Background Methodology Current Survey Analysis Copyright Version franšaise


Analysis of 9th HON Survey of Health and Medical Internet Users


Winter 2004-2005

      

Contents :

            Executive Summary of HON Survey Results 2004-2005

            Section I : Usage of Internet for Health/Medical Purposes

            Section II : Quality

                  II. 1 Most Important Issues Facing the Internet
                  II. 2 Most Familiar Certifications, Accreditations, or Trust Mark Systems
                  II. 3 Preferred Web Sites to Obtain Health Information

            Section III : Impact on the Patient -Physician Relationship

                  III. 1 Positive Aspects
                  III. 2 Negative Aspects
                  III. 3 Patients' and Professionals' Search Engine Preferences

            Section IV : Accessibility and other Ongoing Challenges

                  IV.1 Barriers and Preferences when Using the Web
                  IV. 2 Online Consultation, Prescription and Over -the-Counter Drugs

            Section V : Profile of Respondents

            Method
            About Health On the Net Foundation
            Acknowledgements
            References

 


Executive Summary of HON Survey Results 2004-2005

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More Internet users with high-speed access at home; six or more years of online experience in use of the Internet for health/medical purposes.

The number of Web users has steadily increased since its introduction in 1993, as has use of the Web for health-related purposes. In 2002, most Web users, some 33.2%, had used the Internet for 4-6 years (since 1996-1998); In 2005, most survey respondents, some 44.5%, have used the Internet for 7 years or more (since 1997-1998). Among respondents, Internet newcomers were rare (only about 5% got access within the last 6 months). The majority of survey respondents use the Internet daily, for general Web surfing and email, with easy access for most Internet users (42.6%, n=1975) by means of cable modem or DSL. In 2005, the number of Europeans accessing the clinical trials literature was 10% greater than that of Americans. There are now many more Internet users with high-speed or broadband access at home, and more Internet users with six or more years of online experience.

 

Certifications, accreditations and trust mark systems as indicators of quality and usefulness for health Web sites.

In 2005, the criteria perceived as the most important indicators of quality and usefulness for health Web sites among non-professional and professional groups of users: (1) availability of information, (2) ease of finding information/navigation, (3) trustworthiness/credibility and (4) accuracy of information. Both non-professional and professional users, in Europe and the USA, favor academic/university sites (89.4%, n=1403) and sites sponsored by medical journals (88.9%, n=1394), closely followed by government agencies (86.1%, n=1395). We have also observed that a significant number of Web users, about 25% of a sample of 1,386 persons from all over the world, lack confidence in sites sponsored by pharmaceutical manufacturers and commercial, mainstream media organizations. As in 2002, survey respondents in 2005 are aware of certification schemes, accreditation and quality symbols to distinguish reliable health Web sites. The most familiar accreditation or trust mark system was the HONcode, selected by 51.1% of respondents (n=1500). In 2005, certain organizations were better known, such as the Internet Health Care coalition (from 6% recognition in 2002 to 21% in 2005, n=1500) and Trust-e (from 13.3% in 2002 to 28.9% in 2005, n=1500). We also report the existence of new actors, such as Web Medica Acreditada and MedCircle. Hence, certifications, accreditations and trust mark systems appear to play a role in the key issues facing the Internet.

 

Patients are not only using the Internet to better educate themselves, but many are also using it to assist in discussion with their physicians.

54% of patient-type respondents have discussed the results of their Internet searches with their care providers (n=533). Our results are confirmed by a recent study, from Harris Interactive [7], reporting that a majority (57%) of American adults, who have gone online to get health information, say that they have discussed this information with their doctor at least once. We report, among those who discussed the results of their Internet searches with their care providers, 95.8% (n=334) enjoy obtaining health information from the Internet and some 78.3% said ensuing discussions with their care provider were helpful because it improved doctor-patient communication, a huge increase of 40% compared to 2002 (38.3%, n=796). Most patient-respondents (88.2%) agreed that seeking health information on the Internet improves the quality of consultation with their physician. More than half (53%) of them use the Internet to seek a second opinion about a medical diagnosis. It is important to note that the majority of patient-respondents (90%) said that health care providers should suggest trustworthy online sources of health information. As the other player in the patient-physician relationship, health professionals had a receptive and positive attitude toward this behaviour, professionals’ responses to these questions confirm previous patient-respondent results. Like patient respondents, medical professionals agreed by 77% that patient health information seeking on the Internet improves the quality of patient consultation.

 

As patients gain easy access to more and increasingly complex medical information, they are seeking to become more involved in decisions about their health.

In 2002, 37% of patient-respondents had used online consultation services offered by Web sites (76% of them occasionally, 24% frequently). In 2005, we note an increase of this trend, with 42% of American and 48% of European patients using online consultation occasionally, and 40% of Americans and 38.2% of Europeans using it frequently. We also observe a rise in all the trends concerning online drugs information searches and purchases, for US citizens comparatively to Europeans. However, to answer patient needs, health care providers should be proactive and recommend trustworthy online sources of health information to their patients, as 88% of patient-type respondents think that providing medical information to them is as vital to their overall care as a physician consultation.

 

Internet use by experienced users, patients with specific or chronic conditions; educational levels.

North America, and in particular the USA shows a slight increase of respondents in our survey from 38% in 2002 to 44% in 2005. We also observe in this survey that 5.6% of the healthcare professionals, all over the countries, increased their use of the Internet from 2002 to 2005. Furthermore, patients with chronic or other specific conditions, like vision, hearing, motor or cognitive impairment, are making increasing use of the wealth of medical multimedia available on the Web, from 2.4% in 2002 to 11.5% in 2005. There are no significant differences between 2002 and 2005 when it comes to the population of online health information seekers by gender and level of education completed. When we consider in more details the respondents' profiles by level of education, in particular those without university level education, we observe very similar trends in their information seeking behavior compared with university-educated respondents. Our 2005 survey has given us additional insight into behavior by certain groups of internet users : veteran users, patients with specific conditions and respondents by level of education. From its origins in the academic and military establishments, the internet has fully entered the mainstream, actively used by nearly all social groups.

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Section I : Usage of Internet for Health/Medical Purposes

For the past 10 years, the Health On the Net Foundation has been tracking the opinions of Internet users of health information through its annual online survey, now in its ninth edition. The continuity of the survey results from year to year highlights the potential for understanding trends over the years.

A total of 2,012 respondents voluntarily completed the survey questionnaire between November 2004 and March 2005. Mainly from North America (United States 43%, Canada 4%, Mexico 1%) and Europe (26%), worldwide citizens responded (South America 8%, Asia 5%, Oceania 4%, Middle East 1.4%, Africa 1.2%)(more in Section V). The current paper aims at presenting some observations based on the results. We invite readers to consult the online charts also available for further details [1]

In 2002 (consult the Health On the Net, Spring 2002 Survey Responses) [2], most Web users, some 33.2%, had used the Internet for 4-6 years, since 1996-1998; In 2005, most survey respondents, some 44.5%, have used the Internet for 7 years or more, since 1997-1998. Since, among survey respondents, Internet newcomers are rare (just about 5% got access within the last 6 months), it is interesting to compare veteran user’s change over time than to compare new users to veterans (more in section V).

In 2005, users queried looked for health information 3 times a week or more on average, along with general Web surfing and email, devoting less than 2 hours per day to this activity for American users (36.8%), and from 2-4 hours for European users (39.2%). This can be attributed to easy access for most Internet users (42.6%, n=1975) by means of cable modem or DSL. These trends are confirmed by a recent survey, performed by Pew Internet & American life project [3], that reported that there are now many more Internet users with high-speed or broadband access at home, and more Internet users with six or more years of online experience. These “power users” may now turn to the Internet not only when they have a pressing concern, but also for casual health queries.

Most survey respondents (88%, n=1993) in 2005, as in 2002, go online for email and general Web surfing. The 2005 survey shows an increase in email use among European users of 8% compared with US users. As in 2002, the health information sought by most users consists of medical literature and disease descriptions, with interest for clinical trials. Nonetheless in 2005, the number of Europeans accessing the clinical trials literature was 10% greater than that of Americans.

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Section II : Quality

II. 1 Most Important Issues Facing The Internet

The Internet has become one of the most widely-used communication media. There are now many more Internet users aware of the risk of the Internet and they admit how difficult it is to assess the reliability of information. Wishing to quickly find quality health information they favor certified, trustworthy Web sites.

In 2005, the criteria perceived as the most important indicators of quality and usefulness for health Web sites were the same as in 2002. However, in 2005, their order of importance was identical for non-professional and professional groups of users: (1) availability of information, (2) ease of finding information/navigation, (3) trustworthiness/credibility and (4) accuracy of information.

Divergent opinions exist about the need for accreditation of health Web sites and adoption by Internet users. Attempts to regulate or rate the health Web have been criticized on several occasions [4][5][6]. 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 [6]. This may reveal a lack of awareness about the seal or verification system. The Health On the Net Spring 2002 survey results revealed that respondents showed a positive attitude for the certified sites, 59% of respondents (n=2621) favored certified Web sites. The awareness in trust mark has increased of about 10 % between 2002 and 2005. This may infer that the citizen continue to have a positive attitude towards accreditaiton and trust marks.

In 2005, both patient and professional respondent groups preferred to see the public sector take responsibility for upholding online health information quality, through the establishment of standards. Of all survey respondents, 79% would prefer that such a program be overseen by associations representing nonprofit, health Web site developers at an international or national level, 62% by government agencies at a federal or regional level, and finally 54% accepting United Nations surveillance.

Following the 2002 survey, we observed that sites intended for a professional audience enjoyed greater credibility among non-professional users. This led us to ask, in the 2005 survey, whether Web users thought it would be useful to identify such sites by means of an exclusive top-level domain, such as the proposed “.health.” A majority (44,48%, n=1423) of professional and non-professional users responded favorably to this suggestion, some 39% were undecided, 11% was against and 5% did not answer. Some 50% thought that only sites containing medical evidence should be allowed to use a “.health” domain name. This interesting result shows the receptivity, expressed by a sample of international Web users, to implementation of a top-level domain dedicated to quality health Web sites.

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II. 2 Most Familiar Certifications, Accreditations, or Trust Mark Systems

As in 2002, survey respondents in 2005 increasingly look to certification schemes, accreditation and quality symbols to distinguish reliable health Web sites. The most familiar accreditations or trust mark system is the HONcode, selected by 51.1% of respondents (n=1500). The second most familiar mark is Trust-e (28.9%). About 20.9% of respondents were familiar with the Internet Health Care coalition. The least familiar to respondents was the URAC accreditation (7.1%).

TABLE 1. All population most familiar certifications, accreditations, or trust marks systems

HONcode (n=767)
41.18 % USA
28.98 % Europe
8.75 % South America
5.74 % Asia
4.73 % Canada
10.62 % Others
  Trust-e (n=434)
56.85 % USA
17.26 % Europe
6.09 % South America
5.58 % Canada
5.08 % Asia
9.14 % Others

Source: 9th HON Survey, Health On the Net Foundation, Winter 2004-2005. NB: this year, respondents have a multiple-choice questionnaire.

Of respondents familiar with the HONcode (See TABLE 1), 54.7% come from America and 29% from Europe. 68.5% of America know the Trust-e seal compare to 17.3% in Europe. This number is not surprising at all, Trust-e being an American initiative. If we compare both groups of health professionals and non-professionals (See TABLE 2) it is interesting to note that more non-professionals are familiar with the trust-e seal (44%) compared with health professionals (38.5%). For the HONcode, both groups, American non-professionals and professionals are aware, with 50% and 54% respectively. For the professionals, 69% of Europeans are familiar with the HONcode seal compared with only 52% of non-professionals.

 

TABLE 2. Patients and professionals most familiar certifications, accreditations,
or trust marks systems, in ( USA Europe )

  Patients (n=435) Professionnals (n=507)
HONcode
50.31 %
52.17 %
54.17 %
68.95 %
Trust-e
44.06 %
22.61 %
38.54 %
20.55 %
IHC
20.31 %
21.74 %
21.53 %
21 %
MedCircle
12.5 %
12.17 %
14.24 %
12.33 %
Web Medica Acreditada
3.75 %
6.09 %
4.51 %
9.59 %
URAC
6.78 %
4.91 %
7.75 %
4.32 %
None of them
12.19 %
31.3 %
12.85 %
21 %

Source: 9th HON Survey, Health On the Net Foundation, Winter 2004-2005. NB: this year, respondents have a multiple-choice questionnaire.

However, the Good Housekeeping Seal, which is an emblem of consumer protection for daily products and has begun accreditating commercial sites, remains the leader in the USA (62.5%, n=547). In the 2002 survey, 29.3% of respondents (n=2621) were not familiar with any of the proposed marks, revealing a need for public education. This has improved, since in 2005 we observe an increase of awareness of trust marks of about 10%.

Thus, in 2005, certain organizations are better known, such as the Internet Health Care coalition (from 6% recognition in 2002 to 21% in 2005, n=1500) and Trust-e (from 13.3% in 2002 to 28.9% in 2005, n=1500). This year, in the list proposed we have added two initiatives, Web Medica Acreditada (WMA) and MedCircle. WMA is a Spanish initiative which is reflected in the table above.

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II. 3 Preferred Web Sites to Obtain Health Information

As in 2002, the domain name extensions enjoying the greatest credibility in the 2005 survey are first of all, “.edu” selected by 87% respondents (n=1386), “.gov” in second place, selected by 83.3% of respondents (n=1383), and, third, “.org” with 79.7% of respondents (n=1392). The least credible domain extension is “.com” with 55.5% of respondents (n=1394).

These results are confirmed and gain in clarity when the survey respondents provide the type of sites they prefer when searching for health information. Both non-professional and professional users, in Europe and the USA, favor academic/university sites (89.4%, n=1403) and sites sponsored by medical journals (88.9%, n=1394), closely followed by government agencies (86.1%, n=1395). For a more detailed listing, see the TABLE 3.A below.

TABLE 3.A. Patients and professionals preferred Web sites, in ( USA Europe )

Please rate your preference to obtain health information from the following web sites ?

  Patients (n=436) Professionnals (n=507)
University sites
83.81 %
91.67 %
88.74 %
95.07 %
Consumer sites sponsored by medical journals, or publications
88.96 %
90.75 %
89.55 %
87.44 %
Governmental agencies sites
82.91 %
87.30 %
88.03 %
87.39 %
Consumer sites sponsored by non-commercial medical organizations
77.68 %
83.76 %
76.06 %
77.02 %
Consumer sites sponsored by hospitals
75.00 %
73.73 %
78.24 %
74.78 %
Pharmaceutical manufacturer sites
60.13 %
54.23 %
56.30 %
75.00 %
Consumer sites sponsored by commercial medical organizations
61.71 %
50.01 %
58.26 %
52.26 %
Consumer sites sponsored by the news media
50.48 %
58.82 %
52.65 %
52.94 %

Source: 9th HON Survey, Health On the Net Foundation, Winter 2004-2005. NB: this year, respondents have a multiple-choice questionnaire.

We have also observed that a significant number of Web users, about 25% of a sample of 1,386 persons all over the world, lack confidence in sites sponsored by pharmaceutical manufacturers and commercial organizations of mainstream media sources (TABLE 3.B).

TABLE 3.B. All population less preferred Web sites all over the world

Pharmaceutical manufacturer sites
25.89 %
Consumer sites sponsored by the news media

24.79 %

Consumer sites sponsored by commercial medical organizations
22.24 %
Consumer sites sponsored by hospitals
9.67 %
Consumer sites sponsored by non-commercial medical organizations
8.00 %
Governmental agencies sites
5.24 %
Consumer sites sponsored by medical journals, or publications
4.23 %
University sites
3.71 %

Source: 9th HON Survey, Health On the Net Foundation, Winter 2004-2005.
NB: this year, respondents have a multiple-choice questionnaire.

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Section III: Impact on the Patient- Physician Relationship

Survey respondents demonstrated a high degree of Internet use in their health care dealings. They are not only using the Internet to better educate themselves but many are also using it to assist in discussions with their physicians. However, in 2005 only 54% of patient-type respondents discussed the results of their Internet searches with their care providers (n=533) which is about 8% fewer than reported in 2002 (62%, n=1318) [2]. Our results are confirmed by a recent study, from Harris Interactive [7], reporting that a majority (by 57 to 43%) of American adults, who have gone online to get health information, say that they have discussed this information with their doctor at least once. Furthermore, just one half (52%) of Internet users have searched for health information based on a discussion with their doctor. More (70%) have gone to the Internet, presumably to look for additional information to supplement what their doctor has told them. In agreement with this we observe from our 04-05 survey responses, that more than half (53%) of patient-respondents use the Internet to seek a second opinion about a medical diagnosis. It is important to note that the majority of patient-respondents (90%) said that Health care providers should suggest trustworthy online sources of health information, and 80% of them think that, as they write drug prescriptions, health care providers should prescribe Web sites for patients to obtain specific health information.

So to answer patient needs, health care providers should be proactive and recommend trustworthy online sources of health information to their patients, as 88% of patient-type respondents think that providing medical information to them is as vital to their overall care as a physician consultation, and 92% of them frequently seek health information on the Web to improve their knowledge about health issues.


TABLE 4.A. Patients and professionals point of view concerning Patient-Physician Relationship

  Patients  (n=334)  Professionnals (n=355)
Patient: Communication with my provider improved when I discussed health information I obtained from the Internet
78.25 %
Prof: Patient health information-seeking improves doctor-patient communication
88.40 %
Patient: Health information-seeking on the internet helps me become more knowledgeable.
97.30 %
Prof: Patient health information-seeking on the internet helps patients become more knowledgeable.
90.70 %
Patient: Health information seeking on the internet helps me become a better 'partner' with my physician
90.70 %
Prof: Patient health information seeking on the internet helps a patient become a better 'partner' with his/her physician
83.87 %
Patient: Health information seeking on the internet saves time in consultation with my physician.
79.86 %
Prof: Patient health information seeking on the internet saves time in patient consultation
55.60 %
Patient: Health information seeking on the internet improves the quality of consultation with my physician
88.18 %
Prof: Patient health information seeking on the internet improves the quality of patient consultation
76.9 %
Patient: Patient information seeking on the internet increases the degree that I will follow physician instructions on taking prescribed pharmaceuticals
66.75 %
Prof: Patient information seeking on the internet increases the degree that a patient will follow physician instructions on taking prescribed pharmaceuticals.
60.00 %
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III. 1 Positive Aspects

Among those who discussed the results of their Internet searches with their care providers, 95.8% (n=334) enjoy obtaining health information from the Internet. As indicated in TABLE 4.A, some 78.3% said ensuing discussions with their care provider were helpful because it improved doctor-patient communication, a huge increase of 40% compared to 2002 (38.3%, n=796). More than half of patient-respondents (55.2%) disagreed that seeking information on the Internet fosters mistrust of physicians, this is reassuring as 42% of health professionals think falsely, that patient seeking information on the Internet, fosters mistrust of them. Furthermore, 67% of patients said seeking information on the Internet increases the degree to which they will adhere to a physician's advice and enhances the degree to which they will follow physician instructions on taking prescribed pharmaceuticals. As in 2002, the great majority agreed that it made them more knowledgeable. Finally most patient-respondents (88.2%) agreed that seeking health information on the Internet improves the quality of consultation with their physician.

The majority of patient-respondents (90%) said that health care providers should suggest trustworthy online sources of health information.

71.3% of medical professionals found helpful in their practice to guide patients to a trustworthy source of online health information.

As the other player in the patient-physician relationship, health professionals had a receptive and positive attitude toward this behaviour, however in 2005, only 59% of health care professionals reported having patients discuss information they had found online. This is in decrease compared to 2002, when 69.5% of health care professionals reported having patients discuss information they had found on the Internet. Compared with 2002, more health professionals agreed that patient health information-seeking improves doctor-patient communication and that this behavior was helpful because patients become better "partners". Like patient respondents, medical professionals agreed (77%) that patient health information seeking on the Internet improves the quality of patient consultation (See TABLE 4.A) and 61.7% of them said that patient information seeking on the Internet is not a waste of a patient's time. This confirms previous patient-respondents results.

As in 2002, medical professionals showed that they have embraced the Internet, with nearly half engaging in email correspondence with their patients. Among those who gave details for the frequency of this behavior for 2005, 35% reported emailing their patients frequently and 43% occasionally (n=502), this is an increase over the 2002 result, where 20% reported emailing frequently and 80% occasionally (n=537). More than half of medical professionals make Web site recommendations to patients in 2005, preferably during (51.6%) or after (54.6%) a consultation. Some 38.3% of them recommend Web sites before a consultation. In agreement with these results, 71.3% of medical professionals found helpful in their practice to guide patients to a trustworthy source of online health information. Thus the majority of them would use a trustworthy source of online health information if it is free (91.3%) or inexpensive (75.3%) to the patient.

 

TABLE 4.B. Patients and professionals point of view concerning Patient-Physician Relationship

  Patients  (n=334)  Professionnals (n=355)
Patient: Patient information seeking on the internet increases my interest in self-treatment
69.23 %
Prof: Patient information seeking on the internet increases the risk of patient self-treatment
67.10 %
Patient: Patient information seeking on the internet encourages me to challenge a physician's medical authority
49.25 %
Prof: Patient information seeking on the internet encourages patients to challenge a physician's medical authority
60.40 %
Patient: Patient information seeking on the internet increases the degree I will adhere to a physician's advice
67.07 %
Prof: Patient information seeking on the internet decreases the degree that a patient adheres to a physician's advice
42.30 %

 

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III. 2 Negative Aspects

As can be seen in TABLE 4.B, more than half of health professionals (67%, n=355) agreed that there is a "risk of patient self-treatment" and 60.4% of them complained that information seeking on the Internet encourages patients to challenge a physician's medical authority. About 20% of professionals still do not know if medical information found using the Internet fosters patient mistrust of physicians or decreases the degree to which a patient adheres to a physician's advice. More research is needed in order to better understand the negative role that e-health behavior of patients may play, as reported by some professionals.

 

III. 3 Patients' and Professionals' Search Engine Preferences

Little is known about the potential differences in Internet utilization between patients and health professionals. 91% of patients (n= 631) preferred to use general search tools compared to 51.8% who preferred specialized search tools. Quite similar preferences are observed among health professionals (n= 621) where 70.2% preferred using specialized search tools compared to 92.3% who preferred general search tools. However, caution is needed to analyze these results, which may hide a lower awareness of medical search engines within the general public but not necessarily a definite preference.

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Section IV : Accessibility and other Ongoing Challenges

IV.1 Barriers and Preferences when Using the Web

63.8% of non-medical-professional individuals (patients or others) reported seeking medical sites or sections dedicated to medical professionals (n=547). Among those who gave a reason, the main one was a preference for access to more complex information (selected by 86% of respondents), or because they complain that the information usually accessed is too basic (67.2%, n=543).

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 also be reassuring that patients are acting autonomously; first by performing alternative searches to clarify information (87.2%), representing 88.4% of U.S patients and 85% of Europeans patients-respondents, and to a lesser extent by asking their doctor (50%, n=545) if they do not understand the information read online.

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IV. 2 Online Consultation, Prescription and Over -the- Counter Drugs

In 2002, 37% of patient-respondents have used online consultation services offered by Web sites (76% of them occasionally, 24% frequently), we report an increase of this trend in 2005, since 42% of American and 48% of European patients use online consultation occasionally; whereas 40% of American and 38.2% of European use it frequently.

As for 2002, where only 12.4 % of patient respondents frequently buy medications from the Internet, using online pharmacy services, we observe in 2005 that most of them are Americans (US 15.8%, n=360 and Europe 7.3%, n=124). They buy these medications from the Internet either with a prescription from a doctor (for US 15.4%, n=351 and Europe 6.1%, n=117) or without prescription needed, nearly the same for US patient respondents (16.9%) and Europeans (17.9%). TABLE 5 shows that most patient-type respondents in the USA and Europe are seeking information about : (1) drug side effects, (2) safety, (3) efficacy, (4) drug interactions and (5) generic medicines. Only a few of them complete a medication purchase online (27.6% in USA, n=361 and 16% in Europe, n=121). However we report a rise in all the trends concerning online drugs information searches and purchase, for US citizens comparatively to Europeans.

 

TABLE 5. Patients areas searches for medications and drugs, in ( USA Europe )

How frequently do you search for information about medications or drugs in these specific areas ?

  USA (n=361) Europe (n=121)
Drug Side effects
82.27 %
71.9 %
Drug Safety
75.84 %
66.39 %
Drug Efficacy
71.55 %
60.51 %
Drug Interactions
77.77 %
48.33 %
Generic drugs
61.58 %
48.28 %
Herbal or natural alternative treatments
57.42 %
51.73 %
Drug Prices
45.19 %
29.06 %
Online drug purchases
27.58 %
16.09 %

Source: 9th HON Survey, Health On the Net Foundation, Winter 2004-2005. NB: this year, respondents have a multiple-choice questionnaire.

As patients gain easy access to more and more medical information, they are seeking to become more involved in decisions about their health. This trend has started to alter traditional doctor-patient relationships. However good it is, online information cannot replace the vital personal relationship between patients and their doctors. But it can make for more knowledgeable patients, physicians, nurses and other medical care providers. As we come to understand and act on this, the health benefits will be palpable.

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Section V : Profile of Respondents

The comparison to the respondents' profiles over the years is also an important aspect representative of Internet penetration worldwide. European citizens present increasing e-health behaviors in large proportions (from Internet World Stats) (a usage increase of 161% between 2000 and 2005), despite that in our survey we do not report a greater number of European-respondents over time. However, North America, and in particular USA shows a slight increase of survey-respondents from 38% in 2002 to 44% in 2005.

A small cultural variation was observed when evaluating the ratio of patients or professionals responding to the surveys in USA or Europe, thus as you can see in TABLE 6, European medical specialists present the highest e-health behaviors with 36.73%, while in the USA, the nurses reach the first position with 21.09% .

 

TABLE 6. Profile of medical/health Professionals (Total number all over the world, n=787)

  USA (n=294) Europe (n=226)
Medical specialty
12.24 %
36.73 %
Nurse
21.09 %
3.54 %
General Practice
6.46 %
10.62 %
Educator
8.16 %
7.08 %
Information provider
8.16 %
6.19 %
Health Care Provider
8.16 %
3.54 %
Researcher
4.42 %
4.42 %
Pharmacist
2.72 %
4.87 %
Alternative medicine
2.72 %
2.21 %
Paramedical
1.02 %
2.65 %
Med./health student
0.68 %
2.21 %
General dentistry
1.36 %
0.44 %
Dental specialty
0.68 %
1.77 %
Oncology physician
0.0 %
2.21 %
Genetics Professional
0.34 %
0.00 %
Other
21.77 %
11.5 %

Access to online discussions, career networking and Web site hosting services has opened new horizons for physicians, nurses and all other healthcare professions. We report in this survey that 5.6% of the healthcare professionals, all over the countries, increased their use of the Internet from 2002 to 2005. Furthermore patients with specific condition, like vision, hearing, motor or cognitively impaired conditions, are making increasing use of the wealth of medical multimedia available on the Web, from 2.4% in 2002 to 11.5% in 2005.

There are no significant differences between 2002 and 2005 when it comes to the population of online health seekers by gender and level of education completed, our results are in agreement with those recently published by the Pew Internet & American life project [3]. Most of the Internet users (n=1285) are between 40-59 years old (26.3 to 28%), and those between 50-59 years old reported more interest in 2005 as they did in 2002. This confirms that veterans’ use of the Web increases over time.

 

Focus on the Level of education

When we consider in more detail the respondents' profiles regarding their level of education, in particular those who have completed only elementary school, high school, or a vocational/technical school (2 years), we observe very close results in their use of the Internet to find health information compared to university-educated respondents. However, most of the non-university-educated respondents (31.85%, n=157) have been using the Internet for 4-6 years, less than the university-educated respondents, as most of the latter, some 44.5%, have used the Internet for 7 years or more.

We report that 43.9% (n=157) of non-university-educated respondents continue to access the Internet through a telephone modem (Dial-up connection), 17% more than the university-educated group. Nevertheless, 44.6% of non-university-educated users have embraced the Internet using high-speed access or DSL, this suggests that within a few years the non-university-educated group will catch up the university-educated one, and all Internet users will use a high-speed connection.

More non-university-educated-survey respondents (82-85%, n=165) in 2005, than university-educated ones, go online for email and general Web surfing. Both groups use the Internet to search medical literature, disease descriptions and clinical trials, with a slightly higher percentage of non-university-educated (25.8%) than university-educated (22.6%) searching for support groups.

The criteria perceived as the most important indicators of quality and usefulness concerning health Web sites are the same for both group of users, independent of their level of education : (1) availability of information, (2) ease of finding information/navigation, (3) trustworthiness/credibility and (4) accuracy of information. Again, as for the university-educated group, non-university-educated respondents in 2005, when searching for health information, favored academic/university sites (83.4%, n=150) and sites sponsored by medical journals (88.9%, n=154), closely followed by government agencies (79.7%, n=153).

These results are very interesting and show that the non-university-educated Internet users are progressing quickly and within the next four years a large percentage of this group will be using the Web, with broadband access at home and a vast experience of the Internet. They will probably have the same needs as university-educated users, including an interest in clinical trials and easy access to medical literature. We must be aware of this upcoming surge and prepare to accommodate and meet the needs of these users. The results of this survey are also important regarding another group, the “veterans”, which will soon be in a majority on the Web. It would be useful to study their behavior and trends in use of the medical/health Internet, to analyze this social evolution and prepare to welcome it.

 

TABLE 7. Profile of respondents over time

  2004/2005 2002* 1999§
Geographical Location
- North America
     - USA, Canada, Mexico
- Europe
- Oceania
- South America
- Asia
- Africa
(n=1291)
48%
43%,4%,1%
26%
4%
8%
5%
1.2%
(n=2586)
44%
38%,4%,2%
29%
3%
7%
6%
1.4%
(n=3276)
59%

35%
1%
0%

 

Type of Respondent
- Patients
- Professionals
(n=1442)
45.4%
54.6%
(n=2621)
50%
49%
(n=2893)
49%
51%
Gender
- Female
- Male
(n=1282)
49.7%
50.3%
(n=2586)
48.2%
49.9%
(n=3092)
50.7%
49.2%
Age
<19 yrs
20-29 yrs
30-39 yrs
40-49 yrs
50-59 yrs
60 yrs and over
(n=1285)
<1%
10%
18.7%
26.3%
28.3%
15%
(n=2586)
<1%
12%
19%
29%
24%
13%
(n=3099)
<1%
13%
23%
21%
7%
2%

 

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Method

HON surveys use non-probabilistic sampling and cannot ensure that participants are representative of the entire medical and health information-user community on the Internet. However, HON is one of the most important medical information portals on the Web today, and benefits from one of the highest link factors of all healthcare Web sites.

HON surveys have been posted on the HON Web site. A link from HON's home page led users directly to the questionnaire. HON newsletter recipients were invited by email to fill in the survey. Announcements and links to the 9th HON survey were also posted on collaborative Web sites [8] to help reach participants and potentially increase generalizability with a larger diversity of respondents.

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About Health On the Net Foundation

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 behavior by health Web sites since 1996. HON is mainly recognized 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 been accorded Non-Governmental Organization (NGO) status by the United Nations, becoming the first online health accreditation agency with this status.

 


Acknowledgements

We would like to thank Robert Logan, PhD, from the Lister Hill Center, NLM, for his help to making this survey.
We would like to thank also all respondents and the Web sites who collaborated by announcing the survey. Without this collaborative effort of the Internet community, our understanding of health information seekers would be very limited.

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References

[1] The Health On the Net. Winter 2004-2005 Survey Responses,
   URL: http://www.hon.ch/Survey/Survey2005/raw_data.html

[2] The Health On the Net. Spring 2002 Survey Responses,
   URL: http://www.hon.ch/Survey/Spring2002/res.html

[3] Susannah Fox. Health Information Online : Eight in ten Internet users have looked for health information online, with increased interest in diet, fitness, drugs, health insurance, experimental treatments, and particular doctors and hospitals. Pew Internet & American life project. May 17, 2005.
   URL: http://www.harrisinteractive.com/news/newsletters/healthnews/HI_HealthCareNews2005Vol5_Iss08.pdf

[4] Gagliardi A, Jadad A. Examination of instruments used to rate quality of health information on the Internet : chronicle of a voyage with an unclear destination. BMJ 2002;324:569-73.
   URL: http://bmj.com/cgi/content/full/324/7337/569

[5] Purcell GP, Wilson P, Delamothe, The Quality of Health Information on the Internet., As for any other medium it varies widely; regulation is not the answer. BMJ 2002;324:557-8.
   URL: http://bmj.com/cgi/content/full/324/7337/557 .

[6] Eysenbach G, Kohler C. How do consumers search for and appraise health information on the world wide web? Qualitative study using focus groups, usability tests, and in-dept interviews. BMJ 2002;324:573-7.
   URL: http://bmj.com/cgi/content/full/324/7337/573 .

[7] David Krane. Number of “Cyberchondriacs” – U.S. Adults Who Go Online for Health Information – Increases to Estimated 117 Million. HarrisInteractive News. Volume 5, Issue 8, July 28, 2005.
   URL: http://www.harrisinteractive.com/news/newsletters/healthnews/HI_HealthCareNews2005Vol5_Iss08.pdf

[8] The Health On the Net Foundation. Evolution of Internet Use for Health Purposes, Survey 2005. Financial and Promotional Support for the Survey.
   URL: http://www.hon.ch/Survey/Survey2005/support.html

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  http://www.hon.ch/Survey/Survey2005/res.html Last modified: Thu Jul 20 2006