"Many people use the Internet for health information, but the numbers are smaller than some people think and the effects on actual health-care use appear relatively small," said Laurence Baker, PhD, lead author of the study and associate professor of health research and policy at Stanford. "When we think about how to move forward with the Internet in health care, we should not presume that the use of the Internet for health information is nearly universal or that the Internet regularly has strong effects on health-care use."
Baker's paper appears in the May 14 issue of the Journal of the American Medical Association.
Previous reports on the prevalence of Internet use for health information vary widely. Some studies report that 75 to 80 percent of online adults use the Internet for this purpose; others put the figure as low as 35 percent.
Baker said a lack of clear information makes it difficult to determine how prevalent Internet use really is and what, if any, impact it has on health care. "Used well, the Internet can be a powerful tool for improving health, but without accurate estimates of use and effects, it is difficult to focus policy discussions and develop the best set of next steps," he said.
In an effort to more accurately measure the extent of Internet use, the researchers surveyed 4,764 Internet users over the age of 21 in late 2001 and early 2002. The survey contained an extensive set of questions about use of the Internet and e-mail for health-care information and the perceived effects of Internet or e-mail use on health-care use. Respondents who reported having a chronic condition also were asked about Internet use related to their condition.
The researchers found that 40 percent of American adults with online access use the Internet for health or health-care purposes. They found that men were less likely than women to use the Internet for health information as were individuals over the age of 75 compared to their younger counterparts. They also found that those individuals who use the Internet for health do not do so often: 31 percent of respondents said they used the Internet for health "every two to three months" or less; only 9 percent said they used it once a month or more.
A majority of those who used the Internet for health information reported that it improved their understanding of health-care issues, but only about one-third said it affected a decision about health or their health care.
The Internet had little impact on health-care use. Ninety-four percent said Internet use had no effect on the number of doctor visits they had; 93 percent said it had no effect on the number of telephone contacts.
"Using the Internet seems to have helped consumers become more knowledgeable about health-care issues and perhaps more comfortable with conditions or treatments about which they have questions, without putting a burden on health-care providers," said Baker, adding that the researchers' intent is not to "throw a cold bucket of water" on the Internet. "Forty percent is a significant number, and the Internet is clearly an important tool for disseminating information on health."
Baker said the differences in use rates in his study and previous ones may be attributed to differences in samples. Some earlier work, including surveys reporting the highest rates of Internet use for health, were based on samples developed by recruiting individuals already online and could have overrepresented individuals who are particularly enthusiastic about the Internet. The sample Baker used is more representative of the U.S. population, he said.
The study also showed that e-mail between physicians and patients - while frequently discussed in medicine - is rare. Only 6 percent of respondents said they had e-mailed a physician. E-mailing family members and friends about health-care issues, however, was much more common. "We often overlook the impact that electronic communication with family and friends can have in health, but perhaps we should pay more attention," said Baker.
Baker's collaborators on this study include Todd Wagner, PhD, health economist at the Veterans Affairs Palo Alto Health Care System; Sara Singer, senior research scholar in the Institute for International Studies at Stanford; and M. Kate Bundorf, PhD, assistant professor of health research and policy. The research was funded by the National Institute of Aging, the Department of Veterans Affairs and Stanford University.
Stanford University Medical Center integrates research, medical education and patient care at its three institutions - Stanford University School of Medicine, Stanford Hospital & Clinics and Lucile Packard Children's Hospital at Stanford. For more information, please visit the Web site of the medical center's Office of Communication & Public Affairs at http://mednews.stanford.edu.
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Journal
JAMA