Background Methodology Current Survey Analysis Copyright Version française

5th HON Survey on the Evolution of Internet Use for Health Purposes

October - November 1999

-Selected results-


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].

Table of Contents

Main findings

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.

a. General user trends

  • 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.


b. Drugs and patient-provider communications

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.

c. User top ten

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


National Library Medicine,
MEDLINE, Pubmed,
National Institute of Health (NIH)
British Medical Journal (BMJ)
Mayo Health System
Center for Disease Control


Statistics and Analysis

The findings of this survey are based on 3,276 individual responses to a questionnaire posted on the HON Web site in seven language versions (English, French, German, Italian, Spanish, Portuguese and Polish. The questionnaire was "live" between October 1 and November 30, 1999. All percentages are rounded off to the nearest full number. 58% of the participants accessed the survey from North America, 28% from Europe, while the remaining 14% came, in descending order, from South America, Oceania, Asia, Africa, the Middle East and Central America. To HON's knowledge, this survey was thus one of the most geographically comprehensive and, in terms of respondents, one of the largest of its kind conducted to date.

HON is steadily improving its software tools for analysing the results. For the latest survey, users can now choose between PERL and Java features ([3], [4]) for clear, graphical presentations of the data. You can also track the evolution of Internet use through five consecutive HON surveys by calling up and comparing graphs or charts of results over three-and-a-half years.



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 we benefit from one of the highest link factors of all healthcare Web sites. The observations and inferences we draw from our survey results can therefore arguably apply to a large proportion, if not all, of the healthcare information seekers on the Internet [6].

HON surveys are posted on the HON Web site. A link from HON's home page takes users directly to the questionnaire. Participants are in their great majority regular Web users and are solicited in the following manner :

  1. Announcements and postings on Internet newsgroups such as,,,,, etc. and newsletters such as Nouvelles de l'Internet Médical, etc.
  2. Announcements made to the mailing lists MEDWEBMASTERS-L and Hospital-webmaster (a list maintained by the Health On the Net Foundation).
  3. Additional links to the latest HON survey posted by « friendly » Web sites helped boost participation : Achoo Healthcare Online (U.S.A.), Association internationale Ensemble contre la douleur (Switzerland), Anestesia in Rete [Italy), Catalogue et Index des Sites Médicaux Francophones (France), La revue de presse de Caducee du 29/10/1999 (France), Intelihealth (U.S.A.), Esculape HON Finland (Finland), Hôpitaux Universitaires de Genève (Switzerland), Integrated Healthcare Association (IHA), Lviv State Medical University LSMU Network Centre, Maco Clinic Health Oasis (U.S.A.), Médicine et Hygiène (Switzerland), MediConsult, (France), PharmInfo, TOCOGINECOnet (Argentina) and others .
  4. Reference in journals such as THE LANCET, Vol 354, p.1569, October 30, 1999.
  5. (see annoucement urls below [5])

The questionnaire for the October-November 1999 survey was designed for completion within ten minutes. With 30 separate multiple-choice questions in seven different language versions, it was the most ambitious to date in the HON series, featuring nine new questions on pharmaceutical products and provider-patient communications.

HON surveys offer respondents an opportunity to leave messages, many of which help us to improve the design and content of future questionnaires and other HON services. In the October-November 1999 survey, 521 participants left a wide variety of comments and questions.


About Health on the Net Foundation

Health On the Net Foundation (HON) is a not-for-profit portal for medical and health-related information. We are widely recognised for the power and user-friendliness of our proprietary search engines (MedHunt and HONselect [8],[9]) and for our commitment to responsible self-regulation by medical and health-related information providers on the Web. The HONcode [10] is both the sector's leading ethical standard and the most widely-endorsed set of guidelines for healthcare Web site developers in existence today. The HON Foundation is established in Geneva, Switzerland. Our Web site went live in March, 1996.


Privacy policy and disclaimer

HON pledges always to respect the privacy and anonymity of its users, including survey participants. We do not use cookies. We do not require users to register at our site. We will not supply to any third party the names, email addresses or any other contact information, personal or medical data that users voluntarily provide in their communications with us. HON is committed to working with the Internet community in cultivating and maintaining trust between all its members.

The content provided by Health On the Net Foundation is for information purposes only and is in no way intended to be a substitute for medical consultation with a qualified professional. The Foundation encourages Internet users to be careful when using medical information. If you are unsure about your medical condition, consult a physician. Although we carefully review our content, Health On the Net Foundation cannot guarantee nor take responsibility for the medical accuracy of documents we publish, nor can HON assume any liability for the content of Web sites linked to our site. To find out more about our efforts to improve the quality of medical information on the Internet, visit our Code of Conduct (HONcode [10]).



We wish to thank most sincerely those individuals and organisations that helped us design, plan and conduct this survey. They include expert translators for the six non-English versions of the questionnaire, HON users who spontaneously contacted us with constructive suggestions, and Web sites that provide their own users with a link to us.

All these services were performed voluntarily and entirely free of charge, in the best spirit of the Internet.


[1] Results pages:
[2] October-November 1999 questionnaire
[3] Software tool in PERL for analysing the results
[4] Software tools in Java for analysing the results
[5] Announcement sites:
Achoo Healthcare Online:
Anestesia in Rete:
Association internationale Ensemble contre la douleur
British Medical Journal:
Catalogue et Index des Sites Médicaux Francophones
HON Finland:
Hôpitaux Universitaires de Genève:
Integrated Healthcare Association (IHA)
La revue de presse de Caducee du 29/10/1999
Lviv State Medical University LSMU Network Centre
Mayo Clinic Health Oasis:
Médecine et Hygiène:
Nouvelles de l'Internet Médical:
Nouvelles de l'Internet Médical:
[6] Methodology
[7] Questionnaire
[8] MedHunt
[9] HONselect
[10] HONcode



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Contact Last modified: Thu Jul 18 2002