Health recommendations within the internet: Lessons learned from a planned quantitative study on toothbrushing recommendations (Preprint)

BACKGROUND Analyzing recommendations on websites is a method that is often applied to understand what advice is given to patients. An important health behavior which is carried out by most people on a regular basis is toothbrushing. OBJECTIVE Our objective was to assess toothbrushing recommendations on German websites. METHODS It was planned to include websites related to oral hygiene in German language and to analyze their recommendations quantitatively by counting them regarding frequency, duration and toothbrushing technique. RESULTS Several obstacles emerged during the study which finally rendered a quantitative analysis impossible. Among them are an unreasonable amount of websites fulfilling the inclusion criterion, multiple and contradictory advice within one and the same internet presence and cross-linking between websites. Further, it was impossible to clearly define what should be considered a recommendation and if it would be found by patients as some potential recommendations were mentioned just by the way or at unusual parts of the website. CONCLUSIONS Lessons learned during this analysis are discussed with respect to the present research question but also to other research on health recommendations on the internet. Problems that might occur during quantitative and qualitative analyses are shown and potential solutions are presented along with the biases they might cause. Thereby a checklist is provided which should be considered when planning, reporting and evaluating studies analyzing web contents.