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of the 8th HON's Survey
of Health and Medical Internet Users
For the past six years, the Health On the Net Foundation has been tracking opinions of Internet users of health information through eight online surveys. The similitude of the surveys each year gives an interesting touch to the potential for understanding trends over the years.
A total of 2621 respondents voluntarily completed the survey questionnaire between May and June 2002. Mainly from North America (United States 38%, Canada 4%, Mexico 1.5%) and Europe (29%), worldwide citizens responded (South America 7%, Asia 6%, Oceania 3%, Middle East 2%, Africa 1.4%) (Table 3). This current paper aims at presenting some observations based on the results. We invite readers to consult the online charts also available for further details  http://www.hon.ch/Survey/Spring2002/res.html .
Both groups of respondents, patients and health professionals, agreed that 'Accuracy of Information' is the most important issue facing the medical Internet. The next item of concern for patients was 'Trustworthiness' and for professionals, 'Finding information/Navigation' and 'Availability of information'.
TABLE 1 MOST CRITICAL ISSUES FACING THE MEDICAL INTERNET
Source: 8th HON Survey, Health On the Net Foundation, May-June 2002. NB: this year, respondents were only allowed to select only one answer among the choices.
Divergent opinions exist about the need for accreditation of health web sites and adoption by Internet users. Actions for regulating or rating the health web have been criticized on several occasions   . Although limited by sample size (<25 respondents) and the brief amount of time spent on each web site, a study performed in Germany revealed that none of the participants clicked to verify the seal carried by some of the sites . This later may reveal a lack of awareness about the seal or verification system. More information on the Internet user's opinion and behaviours in respect to the use of health web sites posting seals of accreditation is needed. The following results revealed that respondents showed a positive attitude for the certified sites. About 66% of persons who answered the patient section only (n=1318) think that certification and/or accreditation of medical web sites may help resolve the issues listed above while 71% of professionals (n=1294) expressed a similar opinion. Among all respondents, 59% favor certified web sites, while the rest stated that they did not favor them (25.3%) or did not answer the question (15.6%).
The most familiar accreditations or trust mark systems were the HONcode and the Good Housekeeping Seal of Approval, selected by 50.3% and 27.5% of respondents (n=2621) respectively. The third most familiar mark was Trust-e (13.4%). About 6% of respondents were familiar with the Internet Health Care coalition. The least familiar to respondents were the URAC accreditation and the NetScoring mark (<5%). However, 29.3% were not familiar with any of the proposed marks, revealing a need for public education. Part of the difference observed in familiarity level may be an artefact of the recruitment process.
Survey respondents demonstrated a high degree of Internet use in their health care dealings. As many as 62% of patient-type respondents have discussed the results of their Internet searches with their care providers (n=1318) which is a larger proportion than previously reported (38% USA; 33% German; 17% Japanese respondents) , and 37% have used online consultation services offered by web sites (76% of them occasionally, 24% frequently).
Medical professionals have embraced the Internet, with nearly half (48.9%, n=1294) engaging in email correspondence with their patients. Among those who gave precision about the frequency of this behaviour, 20% reported emailing frequently and 80% occasionally (n=537). About one third of medical professionals reported recommending online discussion lists to their patients while 62.75% make web site recommendations.
Little information is known about the potential differences in Internet utilization among patients and health professionals. Forty-six percent (46%) of patients (n= 1256) preferred to use general search tools compared to 28% who preferred medical search tools. However, contrasting preferences are observed among health professionals (n= 1282) where 57% preferred using medical search tools compared to 28% who preferred general search tools. However, caution is needed to analyse these figures, which may hide a lower awareness of medical search engines within the general public but not necessarily a definite preference.
FIG.1 PREFERENCE OF PATIENTS AND PROFESSIONALS FOR DIFFERENT TYPES OF SEARCH ENGINES
Sources: 8th HON Survey, Health On the Net Foundation, May-June 2002.
Trends Over the Years
TABLE 2 TRENDS OF THE INTEGRATION OF TECHNOLOGY IN HEALTH CARE BEHAVIOURS
Sources: * 8th HON Survey, Health On the Net Foundation, May-June 2002. ** 7th HON Survey, Evolution of the Internet use for health purposes, Health On the Net Foundation, Feb-March 2001. § - 1st HON Survey, Health On the Net Foundation, Oct-Nov 1999.
The comparison of the respondents' profiles over the years is also an interesting aspect representative of Internet penetration worldwide. European citizens may present e-health behaviours in various proportions (data not presented here subject to publication approval). Cultural variation was also observed when evaluating the ratio of patients or professionals responding to the surveys in USA or Europe.
Barriers and Preferences when using the Web
This access to more complex information may raise concerns or fears from some researchers or health professionals, worried that patients could misunderstand or become lost in the torrent of medical information. However, it can be reassuring that patients are taking active autonomous actions; first by performing alternative searches to clarify information (86%) and to a lesser extent, by asking their doctor (32%) if they do not understand the information read online (n=853).
Profile of Respondents
HON surveys have been posted on the HON Web site. A link
from HON's home page led users directly to the questionnaire. HON's
news list members were invited by email to fill the survey. Announcements
and links to the 8th HON survey was also posted on 100 collaborative
Web sites to help reaching
participants and potentially increase generalizability with a larger
diversity of respondents.
The Health On the Net (HON) Foundation (http://www.hon.ch/) has been actively working to improve Internet access to quality health information and encourage ethical behaviour by health web sites since 1996. HON is mainly recognised and known worldwide for its HONcode accreditation of health web sites. As a pioneer observer of the medical Internet HON, established in Geneva, Switzerland, has recently been accorded Non-Governmental Organization (NGO) status by the United Nations, becoming the first online health accreditation agency with this status.
We would like to thank all respondents, and the web sites who collaborated by announcing the survey. Without this collaborative effort of the Internet community, our understanding of the health information users would be very limited.
The Health On the Net. Spring 2002 Survey Responses, URL: http://www.hon.ch/Survey/Spring2002/res.html