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HON's Fourth Survey on the Use of the
Internet for Medical & Health Purposes


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With 4,368 respondents, this was, as far as we know, the largest Internet survey to date of active health information seekers. By way of comparison, readers should refer to the regular Web surveys conducted by GVU. There is also, to our knowledge, no other survey of this type conducted in four languages (English, French, Italian and Portuguese).

Five major trends emerged from the March-April 1999 Health On the Net survey:

  • Baby boomers, now entering middle age, are by far the largest user group;
  • Use of the Internet for medical and health-related information is growing strongly in Europe, especially in the medical profession;
  • Medical and health information on the World-Wide Web is increasingly perceived as "useful" by consumers;
  • A big overall majority believe that the quality of information needs to improve - and the longer users have been on the Net, the more they appear to emphasize this need;
  • Nevertheless, a worrying 34% of respondents from non-medical professions profess to have no opinion on information quality.


The fourth and latest in the HON survey series, conducted by Health On the Net Foundation [1] through the months of March and April, 1999 [2, 3], obtained 4,368 responses, compared to 1,863 for the third survey in May and June, 1998 [3]. Thanks to these surveys, a broad user profile for Web-based medical and health-related information is emerging. The electronic questionnaire (in English, French, Italian and Portuguese) has remained largely the same since HON first posted it on its Web site in February-March, 1997. As in the past, results of the current survey are intended for use by all interested organisations [4].

Health On the Net Foundation (HON) is a not-for-profit portal for medical and health-related information widely recognized for the power and user-friendliness of its proprietary search facilities (HONselect and MedHunt) and for its commitment to responsible self-regulation by medical and health-related information providers on the World-Wide Web. The HONcode is today the most widely endorsed set of ethical guidelines for site developers in this domain. The HON Foundation was established in Geneva, Switzerland, in 1995.



HON surveys use non-probabilistic sampling and cannot ensure that participants are representative of the total medical and health information-user community on the Internet [5]. However, HON is one of the most important medical information portals on the Web today, and its daily traffic as well as its Web impact factor puts it among the top 5 of all health Web sites in the world. The data, observations and inferences we have drawn from the survey results can therefore arguably apply to a large proportion of the healthcare information seekers on the Internet.

The survey is posted on the HON Web site. A link from HON's home page takes users directly to the questionnaire.

Additional links to the latest HON survey posted by "friendly" Web sites helped boost participation (e.g. the on-line edition of the British Medical Journal (eBMJ, UK.), Achoo Healthcare Online (U.S.A.), Anestesia in Rete (Italy), Intelihealth (U.S.A.), DoctorMiner (Brazil), HON Finland (Finland), Hôpitaux Universitaires de Genève (Switzerland), Mayo Clinic Health Oasis (U.S.A.), Médecine et Hygiène (Switzerland), Nouvelles de l'Internet Médical, Numéro 42 du 8 mars 1999 (France), TOCOGINECOnet (Argentina) and others.

The questionnaire is designed for completion within three to four minutes [6]. It starts with a number of statements and a multiple choice of relevant answers, from "Strongly agree" to "Strongly disagree", for simple clicking with the mouse. Next come some basic user-related questions (including age, gender, location and years on the Internet). HON added two new questions to the March-April, 1999 questionnaire: "What type of site do you first go to?", offering six multiple-choice options, and "What are your three most preferred Web sites?". The latter is the only open question in the survey, and invites users to provide their three "favourite" URLs.

Respondents are also given an opportunity to leave spontaneous messages: in the most recent survey, 782 left a wide variety of remarks.



Of the record 4,368 persons answering the latest survey, 64% were healthcare professionals. This appears to confirm an earlier trend. Though this proportion slipped to 46% in May-June 1998, the first and second HON surveys showed 63% and 61% healthcare professionals respectively. The primary place to get connected to the Internet was given as "home", maintaining its pre-eminence with 70 %. There is some decline in the percentage of female respondents to the March-April 1999 survey (47%) when compared to the previous survey (58% in May-June 1998), but it is an improvement on the first (40% in August-September 1997).

The results can be divided into five main themes:

  • Baby boomers, now entering middle age, are by far the largest user group

60% of the respondents in the latest survey are over 40 years of age and 8% of all respondents are over 60. This age profile has remained practically unchanged since the May-June 1998 survey. The interest of this age group in medical information is supported by anecdotal evidence from a large number of spontaneous feedback messages collected during the course of the survey. A great number recount that they are the spouses of persons recently diagnosed with serious acute or chronic illnesses, or suffer from these themselves, and are actively seeking better understanding of pathologies, diagnoses and treatments as well as contact with support communities.

Users in Europe, however, appear to be somewhat younger: 17% in the 20-29 age bracket and 30% in the 30-39 age bracket for Europe against 8% and 18% respectively for North America.

  • Use of the Internet for medical and health-related information is growing strongly in Europe, especially in the medical profession

50% of the respondents were from North America, 31% from Europe, and 9% from South America. The European proportion was only 19% in May-June 1998. 80% of the European respondents are healthcare professionals, compared to 48% in North America. 64% of the European medical community use the Internet from their place of work as well as 62% from home. Using the Web for medical information still appears difficult at work. European clinicians and GPs may find home less hectic than their place of work, and this interpretation is supported by evidence from North America, where 49% of the medical profession access from work, and 65% from home.

Healthcare professionals appear to be actively searching the Web for research information, new treatment and better understanding of pathologies for their patients (51% in Europe, 43% in North America) as well as for themselves (53% in Europe, 74% in North America).

Despite their growing Internet use, Europe's medical community might still be reticent about using this new medium because of competing technologies such as the Minitel in France. But the younger generations of healthcare profession in Europe seem more open to change. Among the respondents, 46% of European caregivers are under 40, against 31% in North America. 28% of the European medical professionals have been using the Net for less than one year (20% for North America).

  • Medical and health information on the World-Wide Web is increasingly perceived as "useful" by consumers

    This latest HON survey confirmed persistently high levels of user satisfaction, given that 95% agreed with the statement "I have found useful medical and health information on the Internet" (93% in the previous survey). Despite concerns about language barriers to widespread Internet usage, given the predominance of English, 82% claim to find information in their mother-tongue. This could support anecdotal evidence of the growth in the number of non-English language healthcare Web sites and other Internet resources, in particular in Europe.

  • The survey also shows an impressive shift of opinion about user-friendliness. While still not ideal user-friendliness appear to be growing: 83% of May-June 1999 respondents agreed with the statement "It is easy to find useful medical information on the Net", as against 68% in the previous survey. This suggests, among other things, that search engines are improving and that users are becoming more sophisticated.
  • A big majority believe that the quality of information needs to improve - and the longer users have been on the Net, the more they appear to emphasize this need.

60% of the less experienced users (under six months on the Net) agree that the quality must improve, while 74% of experienced users (more than three years on the Net) are of this opinion. 69% of all respondents agreed that quality has to improve, up from 53% in the previous survey.

  • Nevertheless, a worrying 34% of respondents from non-medical professions profess to have no opinion on information quality

Medical professions, naturally, seem more concerned about quality than ordinary users: 75% of caregivers say quality must improve, as against only 58% of ordinary users. We must note that 34% of ordinary users have no opinion on the question on improving information quality. Given the large quantity of dubious or downright misleading healthcare information currently on the Web, this is a matter of some concern to the entire Web community of healthcare information providers and users. The "don't-know" finding confirms the results of previous HON surveys, and can only give impetus to HON's three-year campaign to promote quality and encourage concerted efforts on the Web to teach users the basics of medical knowledge.

Some further findings:

a. Participants believe that 46% of physicians and 30% of nurses in their respective countries are using Internet services for medical information and communication. This marks an appreciable increase of 14% for physicians and 8% nurses respectively compared to the May-June 1998 survey. At the same time, the "don't-knows" remain high: 38% and 46% have no opinion on the use of Internet services by physicians and nurses. In the last survey, the numbers were 50% and 57%.

b. Women in Europe appear to be steadily becoming more familiar with Internet use. Their proportion among the respondents to all four HON user surveys has grown steadily: from 22% in February-March 1997, to 23% in August-September 1997, to 28% in May-June 1998, to 32% in March-April 1999. This trend could eventually duplicate a similar phenomenon in North America where all four HON surveys show an average of 60% participation by women. One inference could be that women in Europe and North America are more likely than men to seek information about the health of their children, spouses and loved ones.

c. 67% of respondent prefer first to visit not-for-profit Web sites and 38% hospital Web sites. Most importantly, Web site pages seem to have become the preferred medium for consulting medical and health information: in May-June 1998, only 49% cited Web pages first, preferring listservers, discussions groups and newsgroups. However the March-April 1999 survey gave an 90% vote to Web sites.

d. The first ten results to the question Which 3 medical /healthcare Web sites most closely meet your needs ? are:

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



Overall the survey suggests that, generally speaking, users are mature to middle-aged, increasingly multi-national in terms of country of origin, relatively happy with the variety of medical and health-related information on the Internet, and yet increasingly concerned about quality.

The core user requirement remains proper assessment, control and assurance of the quality of information available on the Web and other on-line services [9, 10].


Note to readers:
The detailed interactive and graphical results of the survey are available on-line. You may use either the Java application or the frame-based software application, which provides comparisons between all surveys: February-March 1997, August-September 1997, May-June 1998 and March-April 1999 [2, 3].

On request, HON would be happy to provide you with further details from the survey.



We thank all those of you who participated in our survey. We hope that the results of HON's Fourth Survey, March-April 1999, are of interest to you. The HON Foundation conducts these surveys as a public service. All the results and the tools developed by HON are available under certain terms and conditions.



[4] C. Boyer, M. Selby, V. Baujard and R.D. Appel, "Medical Information on the Internet: who wants what? , "European Congress of the Internet in Medicine, MedNet97, November 1997, Brighton, UK
[9] W. M. Silberg, G. D. Lundberg, R. A. Musacchio, "Assessing, Controlling, and Assuring the Quality of Medical Information on the Internet," Journal of the American Medical Association - JAMA-, vol. 277, no. 15, pp. 1244-1245, Apr.15, 1997.


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