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Figure.
Mean scores for various sources of medical information as rated by parents prior to their child’s otolaryngology procedure. The scale is from 1 (least important) to 5 (most important). If parents did not use a particular source, they were asked not to score it and it was not considered when calculating the mean score. ENT indicates otolaryngologic.

Mean scores for various sources of medical information as rated by parents prior to their child’s otolaryngology procedure. The scale is from 1 (least important) to 5 (most important). If parents did not use a particular source, they were asked not to score it and it was not considered when calculating the mean score. ENT indicates otolaryngologic.

Table 1. 
Caregiver Demographics of 204 Respondents*
Caregiver Demographics of 204 Respondents*
Table 2. 
Internet Searches for Diagnosis
Internet Searches for Diagnosis
Table 3. 
Internet Searches for Surgical Procedure
Internet Searches for Surgical Procedure
1.
Fox  SFallows  D Health searches and email have become more commonplace, but there is room for improvement in searches and overall Internet access.  Pew Internet & American Life Project. July 16, 2003. Available at: http://www.pewinternet.org/pdfs/PIP_Health_Report_July_2003.pdf. Accessed August 13, 2003
2.
 A nation online: how Americans are expanding their use of the Internet.  Joint Report of the National Telecommunications and Information Administration and the Economics and Statistics Administration. 2002. Available at: http:www.ntia.doc.gov/ntiahome/dn/index.html. Accessed April 25, 2005
3.
Semere  WKaramanoukian  HLLevitt  M  et al.  A pediatric surgery study: parent usage of the Internet for medical information. J Pediatr Surg 2003;38560- 564
PubMedArticle
4.
Chen  LEMinkes  RKLanger  JC Pediatric surgery on the Internet: is the truth out there? J Pediatr Surg 2000;351179- 1182
PubMedArticle
5.
Corpron  CALelli  JL Evaluation of pediatric surgery information on the Internet. J Pediatr Surg 2001;361187- 1189
PubMedArticle
6.
Jejurikar  SSRovak  JMKuzon  WMChung  KCKotsis  SVCederna  PS Evaluation of plastic surgery information on the Internet. Ann Plast Surg 2002;49460- 465
PubMedArticle
7.
Murray  ELo  BPollack  L  et al.  The impact of health information on the Internet on health care and the physician-patient relationship: national US survey among 1050 US physicians. J Med Internet Res 2003;5e17
PubMedArticle
8.
Rokade  AKapoor  PKRao  SRokade  VReddy  KTKumar  BN Has the Internet overtaken other traditional sources of health information? questionnaire survey of patients attending ENT outpatient clinics. Clin Otolaryngol 2002;27526- 528
PubMedArticle
9.
Tuffrey  CFinlay  F Use of the Internet by parents of paediatric outpatients. Arch Dis Child 2002;87534- 536
PubMedArticle
10.
Tassone  PGeorgalas  CPatel  NNAppleby  EKotecha  B Do otolaryngology outpatients use the Internet prior to attending their appointment? J Laryngol Otol 2004;11834- 38
PubMedArticle
11.
Berland  GKElliott  MNMorales  LS  et al.  Health information on the Internet: accessibility, quality, and readability in English and Spanish. JAMA 2001;2852612- 2621
PubMedArticle
12.
Zeng  QTKogan  SPlovnick  RMCrowell  JLacroix  E-MGreenes  RA Positive attitudes and failed queries: an exploration of the conundrums of consumer health information retrieval. Int J Med Inform 2004;7345- 55
PubMedArticle
Original Article
August 2005

Internet Use by Parents of Children Undergoing Outpatient Otolaryngology Procedures

Arch Otolaryngol Head Neck Surg. 2005;131(8):719-722. doi:10.1001/archotol.131.8.719
Abstract

Objectives  (1) To determine the prevalence of Internet medical information searches by parents prior to their child’s surgical procedure, and (2) to evaluate whether Internet-based health information influences parents’ medical decisions on behalf of their children.

Design  A questionnaire designed to gather information regarding preoperative use of the Internet by parents of children who were scheduled to undergo outpatient otolaryngology procedures. Parents were asked to respond to questions regarding Internet searches for information specific to their child’s diagnosis and anticipated surgical procedure.

Setting  Tertiary care pediatric hospital.

Results  Internet access was available to 83% of respondents. Of those parents with Internet access, 48% searched the Internet for information regarding their child’s diagnosis and surgical procedure. Of those who searched the Internet, 93% said they found information that was both understandable and helpful. More important, 84% of parents using the Internet said the information influenced or somewhat influenced the medical decisions they made on behalf of their child. Only 43% of parents discussed the information they found on the Internet with their child’s surgeon.

Conclusions  Approximately 50% of the parents in our study with Internet access used it to find medical information prior to their child’s surgery. Parents who used the Internet found the information helpful and influential, although physicians remain the most important source of information that guides a parent or patient in their medical decision making. Ideally, surgeons would direct parents or patients to a few trusted Internet sites and be prepared to discuss this information.

The Internet is the world’s fastest-growing source of health-related information. A recent Pew Internet & American Life Project survey found that an estimated 93 million American adults have searched for health care information on the Internet.1 Most were looking for information regarding a specific disease or medical problem, and 57% were seeking health information for someone else. The survey also found that 73% of the respondents stated that using the Internet as a resource improved the health information and services they received. With the rate of new Internet use in the United States growing by 2 million users per month, the Internet will continue to be a major source of health care information.2

Parents are increasingly turning to the Internet for information about their children’s health and medical conditions.3 However, recent studies46 have called into question the quality and accuracy of health information on the Internet, and no studies have addressed the degree to which Internet information influences parents’ medical decisions for their minor children.46 In addition, physicians are often ill prepared to discuss specific information obtained from the Internet and are unable to direct parents to reliable information sites on the Internet.7 Despite these limitations, the Internet is an attractive educational resource to supplement and enhance the surgeon-parent/patient encounter. Knowledge of current Internet use practices by parents will help surgeons to direct parental use of the Internet and improve face-to-face discussions of the medical information obtained from the Internet. In addition, information about how patients and their families access and use health information from the Internet will help surgeons to establish practice models that use Internet resources for preoperative counseling.

METHODS

A questionnaire (available from the authors) was developed based on previous studies810 and was pretested for length and content on a small sample of parents. The questionnaire consisted of 20 multiple-choice and yes or no questions. Free-text comments could be made where appropriate. The first survey (n = 92) asked parents to list the Internet search engine they used to look for health information. This question was removed from the second survey (n = 112) and replaced by a question asking parents to rank their sources of preoperative information.

The questionnaires were distributed to the parents of children undergoing routine otolaryngology procedures (tonsillectomy, myringotomy, tubes, etc) on an outpatient basis at Cincinnati Children’s Hospital Medical Center during September 2003 and January 2004. Patients undergoing airway endoscopy were specifically excluded from the study because of the complex nature of this patient population at our institution. An experienced research nurse (A.D.) distributed and collected a total of 204 questionnaires on the day of surgery while the parents waited in the preoperative holding area. The study was approved by our institutional review board.

Data were entered into a computer database for analysis. We did not include responses left blank in the calculations. We used the χ2 test for statistical analysis where appropriate and expressed data as a percentage of respondents to a particular question.

RESULTS
DEMOGRAPHICS

All caregivers who were asked to participate completed the survey (n = 204). The mean parental age was 34 years (age range, 16-65 years), and 130 respondents (64%) were the patients’ mothers. Only 10 parents (5%) had not completed high school, and 83 parents (41%) were college graduates. Internet access was available to 170 parents (83%) (Table 1), and 96% of these parents accessed the Internet from either home or work. Most parents (53%) reported using the Internet daily, whereas only 12% used the Internet less than once per week. College graduates were significantly more likely to have Internet access than non–college graduates (P = .003).

INTERNET ACCESS

Of the 170 parents with Internet access, 83 (48%) used the Internet to look for information about their child’s diagnosis and/or surgical procedure. Neither level of parental education (P>.10) nor frequency of Internet use (P>.10) was a significant factor influencing parental use of the Internet prior to their child’s surgery.

INTERNET SEARCHES FOR DIAGNOSES

Seventy-four parents (43%) used the Internet to look for information about their child’s medical condition or diagnosis (Table 2). Nearly all (92%) agreed or somewhat agreed that the information they found regarding the medical condition was understandable. A similar number (90%) found the same information to be helpful. Most (67%) said the Internet information they found influenced the medical decisions they made on behalf of their child. Only 35 parents (47%) discussed the information they obtained from the Internet with their child’s surgeon.

INTERNET SEARCHES FOR PROCEDURES

Sixty-one parents (36%) used the Internet to look for information specific to their child’s intended surgical procedure (Table 3). Almost all the parents agreed or somewhat agreed that the information was understandable (95%) and helpful (96%). Only 23 parents (38%) discussed the Internet information with their child’s surgeon; however, 47 (77%) agreed or somewhat agreed that the Internet information they found influenced the decisions they made regarding their child’s procedure. Parents were most interested in finding information regarding a description of the procedure (62%), risks and complications (62%), recovery and postoperative care (36%), and indications for surgery (34%).

IMPORTANCE OF INFORMATION SOURCES FOR PARENTS

In the second survey, parents (n = 112) were asked to rank 7 different sources of medical information as to their importance in helping them obtain information about their child’s diagnosis and/or surgical procedure (Figure). Despite the fact that most parents who used the Internet said the information influenced their decisions, the Internet ranked as least important of all sources of information listed.

OTHER INTERNET USE QUESTIONS

In the first survey, parents were asked to list which search engine they used to begin their search for medical information on the Internet. The most frequently cited search engines were as follows: Yahoo, 29% (n=18); MSN, 22% (n=14); America Online, 16% (n=10); WebMD, 14% (n=9); and Google, 13% (n=8). Only 4 parents (2%) stated that they were directed to a particular Web site by their child’s surgeon. Eighty-four percent of parents agreed or somewhat agreed that they would use a medical Web site in the future to look for information about their child’s health. In addition, 72% of parents stated that they would like to be able to communicate with their child’s surgeon or a member of their staff by e-mail.

COMMENT

In this study we sought to determine the role of the Internet in formulating parents’ decisions prior to their child’s outpatient otolaryngology procedure. More than 80% of parents in our study had Internet access that they used at least weekly from either home or work. Even though they had considerable access and Internet experience, less than half of the parents in this study used the Internet to look for information relevant to their minor child’s pending otolaryngology procedure. Possible explanations for this finding include a lack of perceived need for further information because of thorough preoperative counseling, previous experience with the planned procedure, or limited experience using the Internet for medical searches.

Traditional sources of medical information still predominate as references for those seeking more information about diseases and treatments. A recent study found that physicians are still the primary source of heath information for patients and their families.8 Similarly, the parents responding to our survey ranked their child’s surgeon as the most important source of preoperative information and ranked the Internet as the least important of the choices provided. However, the Internet will likely continue to grow in popularity and importance as evidenced by the fact that 84% of our survey respondents stated they would search the Internet for medical information in the future.

Perhaps the most significant finding of this study is the degree to which parents felt the information they obtained from the Internet influenced the medical decisions they made on behalf of their children. This finding is important because patients and their families may not be able to assess adequately the quality and completeness of Internet-based medical information. Recent studies have found that medical information on the Internet is often misleading, inaccurate, or fails to conform to standard medical and surgical recommendations.46 In addition, a high reading ability is needed to comprehend much of the information found on medical Web sites.11 Nearly all of the parents in our study were high school graduates, and most had attended or graduated from college. Less well-educated parents may not find Internet medical resources to be as understandable or helpful as they were to parents in our study.

Our study did not assess the specific medical Web sites that parents visited to obtain the information. It is possible, therefore, that parents described their Internet searches as positive, empowering experiences even though they may not have found exactly what they were looking for. A recent observational study12 found that most health consumers reported their Internet search experiences as positive even though they did not locate their desired medical information during the search. Because all of our study participants had decided in favor of surgery, it is also possible that the Internet information served to reinforce their decision rather than sway it in one direction or another. We did not survey parents who decided against surgery after it was recommended by their child’s surgeon. It is our clinical experience, however, that this is an infrequent occurrence.

Internet queries for medical information have increased dramatically in the past few years. A recent survey found that 85% of US physicians surveyed had seen patients who brought in information from the Internet for discussion.7 In addition, 77% of these physicians said they had encouraged patients to look up health information on the Internet. In a finding similar to that of other studies,3,9,10 only 43% of parents in our study discussed the Internet information with their child’s surgeon, and just 2% were directed to a specific Web site by a physician. Providing Internet access to patients and families will also be important in many medical and surgical practices. Lack of Internet access remains a significant barrier to more widespread adoption of the Internet as a primary source of health-related information. Nearly 40% of American households do not have Internet access, with minorities, lower-income families, and people living in rural areas being most likely to not have Internet access.2

The vast quantity of Internet information may be overwhelming for some parents and patients. Most of the parents in our study generated their searches from nonmedical search engines. These commercial search engines typically provide hundreds or thousands of matches to a given query, most of which are not relevant to the searcher’s request.11 Inefficient Internet searches result in a significant amount of wasted time for the person performing the search as well as for the physician faced with a patient confused by a plethora of irrelevant information. Surgeons should assume a more proactive role in directing patients and parents to specific, accurate medical Web sites to foster relevant discussion, answer patient questions, and supplement the informed consent process.

Preoperative informed consent requires that patients and parents of minor children understand the disease being treated, the treatment options, risks and benefits of surgery, expected outcomes, and postoperative care. This information is primarily provided by the surgeon, who is responsible for obtaining informed consent from the patient or legal guardian. Because most preoperative counseling takes place in the setting of a busy surgical clinic, alternative sources of health information are desirable to enhance and supplement information provided by the surgeon. The Internet is one source of health information that can serve a wide variety of needs as well as provide medical information in multimedia and interactive formats. Because Internet medical information is unregulated, surgeons should be familiar with the content of a few trusted Web sites and be able to direct their patients and families to these sites. In addition, surgeons should be able and willing to discuss health information from Internet sites with their patients. Additional studies will be helpful to determine whether Internet resources can be used to reduce preoperative anxiety and improve postoperative satisfaction for both patients and their families.

In conclusion, nearly all parents who used the Internet to search for medical information about their child’s outpatient otolaryngology procedure found the information to be understandable, helpful, and influential. Otolaryngologists need to be aware of the content of specific medical Web sites and be able to direct and discuss parent and patient use of the Internet as a medical information source.

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Article Information

Correspondence: Maj Mark Boston, USAF, MC, FS, 56 MDOS/SGOSL (ENT Clinic), 7219 Litchfield Rd, Luke AFB, AZ 85309 (mark.boston@luke.af.mil).

Submitted for Publication: January 10, 2005; accepted March 22, 2005.

Disclaimer: The opinions presented in this manuscript are those of the authors only and are not to be construed as representing the US Air Force, Department of Defense, or US government.

Previous Presentation: This study was presented as a poster at the American Society of Pediatric Otolaryngology; May 2, 2004; Phoenix, Ariz.

References
1.
Fox  SFallows  D Health searches and email have become more commonplace, but there is room for improvement in searches and overall Internet access.  Pew Internet & American Life Project. July 16, 2003. Available at: http://www.pewinternet.org/pdfs/PIP_Health_Report_July_2003.pdf. Accessed August 13, 2003
2.
 A nation online: how Americans are expanding their use of the Internet.  Joint Report of the National Telecommunications and Information Administration and the Economics and Statistics Administration. 2002. Available at: http:www.ntia.doc.gov/ntiahome/dn/index.html. Accessed April 25, 2005
3.
Semere  WKaramanoukian  HLLevitt  M  et al.  A pediatric surgery study: parent usage of the Internet for medical information. J Pediatr Surg 2003;38560- 564
PubMedArticle
4.
Chen  LEMinkes  RKLanger  JC Pediatric surgery on the Internet: is the truth out there? J Pediatr Surg 2000;351179- 1182
PubMedArticle
5.
Corpron  CALelli  JL Evaluation of pediatric surgery information on the Internet. J Pediatr Surg 2001;361187- 1189
PubMedArticle
6.
Jejurikar  SSRovak  JMKuzon  WMChung  KCKotsis  SVCederna  PS Evaluation of plastic surgery information on the Internet. Ann Plast Surg 2002;49460- 465
PubMedArticle
7.
Murray  ELo  BPollack  L  et al.  The impact of health information on the Internet on health care and the physician-patient relationship: national US survey among 1050 US physicians. J Med Internet Res 2003;5e17
PubMedArticle
8.
Rokade  AKapoor  PKRao  SRokade  VReddy  KTKumar  BN Has the Internet overtaken other traditional sources of health information? questionnaire survey of patients attending ENT outpatient clinics. Clin Otolaryngol 2002;27526- 528
PubMedArticle
9.
Tuffrey  CFinlay  F Use of the Internet by parents of paediatric outpatients. Arch Dis Child 2002;87534- 536
PubMedArticle
10.
Tassone  PGeorgalas  CPatel  NNAppleby  EKotecha  B Do otolaryngology outpatients use the Internet prior to attending their appointment? J Laryngol Otol 2004;11834- 38
PubMedArticle
11.
Berland  GKElliott  MNMorales  LS  et al.  Health information on the Internet: accessibility, quality, and readability in English and Spanish. JAMA 2001;2852612- 2621
PubMedArticle
12.
Zeng  QTKogan  SPlovnick  RMCrowell  JLacroix  E-MGreenes  RA Positive attitudes and failed queries: an exploration of the conundrums of consumer health information retrieval. Int J Med Inform 2004;7345- 55
PubMedArticle
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