The rapid development of the internet means that both a wealth of health information and a minefield of misinformation are now readily available to our patients. No longer are medical practitioners seen as the sole custodians of medical information.¹

Literature review

A June 2009 survey from the Pew Internet and American Life Study estimated that 61% of American adults search the internet for health information, with many looking for user-generated content written by patients with similar medical conditions.²

Like a lot of the information on the internet, not all medical content is credible. Steps have been taken in health website monitoring recently with the development of organisations to oversee and assess content of health websites such as Health on the Net (HON) Foundation.³ A tool for assessing the quality of websites, DISCERN, has also been created.⁴

It is important to be aware that the content of all Irish health websites has not been suitably analysed for accuracy since 1998.⁵

A 2007 study highlighted that using health information from the internet for decision-making purposes without expert advise could potentially have a negative impact on a patient’s health.⁶

Results from the HON survey 2005 found that over half of the health professionals questioned agreed that there was a ‘risk’ of self treatment, and 60% of them believed that searching for health information online encourages patients to challenge a physician’s authority.⁷

The Irish Medicines Board has highlighted the dangers of purchasing medicines online,⁸ with a total of 1,900 adverse reactions reported to it in 2006.

Internet use in Ireland has been growing steadily in recent years, with the number of homes with internet connections rising from 45% in 2004 to 70% in 2008.⁸ Females and those in the 25-34 year age group exhibited the highest computer and internet usage.^9,10

Online health-seeking behaviour has been documented in Ireland since 2002. Some 12% of respondents to the Survey of Lifestyle, Attitudes and Nutrition (SLAN) had used the internet as a source of health information. This study also showed that age is an important factor when it comes to the digital divide, with respondents aged 18-34 more likely to use the internet as a source of information on health (19%) than those over 55 (3%).¹¹

Results from the 2003 Eurobarometer survey reported that 23.4% of Irish adults had used the internet as a source on health information.¹⁴ The study also found that use of the internet decreased with age and increased with more years of education.

The eUSER survey¹⁵ gave information on the types of information that Irish online health seekers search for:

• • 88.2% searched for specific health issues
• • 49% searched for information on lifestyle
• • 38.4% searched for health service information.

Interestingly, a 2006 survey into the habits of internet users in Ireland over a three month period highlighted that more people look online for health information than to look for a job or at online newspapers.¹⁶

Why did I choose this project?

We live in a ‘digital decade’ and whether we like it or not our patients will seek health information on the internet. Buying medication over the internet is also becoming common practice. As physicians, I feel it is important that we understand our patients’ use of the internet. ‘Knowledge is power’ and ‘power’ potentially equals safer health practices by our patients via guidance to safe, validated sites etc.

Aims of this study

Phase 1 

• • To determine the level of access to the internet by our patient population
• • To determine the types of health information sought
• • To assess how they search for this information
• • To determine how patients choose to validate their newly acquired knowledge.

Phase 2

• • To determine the perceptions of the GPs within the practice of their patients’ use of the internet.

Methods

Initially, a literature search was performed using Pubmed and searching for any articles on ‘internet and general practice’ or ‘internet and primary care’. The search yielded 10 studies – none of which were from Ireland. This was followed up with a Google search, which yielded a study from Ireland by the Health Research Board: Searching for health information online: characteristics of online health users. This was a telephone survey of more than 2000 patients, which focused primarily on mental health. 

During my Pubmed search I came across a study in the Journal of the American Board of Family Physicians from 2006 – focusing on primary care patients’ use of the internet for health information.¹⁷ I contacted the authors who kindly allowed me to use the template of their validated survey for my study:

• • Surveys were offered to all patients over 18
• • Surveys were distributed by practice receptionists
• • Individuals who agreed to participate were asked to complete a questionnaire – including a demographic section, enquiring about internet access, the type of health-related information they sought on the internet, their search strategies, their assessment of the quality of information obtained, and any discussions they had had about internet sources of health information with their GP
• • 200 surveys in total were collected
• • All GPs within the practice were asked to fill out a survey to determine their impressions of their patients’ use of the internet
• • The patient survey instrument was modified to ask physicians similar questions to those that had been asked of the patients
• • Results of the patient survey were not given to physicians until after all physicians had completed the survey
• • All information was entered into an Excel spreadsheet. 

Results

Of the respondents, 92% had internet access. Of these, 79% reported that they had accessed health information on the internet. The majority of GPs surveyed (six out of eight) felt that <50% of patients accessed health information online. The most common searches were on specific diseases or conditions (129 patients), exercise and nutrition (87 patients) and medications (54 patients). The GPs also identified specific diseases or condition as the most common search.

Some 76.5% of patients reported searching for health information by entering key words in a search engine, with only 0.5% of patients going specifically to a validated health website. All of the GPs surveyed felt that patients searched only through search engines. Half (50.5%) of patients reported that they understood the information, which correlated with the GP’s assessment.

Some 71% of patients mostly or sometimes trusted this information. The GPs however thought that 100% of patients trust the information obtained.

Some 38% of patients reported validating websites by discussing it with the GP while 30% validated websites via discussion with family and friends. GPs rated themselves higher, saying 75% of patients would validate their findings with them.

Almost one third (32%) of patients reported never discussing the information obtained from the net with their health provider. This was not reflected by the GP cohort.

Of the patients surveyed, only 10% of patients reported that their GP had suggested internet sources, with seven out of eight of the GPs surveyed reporting always suggesting internet sources.

Finally, GPs were asked if they ever knew of patients using the internet for health reasons in an unsafe way – only one GP answered no; comments from other GPs included: “heard of patient ordering abortion pill online”, “patients buy benzodiazepines and weight loss medication online”, “patients often use symptom checker”.

Learning points

What we learned from this study is that the internet era is here and whether we like it or not our patients will search the internet for health information. What we also learn is that patients’ search techniques are suboptimal and they may trust the wrong information. It also appears that we are not helping people to navigate the internet safely. 

How has this study changed our practice?

As a practice we have updated our website and can now confidently direct patients to safe internet sites via our website. This is also regularly updated. We also recognise that the majority of our patients will look to the internet when it comes to health and I personally have embraced this and use this to empower patients and educate them in the management of their illnesses. 

References

1. General practice on the internet. Australian Fam Physician 2001 Apr; 30(4): 359-61
2. The Pew Internet and American Life Project. Trends 2009
3. Health on the Net 
4. www.discern.org.uk
5. Huntington P et al. Consumer trust in health information on the web. Proceedings: new information perspectives 2004; 56(6): 373-382
6. Giles D. The Internet, information seeking and identity. The Psychologist 2007; 20(7):432-434
7. Health on the Net Foundation. Analysis of 9th HON Survey of Health and Medical Internet Users Winter 2004-2005
8. Irish Medicines Board (2007) Annual Report
9. Information Society Statistics (CSO 2008)
10. Neilson/NetRatings (2007, 16 May). Young women now the most dominant group
11. Centre for Health Promotion Studies (2003). The National Health and Lifestyle Surveys 2002 – Survey of Lifestyle, Attitudes and Nutrition (SLAN). Dublin: Centre for Health Promotion Studies 
12. Fox S, Rainie L. Vital decisions: How Internet users decide what information to trust when they or their loved ones are sick, 2002 www.pewInternet.org 
13. Birru MS et al. Internet usage by low-literacy adults seeking health information: An observational analysis. Journal of Medical Internet Research 2004; 6(3): e25
14. Spadaro R. Eurobarometer 58.0: EU Citizens and Sources of Information about Health. Brussels: The European Opinion Research Group, European Commission, 2003
15. eUser (2005) Public Online Services and User Orientation (2007)
16. Central Statistics Office (2006) Information society and telecommunications. Dublin:Central Statistics Office
17. Schwartz KL et al. Family Medicine Patients’ Use of the Internet for Health Information: A MetroNet Study. J Am Board Fam Med 2006 (Jan-Feb); 19(1): 39-45