3,276 Web users took part in this latest Health On the Net Foundation poll. 58% are from North America and 28% from Europe, with the remaining 14% from South America, Oceania, Asia, Africa, the Middle East and Central America. Overall, there is a good mix of participant-types: 46% of the total number of respondents are professionals or students in healthcare, the rest "non-medical" users.

This survey has helped the HON team set another important milestone in our understanding of the medical Internet. In summary:

• More than half of this random international sampling are women, confirming the steady advance of female users of Web-based healthcare information.
• Healthcare professionals still seem to be struggling to integrate on-line information retrieval with the daily practice of medicine.
• At the same time, healthcare publishers and service providers on the Web are facing increasingly demanding and discriminating consumers.

Below are what we believe to be the most important findings. You can also go directly to our survey results page and select the ingredients for your own analysis [1].

• Main findings
1. General user trends
2. Drugs and patient-provider communications
3. The top ten medical and healthcare Web sites
• Statistics and analysis
• Methods
• About Health On the Net Foundation
• Privacy policy and disclaimer
• Acknowledgements

This is a presentation of some of the data from our October-November 1999, survey. For a better understanding of the replies analysed below, please consult the questionnaire [2].

This data is published in the public interest. We at HON seek to use the information from our surveys to improve our services to users, in keeping with our not-for-profit status and our respect for data privacy and user anonymity (see Privacy policy and disclaimer).

Below is a selection of results that struck us as particularly interesting. They are in three parts.

• The usefulness of medical cyberspace continues to grow.

° 98% of all respondents agreed with the statement, "I have found useful medical/health information on the Internet."
° User appreciation has risen continually ever since the first HON survey in February-March 1997 found 52% strongly agreeing.
° Over the same period, the number of "don't-knows" (those neither agreeing or disagreeing with the statement) has fallen steadily, from 8% to 2%.

• Links, search engines, the presentation of information and users' Web surfing skills all seem to be steadily improving.

° 88% of all respondents either agree or strongly agree with the statement, "I have found the medical/health information I was looking for".
° This figure includes 40% who "strongly agree", up from 22% in the first survey in February-March 1997.
° The total number disagreeing with this statement has fallen steadily, from 21% in the first HON survey down to 7% in the October-November 1999 survey.

• However, despite growing familiarity with the medium, more users than ever say information quality is insufficient.

° A record 71% of all HON survey respondents either agree or strongly agree with the statement "The quality of medical/health information on the Internet needs to improve".
° This number was 53 % in our third survey (May-June 1988) and 69% in the fourth (March-April 1999).
° The number expressing no opinion on this issue (answering "neither agree nor disagree") dropped from 37% of the total to 15% over the same period.

• Less than half of all doctors in the U.S. and Europe are using the Internet.

° Only 45% of all respondents (as well as 45% of all medical professionals in North America) agree with the statement, "Doctors in my country are actively using the Internet".
° The proportion of medical professionals in Europe who agree is only 38%.

• Evidence on access patterns, however, suggests a major reason is lack of time on the job. 74% of North American doctors and 55% of the European colleagues say they access the Internet "primarily" from home.

• Of all healthcare professionals, nurses appear to be the most active users of the Internet.

° 31% of the total number of medical professionals say they are nurses, the biggest single group in this category.
° Nurses, too, appear unable to combine Internet research with their professional duties. In North America 65% – and in Europe, 53% – access "primarily" from home.

• North American seekers of on-line health information are older than their European counterparts and far more likely to access from home.

° 69% of all U.S. and Canadian users are over 40 years old – and 38% are over 50 – while only 49% of Europeans are over 40.
° 65% of all North Americans – across all professions and user types – access mainly from home, compared to 48% of Europeans.

• Women have steadily grown into a clear majority of medical-Internet users.

° 51% of all respondents to the October-November 1999 HON survey are female, compared to 47% in the March-April 1999 survey and 38% in the first survey (February-March 1997).
° North American women outstrip their menfolk, with 64% of the total number of North American respondents in October-November 1999, up from 61% in March-April 1999.

A new section of the October-November 1999 survey questionnaire sought to explore how patients and their care providers learn about – and buy – pharmaceutical products on the Internet. It also questioned them about their use of email and other Web-based communications.

The key findings:

• 79% of all respondents say they use the Web to seek information on pharmaceutical drugs.

° The proportion climbs to 83% of all respondents from medical professions ; 81% of healthcare professionals in North America use the Web for this purpose, compared to 73% of the same category in Europe.
° 84% of all respondents from non-medical professions aged 50-59 years – and 88% of the same category aged 60-69 – use the Web for this purpose.

• 58% of all respondents say they discuss drug information they find on the Web with their care providers.

° 75% of all North American users do this, compared to 44% of all Europeans.

• 29% of all patients among the respondents say the "mostly" search the Internet for evidence from the clinical trials of new pharmaceuticals.

° This proportion climbs to 30% for nurses and 36% for medical specialists.

• 16% of all respondents claim to buy drugs via the Internet, with 8% of all respondents specifying "prescription drugs".

° This figure is 18% for North America alone, and 10% for Europe.

• 62% of all respondents say they would be interested in a special HON survey on pharmaceuticals.

• 32% of all responding patients – and the same proportion of general medical practitioners – say they "mostly" search the Internet for support groups.

(Note: In HON's experience, well-managed support groups can help individual patients cope with chronic disease. They can also offer care providers useful peer-group advice and information.)

• Another 32% of the total say they have used on-line medical consultation services offered by Web sites.

(Note : Have one-third of medical Internet users really had interactive sessions with "cyberdocs" already? HON's questionnaire may not have made respondents sufficiently aware of the distinct notions of information retrieval and on-line, person-to-person medical consultation.)

• 21% of all patients among the total number of respondents say they communicate with care providers by email.

° Contrary to expectations, this figure was 26% for Europeans and only 19% for North Americans.
° By contrast, 46% of all healthcare providers claim to engage in email with their patients. The figure breaks down to 52% for North America and 43% for Europe.

The question Which three medical/healthcare Web sites closely meet your needs resulted in the following popularity ranking :

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