Health and the Internet--changing boundaries in primary care

BACKGROUND: Little is known about the frequency with which information from the Internet is presented by patients within primary care consultations or the subsequent impact that it may have on those consultations. OBJECTIVES: The aims of this study were to describe the frequency with which Internet information was presented within primary care consultations in one inner-city health authority and to describe the characteristics of the subsequent consultation from the perspective of the health professionals involved. METHODS: A postal survey was used to estimate the frequency of Internet information presentation and eight in-depth interviews were used to obtain health professionals' perceptions of the consultations that followed. RESULTS: Presentation of information from the Internet was relatively infrequent within primary care at the time of the survey (November 2000 to March 2001), but frequencies of presentation were higher for GPs than for any other health professional group. Health professionals have stereotypical views of Internet users and fear for their own professional status in relation to the Internet-informed patient or client. CONCLUSIONS: Although presentation of information from the Internet to date remains relatively infrequent, health professionals appear to feel threatened by it and adopt strategies that minimize its impact on the subsequent consultation.     

Did changing primary care delivery models change performance? A population based study using health administrative data

Background

The knowledge about the relationship between health-related activities on the Internet (i.e. informed citizens) and individuals' control over their own experiences of health or illness (i.e. empowered citizens) is valuable but scarce. In this paper, we investigate the correlation between four ways of using the Internet for information on health or illness and citizens attitudes and behaviours toward health professionals and health systems and establish the profile of empowered eHealth citizens in Europe.

Methods

Data was collected during April and May 2007 (N = 7022), through computer-assisted telephone interviews (CATI). Respondents from Denmark, Germany, Greece, Latvia, Norway, Poland and Portugal participated in the survey. The profiles were generated using logistic regressions and are based on: a) socio-demographic and health information, b) the level of use of health-related online services, c) the level of use of the Internet to get health information to decide whether to consult a health professional, prepare for a medical appointment and assess its outcome, and d) the impact of online health information on citizens' attitudes and behavior towards health professionals and health systems.

Results

Citizens using the Internet to decide whether to consult a health professional or to get a second opinion are likely to be frequent visitors of health sites, active participants of online health forums and recurrent buyers of medicines and other health related products online, while only infrequent epatients, visiting doctors they have never met face-to-face. Participation in online health communities seems to be related with more inquisitive and autonomous patients.

Conclusions

The profiles of empowered eHealth citizens in Europe are situational and country dependent. The number of Europeans using the Internet to get health information to help them deal with a consultation is raising and having access to online health information seems to be associated with growing number of inquisitive and self-reliant patients. Doctors are increasingly likely to experience consultations with knowledgeable and empowered patients, who will challenge them in various ways.     

Individual Willingness to Share Personal Health Information with Secondary Information Users in South Korea

ABSTRACT

People’s privacy concerns about electronic health records (EHRs) have been widely discussed. Given that in principle, patients have the right to control their information in EHRs, the system will not reach its full potential without their support. Although human beings are generally inclined toward privacy, contextual differences play a role in individual decisions to disclose personal information. Likewise, patients exhibit different responses in terms of sharing their health information in diverse scenarios. Empirical work on patients’ attitudes towards the secondary use of their health information is scarce. This study aims to investigate individuals’ willingness to share their health information based on anonymity, information type (partial vs. whole), and the type of information user (health professionals, health researchers, health-related governmental agencies, and other governmental agencies). Furthermore, this study attempts to examine the effects of interaction between the three factors. A survey was conducted in South Korea, and the data obtained were analyzed by ANOVA. Despite the recent rapid diffusion of EHRs in South Korea, there is little discussion of patients’ privacy in society. The results show that, although anonymity and the user type have a significant effect on willingness to share health information, the information type has no significant effect. The results also indicate that the willingness to share was higher for health-related governmental agencies and health professionals than for other governmental agencies. The findings reveal that, although willingness to share anonymous information does not vary significantly, the willingness differs for identified information. The study contributes to research on patients’ privacy behavior by analyzing their comprehensive responses to health information-sharing investigations.     

Health Literacy and Use and Trust in Health Information

There is a need to investigate which health information sources are used and trusted by people with limited health literacy to help identify strategies for addressing knowledge gaps that can contribute to preventable illness. We examined whether health literacy was associated with people’s use of and trust in a range of potential health information sources. Six hundred participants from a GfK Internet survey panel completed an online survey. We assessed health literacy using the Newest Vital Sign, the sources participants used to get health information, and the extent to which participants trusted health information from these sources. We performed multivariable regressions, controlling for demographic characteristics. Lower health literacy was associated with lower odds of using medical websites for health information and with higher odds of using television, social media, and blogs or celebrity webpages. People with lower health literacy were less likely to trust health information from specialist doctors and dentists, but more likely to trust television, social media, blogs/celebrity webpages, friends, and pharmaceutical companies. People with limited health literacy had higher rates of using and trusting sources such as social media and blogs, which might contain lower quality health information compared to information from healthcare professionals. Thus, it might be necessary to enhance the public’s ability to evaluate the quality of health information sources. The results of this study could be used to improve the reach of high-quality health information among people with limited health literacy and thereby increase the effectiveness of health communication programs and campaigns.     

An Extension of the Extended Parallel Process Model (EPPM) in Television Health News: The Influence of Health Consciousness on Individual Message Processing and Acceptance

This study explores the role of nurturing communication in distinguishing interpersonal and intergroup interactions between health professionals and patients, from the perspective of communication accommodation theory (CAT). Participants (47 men and 87 women) rated videotapes of actual hospital consultations on 12 goal and 16 strategy items derived from CAT. Health professionals in interpersonal interactions were perceived to pay more attention to relationship and emotional needs and to use more nurturant discourse management and emotional expression. These results point the way toward elucidating the perceived optimal balance in accommodative behavior, both group based and interpersonal, in these contexts, and they highlight the importance of nurturant communication to this process.     

The Effects of Public Concern for Information Privacy on the Adoption of Health Information Exchanges (HIEs) by Healthcare Entities

ABSTRACT

The implementation of Health Information Exchanges (HIEs) by healthcare organizations may not achieve the desired outcomes as consumers may request that their health information remains unshared because of information privacy concerns. Drawing on the insights of concern for information privacy (CFIP) literature, this work extends the application of CFIP to the HIE domain. This study attempts to develop and test a model centered on the four dimensions of CFIP construct (collection, errors, unauthorized access, and secondary use) and their antecedents to predict consumers’ opt-in behavioral intention toward HIE in the presence of the perceived health status’ effects. We conducted an online survey in the United States using 826 samples. The results demonstrate that the perceived health information sensitivity and computer anxiety meaningfully contribute to information privacy concerns and CFIP construct significantly impedes consumers’ opt-in decision to HIEs. Interestingly, contrary to our expectation, perceived poor health status considerably attenuates the negative effects exerted by CFIP on opt-in intention. The model proposed by this study can be used as a useful conceptual tool by both further studies and practitioners to examine the complex nature of patients’ reactions to information privacy threats associated with the use of HIE technology in the healthcare industry.     

How Children Search for Health Information Online: An Observational Study

ObjectiveTo evaluate whether children could find the correct answers to obesity-related health questions on the Internet and observe the search strategies children use when searching for such information.MethodsTwenty-five parent-child dyads, from a southwestern US summer day camp, participated in this cross-sectional study. Parents’ health literacy skills were evaluated. Children searched the Internet for 6 questions related to nutrition and physical activity. Search activities were recorded via Camtasia. Quantitative (ie, time spent per question) and qualitative data (ie, themes related to difficulties searching) were extracted by rewatching the recordings.ResultsAll parents had either proficient or basic levels of health literacy. The question that had the highest rating for being correctly answered pertained to physical activity recommendations, whereas none of the children were able to find recommended servings of food groups.Conclusions and ImplicationsChildren were not successful in finding correct answers to most of the questions and used ineffective search strategies. Interventions that teach children effective search strategies for health information are needed.     

“I was Right about Vaccination”: Confirmation Bias and Health Literacy in Online Health Information Seeking

When looking for health information, many people turn to the Internet. Searching for online health information (OHI), however, also involves the risk of confirmation bias by means of selective exposure to information that confirms one’s existing beliefs and a biased evaluation of this information. This study tests whether biased selection and biased evaluation of OHI occur in the context of early-childhood vaccination and whether people’s health literacy (HL) level either prevents or facilitates these processes. Vaccination beliefs were measured for 480 parents of young children (aged 0–4 years) using an online survey, after which they were exposed to a list of ten vaccine-related message headers. People were asked to select those headers that interested them most. They also had to evaluate two texts which discussed vaccination positively and negatively for credibility, usefulness, and convincingness. The results showed that people select more belief-consistent information compared to belief-inconsistent information and perceived belief-confirming information as being more credible, useful, and convincing. Biased selection and biased perceptions of message convincingness were more prevalent among people with higher HL, and health communication professionals should be aware of this finding in their practice.     

Improving Health

Abstract

The Internet provides a ready source of patient education handouts specific to certain diseases or conditions. Patients and consumers can obtain clear, concise, and reliable information about their diseases or conditions and follow-up instructions for procedures and treatments. Patient education on the Internet can support patients or consumers in making informed health care decisions. Available day and night, patients can access this information at their convenience when they are most interested in learning. Included in this article are selected and annotated resources for locating patient education materials. Also included are Internet sites to locate materials for low literacy patient education.     

Improving the Quality of Health Information on the Internet

Abstract

The Internet Healthcare Coalition (IHC), a nonprofit organization, believes it is possible to improve the quality of health information on the Internet without imposing new regulations and laws that limit the freedom of information providers or consumers. This article traces the history of the grass-roots development of the IHC beginning with an October 1996 FDA-sponsored public meeting. An online call to action led to the creation of the MEDWEB-MASTERS-L e-mail discussion group where important issues were debated and a community of interest developed. Subscribers felt it was important to meet in person during June 1997. At that time, it was resolved to create a coalition of health professionals, patients, industry, publishers, and Web developers with a common goal of promoting improved Internet health resources through education and self-regulation. The IHC is currently involved with efforts to help consumers and governments control health fraud on the Internet without destroying the Internet's ability to provide useful and legitimate health information. The Coalition plans to be an educational resource to support many independent efforts by members to improve the quality of health information on the Internet. In October 1998, it plans to hold its first annual meeting.     

Uso de Internet por parte de los adolescentes de Gijón (Asturias) como fuente de información sobre salud

ObjectivesTo evaluate the use of Internet as a source of health information by adolescents, its reliability and the acceptability of an email service for their questions.DesignCross-sectional study.SettingSecondary schools. Gijón (Asturias).Participants475 students (1st and 4th Secondary, and 1st High School) selected by two-stage cluster sampling.Main outcome measuresSelf-administered questionnaire of ten items.VariablesAge, sex, availability of Internet at home, daily time use, subjects consulted, source health consultation, information obtained reliability, willingness to use e-mail health consultations.ResultsA total of 468 valid questionnaires, of which 88.5% had Internet at home, 42.5% use more than one hour daily on weekdays and 74% during the weekend. The most accessed topics were physical exercise (29.5%), self-image (23.3%) and piercing, and tattoos (18.4%). Internet is the fourth resource used for health concerns (13.9%), behind family, doctor and friends. The majority, 56%, gave a very low reliability to health information obtained on Internet. A total of 70.5% would use an email address that provided answers to health questions.ConclusionsAvailability of Internet at home is above the national average. High usage but low for health information, which gives low credibility. It would be advisable to start a mail service for adolescents treated by a multidisciplinary team from Primary Care.     

Participación ciudadana en salud: formación y toma de decisiones compartida. Informe SESPAS 2012

In recent decades, citizen's participation has become increasingly important in the field of public health, with the new role of the patient as an active agent, manager and producer of his or her own health, and the paradigm of patient-centered care. These changes have represented some of the most important milestones in the continuous improvement of healthcare. The involvement of patients is a new way of understanding the relationship between patients, health professionals and health systems, not only in terms of knowledge management and patients’ control of their own health, individually or collectively, but also in terms of the influence that patients may have in health policy planning. Increased life expectancy and the consequent rise in the prevalence of chronic diseases, which already account for 80% of primary care consultations, is one of the key factors changing the role of patients. The place traditionally occupied by professional consultations given any symptoms or signs of alarm is beginning to be occupied by self-care and information and health education resources within the reach of patients and citizens. Internet access is an inexhaustible source of health information resources aimed at patients and provides participation tools. Social networks are places to exchange information and practical advice among patients, families and health professionals. Patients may be experts in their own illnesses and may thus take a more active role in decisions about their health, such as in shared decision making, as part of initiatives, and as part of evaluation of public health activities and health services.     

How do health professionals acknowledge Web-based knowledge in pregnancy consultations?

ABSTRACT

Websites for pregnancy health are an important source of information for pregnant women, but how different cadres of health professionals value and utilize pregnant women's e-health literacy (e-HL) and Web-based knowledge in pregnancy consultations is not well understood. Using a qualitative research design and pelvic girdle pain as a tracer condition, we explored how Norwegian doctors, midwives and physiotherapists manage women's e-HL and Web-based knowledge in pregnancy consultations. The recognition of pregnant women's e-HL and Web-based knowledge differed across professional groups and produced dismissive, reactive and proactive attitudes depending on time pressure, professional identity and Internet experience.     

Internet como fuente de información sobre salud en pacientes de atención primaria y su influencia en la relación médico-paciente

ObjectiveTo describe the use of the Internet by primary care patients to seek health related information, understand how they are influenced by this information, and evaluate its impact on the doctor-patient relationship.DesignCross sectional study, through self-administered survey.SettingOne urban health center in Madrid.ParticipantsA total of 323 questionnaires were collected from patients between 14 and 75 years old who attended a physician's office for any reason, excluding illiterate patients and those with neurological or psychiatric problems preventing them from completing the survey.MeasurementsInternet usage, ability of the internet to clarify doubts regarding health issues, patient lifestyle changes, socio-demographic variables, and physician's receptivity to the use of internet by patients.Results61% (CI 95%: 56%-67%) of patients used the Internet as a source of health information: Internet queries were able to address health doubts in 92.4% of users, 53.5% reported that the Internet changed their thinking about their health in at least one instance, 30% made behavioral changes (of which 60.1% discussed these changes with their physician), 44.3% had more questions at the physician's office, and 80.8% believe that the doctor would be willing to talk about the information found on the internet.ConclusionsUsing the Internet to find information about health is very common, with positive influence on physician-patient relationship. This may be useful for achieving behavioral changes in patients and can be used as a tool in medical practice.     

General Practitioner's use of online resources during medical visits: managing the boundary between inside and outside the clinic

In an increasingly connected world, information about health can be exchanged at any time, in any location or direction, and is no longer dominated by traditional authoritative sources. We consider the ways information and advice given in consultations by doctors transcends the boundary between the clinic and the home. We explore how information that is widely accessible outside the consultation is transformed by General Practitioners (GPs) into a medical offering. Data comprise 18 consultations identified from 144 consultations between unselected patients and five GPs. We use conversation analytic methods to explore four ways in which GPs used online resources; (i) to check information; (ii) as an explanatory tool; (iii) to provide information for patients for outside the consultation; (iv) to signpost further explanation and self‐help. We demonstrate the interactional delicacy with which resources from the Internet are introduced and discussed, developing and extending Nettleton's (2004) idea of ‘e‐scaped medicine’ to argue that Internet resources may be ‘recaptured’ by GPs, with information transformed and translated into a medical offering so as to maintain the asymmetry between patients and practitioners necessary for the successful functioning of medical practice.     

Overruling uncertainty about preventative medications: the social organisation of healthcare professionals’ knowledge and practices

In this article, we draw on an institutional ethnographic (IE) study of cardiovascular disease prevention in general practice, exploring the work of healthcare professionals who introduce a discussion of risk and preventative medications into consultations with patients. Our aim is to explicate, using IE's theoretical ontology and analytical tools, how troubling patient experiences in this clinical context are coordinated institutionally. We focus our attention on the social organisation of healthcare professionals’ knowledge and front-line practices, highlighting the textual processes through which they overrule patients’ concerns and uncertainties about taking preventative medication, such that some patients feel unable to openly discuss their health needs in preventative consultations. We show how healthcare professionals activate knowledge of ‘evidence-based risk reduction’ to frame patients’ queries as ‘barriers’ to be overcome. Our analysis points not to deficiencies of healthcare professionals who lack the expertise or inclination to adequately ‘share decisions’ with patients, but to the ways in which their work is institutionally orientated towards performance measures which will demonstrate to local and national policymakers that they are tackling the ‘burden of (cardiovascular) disease’.     

How does objective and subjective human papillomavirus knowledge affect information-seeking intentions and source preferences?

ABSTRACT

This study examines the effects of objective (factual information) and subjective knowledge (an individual’s self-assessment of how much knowledge they have) on information-seeking intentions and source preferences. It explores the human papillomavirus (HPV) knowledge inequalities in groups of young adults age 18–26 years with and without vaccinations and diagnosis, and different demographics/socio-economic and perceptions of health status. Higher subjective HPV knowledge leads to greater information-seeking intentions from family/friends and mass media but not from health professionals and the Internet. Objective HPV knowledge did not matter for information seeking. The important role of demographics/socio-economic and perceived health status is also discussed.