Director of Education and Research
The World Wide Web has become a widely utilized source of health information. Although the frequency of health related queries is impressive, the demographics associated with patients making queries has not been clearly delineated.
This study's objective was to determine health related Internet usage patterns of family medicine patients.
Internet use among 824 eligible patients 18 years or older attending seven university based family practice clinics during a two week period in November of 1999 was studied. The survey instrument included 10 items and was designed to collect data in less than five minutes using a paper and pencil format. Statistical significance associated with intended Web site use was computed using a multiple logistic regression model.
A response rate of 72.2% was observed with 63.1% being females and 36.9% being males. The mean and median age were 44.0 and 45.7 years, respectively. A steady decline in intended Web site use was observed with advancing age with significant differences observed above 65 years (OR = 0.30; 95% CI = 0.14 - 0.64; p< .002). Other significant findings associated with intended use of a Web site by clinic based patients included having a home computer (OR = 1.99; 95%, CI = 1.05 - 3.76; p<0.03) and having Internet access at home (OR=5.6, 95%, CI = 2.83-11.18; p<.001). A lack of association between intended Web site use and health insurance status was observed.
Results from this study suggest that Web sites are not likely to be alternative sources of health information for the uninsured or elderly in the near future.
Sophisticated consumer health information systems, supported by emerging technologies, are expected to become integral components of future medical practice [
Nevertheless, questions have been raised regarding access to and the quality of online health information [
Patients at seven family practice clinics affiliated with the University of North Texas Health Science Center at Fort Worth were surveyed. Six of the seven clinics were located in the Fort Worth/Tarrant County metropolitan area. The seventh clinic was located in a rural, health professional shortage area of an adjacent county. The number of surveys allocated to each clinic was in proportion to its patient population. The survey instrument included 10 items and was designed to collect self-reported data in less than five minutes using a paper and pencil format (
1. Age ____
2. Sex
female male
3. Are you:
single married other
4. Do you have children
yes no
5. If you aswered YES please list their age(s)
____ ____ ____ ____ ____ ____
6. Are you
privately insured
a member of an HMO/PPO
uninsured
Medicaid/Medicare
7. Do you have a computer at home?
yes no
8. Do you have access to the internet?
At home: yes no
At work: yes no
9. If you aswered YES, how much time do you spend on the internet?
daily __________ weekly__________
10. Would you use a free health information web site provided by the University of North Texas Health Science Center at Fort Worth?
use frequently
use occasionally
Not use
Survey results were summarized using standard descriptive statistics. The main outcome measure was response to the following survey item: "
A total of 595 (72.2%) of the 824 eligible patients provided survey information. Patient responses are summarized in
Sociodemographic characteristics of survey respondents
Variable | No | % |
|
||
< 35 | 204 | 34.7 |
36-50 | 153 | 26.0 |
51-65 | 115 | 19.6 |
> 65 | 116 | 19.7 |
|
||
Female | 370 | 63.1 |
Male | 216 | 36.9 |
|
||
Single | 251 | 43.7 |
Married | 307 | 53.4 |
Other | 17 | 3.0 |
|
||
No | 151 | 26.1 |
Yes | 427 | 73.9 |
|
||
None | 31 | 5.4 |
Private | 89 | 15.6 |
|
355 | 62.4 |
Medicare or Medicaid | 141 | 24.8 |
|
||
No | 354 | 61.0 |
Yes | 226 | 39.0 |
|
||
No | 378 | 67.9 |
Yes | 179 | 32.1 |
|
||
No | 261 | 51.9 |
Occasionally | 166 | 33.0 |
Frequently | 76 | 15.1 |
The multivariate factors associated with intended use of the clinic-based Web site are presented in
Factors associated with intended use of a Web site by family practice clinic patients
No. of Users | Total No | % Users | Odds Ratio | 95% Confidence Interval | P | |
|
||||||
< 35* | 102 | 180 | 56.7 | 1.00 | ||
36-50 | 72 | 132 | 54.5 | 0.91 | 0.51, 1.63 | .76 |
51-65 | 47 | 97 | 48.5 | 0.69 | 0.36, 1.33 | .27 |
> 65 | 19 | 88 | 21.6 | 0.30 | 0.14, 0.64 | .002 |
|
||||||
Female* | 153 | 314 | 48.7 | 1.00 | ||
Male | 86 | 185 | 46.5 | 1.11 | 0.68, 1.81 | .67 |
|
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Single* | 107 | 220 | 48.6 | 1.00 | ||
Married | 126 | 258 | 48.8 | 0.88 | 0.54, 1.45 | .62 |
Other | 3 | 12 | 25.0 | 0.76 | 0.15, 3.85 | .74 |
|
||||||
No* | 70 | 128 | 54.7 | 1.00 | ||
Yes | 167 | 363 | 46.0 | 1.34 | 0.75, 2.40 | .33 |
|
||||||
No* | 11 | 28 | 39.3 | 1.00 | ||
Yes | 227 | 459 | 49.5 | 1.19 | 0.48, 2.96 | .71 |
|
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No* | 85 | 282 | 30.1 | 1.00 | ||
Yes | 155 | 214 | 72.4 | 1.99 | 1.05, 3.76 | .03 |
|
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No* | 91 | 306 | 29.7 | 1.00 | ||
Yes | 139 | 171 | 81.3 | 5.62 | 2.83, 11.18 | <.001 |
This study indicates that less than 40% of family practice patients attending a network of university clinics have a home computer and less than one-third have Internet access at home. At most, about one-half of this patient population would use a clinic-based Web site to acquire health information. Slightly higher results were previously reported in a study of primary caregivers of pediatric patients or patients aged 16 years or older. Results from this study showed that 58.9% of study participants reported having a computer or some type of Internet connection [
By far, the strongest independent factor associated with intended Web site use was having Internet access at home. (
Simply having a home computer was not as strongly associated with intended Web site use as having home Internet access. These results suggest that Internet access outside the home, such as at the workplace or at public libraries, may not be conducive to accessing health information, although a variable explicitly representing such access was not actually included in the model. One possible explanation for this phenomenon is that Web site users may prefer the privacy of their own homes and computers in accessing potentially sensitive health information. Almost half of genitourinary patients reported difficulty accessing Internet sites with privacy [
Patients greater than 65 years of age were less likely to report intended Web site use, even after adjusting for such factors as having a home computer and Internet access. (
Characteristics such as gender, marital status, and having children were not associated with intended Web site use. These findings, particularly with regard to marital status and children, suggest that intended Web site users may be more interested in acquiring information about personal health matters rather than those of spouses or children. The lack of an association between intended Web site use and health insurance status suggests that Web sites are not currently an important alternative source of health information for those not having health insurance.
There are several limitations of the present study that should be noted. Although the possibility of selection bias among respondents cannot be dismissed, the relatively high response rate achieved in the survey helps minimize its likelihood. However, our results should be extrapolated to other clinic populations with caution because it is unlikely that our survey respondents are representative of the general population, or even of family practice patients in other health care settings. There are also limitations attributable to the survey instrument. For example, data were self-reported and not verified in any manner. Further, there is additional uncertainty because we asked about intended use of a hypothetical Web site rather than current or past use of an existing Web site. Finally, to minimize potential barriers to survey response, we elected not to collect potentially sensitive information such as race/ethnicity, educational level, and income.
It has been noted that the focus of traditional medical informatics is shifting from health professionals to patients, a trend which coincides with the desire of most patients to assume greater responsibility for their health, with the emphasis on public health and prevention [
We would like to thank Carol Pruett, Senior Administrative Assistant, for her support with the survey and data management.
None declared.