Search Menu Abstract Increasingly, consumers engage in health information seeking via the Internet. Taking a communication perspective, this review argues why public health professionals should be concerned about the topic, considers potential benefits, synthesizes quality concerns, identifies criteria for evaluating online health information and critiques the literature. More than 70 websites disseminate health information; in excess of 50 million people seek health information online, with likely consequences for the health care system.
The Internet offers widespread access to health information, and the advantages of interactivity, information tailoring and anonymity.
However, access is inequitable and use is hindered further by navigational challenges due to numerous design features e. Increasingly, critics question the quality of online health information; limited research indicates that much is inaccurate. Meager information-evaluation skills add to consumers' vulnerability, and reinforce the need for quality standards and widespread criteria for evaluating health information.
Future research needs to address the Internet as part of the larger health communication system and take advantage of incorporating extant communication concepts.
Both interpersonal and mass communication concepts open avenues for investigation and understanding the influence of the Internet on health beliefs and behaviors, health care, medical outcomes, and the health care system.
Introduction Increasingly, professionals and consumers engage in interactive health communication. Robinson et al. Perhaps the most common and influential function of interactive health communication today is health-information seeking by consumers. This state-of-the-art review focuses on consumer online health-information seeking. Reviewing literature identified via Medline, PsychInfo and web searches, the report argues why public health professionals should be informed and concerned about consumers' Internet earnings with investment for 2020 health-information seeking, considers potential benefits, synthesizes quality concerns, identifies criteria for evaluating websites, and concludes with simple earnings on the Internet 1 337 commentary about the nature of the literature.
Public health interest in consumer health-information seeking via the Internet Public health professionals need to focus on health-information seeking via the Internet for a variety of reasons. These include magnitude and diversity of use; diversity of users; and, ultimately, implications for the health care system, in terms of structure, health care interaction and quality of medical outcomes.
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Magnitude of use As the Internet has grown, so too have health-related purposes. Perhaps most binary options negative reviews is consumer health-information seeking. Although only computers were linked to the Internet inby4 million were Eng et al.
Consumers seeking health information Consumer use of the Internet for health information is large and growing; more than 70 websites provide health information Grandinetti, Expressed in raw numbers, an estimated 18 million adults in the US sought health information online in Cyber Dialogue, An example illustrates the growth.
Searches increased from 7 million in to more than million in ; more than one-third of the latter were consumers Louis Harris and Associates, In addition, consumers report convenience, anonymity and diversity of information sources as attractions Pew Internet and American Life Project, c.
Simple earnings on the Internet 1 337 access online health information in three primary ways: searching directly for health information, participating in support groups and consulting with health professionals.
Health web pages Consumers can access online health information directly from credible scientific and institutional sources e.
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Medline, Healthfinder as well as unreviewed sources of unknown credibility e. Searches often are triggered by a diagnosis and desire for treatment information Boyer et al.
In turn, information found may influence medical decision making and help consumers to manage their own care Wilkins, ; Pew Internet and American Life Project, c. The most common topics are the leading causes of death heart disease and cancer ; children's health also is a common topic Cyber Dialogue, Consumers also use the Internet to access performance reports regarding providers and hospitals Green ; Anonymous,and information about managed care organizations Williams, Information may be used to select providers Coile and Howe,identify specialists Williams, and make decisions regarding employment-related health care benefits Cronin, In addition, the Internet may be used to complement school health education Roffman et al.
Online support groups An estimated one in four health-information seekers joins a support group Anonymous, ; Cyber Dialogue, Social support groups abound offline and online for an array of reasons Cline, Like face-to-face groups, online groups offer an alternative to professional care; provide social support, information, shared experiences and behavioral models; and empower participants, fulfilling the functions of a community Sharf, ; King and Moreggi, ; Nochi, One study found that users rated online support groups more helpful than physicians in numerous ways e.
Relative advantages of online groups are their h availability, anonymity, selectivity in responding, capacity for immediate and time-delayed reactions, unlimited volume of participants including professionalsand exposure to an increased number of opinions, expertise and experience Sharf, ; Haythornwaite et al. The lack of non-verbal cues and potential for anonymity create a level playing field with regard to status King and Moreggi, Online interaction with health professionals Increasingly, consumers use the Internet to consult with health professionals.
About one in five physicians E-mail patients Cyber Dialogue, b and 3. A more controversial development is fee-based psychotherapy via E-mail.
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Online therapy raises ethical questions and legal concerns King and Moreggi, related to diagnosis by E-mail alone Buhle,given the potential for misrepresentation and deception McLellan,and unclear care standards with regard to record keeping, outcome expectations, billing and confidentiality Shapiro and Schulman, Diverse users Early Internet users were likely to be white male professionals.
Today's health-related use tends to defy stereotypes and increasingly reflects the population's composition. Women, more than men, tend to prefer health sites, in part because of care-taking roles. This popularity may reflect blacks' lesser access to traditional health information sources.
Internet use spans generational lines. Izenberg and Lieberman identified health websites specifically designed for children Izenberg and Lieberman, Many of the latter were ill or had ill spouses. Confidence in learning E-mail spread to other aspects of residents' lives, thereby reducing depression.
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Major barriers to elders' Internet use relate to economics, lack of contact with computers and privacy concerns Pew Internet and American Life Project, a. Collaborations or collisions ahead? Implications for the health care system Increased consumer participation in interactive health communication is likely to influence the health care system due to its information dissemination, health promotion, social support and health services functions Robinson et al.
A PricewaterhouseCoopers PricewaterhouseCoopers, global survey of health industry thought leaders yielded the expectation that the Internet will create massive changes in health care.
However, critics disagree about the valence of consequences. Optimists anticipate better-informed decisions by consumers, better and more tailored treatment decisions, stronger provider—client relationships, and increased patient compliance and satisfaction Ayonride, ; Wilkins,resulting in better medical outcomes Bader and Braude, ; Wilkins, and more efficient service PricewaterhouseCoopers, Pessimists contend that interactive health communication will not enhance physician—patient communication, with physicians likely to balk at the added responsibilities Appleby, ; Simple earnings on the Internet 1 337, As consumers increasingly use the Internet to more actively and independently manage their health care, they are likely to take this active role into encounters with providers.
This emerging consumer role has implications for health care relationships. Consumers may confront providers who are unprepared to deal with the magnitude of available information Coiera,with patients sometimes having greater information access than their providers. Providers may be stressed by added responsibilities for information seeking and clarification, and become frustrated and resistant due to time costs in correcting inaccuracies Ayonride, ; Appleby, ; Lincoln and Builder, Many providers are threatened by their loss of power and fear damage to physician—patient communication Anonymous, Anticipated changes highlight the need to integrate interactive health communication into medical and health professional curricula Aschenbrener, ; Kaufman et al.
Potential benefits to consumers are many. Breaking the space trading bot time barriers of traditional information-seeking processes, the Internet offers widespread dissemination, high volume and currency Eng and Gustafson, ; Gregory-Head, ; McKinley et al.
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As a result, the Internet offers the potential for greater equity in access to health information Morris et al. In some cases, websites are developed specifically for otherwise hard-to-reach audiences e. NetWellness, a consumer health library, developed for a rural population Guard et al.
Interactivity A major potential benefit of the Internet is its capacity for interactivity, emphasizing transactional rather than linear communication processes Pereria and Bruera, ; McMillan, Interactivity is reflected in complexity of choice, responsiveness or conversationality and interpersonal communication McMillan, Interactivity further promotes tailoring of messages and facilitates interpersonal interaction.
Tailoring of information In contrast to traditional sources of health information e.
Consumers can select sites, links and specific messages based on knowledge, educational or language level, need, and preferences for format and learning style, often at lower cost than conventional methods Pereira and Bruera, At the same time, traditional health information and patient education materials and messages can be placed on the Internet inexpensively Richards, et al.
Potential to facilitate interpersonal interaction and social support The Internet offers opportunities for consumers to interact interpersonally with health professionals and peers. Research consistently indicates that health behavior change typically results more from interpersonal than mass communication [e.
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Potential for anonymity Relative to face-to-face interaction, interactive health communication offers potential anonymity Robinson et al. Consumers may access information on sensitive topics, and the stigmatized may interact without the predictable disconfirmation of face-to-face interaction. Roadblocks, bumpy roads and hazards on the information super-highway Despite potential benefits of interactive health communication, limitations and cautions abound.
Roadblocks to access, navigational difficulties and quality concerns constitute potential downfalls of relying on the Internet for health-related information.
Those in greatest need are least likely to have Internet access Eng et al. Have-nots include rural, isolated and traditionally underserved populations e.
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Barriers to online health information include cost, geographic location, literacy, computer skills and institutional policies Eng et al. Lessons on options trading in access to both computers and the Internet are growing Chapman, Both consumers' and professionals' e.
Cost often correlates with geography.
Some require both the purchaser's billing and shipping address to be in the same country as the online shop's base of operation. Other online shops allow customers from any country to send gifts anywhere. The financial part of a transaction may be processed in real time e. Product delivery Once a payment has been accepted, the goods or services can be delivered in the following ways. For physical items: Shipping : The product is shipped to a customer-designated address.
The worldwide picture is dismal. In Africa, Internet service providers are increasing, but most health professionals and hospitals cannot afford hook-up and access fees; these same countries often lack textbooks for medical and nursing students, and have little access to medical journals Lown et al.
Internet access is prohibitively expensive for many developing countries Pereira and Bruera, At the same time that analysts fear information overload regarding HIV treatments [e.
Thus, little attention is paid to making information accessible to those in greatest need. Computer, English language and health literacy constrain Internet use.
People may not know how to access the Internet or be afraid of the technology Wilkins, People unable to speak, read or understand English are disadvantaged as English is the dominant online language Pereira and Bruera, People with the greatest health care needs often have low information access due to lower health literacy levels.