Barrie Gunter and colleagues reveal results of the latest survey into the use of health information on the web.
In the White Paper Choosing Health: making healthy choices easier, published in 2004, the Department of Health presented its blueprint for improving the nation’s health in the years ahead. Online information about health for the public was identified as playing a crucial role in promoting healthy lifestyles in the future. A new service, Health Direct, will ‘provide easily accessible and confidential information on health choices’ (Executive Summary, p. 5). This service will operate over the telephone, internet and digital television. It will be accessible even to those who are not linked to the internet at home via government-funded UK Online centres. How ready is the nation for this kind of service? What are the prospects that it will be widely used?
The British Life and Internet Project has tracked the utility of online health information services in Britain. In 2003,1 we reported that the internet had emerged as an important health information source among internet users in this country, especially among women. Users sought information about specific illnesses and health conditions, with many enquiries being concerned with nutrition and weight control. This was a significant finding in view of the government’s growing concern about the prevalence of obesity in Britain. A year later, we have updated our findings through another survey.
The latest health survey was conducted with a national online panel of 30,000+ between 22 October and 30 November 2004. Usable replies were obtained from 986 respondents, of whom the majority were male (62 per cent). The sample had a wide age spread, ranging from 16 to 75+ years, with most respondents being aged between 25 and 54 (68 per cent). Two-thirds were married (55 per cent) or cohabiting (15 per cent), and others were single (26 per cent) or widowed or divorced (7 per cent). Most were Caucasian (92 per cent), had no children living with them at home (78 per cent), and were in full-time employment (70 per cent).
When asked whether they had ever visited a health information internet site, whether to enquire about illness and medical treatments or diet and exercise, most of the respondents (76 per cent) said that they had. This figure compared with 81 per cent in 2003.
One in six of these respondents (17 per cent) had visited such a site within the previous week, over one in four (28 per cent) had done so in the previous month, one in three (33 per cent) in the previous six months, and the remainder either longer ago or could not remember the last time (22 per cent).
Alternative medicine
Among the health sites visited, the ones named most frequently as the last site visited were NHS Direct Online (43 per cent), Health World online (43 per cent), BBC Health (35 per cent), AOL Health Channel (34 per cent) and Healthchoice (29 per cent). Alternative medicine sites were collectively mentioned by one in three respondents (33 per cent). The popularity of NHS Direct Online confirmed our findings from 2003 when it was also the most widely used site. Most respondents (58 per cent) preferred to use UK sites for health information, though one in six (18 per cent) were willing to use information from any English-language site.
Among respondents who had reportedly accessed health websites, the biggest single category of enquiry (45 per cent) was for information concerning a current health problem. This was followed by information about dieting, nutrition or exercise (12 per cent), keeping up to date with new treatments (8 per cent), learning about health (6 per cent), and information about prescription drugs (6 per cent).
The most used health websites were thought to be fairly easy to use, though some users did experience problems. When asked how easy or difficult it was to find the health information they sought on the last health website visited, the majority of respondents (68 per cent) said they found it easy or very easy. Three in ten (30 per cent), however, said that it was sometimes difficult.
However, overwhelming majorities of respondents understood the information (99 per cent), found it relevant (95 per cent) and that it added to their previous knowledge (85 per cent), while a sizeable majority also made use of that information at least in part (69 per cent).
Furthermore, most respondents said the information found was not at all difficult to read (84 per cent), or out of date (68 per cent) or full of jargon (63 per cent).
Lasting benefit to health
In a further question we asked whether online health information had yielded any lasting benefit to users’ health. The most likely benefit mentioned was helping users to understand the condition they sought information about, where most respondents said it helped them to some degree, either a lot (37 per cent) or a little (40 per cent). For some respondents (49 per cent), online health information had helped to change their feelings about the condition. Few (5 per cent) said that the information helped a lot in improving their condition, while over one in five (23 per cent) said it had helped a little.
Nearly four in 10 respondents (39 per cent) had used health information found on the internet in consultations with the doctor. For around one in three respondents only, such information helped them in dealing with their doctor (helped a lot ą 11 per cent, helped a little ą 21 per cent). Among those respondents who had used online health information in this way, the main reasons why this was useful were because it meant they could ask the right questions of their doctor (99 per cent) and it helped to inform the consultation (89 per cent). In a minority of these instances (28 per cent), the doctor did not know about the information the respondent had found. It was relatively rare, however, for a doctor to advise respondents against using information found on the internet (10 per cent). At the same time, only a minority (26 per cent) reported that a doctor or nurse had ever recommended that they use a health website. Among those to whom this advice had been given, the site most recommended was NHS Direct Online (43 per cent).
Further probing revealed a range of other potential benefits respondents were prepared to acknowledge in relation to internet health information. Significant minorities said that web health information had been important in causing them to think about the things they eat (55 per cent), encouraging them to take more exercise (48 per cent), making them more aware of the need to live a healthy life (47 per cent), making them eat more fruit and vegetables (40 per cent), and encouraging them to relax more (38 per cent).
It is important that online health information sources can be trusted, especially if users are to act on the information received. Most users rated the trustworthiness of the information they found on the last health site they visited as ‘good’ (63 per cent), with most others ‘excellent’ (23 per cent).
When asked if they had ever visited a health website and thought that some of the information provided there was wrong or misleading, 56 per cent said they had. These findings indicate that, although the internet has become an increasingly sought-after and trusted health information source, web users are becoming more discerning about health websites.
Online information searchers use a variety of avenues to reach health content. An overwhelming majority of respondents (90 per cent) said they had used a search engine to find health websites. The most popular is Google (83 per cent), while small minorities also mentioned Yahoo (6 per cent) and the BBC (3 per cent). Although British sites were the most often mentioned for these UK-based respondents, it was noted by most that US sites are sometimes (76 per cent) or always (10 per cent) returned by the most widely used search engines. Hence, online health information searchers are presented with large amounts of health content on the web from many different sources and geographical points of origin. They must therefore know how to find and identify those sites that are most relevant for them and differentiate them from the many other health sites available.
Search methods
Most popular of all routes is typing in the health query into a search engine (48 per cent). Other search methods included typing the name of the website into a search engine (18 per cent), typing in the web address (11 per cent), and using a bookmark to locate the site (10 per cent). Small numbers of respondents found health websites through casual browsing (6 per cent), by using an online directory (1 per cent) or by following up an advertisement (1 per cent).
Internet surfers exhibit limited tolerance of difficulties in finding information. Seven in 10 respondents (70 per cent) often stop viewing a site if it takes too long to load. Over one in two (56 per cent) often leave a site if they cannot find what they are looking for within one or two menu screens, with a further 36 per cent saying they sometimes leave for this reason. Many respondents (44 per cent) frequently jumped from site to site in the search for the right information. It is also important that the page at which the surfer lands in a site contains relevant information. Nearly half (47 per cent) sometimes leave a site if the initial information they find appears not to be relevant to their needs, while a further 37 per cent often leave a site when this happens. These findings indicate the importance of website design to online health information searchers. They not only seek the most personally relevant information, but also content that is readily accessible.
These attitudes are underscored by the reported search behaviour of online health information seekers. They are prepared to explore, but not that far. When asked how many different websites they visited the last time they went online to get health advice and information, 47 per cent said they visited two or three sites, 23 per cent visited four or five sites, and 17 per cent visited just one site. Only around one in ten (11 per cent) search six or more sites.
What has become clear is that the internet has emerged as an important source of health information (endorsed by 63 per cent of respondents as fairly or very important). In the current survey, it was the third most widely endorsed important health information source after doctors (85 per cent) and surgery nurses (69 per cent). The significance of this finding is further underlined by other online services patients would like to have available. Clear majorities of respondents said they would like to be able to make or check appointments with their doctor via the internet (84 per cent) and access their own medical records online (76 per cent). Nearly seven in 10 (69 per cent) indicated that at present their surgery does not permit or provide email contact with their doctor, but that they would like to be able to contact them this way.
While the government is determined to provide greater quantities of health information online ą and there is clear evidence here that ordinary people and patients are prepared to use such content ą there is a growing demand for online health services to go far beyond this simple provision of information and to facilitate a more personalised interactive health service for the public.
Reference
1 Library + Information Update, 2(12), December 2003, pp. 50-51.
Barrie Gunter is Professor of Mass Communications and Director of the Centre for Mass Communications Research, University of Leicester; Paul Huntington is Research Fellow and David Nicholas Professor of Information Science and Director at the School of Library, Arts and Information Studies, University College London; and Chris Russell is a partner at eDigitalResearch.com. All are founder members of the British Life and Internet Project.
Updated: 20 April 2005