Analysis of internet educational websites on tobacco cessation: A content analysis

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Both smoking and chewing forms of tobacco are highly prevalent, especially in India, and are implicated as causes of diseases, including oropharyngeal carcinomas. Effective tobacco cessation techniques and sources can help overcome addiction and reduce the disease burden in society. The aim was to evaluate the quality and readability of contents of various sources on an internet website about tobacco cessation. Objectives i) To evaluate the readability of internet content (Google) regarding tobacco cessation using Flesch–Kincaid readability tests and the quality of internet content (Google) by using the JAMA benchmark, HONcode and DISCERN questionnaire. Methods A content review was employed to screen the content of the Google search engine for educational tobacco cessation websites, and the top 50 websites were selected according to criteria and reviewed by two reviewers. The readability of the internet content (Google) regarding tobacco cessation was evaluated using Flesch–Kincaid readability tests. The quality of the screened sites was evaluated by using the JAMA (Journal of the American Medical Association) benchmark, HONcode (The Health on the Net Code of Conduct) and DISCERN (Discerning the Quality of Information for Choosing Treatments) questionnaire, and the readability and quality of the screened websites were correlated using the above instruments. Results FK readability ease was found to be 49% standard and 30% easy. The FK grade test found that 33% of the content could be easily understood by < 5th grade. All 4 JAMA benchmarks were met by 23% of websites, and authorship was the least fulfilled criterion. Correlation analysis revealed a significant association between FK ease score and FK grade score. Conclusions The Read-ability Ease and Read-ability Grade Levels of the websites related to tobacco cessation were not standard, and few websites fulfilled the JAMA benchmarks and had HONcode certification. " } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/13-822", "name": "Analysis of internet educational websites on tobacco cessation: A..." } } ] } Home Browse Analysis of internet educational websites on tobacco cessation: A... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Avinash BR, Chengappa K, Shenoy R et al. Analysis of internet educational websites on tobacco cessation: A content analysis [version 2; peer review: 2 approved] . F1000Research 2024, 13 :822 ( https://doi.org/10.12688/f1000research.146843.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article Revised Analysis of internet educational websites on tobacco cessation: A content analysis [version 2; peer review: 2 approved] B R Avinash https://orcid.org/0000-0003-0773-2063 1 , Kaveri Chengappa https://orcid.org/0000-0002-1625-5134 1 , Ramya Shenoy https://orcid.org/0000-0003-3126-4415 1 , Ashwini Rao https://orcid.org/0000-0002-2474-5010 1 , Mithun Pai https://orcid.org/0000-0002-4663-627X 1 , G Rajesh 2 B R Avinash https://orcid.org/0000-0003-0773-2063 1 , Kaveri Chengappa https://orcid.org/0000-0002-1625-5134 1 , [...] Ramya Shenoy https://orcid.org/0000-0003-3126-4415 1 , Ashwini Rao https://orcid.org/0000-0002-2474-5010 1 , Mithun Pai https://orcid.org/0000-0002-4663-627X 1 , G Rajesh 2 PUBLISHED 22 Nov 2024 Author details Author details 1 Department of Public Health Dentistry, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, Karnataka, Manipal, 576104, India 2 Department of Health Outcomes and Biomedical Infodemics, Institute for child health Policy , University of Florida., Florida, Florida, USA B R Avinash Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Software, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Kaveri Chengappa Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Resources, Software, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Ramya Shenoy Roles: Conceptualization, Data Curation, Formal Analysis, Project Administration, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Ashwini Rao Roles: Conceptualization, Investigation, Project Administration, Resources, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Mithun Pai Roles: Conceptualization, Data Curation, Formal Analysis, Methodology, Project Administration, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing G Rajesh Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Manipal Academy of Higher Education gateway. Abstract Background There have been significant changes in the lifestyles of individuals in the past few decades, which has led to increased morbidity and mortality worldwide. Both smoking and chewing forms of tobacco are highly prevalent, especially in India, and are implicated as causes of diseases, including oropharyngeal carcinomas. Effective tobacco cessation techniques and sources can help overcome addiction and reduce the disease burden in society. The aim was to evaluate the quality and readability of contents of various sources on an internet website about tobacco cessation. Objectives i) To evaluate the readability of internet content (Google) regarding tobacco cessation using Flesch–Kincaid readability tests and the quality of internet content (Google) by using the JAMA benchmark, HONcode and DISCERN questionnaire. Methods A content review was employed to screen the content of the Google search engine for educational tobacco cessation websites, and the top 50 websites were selected according to criteria and reviewed by two reviewers. The readability of the internet content (Google) regarding tobacco cessation was evaluated using Flesch–Kincaid readability tests. The quality of the screened sites was evaluated by using the JAMA (Journal of the American Medical Association) benchmark, HONcode (The Health on the Net Code of Conduct) and DISCERN (Discerning the Quality of Information for Choosing Treatments) questionnaire, and the readability and quality of the screened websites were correlated using the above instruments. Results FK readability ease was found to be 49% standard and 30% easy. The FK grade test found that 33% of the content could be easily understood by < 5 th grade. All 4 JAMA benchmarks were met by 23% of websites, and authorship was the least fulfilled criterion. Correlation analysis revealed a significant association between FK ease score and FK grade score. Conclusions The Read-ability Ease and Read-ability Grade Levels of the websites related to tobacco cessation were not standard, and few websites fulfilled the JAMA benchmarks and had HONcode certification. READ ALL READ LESS Keywords Oral cancer, Oral health, Online resources, readability tests, Smokeless tobacco, Tobacco cessation Corresponding Author(s) Mithun Pai ( [email protected] ) Close Corresponding author: Mithun Pai Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2024 Avinash BR et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Avinash BR, Chengappa K, Shenoy R et al. Analysis of internet educational websites on tobacco cessation: A content analysis [version 2; peer review: 2 approved] . F1000Research 2024, 13 :822 ( https://doi.org/10.12688/f1000research.146843.2 ) First published: 23 Jul 2024, 13 :822 ( https://doi.org/10.12688/f1000research.146843.1 ) Latest published: 22 Nov 2024, 13 :822 ( https://doi.org/10.12688/f1000research.146843.2 ) Revised Amendments from Version 1 1. The extended data for all tools added as tables 2. The tools of research explained in detail 3. The corrections are made according to the suggestions of the reviewers 1. The extended data for all tools added as tables 2. The tools of research explained in detail 3. The corrections are made according to the suggestions of the reviewers To read any peer review reports and author responses for this article, follow the "read" links in the Open Peer Review table. READ REVIEWER RESPONSES Introduction There have been significant changes in the lifestyles of individuals in the past few decades, which has led to increased morbidity and mortality worldwide. 1 Habits such as tobacco use, alcohol, diet and other lifestyle factors have been implicated as cause of diseases such as cancers of the body, including oropharyngeal cancer. 2 – 4 The disease burden is higher in underdeveloped and developing countries than in their economically stable counterparts. The hallmark of these diseases is their preventability. Among adolescents and adults, the burden seen is staggering. According to Global Youth Tobacco Survey (GYTS) and Global Adult Tobacco Survey (GATS), tobacco usage is seen to be 14.6% and 28.6% respectively. With effective motivation and implementation of programs aimed at tobacco control, the burden of such deadly diseases can significantly be decreased. Effective tobacco cessation techniques and internet web contents like websites, applications, and e-educational content can help overcome addiction and reduce the disease burden in society. 5 , 6 Recent decades have also witnessed a substantial rise in the number of individuals using mobile and smartphones and, with it, the internet. Everyone with a smartphone now has easy access to information on the internet, which can have a significant impact on an individual’s lifestyle. 7 Regardless of the background of individuals, they can now browse the internet for information related to various health-related issues and conditions. 8 , 9 Various web resources like websites, applications, e-educational contents on tobacco etc., can provide information about tobacco cessation to general population. 7 This raises concerns about the quality of information on tobacco cessation and the contents of the same information on the internet, which may or may not be optimal, credible and standardized. Very few investigations reported in the literature have explored the content, quality and readability (comprehensibility) of internet resources on tobacco cessation. They can provide valuable information paving the way for standardizing this tobacco cessation content on various websites specifically tailored to reach common men. Hence, the present study aimed to evaluate the quality and readability of the contents of various resources on internet websites about tobacco cessation. Objectives: i) To evaluate the readability of internet content (Google) regarding tobacco cessation using Flesch–Kincaid readability tests. ii) Evaluate the quality of the internet content (Google) regarding tobacco cessation by using the JAMA (Journal of the American Medical Association) benchmark, HONcode (The Health on the Net Code of Conduct) and DISCERN (Discerning the Quality of Information for Choosing Treatments) questionnaire. Methods The present study was performed using a review of the internet content on tobacco cessation. The study design employed was Cross Sectional for Health Technology Assessment. Google, a common search site, was deployed to search for content on tobacco cessation. The search term used was “How to quit Tobacco?”. After discussion with two Institutional Tobacco Cessation Cell subject experts, the search term was arrived at. Fifty websites that appeared first on the specific day were reviewed for their content, readability & quality. Two experts ABR and KC scored the parameters to do away with the subjectivity bias. In case of any discrepancy in the score between two experts, final decision will be based on the analysis of expert R. Reliability was checked using kappa statistics, whose value was 1 indicating total agreement. Inclusion criteria were websites that are patient focused and websites that do not involve any cost or subscription. Websites that were password-protected and contained only videos and journals were excluded. Selected websites after screening were evaluated for their quality, content and readability. Flesch–Kincaid readability tests 10 , 11 evaluated the readability of the internet source. Flesch–Kincaid readability tests include Flesch readability ease and Flesch–Kincaid grade level. The JAMA benchmark, 12 , 13 HONcode, 13 , 14 and DISCERN questionnaire were used to assess website quality. 15 Ethics Ethical approval was obtained before the study process from Institutional Ethics Committee. (Protocol ref no. 19051). Data management and statistical analysis The parameters were entered in excel sheet and Statistical Package for Social Sciences (SPSS), version 16.0 (SPSS Inc, Chicago IL). 16 P value <0.05 was significant. Mean was used for descriptive data. Percentage was used to interpret FK readability tests. Mean and median was taken for DISCERN-16 questionnaire. Student’s t test was employed to evaluate HONcode Scores with DISCERN tool and FK readability scores. Pearson’s correlation was done to assess the relationship between DISCERN, FK scores and HONcode values. Results Forty-three websites were reviewed. Seven websites were not included because they did not fulfil the inclusion criteria; hence A total of 21 (49%) websites were of standard Readability with an Ease Score of the Flesch–Kincaid readability test. Overall, 13 (30%) websites had a fairly easy readability ease score. Readability Grade Level analysis of the Flesch–Kincaid readability test indicates that a majority of 14 (33%) websites could be read by individuals lower than 5 th grade, while 13 (30%) websites could be read by individuals belonging to 6 th grade. A total of 5 (12%) websites could be read by individuals belonging to 8 th grade ( Table 1 ). Table 1. Website content assessed with Flesch–Kincaid readability tests. Flesch–Kincaid readability tests Websites n % Readability Ease Score Very confusing 3 7 Fairly difficult 4 9 Difficult 2 5 Standard 21 49 Fairly easy 13 30 Easy 0 0 Readability Grade Level college level graduate 0 0 12 th grade 1 2 11 th grade 0 0 10 th grade 2 5 9 th grade 1 2 8 th grade 5 12 7 th grade 4 9 6 th grade 13 30 5 th grade 3 7 <5 th grade 14 33 The findings of the current study indicate that a total of 10 (23%) of the websites satisfied all 4 JAMA benchmarks for quality and reliability of the content. Overall, the number of websites satisfying 1, 2 and 3 of the JAMA benchmarks was 6 (14%), 7 (16%) and 19 (44%), respectively. A total of 41 (95%) websites satisfied the JAMA benchmark of disclosure, while a total of 15 (35%) websites satisfied authorship criteria. It was also observed that a total of 8 (19%) websites did not have HONcode certification, while a total of 35 (81%) websites had HONcode certification. The median and mean scores for questions in DISCERN-16. It can be observed that the mean score was maximum for item number 1 and was minimum of 2.91 for item numbers 5, 6 and 8. Item number 5,6 and 8 speaks on clarity, bias and areas of uncertainty. A majority of 21 (49%) of the websites as assessed by DISCERN-16 belonged to the fair category, while none of the websites belonged to the very poor and excellent categories. The results of the correlation analysis indicate that there were significant associations between HonCODE certification and DISCERN total scores (p=0.021), DISCERN S1 (p=0.033) and DISCERN S2 (p=0.021). It can also be observed that there were statistically significant associations between DISCERN-S1 and DISCERN-S2, DISCERN-S1 and DISCERN-S3, DISCERN-S1 and DISCERN-16 total, DISCERN-S2 and DISCERN-S3, DISCERN-S2 and DISCERN-16 total, DISCERN-S3 and DISCERN-16 total. There were also statistically significant associations between HonCODE certification and DISCERN S1, DISCERN-S2 and DISCERN-16 total scores. Additionally, significant associations were found between FK ease and FK grade scores ( Table 2 ). Table 2. Correlation analysis between various evaluation scores. DISCERN S1 DISCERN S2 DISCERN S3 DISCERN Total FK Ease FK Grade HonCODE r-value p-value r-value p-value r-value p-value r-value p-value r-value p-value r-value p-value r-value p-value DISCERN S1 - - DISCERN S2 0.846 ** 0.000 - - DISCERN S3 0.809 ** 0.000 0.789 ** 0.000 - - DISCERN Total 0.964 ** 0.000 0.955 ** 0.000 0.857 ** 0.000 - - FK Ease -0.158 0.312 -0.129 0.408 -0.130 0.407 -0.150 0.336 - - FK Grade 0.178 0.253 0.091 0.563 0.077 0.623 0.138 0.376 -0.935 ** 0.000 - - HonCODE 0.326 * 0.033 0.351 * 0.021 0.275 0.075 0.350 * 0.021 0.006 0.967 0.050 0.748 - - * Significant at 5 % level of significance. ** Significant at 1% level of significance. Discussion There have been significant advancements in the field of information technology and mobile phone services. These developments are very dynamic and are witnessing tremendous growth every passing day. 9 The present study employed F–K readability, consisting of Flesch ease and grade level in place of a similar index such as the SMOG index. One of the issues with the use of the SMOG (Simple Measure of Gobbledygook) index has been its tendency to forecast readability 2 grades higher than the other estimates. The SMOG index depends upon the strict criteria of 100% accurate answers by participants. The current study's findings indicate that the Ease Score was standard and fairly easy for most of the content included in the study. The current study contrasts with those reported by Wiriyakijja et al ., 17 for websites on oral leukoplakia and Diniz-Freitas et al ., 18 for tobacco cessation net-contents. Material in the current study was primarily readable by individuals lower than 5 th grades and in agreement with the study conducted by Joury et al . 19 The National Institutes of Health recommended readability age is between 7 th and 8 th grades. However, reduced reading grades lead to dilution of contents. The results of the present study indicate that 23% of the websites fulfilled all the JAMA (Journal of the American Medical Association) benchmarks. In a similar study conducted by Wiriyakijja et al ., it was noted that 17% of websites on oral leucoplakia fulfilled all four JAMA benchmarks, 17 and Ni Riordain et al ., observed that 45% of websites on head and neck cancer fulfilled all four JAMA benchmarks. 20 Diniz-Freitas et al ., 18 who observed that none of the websites related to tobacco cessation services by dentists fulfilled all 4 JAMA benchmarks. A majority of the JAMA benchmarks fulfilled in the present study include disclosure (95%) and attribution (79%). The findings are in concordance with those reported by Wiriyakijja et al ., 17 for websites on oral leucoplakia but in disagreement with those observed by Diniz-Freitas et al ., 18 for websites on tobacco cessation services by dentists. Authorship and currency were the frequently fulfilled JAMA benchmark in websites on adult orthodontics, as reported by McMorrow et al . 21 The Health on the Net Code of Conduct (HONcode) is a set of guidelines for medical and health websites that aims to improve the quality of health information on the internet. Its usually seen at the end of the internet content. It was observed in study that 81% of the sites lacked HONcode certification, which is in agreement with those observed by Wiriyakijja et al ., Diniz-Freitas et al ., 18 and Joury et al. 19 and in disagreement with the reports of McMorrow et al . 21 It has been reported by Ni Riordain et al ., that 39% of websites had HON code seals. 20 HON code assesses ethics and reputation rather than quality and information. The number of subjects browsing internet sources for health information has considerably increased in the recent decade. 22 This finding shed light on the importance of the ease and readability of available content. 17 Reliability of information in the field of oral cancer in different languages is also not standardized. 23 Reading readily available internet content pertaining to tobacco increases anxiety due to the realization of unmet health needs. 24 Increased levels of anxiety may also be related to poor health outcomes, and low compliance with treatment regimens and instructions. Therefore, there is a definite need for accurate information related to tobacco cessation on the internet. Varela-Centelles et al ., observed that the overall quality for oral cancer in health care professionals (HCP) addressed websites were of good standards. 25 There needs to be a consensus on what constitutes good information for patients who are seeking information on the internet on tobacco cessation. On the other hand, it can be observed that there is information overload on the internet, and there can be information that is conflicting in nature. 26 The subjects need to be sensitized about the issues related to information overload, such as dubious information sources and the availability of too much information for one’s perusal. Patients may specifically be interested in the treatment outcomes associated with tobacco cessation services in particular. This may shape the patients’ expectations to be more realistic in nature, and the patients may be more receptive of various treatment outcomes. 27 Various factors might influence the diverse nature of information available on the internet. Various websites are fabricated by a wide variety of individuals hailing from diverse philosophical backgrounds. The purpose of website preparation may also be very different. Moreover, health literacy levels, and access to the internet may vary among patients. Limitations of the present study will have to be borne in mind. The cross-sectional design of the study and the inclusion of a limited number of websites are its limitations. Internet content is very dynamic and is constantly changing by day. Further studies that consider a greater number of websites need to be conducted. The assessment of the content of the websites was performed by using a checklist prepared specifically for the present study. All the issues related to tobacco cessation may not be encompassed by this checklist. The websites excluded in the present study might be viewed by the patients. The present study also excluded scientific articles and books, which might be good sources of accurate information. The websites were evaluated by a dentist who was qualified and specifically trained for the purpose of the study. This type of dentist might have greater knowledge than those who check the websites. The trained dentist may also be more critical in analysing the contents of the websites than the common person. Conclusions It can be observed that the read-ability ease and read-ability grade levels of the websites related to tobacco cessation were not easily read and understandable by the common man. Very few websites fulfilled all the JAMA benchmarks and had HONcode certification. There is a definite need for stricter rules and regulations for websites providing information related to tobacco cessation. There is a need for policy change to reinforce stricter regulation. Ethics and consent Ethical clearance was obtained from the Institutional Ethics Committee of Manipal College of Dental Sciences, Mangalore (Ref No. 19051). Informed consent: Ethical committee permission was taken and was exempted (Ref No. 19051). Data availability Underlying data Figshare: Analysis of internet Educational websites on tobacco cessation health sciences. https://doi.org/10.6084/m9.figshare.24933876 . 28 This project contains the following underlying data: - EQIP (2).xlsx - How to quit tobacco (2).xlsx - The tables with scores from individual tools id added Data are available under the terms of the Creative Commons Zero “No rights reserved” data waiver (CC0 1.0 Public domain dedication). References 1. 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Diniz-Freitas M, Insua A, Keat R, et al. : Web-Based Information on the Treatment of Tobacco Dependence for Oral Health Professionals: Analysis of English-Written Websites. J. Med. Internet Res. 2017; 19 : e349. PubMed Abstract | Publisher Full Text | Free Full Text 19. Joury AU, Alshathri M, Alkhunaizi M, et al. : Internet Websites for Chest Pain Symptoms Demonstrate Highly Variable Content and Quality. Acad. Emerg. Med. 2016; 23 : 1146–1152. PubMed Abstract | Publisher Full Text 20. Ni Riordain R, McCreary C: Head and neck cancer information on the internet: Type, accuracy and content. Oral Oncol. 2009; 45 : 675–677. PubMed Abstract | Publisher Full Text 21. McMorrow SM, Millett DT: Adult orthodontics: a quality assessment of Internet information. J. Orthod. 2016; 43 : 186–192. PubMed Abstract | Publisher Full Text 22. Kummervold PE, Chronaki CE, Lausen B, et al. : eHealth trends in Europe 2005-2007: A population-based survey. J. Med. Internet Res. 2008; 10 : 1–16. 23. Vivien A, Kowalski V, Chatellier A, et al. : Information quality in general public French-speaking websites dedicated to oral cancer detection. J. Stomatol. Oral Maxillofac. Surg. 2017; 118 : 20–28. 24. Lin HY, Chen SC, Peng HLCM: Unmet information needs and clinical characteristics in patients with precancerous oral lesions. Eur. J. Cancer Care. 2015; 24 : 911–919. PubMed Abstract | Publisher Full Text 25. Varela-Centelles P, Insua A, Seoane-Romero JM, et al. : Available web-based teaching resources for health care professionals on screening for oral cancer. Med. Oral Patol. Oral Cir. Bucal. 2015; 20 : e144–e149. PubMed Abstract | Publisher Full Text 26. Kiley R: Quality of medical informationon the internet. J. R. Soc. Med. 1998; 91 : 369–370. PubMed Abstract | Publisher Full Text 27. Rogers SN, Hogg ES, Cheung WKA, et al. : The use of health related quality of life data to produce information sheets for patients with head and neck cancer. Ann. R. Coll. Surg. 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Publisher Full Text Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 23 Jul 2024 ADD YOUR COMMENT Comment Author details Author details 1 Department of Public Health Dentistry, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, Karnataka, Manipal, 576104, India 2 Department of Health Outcomes and Biomedical Infodemics, Institute for child health Policy , University of Florida., Florida, Florida, USA B R Avinash Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Software, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Kaveri Chengappa Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Resources, Software, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Ramya Shenoy Roles: Conceptualization, Data Curation, Formal Analysis, Project Administration, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Ashwini Rao Roles: Conceptualization, Investigation, Project Administration, Resources, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Mithun Pai Roles: Conceptualization, Data Curation, Formal Analysis, Methodology, Project Administration, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing G Rajesh Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (2) version 2 Revised Published: 22 Nov 2024, 13:822 https://doi.org/10.12688/f1000research.146843.2 version 1 Published: 23 Jul 2024, 13:822 https://doi.org/10.12688/f1000research.146843.1 Copyright © 2024 Avinash BR et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Avinash BR, Chengappa K, Shenoy R et al. Analysis of internet educational websites on tobacco cessation: A content analysis [version 2; peer review: 2 approved] . F1000Research 2024, 13 :822 ( https://doi.org/10.12688/f1000research.146843.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 2 VERSION 2 PUBLISHED 22 Nov 2024 Revised Views 0 Cite How to cite this report: Ramanarayanan V. Reviewer Report For: Analysis of internet educational websites on tobacco cessation: A content analysis [version 2; peer review: 2 approved] . F1000Research 2024, 13 :822 ( https://doi.org/10.5256/f1000research.174934.r342717 ) The direct URL for this report is: https://f1000research.com/articles/13-822/v2#referee-response-342717 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 29 Nov 2024 Venkitachalam Ramanarayanan , Department of Public Health Dentistry, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Coimbatore, Tamil Nadu, India Approved VIEWS 0 https://doi.org/10.5256/f1000research.174934.r342717 No ... Continue reading READ ALL No further comments Competing Interests: No competing interests were disclosed. Reviewer Expertise: Dental Public Health. Evidence synthesis, Dental Education I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Ramanarayanan V. Reviewer Report For: Analysis of internet educational websites on tobacco cessation: A content analysis [version 2; peer review: 2 approved] . F1000Research 2024, 13 :822 ( https://doi.org/10.5256/f1000research.174934.r342717 ) The direct URL for this report is: https://f1000research.com/articles/13-822/v2#referee-response-342717 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Version 1 VERSION 1 PUBLISHED 23 Jul 2024 Views 0 Cite How to cite this report: Bhagat T and Agrawal SK. Reviewer Report For: Analysis of internet educational websites on tobacco cessation: A content analysis [version 2; peer review: 2 approved] . F1000Research 2024, 13 :822 ( https://doi.org/10.5256/f1000research.160966.r312908 ) The direct URL for this report is: https://f1000research.com/articles/13-822/v1#referee-response-312908 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 26 Aug 2024 Tarakant Bhagat , BP Koirala Institute of Health Sciences, Dharan, Nepal Santosh Kumari Agrawal , Public Health Dentistry, B. P Koirala Institute of Health Sciences, Dharan, Koshi, Nepal Approved VIEWS 0 https://doi.org/10.5256/f1000research.160966.r312908 Abstract and Introduction Whenever using an abbreviation, please mention it along with the full form for the first time; e.g: Flesch–Kincaid (FK), JAMA, HONcode, DISCERN etc. Methods i. Who all were involved in the screening process? Incase multiple ... Continue reading READ ALL Abstract and Introduction Whenever using an abbreviation, please mention it along with the full form for the first time; e.g: Flesch–Kincaid (FK), JAMA, HONcode, DISCERN etc. Methods i. Who all were involved in the screening process? Incase multiple person were involved, how was the dispute resolved, if there was any? ii. Various tools were used, please mention how the scores of each tool was calculated. Also, mention the number of questions used in each tool; e.g. DISCERN-16. Results i. What does "satisfied all 4 JAMA benchmarks" indicate? ii. Please make the short-terms uniform. e.g: HONcode v HONCODE. iii. Table 2: Is it necessary to mention 1% significance level when in the methods section it is mentioned as 5%? Will it make any difference? Discussions i. "Moreover, health literacy levels, and access to the internet may vary among patients" - Please provide references. ii. "Further studies that consider a greater number of websites need to be conducted" - What is the minimum or maximum number of websites required for content analysis? Conclusions "It can be observed that the read-ability ease and read-ability grade levels of the websites related to tobacco cessation were not up to the mark" - but the results showed that 49% were standard content. Please justify. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Dental public health, epidemiology, oral health, health literacy We confirm that we have read this submission and believe that we have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Bhagat T and Agrawal SK. Reviewer Report For: Analysis of internet educational websites on tobacco cessation: A content analysis [version 2; peer review: 2 approved] . F1000Research 2024, 13 :822 ( https://doi.org/10.5256/f1000research.160966.r312908 ) The direct URL for this report is: https://f1000research.com/articles/13-822/v1#referee-response-312908 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Ramanarayanan V. Reviewer Report For: Analysis of internet educational websites on tobacco cessation: A content analysis [version 2; peer review: 2 approved] . F1000Research 2024, 13 :822 ( https://doi.org/10.5256/f1000research.160966.r306334 ) The direct URL for this report is: https://f1000research.com/articles/13-822/v1#referee-response-306334 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 16 Aug 2024 Venkitachalam Ramanarayanan , Department of Public Health Dentistry, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Coimbatore, Tamil Nadu, India Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.160966.r306334 Introduction Effective tobacco cessation techniques and sources: Kindly use a different terminology for sources. Some information on the prevalence or burden of tobacco use especially among adolescents or adults could add more context to the introduction. ... Continue reading READ ALL Introduction Effective tobacco cessation techniques and sources: Kindly use a different terminology for sources. Some information on the prevalence or burden of tobacco use especially among adolescents or adults could add more context to the introduction. Various web resources - could add a few examples here. Methods There is no mention of study design. I feel it can be closely related to, though purely not, a "Health Technology Assessment" Google, a common search site, was deployed to search for content on tobacco cessation - What were the search words used in Google. It is very important to mention this as it determined the "hits" obtained. Was the wording used in tune with what a layman would use? How did the team come to a consensus on which words to use? The manuscript could explain a bit more on the different scales used to assess the quality and readability ... Why were these scales chosen and what aspect it measures? .. Even though citations have been provided, it would be beneficial for the reader if a brief idea is given about these scales. The parameters were entered - Parameters would be more clear if the above comment is incorporated. How many investigators evaluated the websites? As some of the parameters seem subjective, How was reliability ensured? Would be interesting and informative to note how readability score levels were assessed. The findings of the current study indicate that a total of 10 (23%) of the websites satisfied all 4 JAMA benchmarks. Overall, the number of websites satisfying 1, 2 and 3 of the JAMA benchmarks was 6 (14%), 7 (16%) and 19 (44%), respectively. - 1, 2 and 3 of JAMA benchmarks need to be named. There is no table for this which would help the uninitiated reader to understand the tool. The median and mean scores for questions in DISCERN-16. It can be observed that the mean score was maximum for item number 1 and was minimum of 2.91 for item numbers 5, 6 and 8. A majority of 21 (49%) of the websites as assessed by DISCERN-16 belonged to the fair category, while none of the websites belonged to the very poor and excellent categories. - Need a table for this. Item numbers 5,6 and 8 needs to be elaborated. Discussion Add more information on HONcode certification. How will a layman be able to identify it ? The assessment of the content of the websites was performed by using a checklist prepared specifically for the present study. - Provide checklist as an attachment Would have been more interesting to explain more on the websites which were selected. Was it government websites? professional bodies? or blogs etc, ... who were the authors .. what was the content .. all of this in brief at least .. What guidance do you offer to a layman to ensure that the website he reads is of good quality. Any red-flags you can propose based on your analysis? Conclusion were not up to the mark.- Reframe using scienfic language Overall comments - The study is interesting and relevant. But the information provided is too short, superficial and generic. There is scope for explanation in all sections of the manuscript which would help the reader follow the article better. The quantum of work done in evaluating all 41 websites using various scales is not reflecting in the manuscript. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? No If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: Dental Public Health. Evidence synthesis, Dental Education I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Ramanarayanan V. Reviewer Report For: Analysis of internet educational websites on tobacco cessation: A content analysis [version 2; peer review: 2 approved] . F1000Research 2024, 13 :822 ( https://doi.org/10.5256/f1000research.160966.r306334 ) The direct URL for this report is: https://f1000research.com/articles/13-822/v1#referee-response-306334 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 23 Jul 2024 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 Version 2 (revision) 22 Nov 24 read Version 1 23 Jul 24 read read Venkitachalam Ramanarayanan , Amrita Vishwa Vidyapeetham, Coimbatore, India Tarakant Bhagat , BP Koirala Institute of Health Sciences, Dharan, Nepal Santosh Kumari Agrawal , B. P Koirala Institute of Health Sciences, Dharan, Nepal Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Ramanarayanan V. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 29 Nov 2024 | for Version 2 Venkitachalam Ramanarayanan , Department of Public Health Dentistry, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Coimbatore, Tamil Nadu, India 0 Views copyright © 2024 Ramanarayanan V. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions No further comments Competing Interests No competing interests were disclosed. Reviewer Expertise Dental Public Health. Evidence synthesis, Dental Education I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Ramanarayanan V. Peer Review Report For: Analysis of internet educational websites on tobacco cessation: A content analysis [version 2; peer review: 2 approved] . F1000Research 2024, 13 :822 ( https://doi.org/10.5256/f1000research.174934.r342717) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-822/v2#referee-response-342717 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Bhagat T et al. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 26 Aug 2024 | for Version 1 Tarakant Bhagat , BP Koirala Institute of Health Sciences, Dharan, Nepal Santosh Kumari Agrawal , Public Health Dentistry, B. P Koirala Institute of Health Sciences, Dharan, Koshi, Nepal 0 Views copyright © 2024 Bhagat T et al. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Abstract and Introduction Whenever using an abbreviation, please mention it along with the full form for the first time; e.g: Flesch–Kincaid (FK), JAMA, HONcode, DISCERN etc. Methods i. Who all were involved in the screening process? Incase multiple person were involved, how was the dispute resolved, if there was any? ii. Various tools were used, please mention how the scores of each tool was calculated. Also, mention the number of questions used in each tool; e.g. DISCERN-16. Results i. What does "satisfied all 4 JAMA benchmarks" indicate? ii. Please make the short-terms uniform. e.g: HONcode v HONCODE. iii. Table 2: Is it necessary to mention 1% significance level when in the methods section it is mentioned as 5%? Will it make any difference? Discussions i. "Moreover, health literacy levels, and access to the internet may vary among patients" - Please provide references. ii. "Further studies that consider a greater number of websites need to be conducted" - What is the minimum or maximum number of websites required for content analysis? Conclusions "It can be observed that the read-ability ease and read-ability grade levels of the websites related to tobacco cessation were not up to the mark" - but the results showed that 49% were standard content. Please justify. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Dental public health, epidemiology, oral health, health literacy We confirm that we have read this submission and believe that we have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Bhagat T and Agrawal SK. Peer Review Report For: Analysis of internet educational websites on tobacco cessation: A content analysis [version 2; peer review: 2 approved] . F1000Research 2024, 13 :822 ( https://doi.org/10.5256/f1000research.160966.r312908) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-822/v1#referee-response-312908 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Ramanarayanan V. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 16 Aug 2024 | for Version 1 Venkitachalam Ramanarayanan , Department of Public Health Dentistry, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Coimbatore, Tamil Nadu, India 0 Views copyright © 2024 Ramanarayanan V. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Introduction Effective tobacco cessation techniques and sources: Kindly use a different terminology for sources. Some information on the prevalence or burden of tobacco use especially among adolescents or adults could add more context to the introduction. Various web resources - could add a few examples here. Methods There is no mention of study design. I feel it can be closely related to, though purely not, a "Health Technology Assessment" Google, a common search site, was deployed to search for content on tobacco cessation - What were the search words used in Google. It is very important to mention this as it determined the "hits" obtained. Was the wording used in tune with what a layman would use? How did the team come to a consensus on which words to use? The manuscript could explain a bit more on the different scales used to assess the quality and readability ... Why were these scales chosen and what aspect it measures? .. Even though citations have been provided, it would be beneficial for the reader if a brief idea is given about these scales. The parameters were entered - Parameters would be more clear if the above comment is incorporated. How many investigators evaluated the websites? As some of the parameters seem subjective, How was reliability ensured? Would be interesting and informative to note how readability score levels were assessed. The findings of the current study indicate that a total of 10 (23%) of the websites satisfied all 4 JAMA benchmarks. Overall, the number of websites satisfying 1, 2 and 3 of the JAMA benchmarks was 6 (14%), 7 (16%) and 19 (44%), respectively. - 1, 2 and 3 of JAMA benchmarks need to be named. There is no table for this which would help the uninitiated reader to understand the tool. The median and mean scores for questions in DISCERN-16. It can be observed that the mean score was maximum for item number 1 and was minimum of 2.91 for item numbers 5, 6 and 8. A majority of 21 (49%) of the websites as assessed by DISCERN-16 belonged to the fair category, while none of the websites belonged to the very poor and excellent categories. - Need a table for this. Item numbers 5,6 and 8 needs to be elaborated. Discussion Add more information on HONcode certification. How will a layman be able to identify it ? The assessment of the content of the websites was performed by using a checklist prepared specifically for the present study. - Provide checklist as an attachment Would have been more interesting to explain more on the websites which were selected. Was it government websites? professional bodies? or blogs etc, ... who were the authors .. what was the content .. all of this in brief at least .. What guidance do you offer to a layman to ensure that the website he reads is of good quality. Any red-flags you can propose based on your analysis? Conclusion were not up to the mark.- Reframe using scienfic language Overall comments - The study is interesting and relevant. But the information provided is too short, superficial and generic. There is scope for explanation in all sections of the manuscript which would help the reader follow the article better. The quantum of work done in evaluating all 41 websites using various scales is not reflecting in the manuscript. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? No If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise Dental Public Health. Evidence synthesis, Dental Education I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Ramanarayanan V. Peer Review Report For: Analysis of internet educational websites on tobacco cessation: A content analysis [version 2; peer review: 2 approved] . F1000Research 2024, 13 :822 ( https://doi.org/10.5256/f1000research.160966.r306334) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-822/v1#referee-response-306334 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions Adjust parameters to alter display View on desktop for interactive features Includes Interactive Elements View on desktop for interactive features Competing Interests Policy Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. 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