The majority of the sample was white (69.60%, 2098/3014) and insured (86.86%, 2618/3014) (Table 1). A little more than half of the sample was female (55.64%, 1677/3014); the mean age (SD) was 52.6 (19.8). Over one-third of the sample had a college degree or higher (36.99%, 1115/3014), and 8.93% (269/3014) had less than a high school education. Over a third (38.69%, 1166/3014) of the sample earned less than US $40,000 annually. However, high earners were also well represented in this sample; 13.70% (413/3014) made more than US $100,000 per year. The majority of the sample reported good or excellent health (79.66%, 2401/3014), although half (1498/3014) also reported having at least one chronic condition. About a fifth (20.21%, 609/3014) of the sample experienced an acute medical exacerbation in the past year. Of the 2392 persons who answered questions about health-related Internet use, 1717 (71.78%) reported consuming Web-based health information. Only 254 (10.62%) reported producing Web-based health information. The vast majority (97.9%) of persons who produced Web-based health information also consumed Web-based health information. There were 622 participants (20.6%) who reported neither consuming nor producing Web-based health information.

Regression analyses incorporating survey sampling weights revealed differences in consumption of Web-based health information according to a number of demographic characteristics. Consumption of Web-based health information decreased with age and increased with education (Table 2). Participants with some college education or more were significantly more likely than persons who did not finish high school to consume Web-based health information (OR 2.24, P<.01). Participants with a 4-year college degree or higher had 3.99 times the odds of consuming Web-based health information compared with patients who did not finish high school (P<.001). Consumption of Web-based health information was equivalent among persons aged 18-29 and 30-44; after age 45 people were significantly less likely to consume Web-based health information. After adjusting for other covariates, there were no differences in consumption of Web-based health information by race.

Self-reported health status was not independently associated with consuming Web-based health information. However, presence of a chronic condition was associated with significantly more consumption of Web-based health information (OR 1.54, P<.01). Having an acute medical exacerbation was also a significant predictor of such consumption; in fact, of all the health-status-related measures, having an acute medical exacerbation was most strongly associated with consuming Web-based health information (OR 2.39, P<.001).

Having an acute medical exacerbation was significantly associated with producing Web-based health information (Table 3). Persons with an acute medical exacerbation had 1.97 the odds of producing Web-based health information compared to people without an acute medical exacerbation (P=.003). In contrast, self-reported health status and the presence of a chronic condition were not significantly associated with being a producer of Web-based health information. Similarly, no demographic variables (including sex, race, age, and education) were associated with producing Web-based health information.

In a post-hoc analysis, we evaluated the type of Web-based health information consumed and produced by participants with and without acute medical exacerbations. In multivariate regression, compared to participants without acute medical exacerbations, participants with acute medical exacerbations were much more likely to seek medical treatment or procedure information, drug safety information, medical test results information, information about drugs advertised, and reviews of providers or treatments (Table 4). Data indicate that regardless of whether patients had acute medical exacerbations, the type of Web-based health information they were most likely to consume was that regarding a disease or medical problem. We found no difference among patients with and without acute medical exacerbations in terms of the source of the Web-based health information they consumed (peer, professional, or both). There were also no differences among patients with and without acute medical exacerbations with respect to the type of Web-based health information they produced (personal health experience vs reviews of providers, hospitals, or treatments).

Our analyses revealed a number of demographic characteristics associated with consumption of Web-based health information. Females, persons with some college education or more, and persons younger than 44 years were significantly more likely to consume Web-based health information. Conversely, no demographic variable was significantly associated with producing Web-based health information. These results corroborate other studies, which have found that Web-based health information-seeking typically increases with education and income and decreases with age [1,17,21,22].

In evaluating health-related variables and consumption and production of Web-based health information, we found having a chronic condition and having an acute medical exacerbation were independently associated with Web-based health information consumption, with acute medical exacerbations being the stronger predictor of this type of consumption. Having an acute medical exacerbation was the only health status–related predictor of becoming a producer (rather than a consumer) of Web-based health information. Therefore, having an acute medical exacerbation or a chronic condition is associated with greater engagement with consuming health information technology. For persons who already consumed Web-based health information, having an acute medical exacerbation is associated with becoming a producer of such information.

While over 90% of patients with and without acute medical exacerbations seek Web-based information about health conditions, there are some important differences about the other types of Web-based health information they consume. Persons with acute medical exacerbations in the past 12 months are significantly more likely to seek information regarding medical treatments or procedures, medications, and medical treatment results, and reviews of providers or treatments compared with persons who did not experience an acute medical exacerbation in the past 12 months.

Results indicate that having an acute medical exacerbation was the only significant predictor of producing Web-based health information. This suggests that peer-to-peer health-related Internet content may be skewed towards persons who are sicker. This is important to recognize, given that patients with stable chronic conditions are often consuming this peer-generated information. This overrepresentation of the experiences of persons with acute medical exacerbations may mean there is not enough peer-generated Web-based health information available regarding stable chronic conditions and that the information available may not be applicable to those with stable chronic conditions who wish to prevent an acute medical exacerbation.

Our analysis also revealed the discrepancy between objective evaluations of health and interpretation of one’s own health. The vast majority of our sample had a self-reported health status of good or excellent, yet over half reported having at least 1 chronic condition. Among persons with a chronic condition, 16% reported their health as excellent and half reported their health as good. Among persons with an acute medical exacerbation, 16% reported their health as excellent and less than half reported their health as good. These results suggest that patients are likely to overestimate their own health status.

Having an acute medical exacerbation may be a “window of opportunity” in which health-related online behavior changes. Patients appear to be seeking health information at this time and may be especially receptive to health information provided by their care team. It is also possible that patients are seeking Web-based health information because they are not receiving sufficient information from their providers. The desire for health information around the time of a health status change suggests a role for providers to direct patients to high-quality, easy-to-understand online information, especially information regarding treatments and procedures. This is especially important to provide to patients who have had a recent acute medical exacerbation. These online resources should augment, but not replace, the distribution of printed patient care instructions and information about relevant procedures and treatments.

The fact that patients are both more likely to consume as well as produce Web-based health information around the time of an acute medical exacerbation suggests that this time may also represent a window of opportunity regarding health behavior. Experiencing an acute exacerbation may be a time when patients take more ownership over their health status. There is some cohort-based data to support this. In a study of 253 patients followed one month after an Emergency Department (ED) visit, 12% reported abstaining from smoking for 30 days after the emergency department visit and another 38% reported that they were able to quit smoking for some period of that time. Having a smoking-related emergency department visit was the strongest predictor of abstinence/attempts to quit in these patients [23]. While this indicates that acute medical exacerbations are catalyzing health behavior change, more causal studies are needed to further explore this line of inquiry, as well as what kinds of Web-based and other health-oriented tools may be more helpful and effective at this point.

It may be important to expand the role of the health provider to educate patients not only verbally about their health and medical conditions, but also educate them as to the best Web-based sources of accurate and relevant health information. Not all Web-based health information is considered equal [24]. It can be difficult for patients to identify high-quality versus low-quality information, especially as the accuracy of a website is in fact poorly associated with its credibility [24]. However, routing all patients to the same high-quality website is likely not the optimal solution, as patients have varying abilities in understanding this information. For example, evidence indicates over 80% of post-surgical patients had difficulty understanding Web-based health information and approximately one-third reported that retrieving such information was overwhelming [25].

This analysis was based on previously collected survey data and is subject to limitations. All data were self-reported and may be subject to recall or other bias. Data were collected via mobile phone and landline telephone surveys, and it is possible that persons who choose to respond to such surveys are systematically different from persons who choose to not participate in these surveys. Internet use was assessed as a binary variable, and it is possible the frequency or timing of Internet use varied among survey participants. These data are also cross-sectional, and we are therefore not able to tease out the chronology of events. We found that having an acute medical exacerbation was significantly associated with consuming and producing Web-based health information. It is possible that an acute medical exacerbation led to persons seeking Web-based health information, or that persons used the Internet to search for health information that led them to conclude they were having an acute medical exacerbation for which they sought medical attention.

This analysis provides new insight into the use of the Internet for health purposes and suggests that having an acute medical exacerbation is a time when patients’ Web-based health behavior changes and patients become more engaged with the Internet for the purposes of heath information. Practice-based implications of this research include providing high-quality Internet health links for patients around the time of an acute medical exacerbation and leveraging the window of opportunity around an acute medical exacerbation to provide patients with online tools to engage health behavior change.