Using both quantitative and qualitative approaches to data collection, this study aimed to examine the quality of health news published and the factors affecting their publication. The results of the quantitative section revealed that 18% of the news did not scientifically qualify for public dissemination. The qualitative data illustrated that multiple factors at different levels affect the quality of news. From the journalists and editors-in-chief's perspectives they were level of research, health awareness and also difficulties in translation of documents. The factors that influenced research quality from the researchers’ side were lack of familiarity with journalistic techniques, not having a clear perspective towards the media, competition among researchers and also ties between researchers and commercial or pharmaceutical companies. Context-related barriers e.g. organizational policies, affected both sides.
The generalizability of the results of examining 100 out of 410 news articles can be considered the limitation of this study. However, it is safe to say that selection bias does not appear to be a problem. We argue that because the 29 research articles accessed were from reputable journals, enlisted in Tehran University of Medical Sciences digital library, the full texts that were not accessible are not expected to be of higher quality than those found. Therefore, not only is 18% not an overestimate, but also the percentage may even be considered an underestimate, because, in this study we only examined the quality of news evidence. No doubt, if more than one criterion, i.e., examining the quality of evidence, such as those recommended by Media Doctor (was taken into consideration, assessment of advantages and disadvantages, and conflicts of interests) , then the percentage of news unfit for public dissemination would exceed 18%, but the purpose of this study was to study the quality of evidence alone.
According to Table 1, 27.6% of the news articles that had cited a peer-reviewed journal did not qualify for publication. This proportion was 7.5% in the news that had not referred to the research articles at all. It seems that journalists do not appropriately reflect evidence from research articles. They disseminate their own impressions of the subject, while they cite the research article.
The two factors identified at the level of researchers and journalists in the qualitative section of the study were inadequate knowledge and motivation. Studies conducted elsewhere also report that the selection and creation of news is inevitably influenced by journalists’ knowledge, ideology, interests, and factors such as driving the viewer or reader’s attention, practical limitations and political atmosphere [16–19]. Another aspect of health news is that even though journalists may be professional in the field of news, they have insufficient knowledge in health sciences [20, 21]. Other identified factors are health news translators’ inadequate knowledge of health topics and mastery of the language, competition among journalists, and absence of specialized health journalists. Many of the news items published are based on translations of literature and articles, therefore it is better to have translators familiar with medical and health sciences, national health policies and priorities, to prevent unscientific translations and to promote appropriate news selection . In the qualitative section of our study too, some of the journalists expressed concern over their ability to understand, interpret and translate English into their own language. Therefore focusing on this aspect will help improve the quality of health news. Journalists’ time constraints and limited knowledge have been stated as the most important barriers in promoting health journalism by Larsson. Competition, difficulties in understanding scientific terminologies, finding and using references and economic issues are other barriers she underscored . Even though we also identified economic factors to be influential in news selection, which is a similar finding to that in developed countries, its nature and severity may be different. Hochman et al. were concerned with pharmaceutical company funding of medical research as an influential factor; in many instances the journalists are not aware of a pharmaceutical company sponsor . Moynihan et al. believed that the benefits of medications are exaggerated or highlighted and their side effects are sidestepped and that such behaviors are the results of financial ties with drug manufacturers .
Inadequacy of editors and gatekeepers awareness regarding research methodology and critical appraisal is another reason identified in our study. These individuals are the ones who have ultimate authority over what gets published, so it is necessary for them to acquire such knowledge.
On the other hand most researchers do not possess journalistic skills, and do not pay attention to the appeal of the title. That is why journalists alter the content of the news and its accuracy to make the news appealing. Training researchers or directly linking them to journalists in the news production process can prove helpful.
The third factor identified was context-related barriers. Certain steps taken in other countries have strengthened their infrastructures. For example, in 1991 the ‘Press Complaints Commission’ in UK designed a framework and obligated it for the press. Subsequently, if incorrect material is published, immediate notification and fair reporting should take place . Also, principles for producing and disseminating health news have been designed by ‘The Association of Health Care Journalists’ (AHCJ), an independent association compromising 750 members . Such measures have not entered Iran’s health news arena and we have yet to take steps toward standardizing the procedure. Literature shows that pressurizing alone does not help in implementing these principles; educating journalists and editors in the field is a more effective approach . Our results also show that educating journalists may prove beneficial. In Iran the Masters degree in Medical Journalism was initiated in the universities in 2009. But, only MD degree holders are admitted, and, by the time this paper was written (2011) the admittance capacity was three per year only . Training researchers and health journalists and monitoring health news production have been recommended elsewhere too. Entwistle et al. have proposed solutions for improving the current situation through creation of health news knowledge networks under which health journalists, editors-in-chief, clinical service providers, researchers and consumer right activists can act unanimously. Among other solutions are: commitment to establishment of medical report review committees for quality monitoring, pointing out possible flaws and shortcomings of research, and educating news producers to critically appraise medical news [3, 20, 23]. Already, certain organizations comprising specialists have been created around the world to monitor the news disseminated. For example ‘Media Doctor’ in Australia and Canada and ‘Health News Review’ in USA review health news reports on the basis of certain criteria and display only those news items that are eligible in their sites . Developing and strengthening such sites is one way of overcoming the current problems in the field.
To wrap it up, the results of our study imply that developing countries need to create infrastructures in news producing organizations; to strengthen the quality of health news, to design guidelines and to foresee necessary procedures for capacity building among the concerned manpower.