People with chronic conditions vary in their use of the Internet for health information and advice. After adjusting for education, sex, and age, Internet use for health information in the past year clustered at about 33.8% to 42.9% for hypertension only, cancer only, and heart problems only. Rates were slightly higher (47.6%) for people with any two of the five chronic conditions and were 51.0% to 52.0% for people with diabetes only, depression only, and three or more chronic conditions.
People who have depression only and people who have multiple chronic conditions were among the most frequent users of the Internet for health information — for overall use and for communicating with health professionals. Use of the Internet was also common for people with diabetes only, although these people were less likely to communicate with family and no more or less likely to communicate with health professionals or other patients than the other chronic condition groups. These data confirm past reports that people who have depression are more likely to seek health information than people who have other chronic conditions (13
). The higher rates for depression only may reflect that the disorder still carries some stigma, leading individuals to seek information outside traditional routes. The higher rates for depression could also reflect that depression care often has greater limits on mental health care insurance benefits and higher out-of-pocket expenses. It would be useful to know whether this association is driven by stigma or by costs. If the association is driven by stigma, this could identify opportunities for using the Internet to reach people with stigmatized and potentially communicable chronic conditions (e.g., HIV).
Although a large percentage of people with depression searched the Internet only for health information, the depression-only group reported one of the lowest rates for having been affected by Internet use. People who had diabetes, cancer, or heart problems were more likely to agree that Internet information improved their understanding of their condition than were people who had hypertension or depression. More research is needed to determine which type of information is received by people who have depression and whether they find it helpful.
We interpret Internet use among people with chronic conditions as a glass half empty or half full. We see smaller effects on treatments and providers and larger effects on self-management, eating, and exercise. Fewer than one in eight people agreed that the Internet led them to seek care from different health professionals for their conditions, and fewer than one in four said that the Internet affected their choice of treatment. These numbers can be viewed as substantial or meager, depending upon perspective. If these numbers are accurate, the effect of the Internet on improved understanding is larger than other computerized patient education interventions, such as the one described in the study by Rostom et al on decision support for hormone replacement therapy (19
) or in the study by Consoli et al on hypertension (20
). Caution must be used in interpreting these responses because the data are self-reported, and we do not have information about respondents' knowledge before they used the Internet and cannot compare these data to a control group. We also have no way of verifying if the information they obtained was factually correct.
Attitudes toward health information on the Internet were generally favorable. Slightly more than one third of the people with one or more of the five chronic conditions agreed that it takes too long to find information on the Internet, indicating that search time is an important determinant in using the Internet. When people do find information, they then have to identify whether it is high quality and accurate. Approximately one in five people agreed that they cannot trust Internet health information, but it is unclear how they determine whether they can trust the information. Other studies have discussed problems with the quality and coverage of health information on the Internet (6
), and research has found that people are not particularly good judges for identifying accurate health information and often forget which sites they searched (7
). Efforts to help people identify high-quality information more quickly could result in more people using the Internet for health information.
A limitation of this study was that all the data were self-reported. Some respondents might have avoided labeling themselves as chronically ill, especially for depression, which is stigmatized. Additionally, the survey questions required that people reconstruct memories of how they used the Internet in the past year. This process can be cognitively difficult, especially when a question asks respondents to remember how they used the Internet and then to estimate its net effect.
The KN panel has been used in other research studies (22
). This method of sampling departs from traditional random-digit dialing. Both methods start with a sampling frame that consists of U.S. households with telephone access. Both methods have strengths and weaknesses. The strength of the panel approach is that people are asked to participate in the panel, and a subset is sampled for a particular survey. We have information on those who were sent the survey and did not respond. The weakness is that some people may dislike being on a panel and opt out when first asked or ask to be removed from the panel over time. KN and independent researchers have studied these issues and reports are available online (http://www.knowledgenetworks.com/ganp/reviewer-info.html
). Random-digit dialing is performed each time a survey is fielded, so it is not susceptible to panel attrition. At the onset of the call, however, the respondent is told about the intent of the survey. People then choose whether to complete the survey, and, typically, little if any information on the non-respondents is collected. Many national surveys, including the Behavioral Risk Factor Surveillance Survey and 2000 Census, report median response rates below 70%. The latest study on the Internet and health conducted by Pew Internet and American Life Project reported a response rate of 32.8% (15
). As mentioned earlier, we compared our sample to other national surveys. Although the results were similar on all the variables we compared (17
), we cannot rule out the existence of potential biases on other variables, such as Internet use.
This study focuses on common chronic conditions. Perhaps we would see higher rates of Internet use among people who have rare diseases. There is a substantial amount of health information available on the Internet (24
), and people with rare illnesses can obtain peer support on the Internet in ways that would not be possible off-line. Further research could evaluate these matters.
A common perception is that the provision of health information via the Internet is a "field of dreams" — that is, if we build it, they will come. In the past decade, public and private investments have poured into Internet sites. Although the Internet can offer several clear advantages over traditional information sources, such as very low distribution costs, we found that few people who have the five common chronic conditions studied use it routinely. When they do, however, they report notable gains in knowledge and small changes in behavior.