Worried patients who search the web for health advice often reject the best sites in favour of those with a human touch, researchers have found.

Despite the boom in online self-help, patients’ search strategies often deny them the best sources of information, such as sites run by drug companies or by NHS Direct.

Research at Northumbria University has identified the factors that get most sites passed by: too much detail, too much advertising, or too general a portal that involves lengthy searching.

Professor Pamela Briggs and her colleagues conducted research, funded by the Economic and Social Science Research Council, to discover how internet users identify sites and how they decide whether or not to trust the information that they find on it.

Millions of people scan the internet for health advice: two thirds of European adults with access to the internet have used it for health advice, and about a third of users, when questioned, say that the internet has influenced a decision about healthcare.

So what makes one website attractive and another unattractive could be significant. The study found that, faced with a minefield of information of variable quality, health consumers subject websites to an initial weeding-out process that will eliminate most NHS and drug company websites from the search within a matter of seconds.

“One thing that really put people off was advertising, so people clicked off drug company websites straight away,” Professor Briggs said.

“Generally, the medical information on drug company sites is very accurate but people question the authors’ motivation and agenda. The issue of impartiality is quite crucial in building trust.”

The NHS websites fared little better. Often these were rejected because the first page that participants saw was a portal or had too much background or generic content.

“People don’t have the patience to scroll through pages in order to find something useful. Ease of access is so important,” Professor Briggs added.

Even sites that make a good first impression quickly pall if they lack personal stories that users can relate to.

People want advice from like-minded people with the same problems and concerns, the study found.

Content matters less. When women with an interest in hormone replacement therapy were questioned about their use of internet sites, irrelevant or inappropriate content was listed by only 6 per cent as a reason for rejecting a site.

Design, including issues such as layout, navigation aids, use of colour, pop-up advertisements, small print, too much text, a “corporate look and feel” and poor search facilities, were listed by 94 per cent.

Professor Briggs gave a warning that the searching strategy people use has its dangers. Although most users did find material of reasonable quality, the tendency to trust sites that contain contributions from like-minded peers could have dangerous effects on some groups, such as those with anorexia, by reinforcing unhealthy behaviour patterns.

The study was carried out by inviting people to come to an internet café, for two hours a week for four weeks, to search for relevant health information and then to discuss it with others. Participants were also given diaries to log the internet sessions they had at home.

Next, the researchers launched a web-based questionnaire soliciting information from users, three quarters of whom were women.

On the basis of these two parts of the study, researchers designed several websites for the third part, specifically about the dangers of alcohol.

Users were watched as they studied the websites, using eye-tracking equipment. While this showed that participants spent more time looking at “untrustworthy” elements of the websites, such as advertisements, a follow up a week later showed that heavy drinkers who looked at the more trustworthy sites subsequently developed a more negative attitude towards alcohol.

The single most important piece of advice for those trying to promote health information online is to use engaging stories about people with similar experiences, Professor Briggs said.

“The great strength of the internet is that you can find people who have had the same problem that you have and see how they have coped with it. To forget about that, or to act as if it’s not happening, is missing the point,” she added.

Healthy sites

— Among the sites given a high rating by users in the University of Northumbria study is www.dipex.org , a site run by an Oxford-based charity that has won a string of awards. DIPEx has a steering group of doctors, and covers cancers, heart disease, mental health, neurological conditions, screening programmes, pregnancy, teenage health and many others. It includes forums where patients can exchange experiences, and detailed information on a wide range of diseases

— An American website designed for women, www.project-aware.org , also got the thumbs-up from the Northumbria team. It deals with issues such as the menopause, HRT, osteoporosis and heart health. It is run by a team of eight, working from their own homes across the US. The site is accessible and professional without being too dauntingly medical

— The NHS Direct website lacks first-hand patient experience, but is clear and accurate and offers a way of finding local GP surgeries and pharmacies. But for the volunteers in the study, it took too long to get details they wanted Drug company sites abound, despite legislation in Europe that prohibits direct-to-consumer advertising. Because of these restrictions, the US-based sites are often far more informative. Data on Pzifer’s drugs is easily found on Pfizer.com , the US site, but is not available on Pfizer.co.uk , the British site

— Other sites that have scored highly in surveys, including Body&Soul, The Times’s Saturday medical section, and Patient UK (www.patient.co.uk )

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