Reasons, assessments, and actions taken:
A national study of consumer use of Internet
health information
by

Michele Ybarr...
Acknowledgements
We would like to thank our colleagues working
with us on the Growing up with Media
Project:
Dr. Marie Die...
Background
 Access to reliable disease information online
has been linked to



Reduced anxiety (Gufstason, Hawkins, Bo...
Problem statement and Study
question
The Internet’s influence on health care consumers is likely
to only increase, necessi...
Surveying the Digital Future Year 4
Methodology
 Conducted by the Center for the Digital
Future, University of Southern C...
Statistical methods
1. Valid answer to Internet use, N=2,007
2. Missing data imputed using best-set
regression (Stata 7)
3...
Measures
1.

Reasons: Open-ended question about why
respondent chose the Internet to look for health
or medical informatio...
Study sample characteristics
(N=2,007)
Non-Internet
users
(N=548)

Internet users, nonhealth information
seekers (N=640)

...
Internet use and health information
seeking


72% of all respondents were Internet
users



56% of Internet users were h...
Internet use by sex and age (N=2,007)
Health
information
seekers
(N=819)

Internet users,
non-health
information
seekers (...
Internet health information seeking by
sex among Internet users (N=1,459)
Healt h infor m at ion seek er
Non- seek er

80%...
Internet health information seeking by
age among Internet users (N=1,459)
80%

Healt h infor m at ion seek er
Non- seek er...
The health information seeking
experience (N=819)
Reasons




75%: to search about a personal health problem
70%: to se...
Internet health information seeking
by sex (N=819)
80%

*p-value<.05; **p-value<.01

70%

Men
60%
50%
40%

Wom en

49%

46...
Internet health information seeking
by age: Reasons (N=819)
76% 78%

80%

Childr en and adolescent s

71%

70%

Young adul...
Internet health information seeking
by age: Assessments (N=819)
80%
70%

Childr en and adolescent s
Young adult s

60%

Mi...
Internet health information seeking
by age: Results / Actions taken
(N=819)
90%
79%

78%

80%

84%

Childr en and adolesce...
Study Limitations
The current investigation does not
include medical conditions or
treatment outcomes.
Data do not provide...
Conclusions: Age
As age increases, so too does the
likelihood of reporting:


The reason for using the Internet was
the w...
Conclusions: Sex
Men and women were equally likely to
be searching for information about a
personal problem as well as a l...
Implications: Medical Care
One in two seekers contact a physician
because of information found online.
No difference in li...
Implications:
Intervention and prevention
Although we tend to think of the Internet
as a young person’s tool, it may be a
...
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Reasons, assessments, and actions taken: A national study of consumer use of Internet health information

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  • Year 1 sample in 2000, as well as replacement respondents in subsequent years. In Year 1, 19,247 phone numbers were generated, resulting in 2,104 completed interviews.
    In Year 4, all 1,960 respondents from the previous year who indicated they were willing to be contacted again were called. To replace dropouts, an additional 18,500 phone numbers were randomly identified via EPSEM and contacted. In total, 2,010 interviews were completed. Five hundred and seventy of the 2,104 participants from Year 1 were in the panel in Year 4.
    20,460 phone numbers were dialed. Of the 6468 households contacted, 6279 were eligible (97% of households contacted). 2010 completed the interview – 32% of households identified as eligible.
  • Year 1 sample in 2000, as well as replacement respondents in subsequent years. In Year 1, 19,247 phone numbers were generated, resulting in 2,104 completed interviews.
    In Year 4, all 1,960 respondents from the previous year who indicated they were willing to be contacted again were called. To replace dropouts, an additional 18,500 phone numbers were randomly identified via EPSEM and contacted. In total, 2,010 interviews were completed. Five hundred and seventy of the 2,104 participants from Year 1 were in the panel in Year 4.
    20,460 phone numbers were dialed. Of the 6468 households contacted, 6279 were eligible (97% of households contacted). 2010 completed the interview – 32% of households identified as eligible.
  • Sex-specific medical conditions will have implications for the type of information male and female patients will seek. For example, women are significantly more likely than men to search for information about depression, anxiety and stress [16]. Age-specific lifestyle trends (e.g., middle-aged adults becoming caregivers for older parents as well as their children) and typical health status changes as one grows older also likely influence the decision to use the Internet as a resource. Although adolescents have more readily adopted the Internet in general, middle-aged adults are most likely to look for health information online [2].
  • Year 1 sample in 2000, as well as replacement respondents in subsequent years. In Year 1, 19,247 phone numbers were generated, resulting in 2,104 completed interviews.
    In Year 4, all 1,960 respondents from the previous year who indicated they were willing to be contacted again were called. To replace dropouts, an additional 18,500 phone numbers were randomly identified via EPSEM and contacted. In total, 2,010 interviews were completed. Five hundred and seventy of the 2,104 participants from Year 1 were in the panel in Year 4.
    20,460 phone numbers were dialed. Of the 6468 households contacted, 6279 were eligible (97% of households contacted). 2010 completed the interview – 32% of households identified as eligible.
  • Missing and non-responsive answers (i.e., “don’t know” and “refused”) were imputed using best-set regression [20]. This affected less than 1% of data with one exception: 11.3% of health information seekers were unresponsive to queries about their household income.
  • Missing and non-responsive answers (i.e., “don’t know” and “refused”) were imputed using best-set regression [20]. This affected less than 1% of data with one exception: 11.3% of health information seekers were unresponsive to queries about their household income.
  • Note: income was entered into the model as an ordinal variable (range: 22). The above is simply an indicator and is truncated for space. The statistical comparison reflects a comparison of medians test
  • Missing and non-responsive answers (i.e., “don’t know” and “refused”) were imputed using best-set regression [20]. This affected less than 1% of data with one exception: 11.3% of health information seekers were unresponsive to queries about their household income.
  • Note: income was entered into the model as an ordinal variable (range: 22). The above is simply an indicator and is truncated for space. The statistical comparison reflects a comparison of medians test
  • 95% of kids are on the Internet
    87% of young adults
    80% of middle aged
    46% of older adults
  • Missing and non-responsive answers (i.e., “don’t know” and “refused”) were imputed using best-set regression [20]. This affected less than 1% of data with one exception: 11.3% of health information seekers were unresponsive to queries about their household income.
  • Note the scale changing
  • Challenges include callerID, confusion with telemarketers, and saturation of surveys among the public. Our survey is additionally challenged because of its broad inclusion criteria; targeting a more select population would have likely increased the response rate but decreased the generalizability.
  • Reasons, assessments, and actions taken: A national study of consumer use of Internet health information

    1. 1. Reasons, assessments, and actions taken: A national study of consumer use of Internet health information by Michele Ybarra, MPH PhD* Michael Suman, PhD ** American Public Health Association Annual Conference December 14, 2005, Philadelphia, PA *Center for Innovative Public Health Research **Center for the Digital Future, University of Southern California * Thank you for your interest in this presentation.  Please note that analyses included herein are preliminary.  More recent, finalized analyses can be found in: Ybarra, M., & Suman, M. (2006). Reasons, assessments, and actions taken: Sex and age differences in uses of Internet health information. Health Education Research, or by contacting CiPHR for further information.
    2. 2. Acknowledgements We would like to thank our colleagues working with us on the Growing up with Media Project: Dr. Marie Diener West, JHSPH Dr. Merle Hamburger, CDC Mr. Levator Brown, CDC Dr. Dana Markow, Harris Interactive Dr. Suzanne Martin, Harris Interactive Ms. Amie Kim, Harris Interactive
    3. 3. Background  Access to reliable disease information online has been linked to   Reduced anxiety (Gufstason, Hawkins, Boberg et al., 2002), Increased feelings of self-efficacy  48% of health information seekers indicate that their findings help them to take better care of themselves (Fox, Rainie, Horrigan et al., 2000).  41% of adolescents have changed their behavior because of information they found online (Kaiser Family Foundation, 2002).
    4. 4. Problem statement and Study question The Internet’s influence on health care consumers is likely to only increase, necessitating more information about the seeking experience. Personal characteristics may significantly influence Internet health information seeking behavior. Study questions: What are the common reasons, assessments and actions taken as a result of Internet health information How do the RAAs vary by sex and age?
    5. 5. Surveying the Digital Future Year 4 Methodology  Conducted by the Center for the Digital Future, University of Southern California  N = 2,010  4th year of a longitudinal telephone survey  Nationally representative (EPSEM)  Conducted in summer 2003  Inclusion criteria:    Over the age of 12 years Speak either English or Spanish Consent to participation
    6. 6. Statistical methods 1. Valid answer to Internet use, N=2,007 2. Missing data imputed using best-set regression (Stata 7) 3. Differences by sex and age were investigated via chi-square tests.
    7. 7. Measures 1. Reasons: Open-ended question about why respondent chose the Internet to look for health or medical information. Coded into 6 categories. 2. Assessments: 10 statements were read aloud and respondents rated how much they agreed with each statement (5-point Likert scale). 3. Actions / results: Respondents asked if they engaged in each of 5 activities (yes / no).
    8. 8. Study sample characteristics (N=2,007) Non-Internet users (N=548) Internet users, nonhealth information seekers (N=640) Race     White 82.1% (450) 79.7% (510) 88.6% (726) Black 7.1% (39) 8.3% (53) 3.9% (32) Asian 0.4% (2) 1.9% (12) 1.8% (15) American Indian 1.8% (10) 1.4% (9) 1.2% (10) Other 8.6% (47) 8.8% (56) 4.4% (36) Hispanic ethnicity 11.0% (60) 8.3% (53) 5.6% (46) X2=13.0 (2)** Female 63.7% (349) 52.5% (336) 64.6% (529) X2=25.2 (2)*** Age [M (SD)] 61.1 (18.1) 40.7 (19.0) 45.9 (15.2) F=5.3 (82)*** Income ($80,000+) 3.7% (20) 18.9% (121) 24.7% (202) Demographic characteristics *p-value<.05; **p-value<.01; ***p-value<.001 Health information seekers (N=819) Statistical Comparison X2=35.7 (8)*** X2=104.5 (2)***
    9. 9. Internet use and health information seeking  72% of all respondents were Internet users  56% of Internet users were health information seekers (41% of all respondents)
    10. 10. Internet use by sex and age (N=2,007) Health information seekers (N=819) Internet users, non-health information seekers (N=640) Non-Internet users (N=548) % (N) % (N) % (N) Adolescents (12-19 yrs) 23 (37) 72 (114) 5 (8) Young adults (20-39 yrs) 47 (235) 40 (201) 13 (67) Middle age (40-59 yes) 53 (388) 27 (203) 20 (148) Older adults (60+ yrs) 26 (159) 20 (122) 54 (325) Men 37 (290) 38 (304) 25 (199) Women 44 (529) 28 (336) 29 (349) Age Sex Percentages sum to 100% across the row
    11. 11. Internet health information seeking by sex among Internet users (N=1,459) Healt h infor m at ion seek er Non- seek er 80% 70% 61% 60% 50% 51% 49% 39% 40% 30% 20% 10% 0% Males X2(1) = 21.8   p<.001 Fem ales
    12. 12. Internet health information seeking by age among Internet users (N=1,459) 80% Healt h infor m at ion seek er Non- seek er 75% 66% 70% 60% 57% 54% 46% 50% 40% 30% 43% 34% 25% 20% 10% 0% Childr en & adolescent s ( 12- 19 yr s) X2(3) = 84.0  p-value<.001 Young adult s ( 20-39 year s) Middle aged adult s ( 40-59 years) Older adult s ( 60 years+ )
    13. 13. The health information seeking experience (N=819) Reasons    75%: to search about a personal health problem 70%: to search about a loved one’s health problem 4%: privacy / embarrassing topic Assessments    73% satisfied with information found 21% concerned about the quality of information 8% information too hard to understand Action taken / results   55% contacted a healthcare provider 78% felt more comfortable about information from a healthcare provider
    14. 14. Internet health information seeking by sex (N=819) 80% *p-value<.05; **p-value<.01 70% Men 60% 50% 40% Wom en 49% 46% 40% 37% 34% 30% 24% 23% 16% 20% 16% 9% 10% 0% I nfor m at ion is Not enough t im e easy t o f ind ** t o find inform at ion* Reasons Took a lot of effor t ** Assessments Tr ied t o Dx a pr oblem * Seek support fr om ot her s ** Actions taken
    15. 15. Internet health information seeking by age: Reasons (N=819) 76% 78% 80% Childr en and adolescent s 71% 70% Young adult s Middle aged adult s 60% Older adult s 54% 50% 38% 39% 40% 34% 30% 38% 32% 30% 23% 20% 14% 10% 0% Healt h problem loved one has ** *p-value<.05; **p-value<.01 Wide availabilit y of infor m at ion * Needed inf or m at ion quick ly *
    16. 16. Internet health information seeking by age: Assessments (N=819) 80% 70% Childr en and adolescent s Young adult s 60% Middle aged adult s Older adult s 50% 40% 31% 30% 20% 23% 20% 16% 15% 10% 10% 14% 0% 0% Want ed m ore inform at ion but didn't k now w her e t o find it ** **p-value<.01; ***p-value<.001 Took a lot of effort ***
    17. 17. Internet health information seeking by age: Results / Actions taken (N=819) 90% 79% 78% 80% 84% Childr en and adolescent s Young adult s 72% Middle aged adult s 70% Older adult s 60% 50% 41% 40% 32% 30% 32% 26% 20% 10% 0% Felt m ore com for t able w it h infor m at ion from healt h pr ovider * *p-value<.05 Tr ied t o t r eat a healt h pr oblem *
    18. 18. Study Limitations The current investigation does not include medical conditions or treatment outcomes. Data do not provide enough detail to disentangle reasons why consumers sought medical care / support.
    19. 19. Conclusions: Age As age increases, so too does the likelihood of reporting:  The reason for using the Internet was the wide availability of information But also,   The search took a lot of effort and More information was wanted but the consumer didn’t know where to find it.
    20. 20. Conclusions: Sex Men and women were equally likely to be searching for information about a personal problem as well as a loved one’s health problem. Women were significantly more likely to report a negative assessment of the seeking experience than men.
    21. 21. Implications: Medical Care One in two seekers contact a physician because of information found online. No difference in likelihood of seeking medical care was noted by sex or age. Health behavior and perceptions of health services received are likely influenced by information found online, which may vary by sex and age.
    22. 22. Implications: Intervention and prevention Although we tend to think of the Internet as a young person’s tool, it may be a viable delivery method for older adults too. The Internet is being used by caregivers. “Multiple hit” interventions should be considered.

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