclosure of information, and the display of kitemarks. Most websites did not have kitemarks and scored low on authorship, attribution, and currency. While most websites did well only on disclosure, the lack of transparency contributes to the low quality of information, as readers cannot easily determine who is providing the information they are reading. Compared to the websites of other organizations and in other languages, colon cancer-specific sites in Arabic scored lower than the general health websites. 15 However, it has been found that even websites in the English language are not of good quality. Grewal et al. 32 assessed the readability and quality of websites for CRC. While they used a different tool for rating websites, they also used the DISCERN instrument with mean scores of 52.2 (95% CI 45–59.4), which were only modestly higher than our results (52.2 v. 42.5). They concluded that the English-language colon cancer websites were not sufficiently reliable to provide quality information to patients. Burke et al. 33 looked at the quality of information on esophageal cancer available to patients on the Internet by analyzing the top 20 websites returned by Google search and the top 10 websites returned by Yahoo and Bing searches. Using the DISCERN tool, they calculated the mean score at 51.5, with no website achieving a maximum score of 80. Wasserman et al. examined the quality of web-based patient information regarding surgery for colorectal cancer. 34 They found the quality to be highly variable and the information often incomplete. Overall, evaluators ranked 29.7% of the websites as good or excellent, compared to only 11% rated good or excellent in the current study. Most websites on colon cancer or other health topics in Arabic have been translated from English language sites. Translating low-quality or unreliable information leads to poor use of resources. Moreover, the data may be summarized, and meaning can be lost due to low-quality translation. Another problem is the lack of initiative by official organizations to improve the quality of vital health-related information. Because the number of sites rated as good quality was low, users who search for information about colon cancer may not find the information they are seeking, and they may not even be aware that what they are finding is incorrect or limited. Theoretically, the inconvenience of incomplete and inaccurate information can be mitigated by obtaining information from multiple sites with complementary information. This strategy requires highly motivated users with a better-than-average knowledge of Internet resources and the time to spend consulting multiple websites to obtain the information sought. 35 The medical community needs to take responsibility to ensure that complete, comprehensive, up-to-date, and accurate information is available to guide patients. Additionally, given the findings of the current study, health care providers should ask patients what beliefs they already have and where those beliefs came from. Knowing that patients may not bring up what they have read on the Internet can leave a provider at a disadvantage when discussing and recommending diagnostic and treatment options. One limitation of the current study is the relatively small number of websites evaluated, which highlights the scarcity of Arabic health websites (0.7–1.5%). 17 Also, information on the Internet can and often does change regularly. What a patient might see today can differ from what he will find tomorrow. Changing information and different websites have also been discovered as the number of search engines expands. 35 To conclude, to the best of our knowledge, this is the first study to evaluate the quality of online patient information regarding colon cancer in Arabic. Cancer patients and cancer survivors need quality information in their native language. 12 The Internet can easily provide information, but the quality of each site remains difficult for patients to distinguish. Whether the information being provided is comprehensive or accurate is not something the average user can distinguish. 36 An opportunity exists for professional medical societies to create more comprehensive online patient information materials that can serve as a valuable (and accurate) resource for patients. The criteria examined in our study can serve as a guide for developing and improving the quality of online patient information. References 1. Tonsaker T, Bartlett G, Trpkov C. Health information on the Internet: gold mine or minefield? Can Fam Physician 2014;60:407-8. Accessed 7 May 2018. http://www.ncbi.nlm.nih.gov/pubmed/24828994 2. Baker L, Wagner TH, Singer S, et al. Use of the Internet and e-mail for health care information. J Am Med Assoc 2003;289:2400. 3. Kitchens B, Harle CA, Li S. Quality of health-related online search results. Decis Support Syst 2014;57:454-62. 4. World Internet Users Statistics and 2016 World Population Stats. Internet Usage Statistics: The Internet Big Picture. http://www.internetworldstats.com/stats.htm; 2016. Accessed 25 July 2019. 5. Clement J. Global digital population 2019. Statista, https://www.statista.com/statistics/617136/digital-population-worldwide/; 2019. Accessed 15 April 2019. 6. Cancer Research UK. Worldwide cancer mortality statistics. Worldwide cancer statistics. http://www.cancerresearchuk.org/cancer-info/cancerstats/world/mortality/; 2014. Accessed 26 July 2019. 7. Obaid AR. Colon Cancer and Saudi Population 2017. www.ijcmr.com; 2017. Accessed 26 July 2019. 8. Alsanea N, Abduljabbar AS, Alhomoud S, et al. Colorectal cancer in Saudi Arabia: incidence, survival, demographics and implications for national policies. Ann Saudi Med 2015;35:196-202. 9. Rutten LJF, Arora NK, Bakos AD, et al. 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Measurements, Formulas, and Score Ranges Quality: Completeness + Correctness [Range = 0–50] Completeness: Breadth Score + Depth Score [Range = 0–30] Breadth : Each of the 10 themes scored 0 or 1 [Range = 0–10] Depth: Each of the 10 themes scored 0, 1, or 2 [Range = 0–20] Correctness: Scored 0, 1, or 2 [Range = 0–20] Transparency: Sum of five scores below [Range = 0–46] Authorship: Scored 0, 1, 2 [Range = 0–10] Attribution: Scored 0, 1, 2 [Range = 0–8] Currency: Scored 0, 1, 2 [Range = 0–6] Disclosure: Scored 0, 1, 2 [Range = 0–12] Kitemarks: Scored 0, 1, or 2 [Range = 0–10] DISCERN [Range = 16–80] Likert Scale: Scored 1–5 for each of the 16 questions Reliability of Information : 8 questions Quality of Information on Treatment Options: 7 questions Overall Quality of Information: 1 question Table 2. DISCERN instrument scoring system. Category Score Excellent 68–80 Good 55–67 Fair 42–54 Poor 29–41 Very Poor 16–28 Table 3. DISCERN Score versus Type of Website. % of Poor Fair Good Excellent Total Commercial 6 50.0% 6 50.0% 0 0.0% 0 0.0% 50.0% University 6 66.7% 2 22.2% 1 11.1% 0 0.0% 37.5% Non-profit 0 0.0% 1 100.0% 0 0.0% 0 0.0% 4.2% Government 2 100.0% 0 0.0% 0 0.0% 0 0.0% 8.3% Table 4. Mean ± Standard Deviation of Measurements of 24 Websites Variable Mean Standard Measured Deviation Quality 28.04 8.411 Completeness 15.71 3.189 Breadth 6.21 1.560 Depth 9.50 3.867 Correctness 12.33 3.371 Transparency 19.83 6.485 Authorship 2.25 2.592 Attribution 1.71 2.881 Currency 4.46 2.637 Disclosure 10.58 2.466 Kitemarks 0.83 2.823 Scores are based on the 24 websites evaluated. Declarations Ethical statement This study was conducted on public websites. No human data or human participants were included in this study. This study was thus exempt from ethical approval from the local institutional review board. Conflict of Interest The author declares no conflict of interest. Funding details This work was supported by a grant from the “Research Center of the Female Scientific and Medical Colleges,” Deanship of Scientific Research, King Saud University. Author Statement The author, has provided substantial contributions to the conception or design of the work, or the acquisition, analysis, or interpretation of data for the work, in addition to drafting the work or revising it critically for important intellectual content, and provided final approval of the version to be published. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-1446709\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":91657295,\"identity\":\"28e5781c-862f-41b0-93d2-0f574d20adbd\",\"order_by\":0,\"name\":\"lamya alnaim\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1ElEQVRIie3OMQuCQBjG8VcEWyzXE0O/wiuNfRklyMXAybnpWgRXJeg7tDQrQpPYKrjo3tDoYNDh1hCnW8P9wYMDfzwHIBL9YSuQjwAIJhmvygSigDSSzVwC4CbTySKnbR/cvDQuEV5hAdYp4xDVPdkRNocz8VFKqgKwdHgPcylRGbmwU15SRoBHtI7qAzaeqZUovxmx4pZDiEsNtuIY4KMsMQI1b4V01FhjY6fJPsijylOx5qxo2u6uP4fGIo/i2vbh1rRizspXGfvUGf+LRCKR6FcfAdk+yVT09tYAAAAASUVORK5CYII=\",\"orcid\":\"https://orcid.org/0000-0001-6442-1646\",\"institution\":\"King Saud University\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"lamya\",\"middleName\":\"\",\"lastName\":\"alnaim\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2022-03-13 10:38:36\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-1446709/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-1446709/v1\",\"draftVersion\":[],\"editorialEvents\":[{\"content\":\"https://doi.org/10.4103/ajprhc.ajprhc_17_22\",\"type\":\"published\",\"date\":\"2022-10-26T00:00:00+00:00\"}],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":29204157,\"identity\":\"d6b7ca45-73de-4c98-84b7-334bd79cec13\",\"added_by\":\"auto\",\"created_at\":\"2022-11-17 18:36:37\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":335792,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-1446709/v1/ca55ec1c-e306-4023-bef5-156fa61066dc.pdf\"},{\"id\":19440079,\"identity\":\"4c103e7c-3d46-4da6-b9d0-9c1b5e3922e1\",\"added_by\":\"auto\",\"created_at\":\"2022-03-21 15:54:48\",\"extension\":\"xlsx\",\"order_by\":6,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":30785,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"datacollectionsheetCopy.xlsx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-1446709/v1/b2675b96fb7fac256f9048c3.xlsx\"}],\"financialInterests\":\"\",\"formattedTitle\":\"Evaluation of the quality of online colon cancer patient information in the Arabic language\",\"fulltext\":[{\"header\":\"Strengths And Limitations Of This Study\",\"content\":\"\\u003cul\\u003e\\n \\u003cli\\u003eNo previous study has evaluated Arabic language information on colon cancer found on the Internet.\\u003c/li\\u003e\\n \\u003cli\\u003eA validated tool to assess website quality was used (DISCERN instrument).\\u003c/li\\u003e\\n \\u003cli\\u003eThree pharmacists independently evaluated each website and compared the results.\\u003c/li\\u003e\\n \\u003cli\\u003eOnly a few websites were found on colon cancer in the Arabic language, limiting the power of the study.\\u003c/li\\u003e\\n \\u003cli\\u003eThe fact that Internet content and quality can change rapidly and regularly limits the generalizability of any study using websites.\\u003c/li\\u003e\\n\\u003c/ul\\u003e\"},{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eRetrieving information on medical topics is now simpler than ever. Since the use of contemporary Internet search engines, social networks, and universal access via devices like smartphones, tablets, and computers is increasingly widespread, health-related information is now accessible at any moment right at people\\u0026rsquo;s fingertips.\\u003csup\\u003e1\\u003c/sup\\u003e Health information on the Internet varies from personal blogs and accounts of illness, discussion, and support groups to published research and formal guidelines produced by medical and health-related organizations.\\u003csup\\u003e2\\u003c/sup\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;However, like all information on the Internet, health information is unregulated; data could be incorrect or false, while other information could be confusing or harmful to vulnerable patients by endorsing harmful products and treatments or by providing inaccurate advice.\\u003csup\\u003e3\\u003c/sup\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; Many individuals seek information from the Internet before speaking to their physicians.\\u003csup\\u003e1\\u003c/sup\\u003e It is much easier to search for an ailment or a set of symptoms on a search engine at home than to schedule, wait for, and attend an appointment in the doctor\\u0026rsquo;s clinic.\\u003csup\\u003e1\\u003c/sup\\u003e We live in a world where people are used to getting immediate answers to their questions and concerns. Why wait a week or two for a doctor to diagnose and educate you when a simple online search can seemingly give you the same information right now?\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; Based on statistics from June 2019, 4.42 billion people, 57.3% of the total world population, were active Internet users. The largest number of users were reported to be in Asia and North America.\\u003csup\\u003e4\\u003c/sup\\u003e The countries with the most internet users were China, India, and the United States.\\u003csup\\u003e5\\u003c/sup\\u003e Also, about 3.5 billion people were regular social media users.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; According to the latest health statistics, 17 million new cases of cancer were diagnosed worldwide in 2018, with the most common being lung, breast, colon, and prostate cancer.\\u003csup\\u003e6\\u003c/sup\\u003e In Saudi Arabia, colon cancer is the most prevalent cancer in males and the third most common in females.\\u003csup\\u003e7\\u003c/sup\\u003e Additionally, the percentage of patients diagnosed with colon cancer and the mortality rates from this disease have increased significantly in the last 10 years. Today, the median age at diagnosis for colon cancer is 60 years for men and 56 years for women.\\u003csup\\u003e7,8\\u003c/sup\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; Notably, access to appropriate and accurate information not only promotes better health results for colon cancer patients, but it also helps patients and caregivers to deal with the effects of colon cancer from initial diagnosis through disease management.\\u003csup\\u003e9\\u003c/sup\\u003e It has been demonstrated to have a positive effect on patients\\u0026rsquo; emotions, attitudes, and coping skills. It also helps to reduce anxiety and mood disorders while preparing the patient for future management and potential long-term outcomes.\\u003csup\\u003e10\\u003c/sup\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; The specific information needs of patients with cancer pertain to many domains. Early in the disease, information regarding staging, treatment options, and treatment side effects is most important. After treatment, recovery and long-term prognosis are the details that most patients seek information about.\\u003csup\\u003e9,10\\u003c/sup\\u003e This information helps patients gain a sense of control, reduce anxiety, and encourage self-care while improving their abilities to make informed decisions about their care.\\u003csup\\u003e11\\u003c/sup\\u003e Patients will use the Internet, their doctors, cancer organizations, family and friends, and the library to obtain information.\\u003csup\\u003e12\\u0026ndash;14\\u003c/sup\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; The Arabic language is the official language in 22 countries, with 423 million speakers. Although Arabic is the 7\\u003csup\\u003eth\\u003c/sup\\u003e most widely spoken language, its online content accounts for only 0.7\\u0026ndash;1.5% of the total across the Internet.\\u003csup\\u003e17,18\\u003c/sup\\u003e Although the number of Arabic websites and speakers continues to grow, research by Al Huziah et al. (2009) has demonstrated that health-related online contact is weak. It has been characterized as overly simplistic and as lacking specificity and accuracy. This is especially true of websites that purport to be specialized in dispensing medical information originating from Saudi Arabia, Egypt, and Syria. The data, however, are usually posted in English.\\u003csup\\u003e19\\u003c/sup\\u003e Currently, Egyptian health websites are considered the best in authoritativeness and transparency.\\u003csup\\u003e17,19\\u003c/sup\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; There have been some recent initiatives aimed at providing more trustworthy health information in Arabic on the Internet. One such initiative is being undertaken by the King Abdullah Bin Abdul-Aziz Arabic Health Encyclopedia (KAAHE) in Saudi Arabia, which specializes in health information for consumers and healthcare professionals.\\u003csup\\u003e20\\u003c/sup\\u003e Other examples in Saudi Arabia include the Saudi Ministry of Health (MOH), King Faisal Specialist Hospital \\u0026amp; Research Centre,\\u003csup\\u003e20\\u003c/sup\\u003e the Ministry of Health Portal in the Hashemite Kingdom of Jordan, and the Ministry of Health Portal, United Arab Emirates. These government-run websites provide Arabic and English health information.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; Nevertheless, there remains a large gap between the needs of Arabic-speaking individuals for accurate and timely health-related information and what is found on the Internet. Moreover, there has been very limited research published on the quality of Arabic information related to health in general and colon cancer in particular.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; Many studies have attempted to draw attention to the prevalence of inadequate health information using different quality criteria.\\u003csup\\u003e15\\u003c/sup\\u003e However, there is no consensus on which is the best method to ensure quality for consumers. Five approaches and tools to evaluate website quality have been described: codes of behavior, quality labels, user guides, filters, and accreditation by third parties.\\u003csup\\u003e16\\u003c/sup\\u003e Codes of conduct are standards applied during the development of websites to help ensure quality. Quality labels are marks displayed on websites to show their assurance to abide by a code of conduct. These labels may be assigned by a third party, which certifies websites against codes of conduct. Filters are entries that may be used to show only websites that satisfy a certain set of quality criteria. Finally, user guides are tools that may be published by organizations to assist users in judging website quality.\\u003csup\\u003e16\\u003c/sup\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe aims of this study are to:\\u003c/p\\u003e\\n\\u003cp\\u003e1. evaluate the quality of the colon-cancer related information available in Arabic on the Internet;\\u003c/p\\u003e\\n\\u003cp\\u003e2. determine which website(s) provide the best (i.e., most accurate and complete) information in Arabic for individuals seeking information on colon cancer; and\\u003c/p\\u003e\\n\\u003cp\\u003e3. in the poorer quality websites focused on colon cancer in Arabic, determine how much and which specific information is missing and inaccurate.\\u003c/p\\u003e\"},{\"header\":\"Material And Methods\",\"content\":\"\\u003cp\\u003eWe conducted a\\u0026nbsp;cross-sectional study using three search engines (Bing, Google, and Yahoo), as these were the most popular search engines during our study in 2019. The Arabic word(s) for colon cancer were used as search terms (\\u003cspan dir=\\\"RTL\\\"\\u003eسرطان القولون\\u003c/span\\u003e).\\u003c/p\\u003e\\n\\u003cp\\u003eThese search terms were chosen based on the input from a convenience sample of medical patients without a personal history of colon cancer. The search terms were kept short yet broad to reflect the typical practice of Internet users of all abilities seeking information about colon cancer. The searches resulted in more than 122,000 hits on Bing, 94,900 on Yahoo, and 5,390,000 from Google. Published marketing data show that when people search the Internet, they typically do not go beyond the first two pages of search output.\\u003csup\\u003e21\\u003c/sup\\u003e We expanded our search to the first 10 pages because there are few Arabic websites and we wanted to ensure the collection of nearly all Internet sources.\\u003c/p\\u003e\\n\\u003cp\\u003e*****\\u0026nbsp;\\u0026nbsp;We identified all websites that contained health information on colon cancer in the Arabic language. In total, we found 24 relevant websites, all of which were accessible when the study was conducted in November 2019. We excluded websites provided by private individuals, those containing links to other websites, and those containing only chat rooms or discussion groups. Additionally, websites were excluded if they were not provided in the Arabic language, provided information irrelevant to colon cancer or its treatments, or required payment or registration to access. Blogs and posts addressing specific questions were excluded, as were commercial websites selling or promoting a product and online news articles referring to a specific treatment or medical study. Every website that met the inclusion criteria was independently reviewed by two research assistants (Table 1).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eEvaluation of the websites\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;To assess each website, we adopted an evaluation method previously developed and published.\\u003csup\\u003e22\\u003c/sup\\u003e Two junior pharmacists, in addition to a\\u0026nbsp;clinical pharmacist with medical oncology experience, used the evaluation forms to assess the websites.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;The criteria evaluated for each website were divided into two principal categories: quality and transparency. Quality is the sum of the scores for each website in three subsections: breadth of topics, depth of topics, and correctness of information. Adding the scores for the breadth and depth of the website\\u0026rsquo;s topics provided a score for the completeness of the information.\\u003csup\\u003e23\\u003c/sup\\u003e The transparency score was the sum of scores for five subsections: authorship, attribution, currency, disclosure, and kitemarks.\\u003csup\\u003e24\\u003c/sup\\u003e The completeness of each website (sum of breadth and depth) looked at 10 themes: risk factors, staging and prognosis, screening and colonoscopy, surgical treatment, chemotherapy, radiotherapy, biological treatment, other pharmaceutical treatments, complementary medicine, and emotional/psychological support\\u003csup\\u003e23\\u003c/sup\\u003e (Table 1).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;Five criteria were used to calculate transparency: authorship, attribution, currency, disclosure, and kitemarks. Organizations use the first four transparency criteria to award kitemarks that identify trusted sites.\\u003csup\\u003e24\\u003c/sup\\u003e Each criterion\\u0026nbsp;is scored as listed in Table 1.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;Appropriate references were chosen by a practicing oncologist to verify the accuracy of the website information. The National Comprehensive Cancer Network (NCCN) guidelines for colon cancer were used for this assessment.\\u003csup\\u003e25\\u003c/sup\\u003e The transparency criteria are based on the criteria described by Silberg et al. in 1997.\\u003csup\\u003e26\\u003c/sup\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eDISCERN Instrument\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;The DISCERN instrument was used as an additional tool to assess the quality of the websites.\\u003csup\\u003e28\\u003c/sup\\u003e This validated 16-item instrument is a Likert-style questionnaire used for scoring the quality of printed health information. The first eight questions evaluate the reliability of the information. The next seven questions rate the quality of the information regarding treatment options. The final question assesses the overall rating of the publication\\u003csup\\u003e29\\u003c/sup\\u003e (Table 1).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;The maximum score for the DISCERN instrument was 80,\\u0026nbsp;with a minimum\\u0026nbsp;score of 16.\\u0026nbsp;Each score was rated from very poor to excellent (Table 2). Each evaluator was provided with the instrument and the DISCERN Handbook, which includes comprehensive details about DISCERN element scoring.\\u003csup\\u003e30\\u003c/sup\\u003e\\u003c/p\\u003e\\n\\u003ch2\\u003eStatistical analysis\\u0026nbsp;\\u003c/h2\\u003e\\n\\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;Data were analyzed using SPSS version 25.0 statistical package (SPSS Inc., Chicago, IL, USA). A descriptive study was conducted for each variable. The associations between the DISCERN scores for each website and the type of website were analyzed using\\u0026nbsp;the chi-square test. The Kruskal\\u0026ndash;Wallis test was applied between different websites using type and quality as variables.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003e\\u0026nbsp;Interrater reliability\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;The interrater reliability of the information was assessed by three independent investigators using the same rating form and instructions. Intercorrelations between the first evaluator and the two other evaluators were calculated separately using a two-tailed Spearman\\u0026rsquo;s rho with a range of \\u0026rho; = 0.82\\u0026ndash;0.95 (\\u003cem\\u003ep\\u003c/em\\u003e \\u0026lt; 0.0001).\\u003c/p\\u003e\\n\\u003cp\\u003eThe interrater reliability showed an agreement of 88%. Where initial agreement was lacking, a consensus was reached after discussion..\\u003c/p\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; The different types of 24 websites that provide information about colon cancer in the Arabic language are presented in Table 1. Most of the websites that provided information about colon cancer were commercial (50%), 37.5% were academic, 8.3% were governmental, and 4.2% from non-profit organizations. Regarding quality as assessed by the DISCERN instrument, the mean score for all websites was 42.5% (95% CI 39.6\\u0026ndash;45.5).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; Fifty percent of commercial websites scored \\u0026ldquo;poor\\u0026rdquo; and another 50% were \\u0026ldquo;fair.\\u0026rdquo; Two-thirds (66.7%) of university websites were \\u0026ldquo;poor,\\u0026rdquo; with only 11.1% \\u0026ldquo;good.\\u0026rdquo; All non-profit websites were \\u0026ldquo;fair,\\u0026rdquo; and all government websites were \\u0026ldquo;poor\\u0026rdquo; (\\u003cem\\u003ep\\u003c/em\\u003e \\u0026gt; .05). None of the websites had a high rating (Table 3).\\u003c/p\\u003e\\n\\u003cp\\u003e[Insert Table 3 about here]\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; The mean and standard deviation of each attribute under the categories of breadth and transparency of the websites are presented in Table 4.\\u003c/p\\u003e\\n\\u003cp\\u003e[Insert Table 4 about here]\\u003c/p\\u003e\\n\\u003ch2\\u003eBreadth of information\\u003c/h2\\u003e\\n\\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; In terms of completeness, only one website included information about complementary medicine, while all websites included information about screening, colonoscopy, and surgical treatment. Most websites mentioned risk factors and chemotherapy and radiotherapy as forms of treatment. Only about one-third of websites covered staging and prognosis, biological treatments, and other pharmaceutical treatments. Emotional and psychological support was covered by 20% of the assessed websites. A Kruskal-Wallis H test showed a non-significant difference in completeness score among the different website categories, \\u0026chi;\\u003csup\\u003e2\\u003c/sup\\u003e(3) = 1.833, \\u003cem\\u003ep\\u003c/em\\u003e = 0.608, with a mean rank \\u003cem\\u003et\\u003c/em\\u003e-total score of 13.88 for commercial websites, 12.11 for university websites, 6.00 for non-profit websites, and 9.25 for government websites.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; For depth, 55% of the information provided was complete and comprehensive. The remainder included information that might have been accurate but did not cover the details thoroughly. There was no clear pattern in which websites provided complete information or themes. A Kruskal-Wallis H test showed a non-significant difference in depth score among the website categories, \\u0026chi;\\u003csup\\u003e2\\u003c/sup\\u003e(3) = 2.331, \\u003cem\\u003ep\\u003c/em\\u003e = 0.507, with a mean rank \\u003cem\\u003et\\u003c/em\\u003e-total score of 13.96 for commercial websites, 11.83 for university websites, 3.5 for non-profit websites, and 11.25 for government websites.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; Regarding correctness, 94.6% of the websites provided completely correct information regarding the themes covered. The information that was not completely accurate was primarily related to treatment modalities, specifically surgical treatments, chemotherapies, and radiotherapy. A Kruskal-Wallis H test showed a non-significant difference in correctness score among the website categories, \\u0026chi;\\u003csup\\u003e2\\u003c/sup\\u003e(3) = 1.923, \\u003cem\\u003ep\\u003c/em\\u003e = 0.588, with a mean rank \\u003cem\\u003et\\u003c/em\\u003e-total score of 13.5 for commercial websites, 12.89 for university websites, 7.00 for non-profit websites, and 7.5 for government websites.\\u003c/p\\u003e\\n\\u003ch2\\u003eTransparency\\u003c/h2\\u003e\\n\\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; Only two of the websites had health-related and verifiable kitemarks. None of the websites scored 10 on authorship, and 50% had a score of 0. Almost 67% scored 0 for attribution, while three websites received a full score of 8. A quarter of the websites scored a perfect 6 on currency, while 12.5% scored 0. The websites scored best on disclosure, with 67% achieving a perfect score of 12 and none receiving a score of 0.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; A Kruskal-Wallis H test showed a non-significant difference in \\u003cem\\u003et\\u003c/em\\u003e-total scores among the different website categories, \\u0026chi;\\u003csup\\u003e2\\u003c/sup\\u003e(3) = 2.658, \\u003cem\\u003ep\\u003c/em\\u003e = 0.447, with a mean rank\\u003cem\\u003e\\u0026nbsp;t\\u003c/em\\u003e-total score of 13.42 for commercial websites, 10.22 for university websites, 21.00 for non-profit websites, and 13.00 for government websites.\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eThe primary aim of this study was to evaluate the quality of Arabic language knowledge and information related to colon cancer available online on different websites. Patients need accessible and high-quality information to assist them in making decisions about their health. Given the high prevalence of colon cancer worldwide, combined with the finding that more than half of the population turns to the Internet as a major source of health information,\\u003csup\\u003e\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e\\u003c/sup\\u003e it is vital that the information provided on websites be as complete and accurate as possible.\\u003c/p\\u003e \\u003cp\\u003eThis study showed that the information available in Arabic regarding colon cancer is limited and of low quality. The completeness, depth, and correctness of the 24 websites showed varied results for the topics assessed. Surgical treatment of colon cancer and screening and colonoscopy were the two main topics covered, with most of the information being correct (50\\u0026ndash;70% of the websites examined). The topic of \\u0026ldquo;complementary medicine for the treatment of colon cancer\\u0026rdquo; was the topic that was least covered (only 4% of the websites alluded to it). Users looking for information about colon cancer in Arabic will find only a little more than half of the information considered necessary for a thorough understanding of the topic. This leaves a large gap in the knowledge available to the Arabic-speaking population, who are just as likely to turn to the Internet as to physicians for medical-related information.\\u003c/p\\u003e \\u003cp\\u003eThe transparency of the websites was calculated using attributes such as authorship, attribution, currency, disclosure of information, and the display of kitemarks. Most websites did not have kitemarks and scored low on authorship, attribution, and currency. While most websites did well only on disclosure, the lack of transparency contributes to the low quality of information, as readers cannot easily determine who is providing the information they are reading.\\u003c/p\\u003e \\u003cp\\u003eCompared to the websites of other organizations and in other languages, colon cancer-specific sites in Arabic scored lower than the general health websites.\\u003csup\\u003e\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e\\u003c/sup\\u003e However, it has been found that even websites in the English language are not of good quality. Grewal et al.\\u003csup\\u003e\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e\\u003c/sup\\u003e assessed the readability and quality of websites for CRC. While they used a different tool for rating websites, they also used the DISCERN instrument with mean scores of 52.2 (95% CI 45\\u0026ndash;59.4), which were only modestly higher than our results (52.2 v. 42.5). They concluded that the English-language colon cancer websites were not sufficiently reliable to provide quality information to patients.\\u003c/p\\u003e \\u003cp\\u003eBurke et al.\\u003csup\\u003e\\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e\\u003c/sup\\u003e looked at the quality of information on esophageal cancer available to patients on the Internet by analyzing the top 20 websites returned by Google search and the top 10 websites returned by Yahoo and Bing searches. Using the DISCERN tool, they calculated the mean score at 51.5, with no website achieving a maximum score of 80.\\u003c/p\\u003e \\u003cp\\u003eWasserman et al. examined the quality of web-based patient information regarding surgery for colorectal cancer.\\u003csup\\u003e\\u003cspan citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e\\u003c/sup\\u003e They found the quality to be highly variable and the information often incomplete. Overall, evaluators ranked 29.7% of the websites as good or excellent, compared to only 11% rated good or excellent in the current study.\\u003c/p\\u003e \\u003cp\\u003eMost websites on colon cancer or other health topics in Arabic have been translated from English language sites. Translating low-quality or unreliable information leads to poor use of resources. Moreover, the data may be summarized, and meaning can be lost due to low-quality translation. Another problem is the lack of initiative by official organizations to improve the quality of vital health-related information.\\u003c/p\\u003e \\u003cp\\u003eBecause the number of sites rated as good quality was low, users who search for information about colon cancer may not find the information they are seeking, and they may not even be aware that what they are finding is incorrect or limited. Theoretically, the inconvenience of incomplete and inaccurate information can be mitigated by obtaining information from multiple sites with complementary information. This strategy requires highly motivated users with a better-than-average knowledge of Internet resources and the time to spend consulting multiple websites to obtain the information sought.\\u003csup\\u003e\\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003eThe medical community needs to take responsibility to ensure that complete, comprehensive, up-to-date, and accurate information is available to guide patients. Additionally, given the findings of the current study, health care providers should ask patients what beliefs they already have and where those beliefs came from. Knowing that patients may not bring up what they have read on the Internet can leave a provider at a disadvantage when discussing and recommending diagnostic and treatment options.\\u003c/p\\u003e \\u003cp\\u003eOne limitation of the current study is the relatively small number of websites evaluated, which highlights the scarcity of Arabic health websites (0.7\\u0026ndash;1.5%).\\u003csup\\u003e17\\u003c/sup\\u003e Also, information on the Internet can and often does change regularly. What a patient might see today can differ from what he will find tomorrow. Changing information and different websites have also been discovered as the number of search engines expands.\\u003csup\\u003e\\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003eTo conclude, to the best of our knowledge, this is the first study to evaluate the quality of online patient information regarding colon cancer in Arabic. Cancer patients and cancer survivors need quality information in their native language.\\u003csup\\u003e\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e\\u003c/sup\\u003e The Internet can easily provide information, but the quality of each site remains difficult for patients to distinguish. Whether the information being provided is comprehensive or accurate is not something the average user can distinguish.\\u003csup\\u003e\\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e\\u003c/sup\\u003e An opportunity exists for professional medical societies to create more comprehensive online patient information materials that can serve as a valuable (and accurate) resource for patients. The criteria examined in our study can serve as a guide for developing and improving the quality of online patient information.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003cp\\u003e1. \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;Tonsaker T, Bartlett G, Trpkov C. Health information on the Internet: gold mine or minefield? \\u003cem\\u003eCan Fam Physician\\u003c/em\\u003e 2014;60:407-8. Accessed 7 May 2018. http://www.ncbi.nlm.nih.gov/pubmed/24828994\\u003c/p\\u003e\\n\\u003cp\\u003e2. \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;Baker L, Wagner TH, Singer S, et al. Use of the Internet and e-mail for health care information. \\u003cem\\u003eJ Am Med Assoc\\u003c/em\\u003e 2003;289:2400.\\u003c/p\\u003e\\n\\u003cp\\u003e3. \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;Kitchens B, Harle CA, Li S. 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DISCERN: an instrument for judging the quality of written consumer health information on treatment choices. \\u003cem\\u003eJ Epidemiol Community Health\\u003c/em\\u003e 1999;53:105-11.\\u003c/p\\u003e\\n\\u003cp\\u003e29. \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;Ademiluyi G, Rees CE, Sheard CE. Evaluating the reliability and validity of three tools to assess the quality of health information on the Internet. \\u003cem\\u003ePatient Educ Couns\\u003c/em\\u003e 2003;50:151-5.\\u003c/p\\u003e\\n\\u003cp\\u003e30. \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;Sanger S. DISCERN. \\u003cem\\u003eHeal Expect\\u003c/em\\u003e 1998;1:135-6.\\u003c/p\\u003e\\n\\u003cp\\u003e31.\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;Diaz JA, Griffith RA, Ng JJ. Patients\\u0026rsquo; use of the Internet for medical\\u003c/p\\u003e\\n\\u003cp\\u003einformation. \\u003cem\\u003eJ Gen Intern Med\\u003c/em\\u003e 2002; 17:180-5.\\u003c/p\\u003e\\n\\u003cp\\u003e32. \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;Grewal P, Alagaratnam S. The quality and readability of colorectal cancer information on the internet. \\u003cem\\u003eInt J Surg\\u003c/em\\u003e 2013;11:410-3.\\u003c/p\\u003e\\n\\u003cp\\u003e33. \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;Burke E, Harkins P, Saeed M, et al. \\u0026ldquo;Dr. Google\\u0026rdquo; will see you now\\u0026mdash;assessing the quality of information on oesophageal cancer on the Internet. \\u003cem\\u003eJ Gastrointest Surg\\u003c/em\\u003e 2020;24:2466-70.\\u003c/p\\u003e\\n\\u003cp\\u003e34. \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;Wasserman M, Baxter NN, Rosen B, et al. Systematic review of internet patient information on colorectal cancer surgery. \\u003cem\\u003eDis Colon Rectum\\u003c/em\\u003e 2014;57:64-9.\\u003c/p\\u003e\\n\\u003cp\\u003e35. \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;Popescu SD, Popescu AO, Dănilă M, et al. General characteristics and quality of stroke-related online information \\u0026ndash; a cross-sectional assessment of the Romanian and Hungarian websites. \\u003cem\\u003eActa Medica Marisiensis\\u003c/em\\u003e 2018;64:116-20.\\u003c/p\\u003e\\n\\u003cp\\u003e36. \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;Sajid MS, Shakir AJ, Baig MK. Information on the Internet about colorectal cancer: patient attitude and potential toward web browsing. A prospective observational study. \\u003cem\\u003eCan J Surg\\u003c/em\\u003e 2011;54:339-43.\\u003c/p\\u003e\"},{\"header\":\"Tables\",\"content\":\"\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003eTable 1. Measurements, Formulas, and Score Ranges\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003eQuality:\\u003c/strong\\u003e Completeness + Correctness\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e[Range = 0\\u0026ndash;50]\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; Completeness:\\u003c/strong\\u003e Breadth Score + Depth Score [Range = 0\\u0026ndash;30]\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u003cstrong\\u003eBreadth\\u003c/strong\\u003e: Each of the 10 themes scored 0 or 1 [Range = 0\\u0026ndash;10]\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;text-indent:.5in;'\\u003e\\u003cstrong\\u003e\\u0026nbsp; Depth:\\u0026nbsp;\\u003c/strong\\u003eEach of the 10 themes scored 0, 1, or 2 [Range = 0\\u0026ndash;20]\\u003c/p\\u003e\\n\\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; Correctness:\\u0026nbsp;\\u003c/strong\\u003eScored 0, 1, or 2 [Range = 0\\u0026ndash;20]\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003eTransparency:\\u0026nbsp;\\u003c/strong\\u003eSum of five scores below [Range = 0\\u0026ndash;46]\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u003cstrong\\u003eAuthorship:\\u003c/strong\\u003e Scored 0, 1, 2 [Range = 0\\u0026ndash;10]\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u003cstrong\\u003eAttribution:\\u003c/strong\\u003e Scored 0, 1, 2 [Range = 0\\u0026ndash;8]\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u003cstrong\\u003eCurrency:\\u003c/strong\\u003e Scored 0, 1, 2 [Range = 0\\u0026ndash;6]\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u003cstrong\\u003eDisclosure:\\u0026nbsp;\\u003c/strong\\u003eScored 0, 1, 2 [Range = 0\\u0026ndash;12]\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;text-indent:.5in;'\\u003e\\u003cstrong\\u003eKitemarks:\\u003c/strong\\u003e Scored 0, 1, or 2 [Range = 0\\u0026ndash;10]\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003eDISCERN\\u003c/strong\\u003e [Range = 16\\u0026ndash;80]\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;text-indent:.5in;'\\u003e\\u003cstrong\\u003eLikert Scale:\\u003c/strong\\u003e Scored 1\\u0026ndash;5 for each of the 16 questions\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;text-indent:.5in;'\\u003e\\u003cstrong\\u003eReliability of Information\\u003c/strong\\u003e: 8 questions\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;text-indent:.5in;'\\u003e\\u003cstrong\\u003eQuality of Information on Treatment Options:\\u0026nbsp;\\u003c/strong\\u003e7 questions\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;text-indent:.5in;'\\u003e\\u003cstrong\\u003eOverall Quality of Information:\\u0026nbsp;\\u003c/strong\\u003e1 question\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:normal;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003eTable 2. DISCERN instrument scoring system.\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u0026nbsp; \\u0026nbsp; Category \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;Score\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u0026nbsp; \\u0026nbsp; Excellent \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;68\\u0026ndash;80\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; Good \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;55\\u0026ndash;67\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;Fair \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; 42\\u0026ndash;54\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; Poor \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;29\\u0026ndash;41\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u0026nbsp; \\u0026nbsp; Very Poor \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;16\\u0026ndash;28\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cbr\\u003e\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003eTable 3. DISCERN Score versus Type of Website.\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; % of\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; Poor \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; Fair \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; Good \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;Excellent \\u0026nbsp; \\u0026nbsp; Total\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003eCommercial \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u003c/strong\\u003e6 \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;50.0% \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; 6 \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;50.0% \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; 0 \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;0.0% \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; 0 \\u0026nbsp; 0.0% \\u0026nbsp; \\u0026nbsp; 50.0%\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003eUniversity\\u003c/strong\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;6 \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;66.7% \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; 2 \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;22.2% \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; 1 \\u0026nbsp; \\u0026nbsp;11.1% \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; 0 \\u0026nbsp; 0.0% \\u0026nbsp; \\u0026nbsp; 37.5%\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003eNon-profit\\u003c/strong\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;0 \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;0.0% \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; 1 \\u0026nbsp; \\u0026nbsp;100.0% \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; 0 \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;0.0% \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; 0 \\u0026nbsp; 0.0% \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; 4.2%\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003eGovernment\\u003c/strong\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;2 \\u0026nbsp; \\u0026nbsp;100.0% \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; 0 \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;0.0% \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; 0 \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;0.0% \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; 0 \\u0026nbsp; 0.0% \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; 8.3%\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003eTable 4. Mean \\u0026plusmn; Standard Deviation of Measurements of 24 Websites\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003eVariable \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; Mean \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;Standard\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003eMeasured \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;Deviation\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003eQuality\\u003c/strong\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;28.04 \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; 8.411\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; Completeness \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u003c/strong\\u003e15.71\\u003cstrong\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u003c/strong\\u003e3.189\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; Breadth \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u003c/strong\\u003e6.21 \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; 1.560\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; Depth \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;\\u003c/strong\\u003e9.50 \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; 3.867\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; Correctness\\u003c/strong\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;12.33 \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; 3.371\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003eTransparency\\u003c/strong\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; 19.83 \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; 6.485\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u003cstrong\\u003eAuthorship\\u003c/strong\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; 2.25 \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; 2.592\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u003cstrong\\u003eAttribution\\u003c/strong\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; 1.71 \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; 2.881\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u003cstrong\\u003eCurrency \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;\\u003c/strong\\u003e4.46 \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; 2.637\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u003cstrong\\u003eDisclosure\\u003c/strong\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; 10.58 \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; 2.466\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u003cstrong\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; Kitemarks \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;\\u003c/strong\\u003e0.83 \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; 2.823\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp style='margin:0in;line-height:200%;font-size:16px;font-family:\\\"Times New Roman\\\",serif;'\\u003eScores are based on the 24 websites evaluated.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003eEthical statement\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;This study was conducted on public websites. No human data or human participants were included in this study. This study was thus exempt from ethical approval from the local institutional review board.\\u003c/p\\u003e\\n\\u003cp\\u003eConflict of Interest\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;The author declares no conflict of interest.\\u003c/p\\u003e\\n\\u003cp\\u003eFunding details\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;This work was supported by a grant from the \\u0026ldquo;Research Center of the Female Scientific and Medical Colleges,\\u0026rdquo; Deanship of Scientific Research, King Saud University.\\u003c/p\\u003e\\n\\u003cp\\u003eAuthor Statement\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;The author, has provided substantial contributions to the conception or design of the work, or the acquisition, analysis, or interpretation of data for the work, in addition to drafting the work or revising it critically for important intellectual content, and provided final approval of the version to be published.\\u003c/p\\u003e\\n\\u003cp\\u003eAvailability of data and material\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eData is available in the supplementary material\\u003c/p\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":true,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":true,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"colon cancer, DISCERN instrument, website quality, Arabic\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-1446709/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-1446709/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003eBackground and Study Aims\\u003c/p\\u003e\\u003cp\\u003eWith the ever-expanding reach of Internet information, more people than ever are using online searches to obtain medical information, often before consulting a medical professional. This study aims to assess the quality of available Internet information on colon cancer in the Arabic language.\\u003c/p\\u003e\\u003cp\\u003ePatients and Methods\\u003c/p\\u003e\\u003cp\\u003eA cross-sectional study was performed to assess the quality of Arabic language websites on colon cancer in Arabic using the DISCERN instrument, a validated 16-item questionnaire, and our assessment of the correctness, completeness, and transparency of each website.\\u003c/p\\u003e\\u003cp\\u003eResults\\u003c/p\\u003e\\u003cp\\u003eA total of 24 websites were identified, of which 12 (50%) were commercial, 9 (37.5%) were university-sponsored, 2 (8.3%) were governmental, and 1 (4.2%) was from a non-profit organization. The DISCERN instrument had an overall mean score of 42.5 (fair) out of a maximum score of 80, with 50% of commercial websites scoring 41 or below (poor) and only 11% scoring in the good range. Two-thirds (66.7%) of the university-sponsored sites were rated poor, the single non-profit website scored fair, and the two governmental sites were rated poor. The most accurate topics covered by the websites were surgical treatment, screening, and colonoscopy. Regarding correctness, 94.6% of the websites were accurate in the information provided, while only 55% scored high in Completeness, meaning that they provided comprehensive information. Transparency was poor for most websites, with only two providing sufficient information to verify their sources.\\u003c/p\\u003e\\u003cp\\u003eConclusion\\u003c/p\\u003e\\u003cp\\u003eThis study demonstrated that while people use the Internet to access medical information about colon cancer, much of this information is incomplete in the Arabic language. This raises the question of how much benefit versus harm individuals receive from using websites to learn about colon cancer, and what can be done to improve the information available.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Evaluation of the quality of online colon cancer patient information in the Arabic language\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2022-03-21 15:54:46\",\"doi\":\"10.21203/rs.3.rs-1446709/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"d0a1173c-7677-4221-a7d9-761abba0c8e9\",\"owner\":[],\"postedDate\":\"March 21st, 2022\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"published-in-journal\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2022-11-17T18:36:32+00:00\",\"versionOfRecord\":{\"articleIdentity\":\"rs-1446709\",\"link\":\"https://doi.org/10.4103/ajprhc.ajprhc_17_22\",\"journal\":{\"identity\":\"asian-journal-of-pharmaceutical-research-and-health-care\",\"isVorOnly\":true,\"title\":\"Asian Journal of Pharmaceutical Research and Health Care\"},\"publishedOn\":\"2022-10-26 00:00:00\",\"publishedOnDateReadable\":\"October 26th, 2022\"},\"versionCreatedAt\":\"2022-03-21 15:54:46\",\"video\":\"\",\"vorDoi\":\"10.4103/ajprhc.ajprhc_17_22\",\"vorDoiUrl\":\"https://doi.org/10.4103/ajprhc.ajprhc_17_22\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-1446709\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-1446709\",\"identity\":\"rs-1446709\",\"version\":[\"v1\"]},\"buildId\":\"J0_U0BvcaRcwD8yVFaRlm\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}