O'Connor JB, Johanson JF. Use of the Web for Medical Information by a Gastroenterology Clinic Population. JAMA. 2000;284(15):1962-1964. doi:10.1001/jama.284.15.1962
Author Affiliations: Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, NC (Dr O'Connor); and Rockford Gastroenterology Associates, Rockford, Ill (Dr Johanson).
Context Surveys have shown that 60 million persons in the United States searched
for health information online in 1998. However, lack of sampling from a clinic
population limits the generalizability of these surveys to clinical practice.
Objectives To determine gastroenterology patients' access to and use of the Web
as a medical information resource, to identify for what information patients
search, and to determine how often physicians recommend that patients search
Design, Setting, and Participants Cross-sectional survey of 1006 gastroenterology outpatients in Durham,
NC, and Rockford, Ill, conducted in August 1999.
Main Outcome Measures Patient characteristics and education level, access to the Web, use
of the Web as a medical information resource, search methods, and plans for
future Web use.
Results A total of 924 patients (92%) completed the questionnaire. Median age
was 53 years, 41% were men, and the median education level was having completed
some college. Fifty percent (462/924) reported having access to the Web. Of
the 462 with access, 235 (51%) had searched the Web for medical information
within the previous 12 months. Therefore, 25.5% of all patients surveyed had
searched the Web for medical information within the previous year. Sixty percent
of patients intended to use the Web as a medical information resource in the
future. Only 35 (4%) of 825 had ever been referred to the Web by a physician.
Conclusions In this clinic setting, more than one quarter of gastroenterology outpatients
reported having obtained medical information from the Web within the previous
year. More than two thirds of patients stated they would use the Web as a
medical information resource in the future.
As of September 1999, there were an estimated 359 million people in
the world online, including 157 million in the United States and Canada.1 A survey by Louis Harris and Associates2
showed that in 1998, 60 million Americans searched for health information
online. A random telephone survey performed by Cyber Dialogue3
revealed that half of all online users would be interested in using a Web
site operated by their physician's office but only 4% are currently doing
so. However, such surveys may be limited by nonresponse bias. In addition,
whether these results apply to a clinical population is unknown. We surveyed
patients in 2 gastroenterology clinics to determine their use of the Web to
obtain medical information, to identify for what information patients search,
and to determine how often physicians recommend that patients search the Web.
A pretested questionnaire was distributed to outpatients attending a
gastroenterology clinic at either of 2 sites in August 1999: Duke University
Medical Center, a tertiary academic center in Durham, NC, and Rockford Gastroenterology
Associates, an academically oriented private practice gastroenterology group
in Rockford, Ill. All consecutive patients were asked to complete the self-administered
questionnaire without assistance or prompting.
The 16-item, multiple-choice questionnaire was constructed and pretested
by administration to a trial group of 30 patients. Although the responders
were gastroenterology outpatients, the content of their responses was not
limited to gastroenterology. Unanswered questions were not included in the
Data recorded in the questionnaire included patient demographics: sex,
year of birth, and education level (0 = no formal education, 1 = some high
school, 2 = high school diploma, 3 = some college, 4 = college degree, and
5 = graduate school attendance). Patient Web access and use were determined
by asking, "Do you have access to the World Wide Web?" and "How many times
in the last year did you search the Web for medical information?" The information
for which the patient was looking was categorized as general disease information,
treatment options, alternative medicine information, diet or nutrition information,
medication information, or other (free text space). Patients were asked to
rate the ease or difficulty with which they performed the search on a 4-point
scale, with 1 = very easy, 2 = somewhat easy, 3 = somewhat difficult, and
4 = very difficult. Patients responded to the question, "How certain were
you that the medical information you got on the Web was of good quality?"
on a similar 4-point scale.
The institutional review board (IRB) at Duke University waived IRB review
(John M. Falletta, MD, written communication, June 1999). The χ2 test was used for categorical data, the t
test for normally distributed data, and the Mann-Whitney test for nonparametric
data. Data for key variables were analyzed separately by site.
A total of 924 (92%) of 1006 patients completed the questionnaire (Table 1). The median age was 53 years (range,
18-90 years; interquartile range [IQR], 42-65 years) and 41% of respondents
were men. Durham patients had a median age of 53 years (range, 18-90 years)
compared with 56 years (range, 18-84 years) in Rockford (Table 1). The Durham group was slightly more educated, with a median
education level of 3 (IQR, 2-4) vs 3 (IQR, 2-3) in Rockford (P<.001).
Overall, 462 (50%) of 924 patients had access to the Web. Of the 462
with Web access, 235 (51%) reported having obtained medical information within
the previous 12 months. Therefore, 25.5% (51% of 50%) of all patients had
searched the Web for medical information. Demographic factors associated with
Web access and use are shown in Table 2. The number of searches per patient ranged from 0 to 100, with
a median of 4 (IQR, 2-10). Analysis by study site showed that in Durham, 166
(32%) of 520 patients searched the Web in the previous year vs 69 (18%) of
404 in Rockford (P<.001).
Patients sought online information in the following categories: general
disease, 195 (31%) of 619; treatment options, 146 (23%); medications, 114
(18%); diet and nutrition, 87 (14%); and alternative medicine, 64 (10%). There
were no differences by site (P = .71 by χ2 test). Most patients obtained medical information via Web search engines.
Search engines used were Yahoo!, 31% (n = 135); Infoseek, 15% (n = 64); AltaVista,
13% (n = 58); Excite, 13% (n = 57); and Lycos, 11% (n = 48); followed by HotBot,
America Online, and Metasearch. Approximately 8% of respondents (19/235) used
medical information–specific Web sites, including the National Institutes
of Health; the American Cancer Society; medical school sites such as Mayo
Clinic, Johns Hopkins University, and Harvard University; and commercial Web
sites such as drkoop, WebMD, HealthNet, and Medscape.
Most patients found it very easy (63 [29%] of 215) or somewhat easy
(114 [53%] of 215) to search the Web for health information. A minority found
searching either somewhat difficult (34 [16%]) or very difficult (4 [2%]).
Reported reasons for search difficulty included "insufficient user search
expertise" (41 [57%] of 72) and "too much information on the Web" (19 [26%]
of 72). In response to the question, "How certain were you that the medical
information you got on the Web was of good quality?" most patients were very
certain (36 [18%] of 202) or somewhat certain (137 [68%] of 202), while 23
(11%) were somewhat uncertain and 6 (3%) were very uncertain. No differences
by site were noted (P = .32 by χ2
test). Of the 825 respondents to the question, "Has any doctor or nurse ever
advised you to get medical information from the Web?" only 35 (4%) answered
yes. Again, no differences by site were observed (P
= .56 by χ2 test).
Of the 755 respondents to the question, "Would you search the Web for
medical information in the future?" 456 (60%) answered yes (278 [67%] of 412
patients in Durham vs 178 [52%] of 343 in Rockford; P<.001).
Compared with patients who did not intend to search the Web for medical information
in the future, patients who did intend such use were younger (median age,
49 vs 61 years; P<.001), more educated (median
education level, 3 vs 2; P<.001), more likely
to be female (61% vs 53%; P = .046), more likely
to already have access to the Web (72% vs 20%; P<.001),
and more likely to have searched the Web in the past (66% vs 6%; P<.001).
At the Durham site, 4 patients sought information about physicians,
1 about medical facilities, and 2 about insurance plans. No patients at the
Rockford site sought information in these categories.
This study showed that in these clinics, more than one quarter of gastroenterology
outpatients searched the Web for medical information in the previous 12 months.
This is consistent with the findings of telephone surveys.4
The typical Web user seeking health information was a female in her early
50s with at least some college education.
Our finding that only 4% of patients were ever advised by a physician
to get medical information from the Web is consistent with a telephone survey
by Cyber Dialogue.3 Although 28% of our patients
searched the Web within the past year, 60% stated that they would search the
Web in the future. Furthermore, a large proportion of the medical information
available on the Web is provided by commercial organizations, rather than
medical professionals or professional medical organizations.5
Therefore, it appears that neither the growth in patient use of the Web as
an information resource nor a significant volume of Web content is being driven
Because of the unregulated nature of the Web, the quality of its medical
information is variable.5,7,8
Therefore, it is surprising that as few as 14% of patients were either somewhat
uncertain or very uncertain about the quality of their search results.
This study is limited in the population sampled and the self-report
nature of the survey.
The major findings of this study are that a significant minority of
patients search the Web for medical information, that most patients feel confident
in their search results, and that despite the fact that few physicians recommend
the Web to patients, patient use of the Web as a medical information resource
likely will increase significantly based on these patients' reports. Medical
professionals must acknowledge the growing importance of electronic health
information by developing their own practice Web sites, using the Web as a
patient education tool, and helping patients identify good vs poor health
information available on the Web.9