Some aspects of the present study should be improved in a follow up study. As mentioned in the methods section, we were unable to calculate an exact response rate due to lacking data from the polling agencies. Even though the number of respondents was high and even though lacking responses to phone calls may be due to many factors, the response rate is of importance to the assessment of the validity of studies such as the present. The telephone penetration in Poland is quite low, which may be of importance to the calculation of the use of e-health services. A future study should therefore include a proportion of mobile phone users in the Polish sample. Income was not included as a variable in the present study. Although education and profession are variables of importance to socio-economic status, adding an income variable could give an even better understanding of the respondents' socio-economic background.
Use of Internet health services varies with country of residence. The North European countries and Poland topped the list, while we found the South European countries at the bottom. As the differences are significant within the sub-sample of Internet users as well, they may not be associated solely with the degree of general Internet access. Two explanations are possible: first, cultural differences, such as preoccupation with health and illness together with other factors, such as the number of accessible web-sites in local languages and the quality and accessibility of general health services, may be of importance [12
]. Second, it may be that the Internet user group in the Southern countries is dominated by early adopters, and that the interest in health issues is lower in this group than it is in the general population. If so, we might assume that geographical differences will even out as access becomes more evenly distributed in the national populations.
In the sub-sample of Internet users, women reported more health-related use. This finding is in line with that reported by some studies from the US [1
], that female Internet users are more interested in health-related issues. The youngest age group comprises the most ardent Internet users, but it is the young adults and the middle aged who take most interest in health information once they are online. A plausible explanation is that we find a large proportion of family caregivers in this group. Having completed higher education has previously been found to be associated with higher use of the Internet for health purposes [1
], a finding which this study confirms. Having a white-collar position usually means longer education; thus it is not surprising that this group are more active Internet health users. We also found a high level of health-related use of the Internet among people who did not have paid work, a possible explanation for this being that students form an important part of this group.
Those who assessed their own health status as poor tended to use the Internet less than others to get health information. However, medical indicators of health, such as a current diagnosis of long-term illness or disability, and a high number of visits to the GP, indicate a higher level of health-related use of the Internet. Hence, we find that those who suffer from illness but who nevertheless feel that they are in good health use the Internet most for health purposes. Concern has been expressed that there might be some patients who feel they are too ill or who do not have the resources to use the Internet [18
]. Our study indicates this might be the case. It is important to keep such differences between patient groups in mind when future e-health services and strategies are developed, in order not to widen the gap between the well off and the less well off in society [19
Our study confirms that the main health-related activity on the Internet is information seeking [1
]. However, a considerably higher number than previously reported [3
] used the Internet as a communication channel. Among Internet users, 27 % had participated in forums or self-help groups and 30 % had interacted with health professionals. This indicates that other health-related activities on the Internet are becoming increasingly important, and that e-health services have already become an important part of health care for many people, as has also been suggested by other studies [20
The possible relation between health related Internet usage and peoples' use of other health services has been given attention in later years [9
]. In our study, three findings are of particular interest with regard to this topic: Only 6 % claim they have made, cancelled or changed a doctor's appointment based on health related Internet activity. Second, we found that people primarily use the Internet for general reading. And third, that approximately a quarter of the respondents actually use the Internet to prepare for or follow up a doctor's appointment. Hence we conclude that the Internet is used as a supplement to the ordinary health services rather than as a replacement. Another finding that supports our conclusion is the relatively low number of respondents (40 %) who claimed that the Internet was an important channel for health information (Table ). Face-to-face contact with a health professional was considered important by almost twice as many, 79 %. However, even if our study shows the Internet is used as a supplement, we also see indications that health related Internet activity affect the populations' use of traditional medical services. One third of the Internet users have brought with them to their doctor suggestions or queries on diagnosis after surfing the net for health information. And almost half of the Internet users claim they have used the Internet to decide whether they need to see a doctor. As the number of European general practitioners offering e-health services is still low, we are not surprised that only 4 % of respondents reported that they had approached their family doctor via the Internet.
It was twice as common to feel reassured as it was as to feel anxious after using the Internet for health purposes. Hence, our study supports the idea that the populations' use of Internet health information is more likely to have a beneficial than a negative influence on individual health experiences [21
A sign of the increasing importance of the Internet in citizens' health management is that about a third of the respondents stated that the doctor's provision of e-health services was of importance when choosing a new doctor. The differences between the expectations of Internet users and the general population, as presented in Table , support the idea that it is likely there will be an increasing demand for provision of e-health services by primary care and hospital services as more and more Europeans obtain Internet access [23