WikiJournal Preprints/Accessing health information online in Sweden: Swedish Wikipedia

Introduction
Wikipedia is the world’s largest encyclopedia and is ranked as the 5th most popular website in the world according to Alexa, Inc.. Wikipedia articles related to human health and medicine received an estimated 4.7 billion page views across all languages in 2018. Wikipedia articles come up early in a Google Search for health-related keywords in many countries and medical content on Wikipedia is available in over 274 languages. The readership of these medical articles varies widely and ranges from members of the public, consumers, medical students, clinicians, journalists, and policymakers. In many parts of the world, Wikipedia plays an important role in public health. Given the extensive viewership, ensuring that the information presented in Wikipedia articles is unbiased and of high quality is important.

Initiatives to improve the quality and reliability of medical content on Wikipedia are expanding. Medical schools are starting to incorporate Wikipedia editing into their undergraduate curriculum, organizations such as Cochrane have established partnerships with Wikipedia with the goal of sharing high-quality health evidence on Wikipedia to improve access to reliable medical information, and there are numerous Wikipedia projects that include translating Wikipedia’s medical content into different languages and making Wikipedia’s medical content available offline.

In this observational study, we were interested in learning more about Sweden’s use of medical content on Wikipedia to determine the potential reach of an initiative to improve Swedish medical content on Wikipedia.

Methods
This observational study included of a literature search on both MedLine and in the grey literature for information related to online health content in Swedish and online trends. Wikistat, a freely available tool to determine page views on Wikipedia, was used to estimate the article views and percentage from Swedish IP addresses. Trends over time were also estimated using Wikistat. Medical articles in Swedish-language Wikipedia were identified by WikiProject Medicine, a usergroup on Wikipedia that promotes the improvement of medical content on Wikipedia. Results and statistics were peformed in excel and reviewed by two authors (JD and JH).

Findings
The population of Sweden is approximately 10 million. 91% of people in Sweden report that they speak more than one language, and 86% speak English. Wikipedia is the 5th most popular website in Sweden. Swedish Wikipedia content received over 1.1 billion article views in 2018 (Figure 1), and approximately 92% of these article views originated from Swedish IP addresses. People in Sweden accessed Swedish Wikipedia articles 78.24 million times in the month of April 2019 and accessed English Wikipedia articles 53.15 million times in the same month.

Swedish medical content on Wikipedia is growing with more than 4,500 medical-related articles available as of 2019. This content was accessed over 34 million times in 2018. As shown in Table 1, the top 25 medical articles on Swedish Wikipedia received page views ranging from 88,000 - 290,000 page views in 2018. The top 500 medical articles alone on Swedish Wikipedia received close to 19 million page views in 2018. One initiative run by the Swedish Agency of Health Technology Assessment and Assessment of Social Services (SBU) has successfully employed a part-time Wikipedian in Residence.

Discussion
The vast majority of Swedes (88%) use the internet to collect information pertaining to their health. Residents presently have free online access to their personal health records though the government run website "1177 e-service", which receives approximately 7 million page view each month. 94% of young adults in Sweden report that they search the internet for health-related information. This health seeking trend in young adults is not only for their information related to their personal healthy, but also the healthy of friends and family members. "internetmedicin.se", is a popular Swedish health information website and receives approximately 1.2 million page views per month. The goals of online health search behaviour may vary, however these is evidence that young adults search search for information on the internet in order to avoid the need to visit a health care professional in person. An estimated one-third of young people report accessing online health-related materials after an in-person visit to a medical professional. Given that Swedish medical articles on Wikipedia receive over 34 million web site views for 4,500 articles per year (approx. 2.4 million visits per month), we feel that improving the existing resources on Wikipedia is a worthwhile endeavour.

Competing interests
Jennifer Dawson works for Cochrane as a Wikipedia Consultant and is an active board Member of Wikimedia Medicine (Wiki Project Medicine Foundation). James Heilman is on the Board of Trustees of the Wikimedia Foundation and is a special advisor of Wiki Project Med Foundation.

Author Contributions
Methods Design: JD, JH Data Collection: JD, EK, JH First Draft of the manuscript: JD Critical Review: JD, CFJ, JH Approval of Final Version: JD, CFJ, JH Corresponding Author: JD