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The last decade witnessed turbulent events in public health. Emerging infections, increase of antimicrobial resistance, deliberately released threats and ongoing battles with common illnesses were amplified by the spread of disease through increased international travel. The Internet has dramatically changed the availability of information about outbreaks; however, little research has been done in comparing the online behavior of public and professionals around the same events and the effect of media coverage of outbreaks on information needs.
To investigate professional and public online information needs around major infection outbreaks and correlate these with media coverage. Questions include (1) How do health care professionals’ online needs for public health and infection control information differ from those of the public?, (2) Does dramatic media coverage of outbreaks contribute to the information needs among the public?, and (3) How do incidents of diseases and major policy events relate to the information needs of professionals?
We used three longitudinal time-based datasets from mid-2006 until end of 2010: (1) a unique record of professional online behavior on UK infection portals: National electronic Library of Infection and National Resource of Infection Control (NeLI/NRIC), (2) equivalent public online information needs (Google Trends), and (3) relevant media coverage (LexisNexis). Analysis of NeLI/NRIC logs identified the highest interest around six major infectious diseases:
Public information needs were more static, following the actual disease occurrence less than those of professionals, whose needs increase with public health events (eg, MRSA/
Significant factors related to a surge of professional interest around a disease were typically key publications and major policy changes. Public interests seem more static and correlate with media influence but to a lesser extent than expected. The only exception was norovirus, exhibiting online public and professional interest correlating with seasonal occurrences of the disease. Public health agencies with responsibility for risk communication of public health events, in particular during outbreaks and emergencies, need to collaborate with media in order to ensure the coverage is high quality and evidence-based, while professionals’ information needs remain mainly fulfilled by online open access to key resources.
There is a large amount of medical information available on the Internet, ranging from specialist databases and indexed collections of articles for health care professionals to less technical information sites for the general public. It is estimated that around 80% of the general public and a comparable proportion of medical professionals access information via the Internet [
The last decade witnessed turbulent events in the domain of infectious diseases and public health. New and emerging infections, such as Severe Acute Respiratory Syndrome (SARS), deliberately released threats (eg, anthrax), and ongoing battles with common illnesses, such as influenza, tuberculosis (TB), Healthcare Associated Infections (HAI), and the A/H1N1 swine flu pandemic outbreak of 2009 were amplified by the spread of disease through increased speed and volume of international travel. It is more important than ever to ensure that health care professionals and members of the public are well informed and kept up to date with the latest public health developments, government advice, and rapid risk communications. However, in addition to official health authorities’ communications, in the Internet era professionals and the public increasingly use online resources to meet their information needs and seek up-to-date evidence. Also, media coverage of infection outbreaks, public health issues, and media-mediated risk advice is increasingly influencing public perceptions and often distorting health critical information [
As of the end of December 2009, there were an estimated 1.8 billion Internet users worldwide. In Europe, 53% of the population use the Internet, which rises to 77% in the United Kingdom (with 69% having a broadband connection) (values are from surveys quoted in Higgins et al [
Various surveys ([
In addition to the increased use of online resources by members of the public to manage their personal health and better understand their conditions, in recent years the online health information environment has become mobile, with 17% of cell phone users having used their phones to look up health information and 9% using software applications on their phones that help them track or manage their health [
While these studies provide cumulative data on Internet usage, it is also essential to investigate users’ search and online behavior to understand their online information needs and how these are fulfilled technically as well as in the context of site usability [
A number of studies have investigated health care professionals’ online information seeking behavior. Younger gives a survey of studies comparing the search behavior of doctors and nurses [
Public health and infection is one of the most varied domains of medicine, subject to rapid changes, disease outbreaks, and control measures involving the general public at regional, national, and international scales. As we run a specialist online digital library for infection and public health professionals and have a unique longitudinal online search dataset, we will focus on the information needs of the public and professionals regarding infection. It is not easy to say what drives the behavior of the public to seek information on particular infectious diseases. An actual outbreak of the disease could be a factor, but the knowledge of the outbreak will usually be obtained via mass media. The media’s reporting of disease outbreaks may be exaggerated due to certain needs, such as a need for a human interest angle [
Media coverage of health-related news stories can influence the decisions and behavior of policy makers and the public [
Media coverage can also help to limit an outbreak, by causing individuals who are susceptible to the disease to isolate themselves from infected individuals [
The 2009 swine flu outbreak was a health event covered extensively by the mass media and with an impact investigated by a number of research studies. Hilton and Hunt examined UK newspaper coverage of the 2009-10 swine flu (A/H1N1) outbreak [
Therefore, in this study we will investigate the following questions:
How do health care professionals’ online search needs around infection differ from the needs of the public?
Does media coverage contribute to the information needs among the public for infection?
How are incidents of a disease and major policy events related to the information needs of professionals?
We used 3 time-based datasets that were selected to cover the levels of interest in various infectious diseases and organisms. The datasets are intended to give a good representation of the search interests of health care professionals and the public and also the level of media coverage of each topic. We were not attempting in this study to prove causal relationships between the highly interrelated worlds of public, professionals, and media coverage, but rather to use a triangulation method [
The 3 time-based datasets are:
The levels of user activity for various infection topics in the NeLI/NRIC specialist online digital library, run by City eHealth Research Centre (CeRC), City University, London. This unique dataset reflects the levels of interest in various topics by health care professionals.
The search statistics for the same infection topics from Google Trends [
The numbers of news articles retrieved from the LexisNexis database, concerning the same topics as were used for the other datasets. This dataset represents the media coverage of the topics. Our search was restricted to English language coverage, but this includes major world newspapers in English.
We were interested in trends in the levels of activity in these datasets (whether activity was above or below the average level, and by how much, and whether activity was rising or falling over the long term or showing sudden peaks) and any correlations between the datasets.
The datasets are described in more detail in the following sections. As our primary interest was professional needs and their correlations, the most reliable results were ensured by selecting the diseases and conditions that had the highest activity levels on the NeLI/NRIC sites.
The average and peak weekly accesses for various diseases/organisms in NeLI/NRIC.
Disease/organism | Average weekly accesses | Peak weekly accesses |
|
43.3 | N/A |
|
23.9 | 72 |
MRSA | 19.4 | 54 |
Tuberculosis | 13.9 | 51 |
Meningitis | 13.2 | 133 |
Norovirus | 6.3 | 74 |
Influenza | 2.6 | 21 |
SARS | 1.4 | 34 |
In our analysis, we decided to combine the results for
The timeframe of the study was from week 31 (end of July) 2006 until the end of 2010, which is the period for which we have NeLI/NRIC data. The other datasets (Google Trends data and LexisNexis news article data) also cover this period.
It is hard to determine the information needs of health care professionals. While surveys of behavior have been performed, the NeLI/NRIC server logs contain an invaluable record of actual search behavior in the domain of infection over several years.
Initially the specialist Library of Infection [
In addition to providing up to date evidence-based resources and stating the level of evidence of each resource (RCT, Meta-analysis, etc), a key benefit of NeLI/NRIC is that
The source of professional health care interest data for our study is the Web traffic logs for NeLI/NRIC that have been automatically recorded since 2005. (Logs were recorded between 2001 and 2005 for NeLI, but as the site architecture changed in 2005, detailed comparisons between the logs for time periods before and after the change are not really possible).The Web server keeps a log of all Web accesses, and this record has been preserved since 2005.
Each log entry contains details of an HTTP request sent from a Web browser to the Web server, including the date of each request, the IP address of the visitor, the page requested, and other data.
We can only observe visitors’ interactions with the NeLI/NRIC sites, with the notable exception that we can often determine which previous page they browsed before arriving at NeLI/NRIC (the
The National electronic Library of Infection (NeLI; information can be found by using drop down menus, left, or the search box, right).
A sample log entry for a Web access to NeLI.
A sample log entry for a Web access to NeLI, annotated with the meanings of the available fields.
The NeLI/NRIC portals are aimed at health care professionals with interests in infection. Initially part of the NHS-led project, they were also promoted through the Health Protection Agency (HPA), the national public health agency in the United Kingdom. The site had over 5000 unique users per month in 2011 and between 20,000 and 30,000 page views (
From 2006 to 2008, NeLI/NRIC was heavily promoted at conferences and at other events, seemingly leading to an increase in visitor numbers. More recently, due to lack of resources, the site has been kept up to date, but promotional activity has lessened, resulting in a decline in site activity, clearly visible in the graph.
NeLI/NRIC is visited most frequently by users in the United Kingdom and the United States, and English speaking countries. However, despite the content being in English only and forming part of a national library, there is a growing number of users from countries such as India, Germany, and China, indicating a global need for such an evidence-based open access portal (see Supplementary Figure 1 in
All the content of the evidence-based library is in the public domain and free to use. In order to improve accessibility and usability no registration is required to access the content although users can subscribe to receive a monthly electronic newsletter that highlights the latest resources and upcoming events and conferences. Users can join the subscription list either personally at a conference, at a study day where NeLI/NRIC is presented, or online at a dedicated subscription page. The subscription database holds details for over 3500 NeLI/NRIC users. Subscribers listed in the database can provide their professions and specialities. Although the primary interest in subscribing to the site is “infection”, in order to better understand the professional backgrounds of NeLI/NRIC users an analysis of these was performed, and the breakdowns of professions and specialities are detailed in Supplementary Figures 2 and 3 in
The numbers of visitors and page views for NeLI/NRIC between 2006 and 2011.
Although there are many public-facing websites about infection (eg, NHS Choices [
Google is currently the most commonly used search engine worldwide, with 90% of the market share globally, and 80% in the United States, according to StatCounter Global Stats [
The third dataset, measuring media coverage of specific topics, is the newspaper articles retrieved from the LexisNexis database [
Before Web server log data could be used, the dataset had to be cleaned. As there are site visits not motivated by specific interest that can be of high volume and at random times, it is important to try to identify and remove them from our data. The main sources of spurious accesses were
Web crawlers (also referred to as spiders) are programs that visit pages of a website, usually for the purpose of indexing the site for search engines. Web crawlers tend to visit the same sites frequently to check for updates. Crawlers can cause serious distortion of the Web log statistics, as they can produce a spike in the logs that is not due to any genuine interest in the site [
Referrer spam [
In order to remove as many spurious log entries as possible, the Web logs were pre-processed with the following steps:
All entries with an IP address in a list of developer IPs were removed.
The browser type field (see
The previous step still left a large number of entries that were clearly produced by Web crawlers. The remainder of the browser type field was examined, and any that contained certain keywords that indicate Web crawlers (specifically “bot”, “crawler”, “spider”, “slurp”, and “jeeves”) were rejected.
Referrer spam was removed by first finding the most common referrer websites in our logs. By concentrating on the most frequently occurring sites, the most likely referrer spam sites were identified manually. A block list of terms and site names was built up, which was used to exclude log entries during the processing phase.
After the pre-processing that was only required for the professional needs containing NeLI/NRIC logs, the analysis of the 3 datasets was performed—each required a different technique to analyze an information need or interest in a certain infection topic.
After pre-processing the logs, the remaining entries were divided into document views (ie, looking at a specific document in the library), category browses (looking at a list of documents about a specific topic, the second level of the two level taxonomy described in section 3.1.1), and searches (ie, the entry of search terms into the search box). Other accesses, such as image views or views of pages not relating to specific diseases or organisms, were not counted. We concentrated on category browsing and document views, as (1) browsing was much more commonly performed than searching (93% of the total) [
Finding information on NeLI/NRIC can be achieved either by using a search (either from an external search engine or by an internal search on the NeLI/NRIC site) or by visiting the site and following links or menus to navigate to the required information (see
After plotting graphs for professional interest in infectious diseases using the NeLI/NRIC dataset, we considered the major peaks in the graphs and attempted to identify any major policy documents that were released at the corresponding times. To verify if these documents may have caused the peak in interest, we studied the NeLI/NRIC logs to measure the download rates of the documents and matched them to the professional interest graphs (which measure the overall browsing activity for the disease).
Alternative methods of finding information on NeLI using the drop down menus (browsing) and free text searching.
Public interest data were obtained by entering search terms at the Google Trends website. The data were downloaded as weekly data in comma separated value (CSV) format, using relative scaling, so that the data are scaled to make the average level over the period is 1. We chose to use single terms (eg, “norovirus”, “tuberculosis”, “
Media articles were extracted from the LexisNexis database, using the same search terms as were used for the Google Trends results. The search was performed over “Major World Publications (English)” and returned articles where the keyword was mentioned near the start of the article. The similarity measure was set to “On, high similarity” to exclude duplicate articles. The articles were sorted by date and counted to give weekly totals.
Once the information from the 3 datasets was plotted as time series, we examined the correlation of the 3 signals and further investigated the real events and key publications to attempt to explain any spikes, trends, and other patterns in the data. These were gathered by searching news and press release databases from the Health Protection Agency (HPA), the European Centre for Disease Prevention and Control (ECDC), the World Health Organization (WHO) and other agencies, and in-depth analysis of access to the actual documents on NeLI/NRIC creating the peak and manually verified by infection domain experts. Also, we related the levels of professional interest with that of the public and each of these to the media coverage.
To compare the 3 datasets, we applied the same scaling that Google Trends uses to the numbers of news stories and levels of professional interest, so that the average level (or “baseline”) over the study period was 1. This means that the 3 measures could be plotted on the same scale.
Graphs were plotted showing the activity over time for NeLI/NRIC and Google Trends. Google Trends normalizes its data so that a level of 1 is the long-term average activity level over the period, and for comparison the same was done with NeLI/NRIC.
The last decade has been eventful in the domain of infectious disease. There have been periods of emerging infections (SARS), epidemic outbreaks (avian flu), a pandemic (swine flu in 2009) as well as recurring outbreaks for common infections (influenza, MRSA). We evaluated the 3 datasets to try to understand the correlations; however, as the primary aim was to understand professionals’ needs, we investigated the NELI/NRIC dataset to determine the most accessed infection topics and disease outbreaks.
The next section describes the results of each disease separately and provides background events to illustrate the information needs of professionals and public.
The first observation (which applies generally to other diseases/organisms) is that the professional interest (measured by NeLI/NRIC accesses) is “noisier” (have a higher variance) than the Google Trends data. This is clearly due to Google’s far larger traffic volume. It is difficult to get exact figures for Google’s search volume, but using Google’s AdWords service indicates that in the year to January 2012, the average monthly global number of searches for the phrase “what is
The maximum level of professional interest occurs at week 43 in 2007 (which also coincides with the maximum levels of public interest and media coverage). The professional interest level at this peak was 2.6 times the baseline level, compared to 5.0 times the baseline for media coverage, and 5.7 times for public interest. There are periods of increased activity early in the second half of 2006 and in the first half of 2010. It is likely that the increased activity in 2006 is due to the high levels of promotional activities for the newly relaunched NeLI/NRIC sites. More evidence for this comes from comparing the graphs in later sections, which show a similar pattern. The heightened activity in 2010 may be due to promotional activities or to the aftermath of pandemic flu, but this is unclear.
The public interest shows a very clear spike in 2007, coinciding with the spikes in the professional interest and media coverage. This spike is at a level that is 5.7 times the baseline. There is also a slight dip in the interest level at the end of each year, which can also be seen in the graphs for most of the other diseases. This is presumably due to lower levels of search over the period of the Christmas and New Year holidays. Also, overall public interest decreases after the 2007 spike until the end of the study period, where it is at a similar level to before 2007.
A possible interpretation of the public interest in MRSA and
The media coverage also shows a clear peak in late 2007. The news stories at this time mainly focused on the findings of the Healthcare Commission in the United Kingdom concerning an outbreak of
Scores of NHS patients were killed during Britain’s deadliest outbreak of a hospital superbug, a damning report by the government’s health watchdog reveals today. The Healthcare Commission attributed the deaths of 90 patients at the Maidstone and Tunbridge Wells hospitals in Kent to infection from
This indicates that heightened media coverage in late 2007 over the Healthcare Commission report had a correlation to professionals’ needs, who were likely to access the report but around 3 times rather than 6 times more frequently than the baseline.
The article is also an example of MRSA being mentioned in a report that is mainly about
Number of news stories from 2006-2011 about
Keyword | “ |
“MRSA” only | Both terms |
Number of articles mentioning the term | 197 | 464 | 138 |
Percentages | 11.3 | 62.3 | 26.4 |
A comparison of Google searches for the terms "clostridium difficile", "MRSA", and "superbug".
The public and professional interest, and media coverage for
Tuberculosis (TB) is an infectious disease that is caused by a bacterium called
From the graphs for TB (see
The overall level of professional interest appears from the graph to be declining, although this may be misleading. The graph shows the same higher level of interest for the first few months of the study period, which coincides with the promotional activities that would generate higher activity levels from professionals. When this is discounted, the remaining interest levels are more level.
A tuberculosis “Knowledge Week” was held on NeLI/NRIC in conjunction with the HPA from March 26-30, 2007, to provide health care professionals with quick and easily accessible up-to-date knowledge on the disease. This activity does not appear as a peak in the graph, as the most accessed page for the Knowledge Week was a special front page that was not counted in our analysis of searches for the disease.
A document “Tuberculosis prevention and treatment: a toolkit for planning, commissioning and delivering high-quality services in England” was published by the NHS on June 15, 2007, as TB was becoming a growing and expensive problem in the United Kingdom. This shows up as a peak (3.2 times baseline) in week 26 of 2007, following a public interest peak in week 21 (2.8 times baseline), a professional interest peak (4.2 times) in week 22, and a media peak (5.7 times) in week 23.
The highest level in public interest occurred in May 2007 (week 21, 2.8 times baseline), which seems to be related to a story concerning a US citizen infected with TB who took a flight to Europe, potentially spreading the disease [
Tuberculosis is not highly prevalent in the United Kingdom but has been increasing and affects immigrants and the homeless more than other groups. This may explain some of the lack of public interest, as these affected groups may not have as much access to the Internet as other members of the public.
There are several peaks in the media coverage, notably in mid-2007 (5.7 times baseline, mainly relating to a long-running story about a bullock kept at a Hindu temple that contracted TB [
The public and professional interest, and media coverage for Tuberculosis.
The NeLI/NRIC accesses for TB, and the accesses for the document “Tuberculosis prevention and treatment” published in June 2007.
Meningitis is “an infection of the meninges (the protective membranes that surround the brain and spinal cord)” and can be caused by either bacteria or viruses [
Professional interest was heightened in the years 2006 and 2007 but has declined since then. Again, some of this decline can be explained as due to enhanced levels of interest when the NeLI/NRIC sites were relaunched in 2006.
The public interest appears to be level, not deviating far from the baseline level, possibly showing a downward trend, as the graph from early 2009 is below the baseline level. The larger dips at the end of 2006 and the end of 2009 are again probably due to the holiday period. This is interesting, as it seems that the presence of heightened media coverage is not influencing the public searches.
The peaks in media coverage show no obvious pattern. On examining the peaks and matching them to news articles, it seems that media coverage is driven by stories about individual tragedies, celebrity stories, and other human interest stories. The four largest peaks are in week 20, 2007 (3.0 times baseline), with the main focus on the singer Peter Andre who contracted meningitis [
The public and professional interest, and media coverage for Meningitis.
Norovirus is a seasonal disease, also called “winter vomiting disease”. “The virus, which is highly contagious, causes vomiting and diarrhoea. [...] Between 600,000 and one million people in the UK catch norovirus every year” [
In contrast to the other outbreaks that we have investigated in this study, there is a clear seasonal trend to the professional and public interest and media coverage (see
Professional interest tends to mirror public interest, except for heightened activity in late 2009 and early 2010 (up to 8.2 times baseline). This extra activity is due to publication of the HPA’s guideline “Norovirus outbreak reporting scheme” in December 2009. The season 2009-2010 was also a “bad” year for norovirus outbreaks (see
The public interest clearly correlates to the seasonal variation in the professional interest graph and in the media coverage. The dips at the end of each year that are clearly visible in the earlier graphs do not appear here.
There is a clear peak (15.1 times baseline) in media coverage in the winter of 2007/2008. There is also another clear spike (8.6 times baseline) at week 29 of 2009, mainly due to coverage of an outbreak of norovirus on a cruise ship [
As the professional interest, public interest, and media coverage show such similar seasonal patterns, it is not surprising that they closely match data for the actual occurrence of the disease.
The public and professional interest, and media coverage for Norovirus.
The NeLI/NRIC accesses for norovirus, and the accesses for a specific document published in December 2009.
Laboratory reports of norovirus from the years 2005 to 2012 (source: Seasonal comparison of laboratory reports of norovirus (England and Wales; HPA).
Laboratory reports of norovirus 2004-2011 (England and Wales; graph from HPA).
“Influenza is a viral infection that affects mainly the nose, throat, bronchi and, occasionally, [complications occur which affect the] lungs. [...] The virus is transmitted easily from person to person via droplets and small particles produced when infected people cough or sneeze. Influenza tends to spread rapidly in seasonal epidemics.” [
“Seasonal flu occurs every year, usually in the winter. It’s a highly infectious disease caused by a virus. The most likely viruses that will cause flu each year are identified in advance and vaccines are then produced that closely match them.” [
According to an internationally accepted standard, the terms “avian influenza” and “swine influenza” refer to influenza viruses found in birds and swine, respectively [
While it may be expected that influenza would feature highest in the NeLI/NRIC accesses over the investigated period, it is actually only in sixth position. The interest in this disease on NeLI/NRIC has shown to be lower as seasonal influenza, being one of the most common diseases, does not require regular and more specialized evidence.
There is once again a heightened level of activity in the second half of 2006, presumably caused by promotional activity of NeLI/NRIC. During the H1N1 outbreak, the levels were higher than average, but there was not a large spike, as was the case for public interest and media coverage. This is probably due to the large number of competing information online resources for public and professionals that were created during the 2009 pandemic, and the public health agencies such as HPA, ECDC, and WHO held daily press conferences publishing the latest evidence and advice. For this reason, in summer 2009, NeLI/NRIC decided to add a dedicated swine flu link to their home pages to redirect visitors to the ECDC flu website for the daily updates [
Interestingly, public interest in the disease peaks in week 17 of 2009, while the peak in media coverage followed in week 18. However, the difference of one week is probably not significant here, as the process of collating results into weekly totals will have some uncertainties. According to a study conducted in 2009:
The highest number of articles (842) was recorded on 27 April, the day WHO raised the level of influenza pandemic alert to phase 4...There was a smaller, though still large, peak of the number of media articles on 30 April (717 articles). This appears to be linked to WHO’s announcement of pandemic alert phase 5 at 22:00 Central European Time on 29 April: many of the European media reports about this were published on 30 April. Media interest dropped considerably after 30 April.
April 27 is near the end of week 17 (23-29 April), and April 30 is at the start of week 18. It is interesting that the announcement of phase 6 (the pandemic level) on June 11, 2009, did not seem to generate any significant interest.
There was a second peak in public interest at week 44 (6.4 times baseline), identifying the autumn 2009 outbreak (this is discussed in the next section, where it is correlated with the media coverage).
There is an earlier peak (10.0 times baseline) in media coverage in August 2007, which corresponds to a serious outbreak of influenza in Australia (for example [
The second main peak (12.0 times baseline) occurred around the end of April 2009. This was around 6 weeks before the WHO declared that H1N1 was officially a pandemic (June 11, 2009). The heightened media interest in these weeks related to the outbreak in Mexico and speculation as to whether the disease would spread. Public interest during the autumn second peak of the disease was 5.7 times smaller than during the April peak, but is clearly visible in
The public and professional interest, and media coverage for Influenza.
The public and professional interest, and media coverage for Influenza focusing on the period of the 2009-10 swine flu pandemic.
In this paper we have analyzed the information needs of public and professionals around key infectious disease outbreaks and events in the 4.5 years from the end of July 2006, until the end of 2010. We compared these with media coverage to illustrate where the media interest could have fueled public interest in the disease and what the reaction was of professionals to key outbreaks and policy changes. Based on the results, the diseases fall into 4 groups:
MRSA and
Tuberculosis and meningitis: low prevalence;
Norovirus: seasonal; and
Influenza: 2009 mass media attention and pandemic event.
The next sections will discuss the results in more detail.
We found that a triangulation of (1) longitudinal Web log data from the NeLI/NRIC infection portals to evaluate the professionals’ needs around infection as a primary goal, (2) Google Trends in these topics to find a complementary public interest, and (3) media coverage from LexisNexis provides the desired correlation to answer our research questions listed in section 3:
How do health care professionals’ online search needs around infection differ from public needs?
Does media coverage contribute to the information needs for infection events among public?
How are incidents of a disease and major policy events related to information needs of professionals?
Our findings include (corresponding research questions 1-3 are listed in parentheses after each finding):
We found that public needs in infection are much more static and do not relate to disease occurrence and media coverage as much as professionals whose needs inevitably increase with a public health event or a key policy change. (for all diseases examined except influenza discussed below) (RQ1).
However, for events of major media interest, such as MRSA/
Meningitis was a clear example of a disease that has a heightened media coverage that tends to focus on individual tragic cases and celebrity stories (RQ2).
Professionals’ interest did not follow media coverage, but spikes in interest occurred during outbreaks (MRSA,
An exception was norovirus, which showed a seasonal pattern for both groups and matched the periodic disease occurrence (RQ3).
Influenza was of a major concern during the H1N1 outbreak in 2009, creating massive information needs among the public. Also in autumn 2009, the public interest again peaked, but on a smaller scale and also irrespective of the media coverage. However, the media coverage was on a large scale around June 2009 when WHO officially declared the H1N1 outbreak to be a “phase 5” pandemic (RQ3).
Additional results (not corresponding to original research questions RQ1-3): The professional interest was heightened early in the study period for all diseases. This appears to be due to the promotional activities that surrounded the relaunch of NeLI/NRIC in 2006. The professional interest reverted to a more even level after a few months. This is also reflected in the overall graph of traffic for NeLI/NRIC (see
In general, we concluded that media plays a role in influencing public information needs but is not as crucial as is often assumed. Professionals naturally respond to disease occurrence, events, or publication of key documents or policy changes that drive their information needs.
Studying information online needs is very difficult, and research seems to pay little attention to uncontrolled study and analysis of Web server logs for professional and public information needs. Due to the nature of the data available, we have had to make a number of assumptions in this study:
We have assumed that a majority of NeLI/NRIC users are health care professionals, compared to Google searches. So we therefore assume that NeLI/NRIC accesses better reflect the interests of health care professionals, whereas Google searches reflect the interests of the wider public. We claim that this assumption is reasonable, as (1) the NeLI/NRIC websites are designed to provide specialist information targeted and promoted at infection professionals, which would be of less interest to the general user, and (2) there are many websites that are more accessible to the general user (such as NHS Choices [
We have assumed that the number of newspaper articles found via LexisNexis mentioning a keyword near the start of the article is a suitable measure of media coverage. More complex measures could be used, perhaps taking into account the number of words in the article or the readership of the newspapers. Furthermore, other media could be considered, such as television and radio, or social media, such as Twitter.
We assumed that levels of keyword searches were sufficient to measure interest in particular topics. For NeLI/NRIC, we measured the accesses of a particular topic page, whereas for media coverage and Google searches, we used specific keywords (due to the nature of the available data). In these cases, we are ignoring possible misspellings and synonyms that would have reflected interest in the topic.
For commercial reasons, Google does not release details of how its search engine algorithms work, and so it is difficult to determine exactly what the Google Trends data represents (whether it includes misspellings and synonyms, for example).
There are many limitations to using Web server logs to analyze user behavior: (1) it is not possible to resolve IP addresses to individual users as one IP address can represent many users, (2) despite all the efforts discussed we’ve discussed, it is not possible to identify all non-human users, eg, spiders and crawlers, and importantly (3) Web logs do not provide any insight into
In the last two decades, the Internet has revolutionized the way we seek up-to-date evidence and information for public, in particular, during major infection events and outbreaks. Also, the role of online media with increasing coverage of public health events has contributed to the demand for information. In this study, we compared professional and public online information needs around major infection events and outbreaks over the period from mid-2006 to the end of 2010, as well as relevant media coverage.
We investigated in depth six diseases with the highest online traffic on NeLI/NRIC:
As expected, professionals’ interest did not follow media coverage but spikes in interest occurred during major outbreaks (MRSA and
Therefore, public health agencies with responsibility for risk communication of public health events, in particular during outbreaks and emergencies, need to collaborate with media in order to ensure the coverage is of the highest quality and evidence-based while professionals information needs remain mainly fulfilled by online open access to key resources.
Supplementary figures.
City eHealth Research Centre
European Centre for Disease Prevention and Control
European Union
health care associated infections
Health Protection Agency
measles, mumps, and rubella
multi-resistant Staphylococcus aureus
National electronic Library of Infection
National Health Service (UK)
National Resource for Infection Control
Severe Acute Respiratory Syndrome
tuberculosis
World Health Organization
Patty Kostkova is the senior author and a primary investigator of this research. Patty is also the manager of NeLI and NRIC projects. David Fowler produced the analysis for this research study. Sue Wiseman, the NRIC content manager, contributed her expertise around interpretation of results related to the outbreaks in the United Kingdom, while Julius Weinberg’s input included the identification and interpretation of key infection events in relation to the NeLI project and infection control in the United Kingdom.
Thanks to all the researchers who worked on the NeLI/NRIC projects: Steve D’Souza, Ed de Quincey, Gawesh Jawaheer, Gayo Diallo, Martin Szomszor, and Gemma Madle, and content managers Jane Mani-Saada and Faiza Hansraj. The projects were funded by the NHS UK, HPA, and UK Department of Health. Publication costs have been subsidized by JMIR Publications, Inc.
None declared.