What Is the Quality of Web-Based Advice for the General Public on Benzodiazepine Misuse and Use Disorder? A Systematic Evaluation of Websites

Figures & data

Figure 1. Flowchart of the search outcomes.

Table 1. Evaluation of benzodiazepine websites using the DISCERN Instrument Questions.

Question	1 = No	2	3 = Partially	4	5 = Yes	Mean	SD	Median
	n (%)	n (%)	n (%)	n (%)	n (%)
Q1. Are the aims clear? (N = 56)	18 (32.1)	25 (44.6)	10 (17.9)	2 (3.6)	1 (1.8)	2.0	0.9	2.00
Q2. Does it achieve its aims? (N = 38; N/A = 18)^a	0 (0)	0 (0)	0 (0)	3 (7.9)	35 (92.1)	4.9	0.3	5
Q3. Is it relevant? (N = 56)	2 (3.6)	0 (0)	4 (7.1)	14 (25)	36 (64.3)	4.5	0.9	5
Q4. Is it clear what sources of information were used to compile the publication (other than the author or producer)? (N = 56)	16 (28.6)	10 (17.9)	11 (19.6)	10 (17.9)	9 (16.1)	2.8	1.5	3
Q5. Is it clear when the information used or reported in the publication was produced? (N = 56)	10 (17.9)	16 (28.6)	10 (17.9)	11 (19.6)	9 (16.1)	2.9	1.4	3
Q6. Is it balanced and unbiased? (N = 56)	4 (7.1)	10 (17.9)	15 (26.8)	12 (21.4)	15 (26.8)	3.4	1.3	3
Q7. Does it provide details of additional sources of support and information? (N = 56)	11 (19.6)	17 (30.4)	8 (14.3)	6 (10.7)	14 (25)	2.9	1.5	2.5
Q8. Does it refer to areas of uncertainty? (N = 56)	34 (60.7)	12 (21.4)	7 (12.5)	2 (3.6)	1 (1.8)	1.6	1.0	1
Q9^b. Does it describe how each treatment works? (N = 50; N/A = 6)	7 (14.0)	14 (28.0)	17 (34.0)	6 (12.0)	6 (12)	2.8	1.2	3
Q10. Does it describe the benefits of each treatment? (N = 50; N/A = 6)	4 (8.0)	20 (40.0)	16 (32.0)	7 (14.0)	3 (6.0)	2.7	1.0	3
Q11. Does it describe the risks of each treatment? (N = 50; N/A = 6)	14 (28.0)	9 (18.0)	19 (38.0)	2 (4.0)	6 (12.0)	2.5	1.3	3
Q12. Does it describe what would happen if no treatment is used? (N = 50; N/A = 6)	8 (16.0)	9 (18.0)	14 (28.0)	10 (20.0)	9 (18.0)	3.1	1.3	3
Q13. Does it describe how the treatment choices affect overall quality of life? (N = 50; N/A = 6)	15 (30.0)	18 (36.0)	11 (22.0)	3 (6.0)	3 (6.0)	2.2	1.1	2
Q14. Is it clear that there may be more than one possible treatment choice? (N = 50; not applicable = 6)	5 (10.0)	8 (16.0)	19 (38.0)	6 (12.0)	12 (24.0)	3.2	1.3	3
Q15. Does it provide support for shared decision-making? (N = 50; N/A = 6)	13 (26.0)	14 (28.0)	11 (22.0)	9 (18.0)	3 (6.0)	2.5	1.2	2
Q16. Based on the answers to all of the above questions, rate the overall quality of the publication as a source of information about treatment choices. (N = 56)	5 (8.9)	19 (33.9)	24 (42.9)	8 (14.3)	0 (0.0)	2.6	0.8	3

N/A = not applicable. ^aOnly rated if question 1 scored 2 or more on. ^bOnly rated if websites included information on treatment, including “self care.”

Table 2. Evaluation of benzodiazepine websites using selected Lida questions.

Question	1 = Never	2 = Sometimes	3 = Mostly	4 = Always	Mean	SD	Median
	n (%)	n (%)	n (%)	n (%)
Q1. Is it clear who runs the site? (N = 56)	1 (1.8)	1 (1.8)	2 (3.6)	52 (92.9)	3.9	0.5	4
Q2. Is it clear who pays for the site? (N = 56)	24 (42.9)	8 (14.3)	7 (12.5)	17 (30.4)	2.3	1.3	2
Q3. Is there a declaration of the objectives of the people who run this site? (N = 56)	3 (5.4)	3 (5.4)	2 (3.6)	48 (85.7)	3.7	0.8	4
Q4. Is the navigation clear and well structured? (N = 56)	0 (0.0)	4 (7.1)	4 (7.1)	48 (85.7)	3.8	0.6	4
Q5. Can you always tell your current location on the site? (N = 56)	9 (16.1)	15 (26.8)	11 (19.6)	21 (37.5)	2.8	1.1	3
Q6. Is the layout of the main block of information clear and readable? (N = 56)	0 (0.0)	2 (3.6)	14 (25)	40 (71.4)	3.7	0.5	4
Q7. Is the site structure (categories or organization of pages) applied consistently? (N = 56)	1 (1.8)	4 (7.1)	8 (14.3)	43 (76.8)	3.7	0.7	4
Q8. Does the website integrate appropriate non-textual media? (N = 56)	14 (25)	8 (14.3)	12 (21.4)	22 (39.3)	2.8	1.2	3

Table 3. Themes present in benzodiazepine websites N = 56 websites.

	Present in websites
	n (%)
Description/indications of benzodiazepines	55 (98.2)
Brand/slang names for benzodiazepines	51 (91.7)
List of withdrawal symptoms	51 (91.1)
Health consequences of benzodiazepine misuse	47 (83.9)
Tapering as treatment option	46 (82.1)
Concurrent drug abuse (e.g., opioids, alcohol)	45 (80.4)
Other non-pharmacological/psychological support	43 (76.8)
Mentions cold turkey/abrupt discontinuation	39 (69.6)
Addition of pharmacological treatment as a treatment option	36 (64.3)
Suggests a short course of benzodiazepine use e.g. ("2–4 weeks max")	35 (62.5)
Onset of benzodiazepine withdrawal	34 (60.7)
Group therapy	33 (58.9)
Referral to specialist services	33 (58.9)
Reasons for misuse	32 (57.1)
Risk factors for misuse	31 (55.4)
Substitution (to another benzodiazepine) as a treatment option	31 (55.4)
Potency and/or half-lives of benzodiazepines	31 (55.4)
Cognitive behavioral therapy	30 (53.6)
Duration of benzodiazepine withdrawal	29 (51.8)
Names support groups/services	29 (51.8)
Monitoring/observing of withdrawal severity and symptoms	28 (50.0)
Different ways people obtain benzodiazepines	23 (41.1)
Mentions about different ways people abuse/misuse benzodiazepines e.g., crushing/snorting	22 (39.3)
Tapering schedule	21 (37.5)
Outpatient vs inpatient treatment	19 (33.9)
Follow up	13 (23.2)
Complementary therapies/natural medications for withdrawal symptoms	10 (17.9)