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Online health information seeking is an activity that needs to be explored in Scotland. While there are a growing number of studies that adopt a qualitative approach to this issue and attempt to understand the behaviors associated with online health information seeking, previous studies focusing on quantifying the prevalence and pattern of online health seeking in the United Kingdom have been based on Internet users in general.
This exploratory study sought to describe the prevalence of online health information seeking in a rural area of Scotland based on primary data from a patient population.
A survey design was employed utilizing self-completed questionnaires, based on the Pew Internet and American Life Project; questionnaires were distributed among adult patients in 10 primary care centers in a rural community in Scotland.
A convenience sample of 571 (0.10% of the total population in Grampian, N=581,198) patients completed the questionnaire. A total of 68.4% (379/554) of patients had previously used the Internet to acquire health information. A total of 25.4% (136/536) of patients consulted the Internet for health information regarding their current appointment on the day surveyed; 34.6% (47/136) of these patients were influenced to attend their appointment as a result of that online health information. A total of 43.2% (207/479) of patients stated the health information helped improve their health and 67.1% (290/432) indicated that they had learned something new. A total of 34.0% (146/430) of patients talked to a health professional about the information they had found and 90.0% (376/418) reported that the information was useful. In total, 70.4% (145/206) of patients were concerned about obtaining health information online from reliable sources. A total of 67.1% (139/207) of patients were concerned that a health site may sell their personal information, yet only 6.7% (36/535) checked the privacy policy of the site visited. However, 27.9% (55/197) of patients were not concerned about their employer finding out what health sites they visited, whereas 37.5% (78/208) were concerned that others would find out.
The results suggest that online health information-seeking behavior influences offline health-related behavior among the population surveyed. Patient attitudes to online health information seeking were focused on issues relating to trust, reliability, privacy, and confidentiality. This study provides support for the growing phenomenon of an empowered, computer-literate, health information consumer, and the impact of this phenomenon must be considered in the context of the patient-health professional dynamic. The unpredictable nature of human thought and action in relation to this field of study requires an ongoing program of ethnographic research, both physical and virtual, within a Health Web Science framework. This study has provided a baseline of the prevalence of online health information seeking in the Grampian region of Scotland.
The Scottish Government recently published a National Framework [
Scotland has a health service that is free at the point of need. As the population increases, the health of the nation continues to be an area of concern for the Scottish Government and the National Health Service (NHS) in Scotland. Internet use has enabled patients to access search engines, online symptom checkers, and health information sites to contribute to positive health outcomes for themselves or a loved one. This digitally literate population are described as "health seekers" [
Online health seekers differ from offline health seekers by age, income, and education [
Health information sought online by patients is not intended to replace physician care, but rather, to support it [
The online health seeker expects convenience, to be a partner in decision making, and almost instant service in all aspects of their health care [
Making a primary care appointment can be highly bureaucratized, often with considerable waiting times. Access to primary care for patients within the United Kingdom is guaranteed within 48 hours of contacting their general practitioner (GP) [
The point of origin for this initial exploratory study is concerned with the effect of online health information on primary care services in Scotland and the potential impact this has on the doctor-patient relationship. As stated previously, health seekers often want to be partners in their health care; as Ball and Lillis [
The empowered, computer-literate public is exerting tremendous influence on healthcare delivery. Consumer interest in and demand for online administrative processes, information-rich Internet health portals, and access to physician web pages and e-mail has introduced a new dimension to maintaining wellness and treating disease.
There is a growing body of literature that is concerned with the prevalence and patterns of online health information seeking. This study hopes to contribute to that body of knowledge by providing an overview of online health information seeking among a patient population in Scotland. It is hoped that this information will create a baseline indicating what is happening in relation to online health information seeking, rather than an explanation of patient motivation to do so. By simply discovering what is happening, for instance, how many and who, the authors hope to provide a starting point for future research focused on finding out what motivates online health seekers and gain a deeper understanding of the behavior involved. The findings of this study will also be useful to health policy makers and health website content regulators.
This study involved a cross-sectional survey and data were gathered using a self-completed questionnaire. The questionnaire was adapted from the Pew Internet and American Life Project [
The timetable for this cross-sectional study was at the health care center manager's discretion, but no more than one calendar month as per ethical approval. A total of 800 questionnaires were distributed to 10 medical centers in Moray, Scotland, and yielded a response rate of 71.4% (571/800). This sample of 571 patients represented 0.10% of the total population in Grampian (N=581,198 [
All adult patients (aged 18 years and over) attending the medical center were invited to participate. The definition of a patient within this study is a person who is attending a medical center on the day surveyed.
Questionnaires were placed in health care centers with the permission and ethical approval of NHS Scotland, the National Research Ethics Service (NRES), and the University of the Highlands and Islands. Health care center personnel handed the questionnaires out to patients as they waited to see a health professional. A study brief and consent form were read and completed prior to the patient completing the questionnaire to ensure that only adult patients responded.
Anonymized self-completed questionnaires were deposited in a post box in the medical center and collected by a researcher. The software program Statistical Package for the Social Sciences (SPSS) version 22 was used to perform statistical analysis. As the data were nominal, nonparametric tests were employed. Chi-square tests with 95% confidence levels were used to identify differences among the patient demographics. Cramer’s V and phi were calculated to indicate the presence and strength of any relationship between variables, as even though the confidence interval is high, the strength of the effect is only indicated by the appropriate coefficient (phi for 2x2 tables or Cramer’s V for larger tables).
Demographic data of patients surveyed in Moray, Scotland (n=571).
Characteristics | Frequency, n (%) | |
|
|
|
|
18-25 | 82 (14.4) |
|
26-35 | 89 (15.6) |
|
36-45 | 107 (18.7) |
|
46-55 | 94 (16.5) |
|
56-65 | 88 (15.4) |
|
66-75 | 51 (8.9) |
|
76-85 | 15 (2.6) |
|
86+ | 2 (0.4) |
|
Not completed | 43 (7.5) |
|
|
|
|
Male | 186 (32.6) |
|
Female | 325 (56.9) |
|
Not completed | 60 (10.5) |
|
|
|
|
Full-time paid employment | 246 (43.1) |
|
Part-time paid employment | 71 (12.4) |
|
Full-time student | 24 (4.2) |
|
Part-time student | 3 (0.5) |
|
Home duties | 26 (4.6) |
|
Retired | 122 (21.4) |
|
Unemployed | 19 (3.3) |
|
Caregiver | 2 (0.4) |
|
Ill | 1 (0.2) |
|
Not completed | 36 (6.3) |
|
|
|
|
No formal qualification | 52 (9.1) |
|
Standard Grade, "O" grade | 102 (17.9) |
|
Highers | 75 (13.1) |
|
Vocational qualification | 73 (12.8) |
|
Higher National Diploma | 2 (0.4) |
|
Undergraduate degree | 63 (11.0) |
|
Masters | 18 (3.2) |
|
Doctorate | 1 (0.2) |
|
Professional qualification | 98 (17.2) |
|
Not completed | 70 (12.3) |
|
|
|
|
Rural | 90 (15.8) |
|
Village | 172 (30.1) |
|
Town | 200 (35) |
|
City | 69 (12.1) |
Furthermore, 25.4% (136/536) of patients had consulted the Internet for health information in relation to their appointment on the day surveyed. This was either by themselves—21.5% (115/536)—or someone had done so on their behalf—3.9% (21/536). Of the patients who consulted the Internet for health information prior to their current appointment, 34.6% (47/136) stated that the information they had found online had influenced them to attend their current appointment and 15.4% (53/344) also indicated that they would not have otherwise attended the current appointment.
A large proportion of patients (211/483, 43.7%) stated that they had found information online which had helped them to improve their health, and 90.0% (376/418) believed the health information that they found online was useful.
The age range dispersion between 18 to 65 years was relatively equal given that opportunity sampling was employed. Patients who took part in the survey were predominantly female (325/571, 56.9%), in full-time employment (246/571, 43.1%) or retired (122/571, 21.4%), and educated to Standard Grade or Highers (177/571, 31.0%)—equivalent to Advanced Subsidiary (AS) level in England and Northern Ireland—which is a reflection of general survey response bias [
Patient responses to the survey.
Questions and responses | Frequency, n (%) | |
|
||
|
Yes, myself | 353 (63.7) |
|
Yes, someone on my behalf | 26 (4.7) |
|
No | 175 (31.6) |
|
Total | 554 (100) |
|
||
|
Yes, myself | 115 (21.5) |
|
Yes, someone on my behalf | 21 (3.9) |
|
No | 400 (74.6) |
|
Total | 536 (100) |
|
||
|
Yes | 47 (11.8) |
|
No | 351 (88.2) |
|
Total | 398 (100) |
|
||
|
Yes | 292 (84.6) |
|
No | 53 (15.4) |
|
Total | 345 (100) |
|
||
|
Yes | 211 (43.7) |
|
No | 272 (56.3) |
|
Total | 483 (100) |
|
|
|
|
Useful | 376 (90.0) |
|
Not useful | 42 (10.0) |
|
Total | 418 (100) |
|
||
|
Yes | 146 (34.0) |
|
No | 284 (66.0) |
|
Total | 430 (100) |
|
|
|
|
Yes | 290 (67.1) |
|
No | 142 (32.9) |
|
Total | 432 (100) |
Channels used by patients to search for health information online (n=108).
Channels | Frequency, n (%) |
Health forum | 19 (17.6) |
Search engine | 53 (49.1) |
National Health Service website | 36 (33.3) |
Total | 108 (100) |
Specific sites used by patients to search for health information online (n=16).
Specific sites used | Frequency, n (%) |
BBC.co.uk [ |
1 (6) |
Menopausematters.co.uk [ |
1 (6) |
Boots.com [ |
1 (6) |
CDC.gov [ |
1 (6) |
Public Health England (GOV.UK) [ |
1 (6) |
Fibromyalgia.co.uk [ |
1 (6) |
Google [ |
5 (31) |
JustAnswer.co.uk [ |
1 (6) |
NHS24.com/SelfHelpGuide [ |
1 (6) |
Patient.co.uk [ |
3 (19) |
Total | 16 (100) |
As shown in
A weak association is evident between educational attainment and those who previously searched for health information online. A weak association was also found between educational attainment and those who were influenced to attend the current appointment as a result of online health information. There was no association between educational attainment and online health information seeking prior to the patient's appointment on the day surveyed.
There was a weak association between location and those who previously searched for health information online. A weak association was also found between location and those who were influenced to attend the current appointment as a result of online health information. There was no association between location and online health information seeking prior to the patient's appointment on the day surveyed.
There was a weak association between age and those who had previously sought health information online. There was also a weak association between age and those patients who were influenced to attend the appointment as a result of online health information. There was no association between online health information seeking prior to the appointment on the day surveyed and age.
A weak association was found between gender and online health seeking prior to the patient's appointment on the day surveyed. There was a weak association between gender and those patients who were influenced to attend the appointment as a result of online health information.
As shown in
Effect of socioeconomic characteristics on health-seeking behavior.
Socioeconomic characteristic and health-seeking behavior effect | χ2(df) |
|
Cramer's V or phi | |
|
||||
|
Patients who previously searched for online health information (n=554) | 23.2 (9) | <.001 | .21 (V) |
|
Patients influenced to attend current appointment (n=571) | 89.9 (27) | <.001 | .23a(V) |
|
Patients who searched prior to current appointment (n=536) | 10.3 (9) | .33 | N/Ab,c |
|
||||
|
Patients who previously searched for online health information (n=554) | 21.0 (9) | <.001 | .36 (V) |
|
Patients influenced to attend current appointment (n=571) | 76.0 (12) | <.001 | .21 (V) |
|
Patients who searched prior to current appointment (n=536) | 4.9 (4) | .29 | N/Ac |
|
|
|
||
|
Patients who previously searched for online health information (n=554) | 21.0 (4) | <.001 | .20 (V) |
|
Patients influenced to attend current appointment (n=771) | 76.0 (12) | <.001 | .21 (V) |
|
Patients who searched prior to current appointment (n=536) | 4.9 (4) | .29 | N/Ac |
|
|
|
||
|
Patients who previously searched for online health information (n=554) | 52.3 (8) | <.001 | .31 (V) |
|
Patients influenced to attend current appointment (n=571) | 94.0 (24) | <.001 | .23 (V) |
|
Patients who searched prior to current appointment (n=536) | 7.7 (8) | .47 | N/Ac |
|
|
|
||
|
Patients who previously searched for online health information | N/A | N/A | N/A |
|
Patients influenced to attend current appointment (n=571) | 46.5 (6) | <.001 | .29 (phi) |
|
Patients who searched prior to current appointment (n=554) | 35.1 (2) | <.001 | .25 (phi) |
aA total of 20 cells were expected to have a count less than 5.
bNot applicable (N/A).
cToo many cells violated the expected count.
Attitudes evident among patients in relation to online health information seeking.
Attitudes | n (%) |
Concerned that their employer might find out what health sites they visited | 55/197 (27.9) |
Concerned about getting health information from an unreliable source | 145/206 (70.4) |
Felt it was important that they could get health information online rather than from other sources | 357/486 (73.5) |
It is important to be able to get health information online anonymously without having to talk to anyone | 357/505 (70.7) |
It is important that they can get health information online at any time | 433/509 (85.1) |
Not concerned about other people finding out what health sites they have visited (1 out of 10 patients were very concerned about this) | 130/208 (62.5) |
Concerned that a website might sell or give away information about what they did online | 139/207 (67.1) |
Checked the health or medical website's privacy policy to read about how the site uses personal information | 36/535 (6.7) |
Patients are searching for health information online and this information influences a small proportion to attend medical centers. Attitudes to online health information seeking suggest a concern for reliability, convenience, privacy, and a preference for online health information above other sources. These results also indicate that location, age, and gender do have an effect on the prevalence of online health information-seeking behavior and the resulting offline behavior.
The Pew Project [
This study suggests that online health information seeking influences the offline behavior of this patient sample through patients consulting the Internet for health information either by themselves or on behalf of someone else. Some patients have been influenced to attend a medical center as a direct result of information they found online, with a small proportion of patients reporting that they would not have attended the appointment without this information.
Almost all of the patients in this sample population stated that they found online health information useful. Two-thirds of patients claimed they had not discussed this information with a health professional and the same proportion of patients indicated that they had learned something new from the online health information. It could be suggested that patients who consult the Internet for health information and are satisfied may not feel the need to then consult a health professional. However, further research is needed to explore this finding and investigate whether health professionals are being bypassed by patient online health information seeking. As the Web evolves and attitudes to the Web change, this research needs to be ongoing.
The results from this primary data suggest that location, age, and gender have an effect on health-seeking behaviors and the resulting actions, but the association is weak. In line with the Pew Project [
The findings provide support that the digital divide has an impact on health information seeking [
Confidentiality and privacy is important to patients when they search for health information online, especially in relation to how their personal information may be used and the privacy of their search content. In this instance, "others" are a concern when it comes to people finding out about the content of searches and employers are not a concern. This may suggest that online health information seeking is not taking place at work, however, this would require further research.
The implications of online health information-seeking behavior on the power dynamic of the traditional health professional and patient relationship should also be the subject of future research as a result of the public availability via the Internet of previously exclusive information (ie, medical information for professionals only). For example, change in the power dynamic because knowledge of the health professional is becoming democratized may cause issues around treatment adherence based on trust and the value that patients place on the knowledge of health professionals.
The findings of this survey provide an indication of how patients' offline behavior is influenced by health information they find online. This study has provided support for the findings from secondary data of previous research which showed that a large number of people are accessing the Internet for health information. This study’s unique contribution lies in its presentation of evidence based on primary data, which quantifies patients who are influenced by online health information to interact with health care professionals by attending medical centers. This phenomenon needs to be considered in the context of individual countries and specific populations in order to be useful to policy makers.
Further research is needed to evaluate the impact that the democratization of medical information through online health information seeking among patients has on health care professionals and organizations, including how to access those who sought health information online and did not attend a medical center as a result. Patients want access to health information online at any time, in preference to other sources, and this may be related to increased anonymity and privacy.
The numbers of online health information-seeking patients are increasing; health care professionals and their supporting organizations need to consider how to respond to this. With the increasing amount of user-contributed health information, consideration must be given as to the provision of online health information for digital natives versus digital immigrants, for instance, those who have been socialized in a culture in which digital technologies are part of everyday life compared to those who have had to develop an understanding of digital technologies as adults.
This study provides support for the growing phenomenon of an empowered, computer-literate, health information consumer and the impact of this phenomenon must be considered in the context of the patient-health professional dynamic. The unpredictable nature of human thought and action in relation to this field of study requires a program of ethnographic research, both physical and virtual, to describe how people use the Web for health.
None declared.
Advanced Subsidiary
information and communication technology
general practitioner
not applicable
National Health Service
National Research Ethics Service
Oxford Internet Survey
Statistical Package for the Social Sciences
University of the Highlands and Islands
Full text of the self-completed questionnaire.