What influence do search engines have on the health information we see?

And how does this curation process impact our digital health literacy and health outcomes?

“There once was a time when Google displayed the same results for everybody, but those days are gone and are changing at a rapid pace.”

Let’s start with a fictional case to set the scene…

We have a fictional child, 15 years old, who is suffering from anorexia nervosa. Not yet treated or recognised, though this problem has been slowly getting worse for several months. Like almost all teenagers, they already have a strong online presence. If they are searching for “do I have an eating disorder” online, what results come up? Are they reputable sources (eg government websites, support groups), or blogs detailing people’s potentially negative perceptions of body image and pro-anorexia websites?

How do these search results impact on their perception of themselves, and their recognition and treatment of their own mental health disorder?

Online health information as the #1 source of health information

Online searching for health information is ubiquitous in health care. Patients will search before and after a health visit, to learn more about the condition to avoid seeing a doctor or to double-check a doctor’s advice for accuracy. However, very few patients look beyond the first page of search results. So, the first page of results is very important to how people consume health information.

Search engines as “choice architects” of our search results

However, we know that people will see different rankings of search results based on a number of factors (eg location, browsing history). This could potentially affect our consumption, and interpretation of health information online. Concerningly, it appears to be very challenging to turn this curation off.

How different search results may affect our digital health literacy

Our digital health literacy (or eHealth literacy) was defined in 2006 by Norman and Skinner as “the ability to seek, find, understand, and appraise health information from electronic sources and apply the knowledge gained to addressing or solving a health problem”. How is this process affected by the largest sources of health information online, the “choice curators” or health information? A brief perusal of Ovid Medline could find no articles exploring this when I searched for consumer health information and health knowledge, and search engines/google. I don’t know whether the process of curating health information to target users affects their health outcomes. But is easy to see how it might. And who makes the decision for how this information is presented to us?

If anyone knows the answer to these questions, please let me know by commenting below or

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