Improving Online Drug Information: Insights from Quality Evaluation and Pharmaceutical System Design

Article information

Healthc Inform Res. 2025;31(4):405-415

Publication date (electronic) : 2025 October 31

doi : https://doi.org/10.4258/hir.2025.31.4.405

Dita Permatasari¹, Syofyan², Ardhian Agung Yulianto³, Wirda Qholbya¹, Andhini Aurellyta Ridwan¹, Yoneta Srangenge¹

¹Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Andalas, Padang, Indonesia

²Department of Pharmaceutics, Faculty of Pharmacy, Universitas Andalas, Padang, Indonesia

³Industrial Engineering, Faculty of Engineering, Universitas Andalas, Padang, Indonesia

Corresponding Author: Yoneta Srangenge, Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Andalas, Limau Manis, Pauh, Padang City, West Sumatra 25175, Indonesia. Tel: +62 751 7740113, E-mail: yonetasrangenge@phar.unand.ac.id (https://orcid.org/0000-0003-4150-876X)

Received 2025 February 1; Revised 2025 August 5; Accepted 2025 August 27.

Abstract

I. Introduction

In the digital era, the Internet has become a dominant platform for accessing information across multiple sectors, including healthcare. Drug-related information is among the most frequently searched topics online [1]. In Indonesia, approximately 95.8% of individuals reportedly seek drug information through online platforms [2], largely because of the ease of access and the vast availability of digital content [3,4]. Despite these advantages, concerns remain regarding the credibility and accuracy of such information. A substantial proportion of drug-related websites lack appropriate verification processes, increasing the risk of misinformation that may negatively affect public health outcomes [5,6].

Given the abundance of online health information, users must exercise discernment in identifying credible sources. Inaccurate or misleading content can lead to inappropriate self-medication and poor health outcomes [7,8]. Thus, systematic evaluation of online drug information is essential to ensure public access to accurate and trustworthy content [9]. Nevertheless, research specifically assessing the quality of online drug information remains limited [10]. Existing studies often focus more broadly on health information and frequently employ tools such as the authority, accuracy, objectivity, currency, and coverage (AAOCC) framework, which, although valuable, are not specifically designed for evaluating drug-related content in Indonesia [11]. To date, no published studies have systematically evaluated Indonesian drug information websites for the general public using validated instruments tailored to drug information assessment.

Robillard et al. [12] introduced the Quality Evaluation Scoring Tool (QUEST), a validated and reliable instrument for assessing the quality of online health information. QUEST, the first quantitative tool developed for this purpose, has been applied to various types of health content, including drug-related information [13]. Its reliability and validity were further supported in a study that systematically assessed the quality and readability of online articles retrieved from frequently searched COVID-19-related terms on Google in the United States [14].

The Faculty of Pharmacy at Universitas Andalas identified a pressing need to develop a verified drug information system for several reasons. First, Indonesia currently lacks a drug information platform explicitly designed to meet international quality standards, such as those reflected in the QUEST framework. Second, there is a clear gap in local research focused on evaluating the quality of drug information available to the public. Third, as an academic institution with established expertise in pharmaceutical sciences, the faculty is positioned to contribute meaningfully to addressing public health challenges by improving access to accurate and reliable drug information.

II. Methods

This study comprised two main components: (1) evaluation of drug information available on Indonesian health websites and (2) development of a web-based drug information system.

1. Evaluation of Online Drug Information

1) Sample selection

The list of websites was obtained from Google search results using keywords identified through Google Search Trends. The query parameters applied were: Indonesia, past 12 months, medicine and treatment, and web search. Keywords were generated from the top queries over the previous twelve months, with the search conducted on August 29, 2024 (covering the period from August 29, 2023 to August 29, 2024).

These keywords (Table 1) were then entered into the Google Search engine. Health websites were collected using the Google extension Instant Data Scraper. Websites appearing within the first 10 pages of search results were included, as users typically review the first 100 results [15]. This approach was intended to replicate how the general public searches for health information [16]. Eligible websites met the following inclusion criteria: (1) drug information websites active in Indonesia and (2) Indonesian-language websites with either an Indonesian or commercial domain that were publicly accessible.

Table 1

Keywords obtained from Google Search Trends

Websites were evaluated based on their first appearance in the search results for each keyword. If a site appeared more than once across different keyword searches, it was classified as a duplicate and evaluated only at its first occurrence. This ensured that each website was assessed once, avoiding redundancy. The exclusion criteria were: (1) websites operated by Indonesian government agencies; (2) websites affiliated with healthcare providers such as hospitals, clinics, pharmacies, or pharmaceutical industries; (3) online forums and social media platforms; (4) websites targeting professional audiences or specific subgroups (e.g., students from a specific institution); (5) sites consisting exclusively of video content, promotional material, or news dashboards; and (6) product listings from e-commerce platforms such as Shopee, Blibli, or Tokopedia. These criteria ensured the inclusion of only general-purpose drug information sources relevant to the public. The complete process of sample selection is presented in Figure 1.

Figure 1

Data collection strategy.

2) Website evaluation

The quality of drug information websites was assessed using the QUEST, a validated instrument developed for the rapid evaluation of health-related content across diverse audience groups [12]. QUEST was selected because of its reliability and ease of use. Alternative tools, such as DISCERN and the LIDA Minervation instrument, were not employed due to their limitations. DISCERN, although publicly accessible, is largely restricted to assessing treatment options and lacks broader applicability, while LIDA is no longer actively maintained or available online [12].

QUEST evaluates six dimensions: authorship, attribution, study type, conflict of interest, currency, complementarity, and tone [12]. The scoring system provides a maximum of 28 points (equivalent to 100%). Websites are categorized into three quality levels based on total score: low (≤9), moderate (10–18), and high (>18) [17]. Higher scores indicate better information quality. The detailed QUEST criteria and scoring framework are provided in Table 2.

Table 2

Description of the QUEST criteria [12]

3) Data analysis

Data analysis was conducted using Microsoft Excel. Results were presented in tabular form, including QUEST scores and percentage distributions. Descriptive statistics were applied to classify website quality into the predefined categories established by the QUEST scoring system (Supplement A).

III. Results

1. Evaluation of Online Drug Information

Evaluation of 14 Indonesian drug information websites using the QUEST instrument produced an average total score of 13.71 out of 28, equivalent to 48.98% (Table 3). Among the assessed dimensions, Tone received the highest average score (78.57%), suggesting that most websites presented information in a transparent and trustworthy manner. This was followed by authorship and complementarity (both 71.43%), indicating that many websites identified their content authors and provided interactive features such as online consultation services.

Table 3

Detailed QUEST evaluation results of drug information websites

In contrast, lower scores were recorded in currency (42.86%) and attribution (28.57%), underscoring weaknesses in content updates and the citation of information sources. The lowest-scoring dimension was the type of study (21.43%), reflecting the general absence of evidence-based references or clearly identified research sources.

As presented in Table 4, the highest-scoring websites included AMK (92.86%), ADR (89.29%), and DST/HST (71.43%), all of which demonstrated strong adherence to QUEST quality criteria. By contrast, the lowest-scoring sites were GTR, GSH, and MSB (28.57%), IPA (25.00%), DHA (3.57%), and HOT (0%). AMK offered the most comprehensive and well-structured information, whereas HOT ranked the lowest due to absent authorship, lack of source attribution, biased presentation, and contradictory or unsupported claims (For detailed information on the drug information website, see Appendix 1).

Table 4

Rankings of drug information websites based on QUEST scores

Based on QUEST score categorization (Table 5), five websites (35.71%) were classified as high quality, five (35.71%) as low quality, and four (28.57%) as moderate quality. These results underscore the wide variability in information quality across drug information websites publicly accessible in Indonesia.

Table 5

Details of websites by quality category based on QUEST score ranges [17]

2. Development of a Website-Based Drug Information System

The website Drug Information – Faculty of Pharmacy, Universitas Andalas was developed using the Google Sites platform and is accessible at https://sites.google.com/view/informasi-obat-farmasi-unand/home. The site features a user-friendly homepage, an alphabetically searchable drug information section, a user suggestion box, and detailed content on paracetamol as the prototype entry. The homepage serves as the main navigation hub, with clearly labeled buttons that provide direct access to site components.

Based on QUEST evaluation (Table 6), the website achieved a total score of 27 out of 28 (96.43%), reflecting excellent overall quality. High scores were recorded across most domains—Authorship, Attribution, Type of study, Conflict of Interest, Currency, and Tone—demonstrating strong credibility, clarity, and up-to-date content. However, the website scored 0 in the Complementarity domain, indicating the absence of interactive features such as direct communication with healthcare professionals.

Table 6

QUEST evaluation results of the drug information website developed by the Faculty of Pharmacy Universitas Andalas

IV. Discussion

Evaluation of 14 Indonesian drug information websites using the QUEST revealed substantial variation in the quality of publicly available health content. The overall average score was 13.71 out of 28 (48.98%), indicating that most websites fall below optimal standards for reliable drug information.

Among the seven QUEST criteria, tone received the highest average score (78.57%). This suggests that most websites employed a balanced, professional, and consistent writing style. A neutral tone, free from exaggerated or biased language, is critical for fostering user trust and minimizing the risk of misinterpretation [20]. For example, the AMK website demonstrated effective use of impartial language, presenting drug-related information clearly without overstating benefits or downplaying potential risks.

The authorship criterion also received a relatively high score (71.43%), reflecting that many websites disclosed either the names of authors or their institutional affiliations. Transparency in authorship is a key component of credibility, as it enables users to assess the expertise and trustworthiness behind the information provided [21,22]. Notably, websites such as DST and HST explicitly listed author credentials and affiliations, thereby strengthening the authority and reliability of their content.

Figure 2

User interface display of the Drug Information – Faculty of Pharmacy, Universitas Andalas website.

Similarly, the complementarity criterion achieved a score of 71.43%, reflecting the availability of supportive features designed to complement core drug information, such as online consultation services. Websites like DST and HST exemplified this by integrating interactive options, including virtual doctor consultations. These services are consistent with recommendations from the World Health Organization, which in 2016 emphasized the importance of digital health tools for improving accessibility and supporting informed decision-making [23].

The conflict of interest criterion yielded an average score of 50%, showing that approximately half of the evaluated websites disclosed potential commercial influences on their content. Several websites—including HDC, KDR, DHA, HOT, GTR, MSB, and HSD—scored 0 in this category, as they provided no conflict-of-interest statements despite visibly displaying affiliate links or sponsor-driven material.

Undisclosed commercial influences undermine the credibility of health information and erode public trust. Prior research has shown that sponsorship or promotional bias, if not transparently disclosed, can significantly distort public perceptions and influence decision-making about drug use [24]. Explicit conflict-of-interest statements are therefore essential to maintain transparency and uphold content integrity.

Despite certain strengths, notable deficiencies were evident in other quality domains. The currency criterion, with an average score of 42.86%, showed that more than half of the websites were not regularly updated. This is concerning because outdated medical information, especially on treatment protocols or drug safety, can mislead users. Prior studies have consistently highlighted the lack of timely updates as a major limitation affecting the reliability of online health resources [25,26].

The attribution criterion also performed poorly (28.57%), reflecting widespread absence of transparent, verifiable references. Many websites failed to cite credible sources to support their claims, and some, such as HOT, displayed overt bias without disclosing their evidence base. The absence of citations reduces users’ ability to evaluate the reliability of content and trace information back to authoritative sources.

The lowest-performing criterion was Type of Study, with an average score of only 21.43%. This indicates that most websites did not reference primary scientific literature or specify the nature of the evidence used. The lack of citations from high-quality studies, such as randomized controlled trials or meta-analyses, weakens the scientific foundation of the content. Only a few websites, such as AMK, ADR, and HSD, adhered to evidence-based standards by referencing peer-reviewed research. In contrast, websites such as HOT and DHA omitted scientific references altogether, underscoring the need for more rigorous sourcing to enhance credibility and user confidence [25].

According to the overall rankings (Table 4), the AMK website achieved the highest QUEST score at 92.86%, followed by ADR (89.29%) and DST and HST (71.43%). AMK consistently demonstrated excellence across nearly all evaluation criteria, reflecting its evidence-based, well-structured, and responsibly curated drug information. Its strong performance suggests deliberate effort to provide scientifically grounded and trustworthy content.

In contrast, websites such as HOT (0%) and DHA (3.57%) received the lowest scores, failing to meet essential quality benchmarks across nearly all domains. These sites lacked basic elements such as authorship disclosure, source attribution, content updates, and references to credible scientific literature. Such deficiencies significantly compromise their reliability and highlight the risks posed by unregulated online health content.

The distribution of websites by quality category (Table 5) shows that among the 14 assessed, 35.71% fell into the low-quality category (QUEST score ≤9), 28.57% into the moderate category (score 10–18), and 35.71% into the high-quality category (score >18). While a proportion of websites achieved acceptable standards, the high prevalence of low-quality sites underscores the urgent need for improvements in content accuracy, credible referencing, and responsible dissemination of drug-related information.

These findings yield several important recommendations for providers of online drug information. First, transparency should be strengthened by clearly disclosing both authorship and institutional affiliations. Second, all health-related claims should be supported by robust scientific references, particularly from peer-reviewed sources such as clinical trials and meta-analyses. Third, content must be updated regularly to reflect the latest developments in medical and pharmaceutical science. Fourth, the incorporation of interactive features—such as online consultations with qualified healthcare professionals—can enhance user trust and encourage appropriate application of the information. Evidence indicates that integrating digital health information with accessible healthcare services improves both user satisfaction and outcomes [23].

The QUEST framework provides a valuable guide for web administrators and health content developers seeking to improve the quality of online drug information. Particular attention should be directed toward addressing recurring weaknesses, including inadequate source attribution, outdated content, and the absence of credible scientific references.

The development of the Drug Information – Faculty of Pharmacy, Universitas Andalas website represents an initial effort to provide an accessible, accurate, and educational drug information platform, particularly in the context of pharmacy education. Employing the RAD model allowed for a phased, user-centered design process responsive to evolving user needs and feedback [27]. The process began with a needs analysis and planning phase, identifying core content, appropriate media, and interface requirements. Ensuring public access to accurate, unbiased drug information—optimized for use across devices—was established as a central priority [28].

During the design phase, the website was created using the Google Sites platform, selected for its simplicity, integration flexibility, and compatibility across devices. Core features include a homepage, a searchable drug information section, health-related articles, and a suggestion box for user feedback. Visual appeal was also prioritized to promote user engagement.

Paracetamol was selected as the prototype entry for drug information content due to its widespread use as an over-the-counter analgesic and antipyretic. As one of the most commonly used drugs worldwide, and included in Indonesia’s list of limited over-the-counter medications available without prescription, paracetamol provides a relevant and valuable starting point for public education [29,30]. The information presented includes dosage guidelines, therapeutic indications, contraindications, and potential side effects, with the aim of promoting informed and safe medication practices.

Evaluation of the website using the QUEST instrument resulted in a total score of 27 out of 28 (96.43%), indicating excellent overall quality. Six of the seven QUEST domains achieved maximum scores. The authorship criterion was rated highly because of clear identification of the author and affiliated institution, enhancing credibility. The Attribution and Currency domains were also satisfied through the inclusion of up-to-date, relevant references. Similarly, the conflict of interest and type of study criteria were addressed transparently, ensuring responsible disclosure and reliance on credible sources. The tone of the information was neutral and professional, avoiding promotional or biased language.

However, the Complementarity criterion received a score of 0, reflecting the absence of interactive features such as direct communication with healthcare professionals. Future development phases will aim to integrate such services, including pharmacist or physician consultations, to improve user engagement and support informed decision-making. These findings suggest that the website has strong potential to fill existing gaps in the quality of online drug information available to the Indonesian public.

This study has several limitations that should be considered. First, the generalizability of the findings is constrained, as the study was conducted within a single institutional setting. Second, in light of the growing role of digital health technologies, future system development should incorporate user feedback throughout both design and implementation phases to enhance usability and relevance to target audiences. Third, although the current platform demonstrates high quality based on QUEST scoring, further enhancements are needed in terms of scalability and functionality. These include upgrading the website development framework, expanding interactive features, and improving the efficiency of content delivery.

Supplementary Materials

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