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The Internet represents an increasingly common source of health-related information, and it has facilitated a wide range of interactions between people and the health care delivery system.
To establish the extent of Internet access and use to gather information about health topics and the potential implications to health care among the adult population in Calabria region, Italy.
This cross-sectional study was conducted from April to June 2012. The sample consisted of 1544 adults aged ≥18 years selected among parents of public school students in the geographic area of Catanzaro in southern Italy. A 2-stage sample design was planned. A letter summarizing the purpose of the study, an informed consent form, and a questionnaire were given to selected student to deliver to their parents. The final survey was formulated in 5 sections: (1) sociodemographic characteristics, (2) information about chronic diseases and main sources of health care information, (3) information about Internet use, (4) data about the effects of using the Internet to search for health information, and (5) knowledge and use of social networks.
A total of 1039 parents completed the questionnaire, with a response rate equivalent to 67.29%. Regarding health-related information types, 84.7% of respondents used the Internet to search for their own medical conditions or those of family members or relatives, 40.7% of parents reported looking for diet, body weight, or physical activity information, 29.6% searched for vaccines, 28.5% for screening programs, and 16.5% for smoking cessation tools and products. The results of the multiple logistic regression analysis showed that parents who looked for health-related information on the Internet were more likely to be female (OR 1.53, 95% CI 1.05-2.25), with a high school diploma (OR 1.69, 95% CI 1.02-2.81) or college degree (OR 2.14, 95% CI 1.21-3.78), younger aged (OR 0.96, 95% CI 0.94-0.99), with chronic conditions (OR 1.94, 95% CI 1.17-3.19), not satisfied with their general practitioner’s health-related information (OR 0.6, 95% CI 0.38-0.97), but satisfied with information from scientific journals (OR 1.99, 95% CI 1.33-2.98).
Our analyses provide important insights into Internet use and health information–seeking behaviors of the Italian population and contribute to the evidence base for health communication planning. Health and public health professionals should educate the public about acquiring health information online and how to critically appraise it, and provide tools to navigate to the highest-quality information. The challenge to public health practice is to facilitate the health-promoting use of the Web among consumers in conjunction with their health care providers.
The increasing use of the Internet over the past few years has allowed for a rapid and worldwide circulation and sharing of different information. The Internet also represents an increasingly common source of health-related information. An estimated 27.5% of the US adult population looked online for information about a health or medical issue in 2000 [
The Internet has also grown in popularity among Italian citizens. The percentage of the Italian population between the ages of 15 to ≥75 years that uses the Internet has increased from 32.3% in 2005 to 52.1% in 2012 [
Therefore, this study was designed to establish the extent of Internet access and use to gather information about health topics and the potential implications in health care among the adult population in the Calabria region, Italy.
This cross-sectional study was conducted from April to June 2012. The sample comprised 1544 adults aged ≥18 years selected among parents of public school students in the geographic area of Catanzaro in southern Italy.
A 2-stage sample design was planned. We divided the target population into kindergarten, elementary, middle, and high schools, which were used as first-stage sampling units. A simple randomization technique with replacement was adopted in selecting each school. A sampling frame of all students was then assembled for each selected school. At the second stage of sampling, a sample of students was randomly selected from each school. During school hours, each selected student was given a letter summarizing the purpose of the study and pointing out the voluntary and confidential nature of participation, an informed consent form, and a questionnaire to deliver to their parents.
Before starting data collection, a meeting with the head of each selected school was arranged to present the project and to discuss the research strategy.
The sample size was determined before study initiation. It was calculated assuming that 50% of the respondents look online to obtain health-related information in accordance with prior European studies, a margin of error of 5%, and a 95% confidence level. Consequently, a sample of 385 parents was sought. Anticipating a response rate of 45%, a total sample size of 789 parents was needed. We included an additional 250 parents in case the response rate among Internet users was not adequate.
The questionnaire was developed based on previous studies [
The final survey was 2 pages in length, designed to be completed within 10 minutes and formulated into 5 sections: (1) sociodemographic characteristics (gender, age, marital status, level of education, and employment); (2) information about chronic diseases and the main sources of health care information; (3) information about Internet use, including whether participants had a computer at home and/or access to the Internet and, if the parent had access to the Internet, if he or she used the Web to search for health information; (4) data about the effects of using the Internet to search for health information; and (5) knowledge and use of social networks.
Each section elicited responses in a variety of formats: closed-ended questions with multiple answers possible, yes or no questions, and open-option questions. The questionnaire culminated with the option of providing additional comments.
The study protocol was approved by the Ethics Committee of the Mater Domini Hospital of Catanzaro (Italy) (2012/04/20).
Multivariable backward stepwise logistic regression models were constructed to determine the explanatory variables independently related to dichotomous measures of whether or not the Internet was used for health-related information seeking. The model building strategy included the following steps: (1) univariate analysis of each variable considered, using the appropriate test statistic (chi-square test or
The following explanatory variables were included in the model: gender (male=0, female=1), age (continuous), satisfaction about information received from general practitioner (GP; dissatisfied=0, satisfied=1), education level (3 categories: elementary/middle school=1, high school=2, university degree=3), number of visits to the GP (ordinal, once per year or less=1, 3-4 times per year=2, once per month=3, 2-3+ times per month=4) and presence of chronic conditions (no=0, yes=1), satisfaction about information received from TV/radio (dissatisfied=0, satisfied=1), and satisfaction about information received from scientific journals (dissatisfied=0, satisfied=1).
Stata version 11 (StataCorp LP, College Station, TX, USA) statistical software package was used in conducting all data analyses.
Ten public schools were selected. A total of 1039 parents completed the questionnaire, with a response rate equivalent to 67.29% (1039/1544). The main sociodemographic characteristics of the study population are shown in
The respondents’ Internet use pattern is reported in
Among parents who used the Internet to search for health-related information, 81.2% (599/738) said that it improved their understanding of health care issues and they learned more about an illness or a specific symptom, and 23.0% (170/738) reported that they used the Internet to obtain more information than that provided by their GP. More than half (58.5%, 432/738) considered the retrieved information very useful and 49.1% (362/738) stated that they were able to find online answers to their health care questions (data not shown).
Data quality on the Web may be of concern and criteria used by respondents were investigated. In all, 59.9% (438/731) stated that they visited websites sponsored by physicians or medical associations, and 16.9% (125/740) did not care about health-related information reliability. At univariate analysis, the Internet use for searching health-related information was significantly higher among female (χ2
1=6.0,
Regarding influence of information obtained from the Web on health care–related behavior, 69.2% (512/740) of the Internet users indicated that the information they found modified the way they thought about their health. In particular, 57.8% (296/512) reported they had become more interested in health issues, and 36.7% (188/512) were less confused about health problems. Moreover, 43.5% (322/740) of the eligible parents started paying more attention to eating habits and food, and 33.9% (169/498) and 18.7% (138/738) started or increased physical activity and increased participation in screening programs, respectively (data not shown).
Among participants who used the Internet to search for health-related information, only 25.4% (188/740) discussed this with their GP. A total of 78.5% (581/740) of the eligible respondents believed that Internet use had not changed their relationship with their GP in any way; 13.4% (99/740) believed it had a positive effect and 8.1% (60/740) believed it had a negative effect. After using the Internet, 12.7% (94/740) of the sample had reduced their frequency of GP visits.
Regarding social networks, more than half of parents (56.9%, 505/886) said they had a profile on a social network; the most used social platform was Facebook (97.6%, 493/505). Almost half of these parents accessed it daily (49.5%, 250/505). A total of 40.8% (206/505) of participants used Internet for health-related social support and access to open forums or groups focused on medical issues in particular to ask for help in the management of a disease or a symptom (60.2%, 124/206) or to share illness experiences (43.7%, 90/206).
Selected characteristics of the study population.
Characteristic | Overall sample |
Internet users |
|
|
|
|
|
|
Female | 704 (67.76) | 590 (66.22) |
|
Male | 335 (32.24) | 301 (33.78) |
|
|
|
|
|
18-35 | 223 (21.46) | 215 (24.13) |
|
36-40 | 240 (23.09) | 213 (23.91) |
|
41-45 | 285 (27.43) | 252 (28.28) |
|
46-50 | 191 (18.39) | 144 (16.16) |
|
>50 | 100 (9.63) | 67 (7.52) |
Age, mean (SD) | 41.2 (7.4) | 40.4 (7.3) | |
|
|
|
|
|
Married | 865 (83.25) | 733 (82.27) |
|
Single/divorced/separated/widowed | 174 (16.75) | 158 (17.73) |
|
|
|
|
|
No formal education/completed elementary/middle school | 195 (18.76) | 106 (11.89) |
|
Completed high school | 518 (49.86) | 465 (52.18) |
|
Holds a bachelor’s degree or any college degree | 326 (31.38) | 320 (35.93) |
|
|
|
|
|
Unemployed/housewife/retired | 312 (30.44) | 215 (24.51) |
|
Employed | 520 (50.73) | 476 (54.28) |
|
Professional/autonomous work | 193 (18.83) | 186 (21.21) |
Chronic conditions, n (%) | 243 (23.38) | 202 (22.67) | |
|
|||
|
Once per year or less | 279 (26.85) | 259 (29.07) |
|
3-4 times per year | 342 (32.91) | 308 (34.57) |
|
Once per month | 276 (26.57) | 226 (25.35) |
|
2-3 times per month | 142 (13.67) | 98 (11.01) |
|
|||
|
General practitioner | 677 (65.16) | 558 (62.62) |
|
Internet | 462 (44.46) | 461 (51.73) |
|
TV/radio | 287 (27.62) | 228 (25.59) |
|
Scientific journals | 158 (15.21) | 150 (16.83) |
|
Magazines/books | 43 (4.14) | 35 (3.92) |
|
Family members/friends/colleagues | 26 (2.50) | 24 (2.69) |
aTotal may not always sum to N because of missing data.
bMultiple responses allowed.
Personal computer and Internet use patterns of respondents.
Use of Internet (number of respondents) | n | % | |
Having a personal computer at home (1039) | 994 | 95.67 | |
Having a personal computer at the workplace (1039) | 602 | 58.16 | |
Use of Internet (1039) | 891 | 85.76 | |
|
|
|
|
|
<1 year | 51 | 5.72 |
|
1-3 years | 193 | 21.66 |
|
4-6 years | 264 | 29.62 |
|
7-10 years | 188 | 21.09 |
|
>10 years | 195 | 21.91 |
Internet use to search for health-related information (891) | 740 | 83.05 | |
|
|
|
|
|
Physicians or medical association | 438 | 59.91 |
|
Ministry of Health | 206 | 28.18 |
|
Chat | 186 | 25.44 |
|
Hospitals | 85 | 11.62 |
|
National scientific societies | 81 | 11.08 |
|
International organizations competent for health | 69 | 9.43 |
|
International scientific societies | 48 | 6.56 |
|
Local organizations competent for health | 30 | 4.10 |
|
Other | 16 | 2.18 |
Internet use to better understand the meaning of a medical term (740) | 672 | 90.81 | |
|
|
|
|
|
Disease diagnosis | 636 | 85.94 |
|
Own, family member, or relative health status | 627 | 84.73 |
|
Disease treatment | 521 | 70.40 |
|
Health services provider | 447 | 60.40 |
|
Drugs | 393 | 53.11 |
|
Diet, weight, or physical activity | 301 | 40.67 |
|
Vaccines and/or vaccinations | 219 | 29.59 |
|
Screening programs | 211 | 28.51 |
|
Smoking cessation | 122 | 16.48 |
|
Internet use to buy drugs or vitamins (740) | 25 | 3.37 |
|
Use email to communicate with the general practitioner (740) | 170 | 22.97 |
|
Talk with general practitioner about information retrieved on the Internet (740) | 188 | 25.41 |
|
Creating an online profile (886) | 505 | 56.99 |
|
|
|
|
|
493 | 97.62 | |
|
62 | 12.27 | |
|
Google+ | 47 | 9.31 |
|
14 | 2.72 | |
|
MySpace | 9 | 1.78 |
|
Viadeo | 2 | 0.39 |
|
|
|
|
|
Never/almost never | 38 | 7.52 |
|
3-4 or less times per month | 43 | 8.51 |
|
1 or less times per week | 60 | 11.88 |
|
2-4 times per week | 69 | 13.66 |
|
5-6 times per week | 45 | 8.91 |
|
Daily | 250 | 49.52 |
Internet use for health- related social support (505) | 206 | 40.79 |
aMultiple responses allowed.
Univariate and multivariate analyses of Internet use for health-related information seeking according to various explanatory variables.
Variable | Univariate | Multivariate | |||||||
|
Mean (SD) |
|
|
Health-related information seekers (n=740)a | OR | 95% CI | |||
|
|
|
|
n (%) | χ2 1 or χ2 1 for trend |
|
|
|
|
|
|
|
|
|
6.0 | .01 |
|
|
|
|
Male |
|
|
|
237 (78.7) |
|
|
1.00b |
|
|
Female |
|
|
|
503 (85.2) |
|
|
1.53 | 1.05-2.25 |
|
|
|
|
|
14.1 | <.001 |
|
|
|
|
Elementary/middle school |
|
|
|
74 (69.8) |
|
|
1.00b |
|
|
High school |
|
|
|
387 (83.2) |
|
|
1.69 | 1.02-2.81 |
|
College degree |
|
|
|
279 (87.2) |
|
|
2.14 | 1.21-3.78 |
|
|
3.6 | <.001 |
|
|
|
|
|
|
|
Users | 40.05 (7.35) |
|
|
|
|
|
0.96 | 0.94-0.99 |
|
Not users | 42.37 (6.83) |
|
|
|
|
|
|
|
|
|
|
|
|
2.4 | .12 |
|
|
|
|
No |
|
|
|
565 (82) |
|
|
1.00b |
|
|
Yes |
|
|
|
175 (86.6) |
|
|
1.94 | 1.17-3.19 |
|
|
|
2.8 | .09 |
|
|
|||
|
Once per year or less |
|
|
|
219 (84.6) |
|
|
—c | —c |
|
3-4 times per year |
|
|
|
266 (86.4) |
|
|
|
|
|
Once per month |
|
|
|
174 (77) |
|
|
|
|
|
2-3 times per month |
|
|
|
81 (82.6) |
|
|
|
|
|
|
9.7 | .002 |
|
|
||||
|
Dissatisfied |
|
|
|
225 (89.3) |
|
|
1.00b | 0.38-0.97 |
|
Satisfied |
|
|
|
515 (80.6) |
|
|
0.6 |
|
|
|
|
22.0 | <.001 |
|
|
|||
|
Dissatisfied |
|
|
|
381 (77.8) |
|
|
1.00b |
|
|
Satisfied |
|
|
|
349 (89.7) |
|
|
1.99 | 1.33-2.98 |
|
|
|
4.6 | .03 |
|
|
|||
|
Dissatisfied |
|
|
|
361 (80.4) |
|
|
—c | —c |
|
Satisfied |
|
|
|
374 (85.8) |
|
|
|
|
aTotal may not always sum to N because of missing data.
bReference category.
cRemoved by the model.
The Internet is broadly recognized as a potentially important instrument for transforming medical care and public health [
Internet access is a widely diffused technology in the surveyed area; approximately 85% of our sample accessed it. Searching for health information online appeared to be a prevalent activity among the population, and the Internet is considered the second most important source of health-related information, preceded only by health professionals who are still the main source of health information by far. Nevertheless, among Internet users, 83.1% reported that they look online to obtain health-related information for themselves, family members, or relatives and the prevalence was higher than those reported in the United States in 2009 (61%) [
The findings from this investigation shed considerable light on the variables related to Internet use for health-related information. Multivariate data analysis results regarding health information seekers characteristics were consistent with many preceding studies pointing out that younger people, females, those with a higher level of education, not satisfied with their GP’s health-related information, and those with chronic conditions reported more frequent access to the Internet to seek health-related information [
As reported in previous research [
In the present survey, we also examined the prevalence of Internet use related to wellness information (ranging from 40.7% for diet, weight, or physical activity to 16.5% for smoking cessation). Most health risks in the modern world are related to lifestyles (eg, overweight, unhealthy diet, physical inactivity, and smoking), and the observation that individuals actively sought these information could be a key in the prevention and management of risk conditions. This suggests that the Internet could provide an efficient channel for primary health promotion and disease prevention activities, encouraging many individuals to search the Internet for health information to maintain a healthy lifestyle. Results of the present survey may be relevant for future development and implementation of Web-based interventions aimed at improving lifestyle behavior. An Internet-based lifestyle intervention may overcome significant barriers to preventive counseling and facilitate the incorporation of evidence-based lifestyle interventions into primary care [
In our Internet users sample, 22.9% reported using email to communicate with their GP, and this finding suggests that online communication with GPs is not widespread in Italy. Communication via email between health providers and health consumers represents an important topic that should be addressed in the future because it may offer opportunities for the public to interact interpersonally with health professionals [
Although the findings of this study are meant to stimulate discussion about the role of the Internet in health promotion and disease prevention, there are several limitations to acknowledge. First of all, it should be noted that, because this study has a cross-sectional design, the relationship between the predictor variables and the dependent variables should not be taken as a cause-and-effect relationship; the study is able only to describe general associations. Second, although the data were produced using a rigorous methodology, they are from self-report assessments and may reflect certain biases as a result. As with any survey based on a self-administered questionnaire, information may not be entirely accurate, primarily because of the long time frame used in the study that may introduce recall bias. On the other hand, longer time frames are useful for formulating broad prevalence estimates in a context in which no data are yet available.
Third, we collected data in 1 Italian region, which might not represent all adult population in Italy; therefore, concern about generalizability and comparability of the findings may arise. However, we are confident that the findings of the study may be representative of the Southern regions and may be referred to the whole country. Moreover, it is well known that the ability to generalize from a sample is limited by the sample frame, and we selected participants from parents of children and students attending kindergarten, elementary, middle, and high schools. This population, compared to the general population, probably underestimates people older than 50 years and excludes those who do not have children. However, we believe that these characteristics do not have a substantial impact on Internet use for health-related information because adults aged between 18 and 49 years are more likely than older adults to participate in social technologies related to health [
Despite the limitations identified, our analyses provide important insights into Internet use and health information-seeking behaviors of the Italian population and contribute to the evidence base for health communication planning. Health and public health professionals should educate patients about acquiring health information online and critically appraising it [
general practitioner
None declared.