

































Title:*Published criteria for evaluating health related websites: An Egyptian pilot study


Bangladesh Journal of Bioethics 2010; 1(3):2-14

A  PILOT  STUDY  FOR  EVALUATING  EGYPTIAN  HEALTH  WEBSITES: 

TECHNICAL AND ETHICAL PERSPECTIVES

Nahed M. Ali1, Amira Gamal2, and  Amr A. Mohamed3

1.  Professor  of  Forensic  Medicine and Toxicology,  Faculty of  Medicine,  Suez Canal  University,  Egypt. 
(Corresponding Author) Email: nmoustafa2004@yahoo.com

2.  Assistant  Prof  of  Community,  Environmental  and Occupational  Medicine,  Faculty  of  Medicine,  Suez 
Canal University, Egypt. Email: gamalamira@gmail.com 

3. IT Department Director,  Egyptian Diabetes Center, Egypt. Email:aibrahim@onlinediabetes.net

Keywords: E-health ethics- Health website.  

Abstract:

Background: The growing popularity of the Internet has made it easier and faster to find 
health information. Much of this information is valuable; however, the Internet also allows 
rapid and widespread distribution of false and misleading information. Aim of the work: 
To  evaluate  some  of  the  Egyptian  health  websites  from  the  Technical  and  Ethical 
perspectives  and  to  compare  the  reliability  of  the  different  types  of  Egyptian  health 
websites.  Materials  and  Methods: This  is  a  descriptive  study.  Search  engines  (eg. 
Google.com  and  Yahoo.com)  were  thoroughly  searched  for  Egyptian  health  websites. 
Some of these websites were not accessible. Out of thirty two health websites, thirteen 
internet health websites were randomly selected and evaluated twice in this study. They 
were classified into 4 categories, official, professional, educational and private. The tool 
used in this study was a questionnaire developed by the research team depending on E-
Health  code  of  ethics,  2000  and  international  technical  guidelines.  The  questionnaire 
consists of two main categories (technical and ethical). The technical evaluation includes 
(authority,  objectivity,  coverage,  currency,  design,  privacy  and  security).  The  ethical 
evaluation  includes  (quality  of  information,  informed  consent  and  professionalism).  A 
score for the questionnaire was developed by the research team to assess the websites. All 
statistical analyses were performed using the Statistical Package for Social Science (SPSS) 
version 11.0. Comparisons between ethical and technical categories were done using the 
student’s t-test and ANOVA test for continuous variables and Pearson’s Chi square test for 
categorical  variables. Results:  On evaluating  the  quality  of  information  of  the  health 
websites,  it  is  noticed  that  in  92.3%  of  the  sample,  medical  care  is  provided  by 
professionals and their information based on scientific studies. Around forty six percent 
(46.2%) of the health websites do not mention the date of publication, date of recent update 
and the source of the information. Concerning the professionalism, 100% of the sample 
obeys  laws  and  regulation  in  identifying  themselves  and  mentioning  the  limitation  of 
online consultation. 76.95% of the sample states clearly the purpose of the health website. 
Only 38.5% of them were recently updated. Privacy policy evaluation shows that 33.3% 

2

mailto:aibrahim@onlinediabetes.net
mailto:gamalamira@gmail.com
mailto:nmoustafa2004@yahoo.com


Bangladesh Journal of Bioethics 2010; 1(3):2-14

mentions if the system prevents unauthorized access to personal data while only 16.7% 
states how the user's personal data is stored and for how long. There is a statistically a 
significant change (p<0.05) on comparing the quality of information between the different 
types of websites. Both of the official and professional websites are better than educational 
and private websites. Conclusion: Some of the Egyptian health websites are reliable and 
up-to-date;  some are not.   Most of them are technically satisfactory.  Evaluation of the 
health  websites  faces  difficulties  due  to  continuous  updating.  Recommendations:  we 
should teach the health seekers to trust what they see or read on the Internet only if they 
can validate the source of the information and the   authors and contributors should always 
be identified. It is necessary to establish mechanisms of Accreditation of Egyptian Health 
Websites. E-Health Ethics Training is very essential for the health professionals. 

Introduction: Ethics can be viewed as a prerequisite for the success of medical practice. If 
the prerequisite is not in place to ensure trust of product or services provided, consumers 
will  not  utilize  the  product  or  services.  In  case  of  medical  field,  the  public  trusts  the 
medical  profession  to  regulate  its  own  practices1.  Knowledge  and  capabilities  of  new 
technology or an area of  study often  develop faster  than the guidelines  and principles 
needed  for  practitioners  to  practice  ethically  in  the  new  arena.  One  area  of  rapid 
technological and economic expansion was that of the internet, in particular how quickly 
the internet is impacting and changing the practice of medicine in the 21st century2. Internet 
health  seekers  may  be  healthy  citizens  with  an  enquiring  mind,  newly  diagnosed  or 
chronically  ill  patients  and  carer  for  a  diagnosed  person.  Different  factors  affect  the 
patient's  safety  on  the  internet  as  the  quality  of  information,  privacy  of  information, 
professionalism in online health care and informed consent. The internet has become and 
will continue to be a significant means by which individuals self educate with respect to 
health,  and  this  self  education  has  the  potential  to  result  in  important  changes  in  the 
dynamics of the physician-patient relationship3.

Concern has been expressed about the quality of medical information displayed generally 
on the internet. Some sites provide inaccurate or misleading information4&5. The quality of 
information in health website plays a pivotal role in patient's safety. It is extremely variable 
from evidence based health care to practice of fraud and dangerous claims. Sometimes the 
medical care or advice is provided by a non professional person who does not state if this 
info based on scientific studied, expert consensus or personal experience or opinion. Many 
health  websites  do  not  mention  the  source  the  site  or  content  provider  has  used  with 
references  or  links  to  sources.   US Food and Drug Administration  (2005) advised the 
health seekers to pay close attention to where the information on the site comes from. 
Many health and medical Web sites post information collected from other Web sites or 
sources. If the person or organization in charge of the site did not write the material, the 
original source should be clearly identified6.  We should to be careful of sites that don't say 
where the information comes from. In case of drug or products, some health websites do 
not inform health seekers if they are approved by authorities or not. Fox, (2007) mentioned 
that Eighty percent of American internet users have searched for health information online. 

3



Bangladesh Journal of Bioethics 2010; 1(3):2-14

They are called "health seekers". Three quarters of health seekers said that they did not 
consistently check the source and date of the health information online. This translates to 
about 85 million Americans gathering health advice online without usually examining the 
quality indicators of the information they find. One possible reason for this diminishing 
diligence in checking sources and dates might lie with health websites themselves7. These 
concerns have led to the development of the ethical  codes for the providers of medical 
information on the internet (Health Internet Ethics). Although these vary depending on the 
specific purpose and context of the proposed codes, there are common themes between 
many of them. There are also several,  international ethical standards and guidelines for 
internet health sites. E-health code of ethics is the one of the commonest guidelines which 
ensures  that  all  people  worldwide  can confidentially,  and  without  risk,  realize  the  full 
benefits of the internet to improve their health8. The large volume of health information 
resources available on the internet has great potential to improve online health services, but 
the  critical  question  is  how to  differentiate  between  the  appropriate  and inappropriate 
information on both medical specialists and patients, many of health field members are 
trying  to  find an accredited  criteria  to evaluate  the wide range of medical  information 
available  on the world wide web (WWW). Now we have a question,  are the Egyptian 
websites providing health services reliable regarding ethical and technical criteria or not? 
To our knowledge, there may be no attempt made to evaluate the Egyptian health websites 
from the technical and ethical perspectives. So the aim of this paper was to evaluate the 
ethical and technical aspects of some Egyptian websites providing health services in the 
form of medical consultation, health related information and selling or advertising health 
products.    

Materials and Methods:  The study design of this work was a descriptive study. Search 
engines (eg. Google.com and Yahoo.com) were thoroughly searched by entering the key 
words healt websites, and Egyptian. Thirty two health websites were found, some of them 
were not accessible. Thirteen internet health websites were evaluated in this study. They 
were classified into 4 categories, official, professional, educational and private. Table (1) 
shows the evaluated Egyptian health websites.

There are 2 educational health websites, 3 official health websites which includes  two for 
Ministry  of  Health  &  Population  and  one  for  the  Egyptian  Medical  Syndicate,  4 
professional  health  websites  which are  developed by scientific  societies,  and 4 private 
health websites which are developed by doctors or health centres. Health websites were 
evaluated twice (February and June, 2007 respectively). The aim of the first evaluation was 
to test the validity of the tool while the aim of the second evaluation was to detect the 
changes in the previous evaluation due to update of the health websites. Masrawy website 
was omitted during the second evaluation due to removal of the health sector from it by the 
authors.

4



Bangladesh Journal of Bioethics 2010; 1(3):2-14

Table (1): The evaluated Egyptian health websites

Type Name Link

1. Official

2. Official

3. Official

4. Professional

5. Professional

6. Professional

7. Professional

8. Educational

9. Educational

10. Private

11. Private

12. Private

13. Private

Ministry of Health& Population of  Egypt

Ministry of Health& Population of  Egypt

Egyptian Medical Syndicate

Heart Journal, Cardiology Dep, Cairo U

Egyptian Hypertension Society

Egypt’s Medical Portal

Egyptian Society of Paediatric allergy

Faculty of Med. Ain Shams U 

Medical Education Online

The ultimate health portal for Egypt

Consultant of Plastic Surgery

E-Males

Online Diabetes.net

www.mohp.gov.eg

www.drguide.mohp.gov.eg

www.ems.org.eg

www.hearj.com,

www.ehs-egypt.net

www.egydoc.com

www.espai-eg.org

www.com-med.ikalogic.com

www.medicaleducationonline.org

www.abcseha.com

www.gamalekonline.com

www.erajol.com

www.onlinediabetes.net

The tool used in this study was a checklist that consisted of two main categories: technical 
and  ethical.  The  technical  category  evaluated  6  items  including  authority,  objectivity, 
coverage, currency, design, privacy and security. The ethical category evaluated the quality 
of  information,  informed  consent  and  professionalism,  The tool  was  developed  by the 
research team depending on:  e-Health Code of Ethics, 20008 for the ethical part and the 
several International Guidelines which are used in evaluating health websites as Health On 
the Net  Foundation (  HON code of conduct  for medical  and health  web sites9 ,Health 
Information  Technology Institute,  British  Healthcare  Internet  Association,  US National 
Institute of Health and others. All questions were answered as yes, no and not applicable, 
which equal to 0 and 1 for no and yes  respectively and omitted from the score if  not 
applicable. A score for the checklist was developed by the research team. For example, the 
quality of information item included 9 questions which means that the total score is 9, if 
we have only 7 answered yes, then dividing 7/9 will give us the score and if we wish to 
express  it  as  score percent  we multiply  it  by 100 (7/9  x 100).  The same process  was 
repeated to calculate the total score for each of the ethical and technical categories. Then 
data was carried out and statistical analysis was performed using the Statistical Package for 

5

http://www.onlinediabetes.net/
http://www.erajol.com/
http://www.gamalekonline.com/
http://www.abcseha.com/
http://www.medicaleducationonline.org/
http://www.com-med.ikalogic.com/
http://www.espai-eg.org/
http://www.egydoc.com/
http://www.ehs-egypt.net/
http://www.hearj.com/
http://www.ems.org.eg/
http://www.drguide.mohp.gov.eg/
http://www.mohp.gov.eg/


Bangladesh Journal of Bioethics 2010; 1(3):2-14

Social Science (SPSS) version 11.0. Data was presented as proportions and percentages, 
mean and standard deviations. ANOVA test for continuous variables was used. Figure (1) 
summarized the process of evaluation of the health websites.

Figure (1): Summary of health websites evaluation process

Results:  The ethical and technical criteria were applied to 13 Egyptian health websites. 
Table (2) shows results of the thirteen Egyptian Health Web- sites accessed by frequency 
with which the criteria are met. The evaluation of the quality of information shows that 
92.3% of the sample provided medical care by professionals and the information is based 
on  scientific  studies,  while  46.2% of  the  health  websites  do  not  mention  the  date  of 
publication, date of recent update and the source of the information. 69.2% states that the 

6

13 Egyptian health websites are randomly 
selected

Literature review to develop the tool

Classification of health websites
(Educational, official, professional and 

private)

Use of e-health code of ethics &international 
health websites evaluation guidelines to develop 

the tool 

1st evaluation to test the tool

Development of the scoring system

2nd evaluation to detect the changes due to updating



Bangladesh Journal of Bioethics 2010; 1(3):2-14

Table (2): Results of the thirteen Egyptian Health Web- sites accessed by frequency 
with which the criteria were met

Parameter Proportion        %
Quality of information:
Medical care is provided by professionals
Information is based on scientific studies 
Information is controversial  
Language is clear                                                            
Mention the date for published information 
Mention the date for review information recently 
Mention the source website used with reference
There is an evaluation of contents of website                             
State if the products are approved by authorities                             
Informed consent 
Type of data clear
Who collects data
How website use data
Professionalism
Fees for online consultation
Obey laws and regulation
Professional identify themselves
Limits of consultation online
Authority:
Authors clearly identified
Is there any institutional affiliation
Can easily contact authors for clarification
Objectivity
Is the purpose of the website clearly stated
Are the information presented relevant to the objective of the website
Coverage 
Is the website bilingual
Is the website divided into sections which cover most of topics
Does the website satisfy the needs of its targeted visitors
Currency 
Is the website updated recently
Is the revision date recent enough to account for the changes in the field
Are the links kept up to date
Design 
Can the website be accessed reliably&  easily navigated
Is there any visual effects 
Do visual effects enhance the resource, banners
Are there interactive features that increase usability
Can the website be accessed without additional viewer or plug in
Does the website provide the links for the software needed for opening the website pages
Privacy 
Does the system prevent unauthorized access to personal data
Does the system tell how the user personal data is stored and for how long  

12/13
12/13
  9/13
13/13
  7/13
  7/13
  7/13
11/13
  8/13

 4/5*
2/5** 
1/5***

 2/4• 
4/4• • 
4/4• • •  
4/4••••   

13/13
  8/13
12/13 

10/13 
13/13  

 6/8♦  
13/13 
12/13

5/13
5/13
10/13 

13/13
10/13
7/10♣ 
9/13   
5/13
1/ 8♣♣ 

2/6♠

1/6♠♠ 

92.3
92.3
69.2
100
53.8
53.8
53.8
84.6
61.5

80.0
40
20

50.0
100.0
100.0
100.0

100.0
61.5
92.3

76.9
100.0

75.0
100.0
92.3

38.5
38.5
76.9

100.0
76.9
70.0
69.2
38.5
12.5

33.3
16.7

N.B: percent calculated from the total number of no and yes, NP= not applicable
* NP= 8/13 (61.7%), ** NP=8/13 (61.5%),*** NP=8/13 (61.5%),• NP=9/13 (69.2%),
• • NP=9/13(69.2%),• • •   NP= 9/13 (69.2%),•••• NP= 9/13 (69.2%),♦ NP= 5/13 (38.5%)
♣ NP= 3/13(23.1%),♣♣  NP= 5/13 (38.5%),♠ NP= 7/13 (53.8%),♠♠NP= 7/13 (53.8%)

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Bangladesh Journal of Bioethics 2010; 1(3):2-14

presented information may be controversial  and 61.5% mentions that their products are 
approved by the authority. On evaluating the informed consent, 40% of the sample states 
who collects the data while only 20% mentioned how the websites uses data. Concerning 
the  professionalism,  100%  of  the  sample  obeys  laws  and  regulation  in  identifying 
themselves and mentioning the limitation of online consultation. 

Regarding the technical evaluation: 100% of the sample identifies the authors, 76.9% of 
the sample states clearly the purpose of the health website, 75% of the sample is bilingual 
and only 38.5% of them are recently updated. The design evaluation shows that all the 
websites are accessed and navigated easily, but 69.2% of them have interactive features 
and only 12.5% provides the links for the software needed for opening the website pages. 
Privacy  policy  evaluation  shows  that  33.3%  mentions  that  the  system  prevents 
unauthorized access to personal data while only 16.7% states how the user's personal data 
is stored and for how long. 

Table  (3) shows the frequency distribution of the 13 Egyptian  internet  health  websites 
according to the score of the technical and ethical evaluation. It is shown that quality of 
information in 7 health websites is 100%, while it is 37.5% in 3 health websites. Authority 
is 100% in 8 health websites and coverage is 76.9% in 10 health websites. Design item 
shows that only 2 health websites have a design score of 83.3% and privacy shows that 4 
out of 6 health websites have no privacy policy. There is a significant change (p<0.05) on 
comparing the quality of information between the different types of websites. Both of the 
official and professional websites are better than educational and private websites as shown 
in (Table 4). 

Discussion: The internet can be a valuable source of health information, but not all sites 
are equally worthy or reliable. Information on the web may be incomplete, inaccurate, or 
overly simplified. The web lacks peer review or quality control; many sites are trying to 
sell a product, and are biased or out of date; and anyone can publish on the web whether 
they are an expert, or not10. 

In this study, the evaluation of the quality of information shows that 92.3% of the sample 
provided medical care by professionals and the information is based on scientific studies, 
while 46.2% of the health websites do not mention the date of publication, date of recent 
update and the source of the information, 69.2% states that the presented information may 
be controversial and 61.5% mentions that their products are approved by the authority. On 
evaluating the informed consent, 40% of the sample states who collects the data while only 
20% mentioned how the websites uses data. Concerning the professionalism, 100% of the 
sample obeys laws and regulation in identifying themselves and mentioning the limitation 
of online consultation.

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Bangladesh Journal of Bioethics 2010; 1(3):2-14

Table (3): Frequency distribution of  the thirteen health websites according to the 
score of technical and ethical evaluation

Frequency  of  web 
sites (n= 13)              

score 
percent 

Quality of information

Informed consent*

Professionalism**

Authority

Objectivity

Coverage

Currency

Design

Privacy

3
2
1
7

1
2
1   
1  

2  
2

1
4
8

3
10

3
10 

2
5
3 
3  

3
3
5
2

4
1
1

37.5
50.0
62.5
100.0

0.00
25.0
50.0
100.0

75.0
100.0

33.3
66.7
100.0

50.0
100.0

66.7
76.9

0.00
33.3
66.7
100.0

33.3
50.0
66.7
83.3

0
50
100

*not applicable 8 websites; **not applicable 9

9



Bangladesh Journal of Bioethics 2010; 1(3):2-14

Table (4): Comparison of quality of information among the different types of health 
websites

N                         Mean ±SD                  
Official
Professional
Educational 
Private 

3                           87.5±21.7
4                             100±0.0
2                            68.8±44.2
4                            43.7±7.2

* ANOVA test was used in this table F= 6.84                  P value= 0.011

The National Cancer Institute (2005) and Medical Library Association (2008) mentioned 
that any Web site should make it easy for people to learn who is responsible for the site 
and its information. If the person or organization in charge of the Web site did not write the 
material, the original source should be clearly identified.  Health-related Web sites should 
give information about the medical credentials of the people who prepare or review the 
material on the site. Any Web site that asks users for personal information should explain 
exactly what the site will and will not do with that information. It added that The Federal 
Trade Commission and the Food and Drug Administration are Government agencies that 
help protect consumers from false or misleading health claims on the Internet11&12.

So it is important to mention that authors and contributors should always be identified and 
we have to avoid any online physician who proposes to diagnose or treat persons without a 
proper physical examination and consultation regarding our medical history.

According  to  Fox  (2006)  about  85  million  Americans  gathering  health  advice  online 
without consistent examining the quality indicators of the information they found. Three 
quarters of them said they checked the source and date "only sometimes", hardly ever, or 
never. One possible reason for this diminished diligence in checking sources and dates 
might lie with health websites themselves. Just 4% of "frequently visited" health websites 
disclosed the source of information on their pages and 2% disclosed how the content is 
updated13.

In the present study, it is noticed that the quality of information of both of official and 
professional websites is better than the educational and private websites (p> 0.05) which 
means  that  both  of  the  official  and  professional  health  websites  follow the  criteria  of 
international guidelines. This result shows that it is necessary to establish mechanisms of 
Accreditation of Egyptian Health Websites.

Aeree and Mee-Kyungs (2001) stated that anyone with a computer and internet access can 
publish on the web, so judging the trust worthiness of scientific and health related web 
sites becomes the responsibility of each individual user14. 

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Bangladesh Journal of Bioethics 2010; 1(3):2-14

It is worthy to mention that in the academic community, the peer review process is used to 
ensure the validity and quality of the information presented in papers and reports. The 
general  public,  however,  is  more  likely  to  understand  a  "seal  of  approval"  from  an 
individual  or group commonly perceived as credible.  Sites should indicate  whether the 
information provided has been subjected to review, and if so, describe the process and the 
individuals involved.

In the present study,  4 out  of 6 health  websites  have no privacy policy,  33.3% of the 
sample mention that the system prevent unauthorized access to personal data while only 
16.7% states how the user's personal data is stored. Winker et al, (2000) stated that medical 
websites, more than any other type of site on the internet, should ensure visitors' personal 
privacy and prevent personal medical information, including patterns of use and interests, 
from being sold, purchased, or inadvertently entering the hands of marketers, employers, 
and insurers15.  The National  Consumers  League (1999) stated that  health  care  websites 
have access to an unprecedented amount of personal information about consumers. The 
public's  concerns  about  internet  privacy are  significant,  and  heightened  with regard  to 
safeguarding their personal health information online16. A survey of 1009 adults released in 
January  2000  by  the  California  Health  Care  Foundation  and  the  internet  Health  Care 
Coalition  found  that  75  %  of  people  were  concerned  about  health  websites  sharing 
information without their permission and 17% of people did not even go online merely to 
seek health information due to their concerns over privacy. The good news is that nearly 
80% of people said that  the existence of a privacy policy that  provides them with the 
ability to make choices about how and whether their information was shared had a positive 
impact on their willingness to engage in online health activities17. There was much work 
needed  to  provide  consumers  with  an  acceptable  level  of  trust  and  confidence  in  the 
privacy safeguards and practices of health websites. Goldman et al, (2000) mentioned that 
at  best,  the privacy policies of health websites were confusing, inconsistent,  weak, and 
often misleading when measured against the site's actual practices. A site with a privacy 
policy that disclaims liability for the actions of third parties on the site in effect negates the 
privacy policy18. 

The present study shows that  100% of the sample identifies  the authors, 76.9% of the 
sample states clearly the purpose of the health website, 75% of the sample is bilingual and 
only 38.5% of them are recently updated. The design evaluation shows that all the websites 
are accessed and navigated easily, but 69.2% of them have interactive features and only 
12.5% provides the links for the software needed for opening the website pages.
Eysenbach (2000) found that consumers assessing the credibility of a website primarily 
looked for the source, a professional design, language and ease of use, study participants 
never checked any "about us" sections of websites, disclaimer or disclosure statements. 
The average consumer paid far more attention for the superficial aspects of a site, such as 
visual cues, than to its content. The consumer assessed the credibility of sites based in part 
on the appeal of the visual design, including font size and color schemes19. Griffiths and 
Christensen  (2000)  evaluated  the  quality  of  web  based  information  on  treatment  of 

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Bangladesh Journal of Bioethics 2010; 1(3):2-14

depression to identify potential indicators of content quality and they found that although 
the sites  examined contained useful  information,  their  overall  quality  was poor20.  Sites 
typically  did  not  cite  scientific  evidence  in  support  of  their  conclusions.  Measures  of 
quality such as display of authorship, attribution or references, currency of information and 
disclosure  did  not  differ  between  popular  and  less  popular  sites21.  In  similar  findings, 
Kunst et al (2002) found that while there is a correlation between credibility features and 
accuracy of information, the associations is relatively weak22.
In this study, as the health websites are evaluated twice, some changes have been noticed 
due to continuous updating. 
At last, physicians, nurses, pharmacists, therapists, and all other health care professionals 
who provide specific, personal medical care or advice online should abide by the ethical 
codes  that  govern  their  professions  as  practitioners  in  face-to-face  relationships.  They 
should also mention the limitations of online consultations.

Conclusion: Some of the Egyptian health websites are reliable and up-to-date; some are 
not.  Most of them are technically satisfactory.  Evaluation of the health websites faces 
difficulties due to continuous updating. 

Recommendations: we should teach the health seekers to trust what they see or read on 
the Internet only if they can validate the source of the information and the   authors and 
contributors  should  always  be  identified.  It  is  necessary  to  establish  mechanisms  of 
Accreditation of Egyptian Health Websites. E-Health Ethics Training is very essential for 
the health professionals. 

Study limitations:  The present study is  a pilot  study to measure the adherence of the 
Egyptian health websites to the ethical criteria of e-heath code of ethics. It did not evaluate 
the quality of health related websites in a certain discipline or certain health topic, so our 
results cannot be generalized.  Also since it is a pilot study, the sample size was rather fair 
and further studies with larger sample size are needed targeting certain  disciplines  and 
different types of health websites.

References:
1. Kassirer J P. Pseudoaccountability. Ann Intern Med. 2001 Apr 3;134(7):587–90.
2. Dyer KA. Ethical Challenges of Medicine and Health on the Internet: A Review. 

J Med Internet Res, 2001, 3(2):e23. 
3. Broom,  A.  “Virtually  He@lthy:  The  Impact  of  Internet  Use  on  Disease 

Experience and the Doctor-Patient Relationship,”  Qualitative  Health Research 
(2005), volume 15, number 3 (March), pp. 325-345.

4. Eysenbach,  G.  and  Diepgen,  T.L.  ‘Towards  quality  management  of  medical 
information  on  the  internet:  evaluation,  labelling,  and  filter  of  information’, 
British Medical Journal, (1998) Vol. 317, No. 71, pp.1496–1499

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Competing interests
The authors declare that they have no competing interests.
Authors' contributions
Nahed Ali helped conceived the idea of the study, contributed to the design of the study 
tool and evaluating the health websites. She wrote the manuscript
Amira  Gamal  contributed  to  the  design  of  the  study  tool  and  evaluating  the  health 
websites. She did the data analysis.
Amr Mohamed conceived the idea of the study, contributed to the design of the study tool 
and evaluating the health websites from the technical point of view.
All authors read and approved the final manuscript
Corresponding Author:
Prof.  Nahed  Ali  is  the  Head  of  the  Department  of  Forensic  Medicine  and  Clinical 
Toxicology, Faculty of Medicine, Suez Canal University, Egypt. She is a Certified Trainer 
of Research Ethics, Maryland University, USA, and an Ethics Expert among Global Ethics 
Observatory (GEObs), UNESCO 
Nmoustafa2004@yahoo.com

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mailto:Nmoustafa2004@yahoo.com

