PracticalDermatology

Search and Engagement Analysis of Association Websites Representing Dermatologists—Implications and Opportunities for Web Visibility and Patient Education:

Website Rankings of Dermatology Associations

By Shuai Xu MD, MSc (Lond.), Ashley M. Nault BS, and Ashish C. Bhatia MD, FAAD

More than 70 percent of Internet users have searched for health information online.1 As a field, dermatology can be considered an early web adopter.2 This is not surprising given the visual nature of the specialty. Prior works have assessed dermatology’s presence in regard to health information online,3 mobile applications,4 and social media.5 Central to a visible web presence is a website’s ability to rank highly with search engines. There is limited understanding of how websites representing dermatological associations perform in regard to visibility and user engagement.

Methods

The Alexa database and the Open Directory Project were used to identify dermatology association websites. For each website, traffic volume and engagement metrics were determined. The top 25 keywords that led users to an association’s website were collected and categorized as a general search term, a diagnosis-specific term, a treatment term, a specific therapy-related term, or miscellaneous. Social media activity on Facebook, Twitter, and Google+ was also determined. This study was IRB exempt per Northwestern University policies.

Results

Of 196 dermatology websites, 29 dermatology association websites were identified (Table 1). Dermnetnz.org (DermNet New Zealand Trust) ranked Number 1 with more than one million visits and 2.3 million page views monthly. The American Academy of Dermatology (AAD) website ranked second with slightly fewer visitors per month than Dermnetnz.org but more page views (2.9 million). However, the AAD website did exhibit the highest number of citing links (5,304) from other websites, suggesting authoritative content. The American Osteopathic College of Dermatology (AOCD) ranked third with approximately 300,000 monthly visitors and page views. For the rest, only global rankings were available based on a three-month average. In terms of engagement, the International Dermoscopy Society website had the highest daily page views and daily time spent on the site. Overall, search engine traffic accounted for 14 percent to 47 percent of a website’s visitors. The keyword analysis shows that the majority of search terms that drive visitors to top association websites pertain to specific diagnoses. For the AOCD website, diagnosis searches accounted for 96 percent of visitors from search engine queries for the top 25 keywords. Generally, websites with higher rankings exhibited the most Facebook and Twitter activity.

Discussion

The 29 websites studied comprise dermatologists worldwide. Two dermatology websites represent the most visible and authoritative websites (dermnetnz.org and AAD.org). These sites have large amounts of content on dermatological conditions. Since the most common search terms that drive traffic to top association websites are diagnosis related, future efforts by associations should include high-quality authoritative content on specific diagnoses. The lack of traffic related to treatments such as medications represents an opportunity for further content development. It is unsurprising that social media activity and highly ranked websites build upon one another—associations with greater social media presence on Facebook and Twitter also exhibited higher website rankings.

Highly ranked websites in this cohort are not always correlative to the number of members. The AAD includes more than 19,000 members while the New Zealand Dermatology Association has approximately 60 members. This suggests that websites representing dermatosurgery (American Society for Dermatologic Surgery), dermatopathology (American Society of Dermatopathology), and pediatric dermatology (Society for Pediatric Dermatology) have opportunities to enrich their web presence despite smaller memberships. Ultimately, websites from dermatology associations have inherent authority. Since credibility and accuracy is assumed, their content overcomes the hurdles that face dermatology mobile applications.4 Analogous to a practice gap in the use of mobile applications,6 dermatology associations have an opportunity to better engage patients, policymakers, and its members online. Advertisement-driven websites such as WebMD.com optimize web visibility through their content. Dermatology associations representing physician-experts should consider the same while building content and leveraging their credibility and user base. n

Table 1: The Alexa® ranking represents a 3-month average while global website rankings represent a snapshot in time. The Alexa® rankings are shown as rankings in the category specifically dermatology associations as well as all dermatology websites. Although some websites may have a higher global rank, the Alexa® ranking may be lower due to temporal variations in regards to visitors. Engagement metrics encompass measurements of whether users leave after viewing only one page (bounce rate). A high bounce rate suggests that more users find the website non-engaging. Thus, low bounce rates suggest higher user engagement. Search engine metrics include two inputs. The first pertains to the amount of traffic generated by a search engine to the website. Backlinks represent the number of other websites that link back to the source site. Websites with large amounts of back links, analogous to citations in academic journal articles, suggest an authoritative web resource.

Table 2: The key term analysis includes the 25 most common search terms that led visitors to a dermatology association website. These key terms were organized by a general search for a dermatologist or the association itself (e.g. AAD), a disease specific query (e.g. poison ivy rash), a treatment query (e.g. psoriasis treatment), a specific therapy query (e.g. imiquimod) or miscellaneous.

Shuai “Steve’ Xu MD MSc (Lond.): Steve Xu is a current 2nd year resident in dermatology at Northwestern University in Chicago. He is a graduate of Harvard Medical School. Steve’s interest lies at the intersection between technology, the Internet, and consumer education in dermatology. To this extent, he has published several manuscripts in JAMA-Dermatology and Dermatologic Surgery on social media and dermatology. Furthermore, he’s spoken at national conferences on the subject.

Ashley Nault MD: Ashley Nault is a graduate of the University of Wisconsin School of Medicine and Public Health. She will be attending Mayo Clinic – Rochester for her residency in dermatology.

Ashish C. Bhatia MD FAAD: Dr. Ashish Bhatia received his medical degree from Northeast Ohio Medical University (NEOMED) in Rootstown, Ohio, and underwent a residency in dermatology at the Medical College of Virginia Hospitals in Richmond, where he served as Chief Resident. He completed a fellowship in Mohs micrographic surgery, cutaneous oncology, reconstruction, laser surgery, and cosmetic surgery at SkinCare Physicians of Chestnut Hill in Chestnut Hill, Massachusetts. Currently he is an associate professor of clinical dermatology at the Feinberg School of Medicine of Northwestern University in Chicago, Illinois, and Medical Director for Dermatologic Research at the Department of Clinical Research at the DuPage Medical Group and Co-Director of Dermatologic, Laser and Cosmetic Surgery at The Dermatology Institute–Naperville in Naperville Illinois. Dr. Bhatia lectures nationally and internationally, and has published extensively in textbooks and medical journals. He is a member of the American Academy of Dermatology, the American Society for Dermatologic Surgery, the American Society for Laser Medicine and Surgery, and the American College of Mohs Surgery. In addition to skin conditions, his clinical focus is on Mohs micrographic surgery, skin cancer therapy, as well as aesthetic surgery.

Acknowledgements

Author contributions: Dr. Xu and Ms. Nault had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Xu and Bhatia. Acquisition, analysis and interpretation of data: Xu, Nault, and Bhatia. Drafting of the manuscript: Xu, Nault, and Bhatia. Critical revision of the manuscript for important intellectual content: Xu, Nault and Bhatia. Statistical analysis: Xu.

Financial Disclosures: None reported

Funding/Support: This study was unfunded.

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