There has been some question about true usage of the internet for seeking health information, with estimates ranging from 20% of all U.S. adults15
to over 50%.41
In the WLS sample, 34% of respondents had used the internet to search for information about their own health or health care. It is worth pointing out that having internet access at home or work was not a necessary condition for using the internet to search for health information, as 6% of the WLS respondents who had searched for health information online did not report such access.
In addition to education and other factors previously associated with online health seeking behavior, our results show a large number of additional factors that explain variation in use. Furthermore, examination of the timing of this information seeking in relation to doctor visits offers important insight into when older adults are using the internet to supplement the information they receive at visits: (1) educational attainment and openness-to-experience predicted ever using the internet to look for health information irrespective of the timing of searches in relation to doctor visits, (2) health and disease-related variables predicted seeking health information after or unrelated to a visit, while (3) psychological variables (with one exception) predicted seeking health information before or unrelated to a visit. It appears that for “health-minded” or otherwise anxious individuals, when the internet is used for information gathering, it is done so before a visit. This behavior may be preparation for a visit or it may have even prompted the visit (e.g., in the case of more neurotic patients). Conversely, for sicker individuals, when the internet is used for information gathering, it is done after doctor visits, perhaps to assist in processing health information.
In some studies, better health has been associated with increased health information seeking online,8,13
while in others the opposite effect of health status has been found.15
In the WLS sample, those with more diagnosed conditions or illnesses were more likely to have ever sought health information online, and those with more regularly taken prescription medications were more likely to have sought information online after a doctor visit specifically. These results offer support for a “procrastination hypothesis,” in which individuals delay health education until they are actually presented with a health crisis.42
Although personality factors have not been related previously to seeking health information online, we were not surprised to see that openness-to-experience was related to health information seeking on the internet, given that openness is associated with adopting new technologies and using technologies for new purposes.34
Likewise, it is reasonable that individuals who reported working hard to stay healthy were most likely to seek health information online before a visit, as this is a concrete way to prepare for a visit and make the most of limited time with a provider.
We were intrigued by the result showing that a preference for being given many treatment choices was a significant predictor of health information seeking but a preference for who (doctor or patient) makes the important decisions was not. Previous research has demonstrated large differences between preferences for complete information and choices versus preferences for actually making decisions,10,37,43,44
and our results again highlight these differences. Patients clearly want information and treatment choices from their doctors regardless of their desire to actually make the final treatment decision. It is essential that strategies to promote shared decision making recognize this distinction.
The main limitation of this study is the generalizability of our results. Although WLS graduates are generally representative of non-Hispanic white women and men with a high school education, constituting approximately 67% of all Americans aged 60 to 64,45
they are not a random sample of the country. African American cancer patients have previously been shown to have high desires for health information, comparable with white patients,44,46
while Mexican and Korean Americans have demonstrated more family-centered views with regard to information.46
Moreover, the question of how minority groups use the internet to look for health information in relation to doctor visits remains unanswered by our data and requires future examination. Lastly, our dependent variables are based on respondent self-reporting of behaviors. The most serious problem with nonthreatening behavioral questions is that human memory is fallible. We used several techniques to reduce this potential bias including asking specific close-ended questions and asking only about whether an event had occurred and not the number of times.47
The internet's potential to facilitate patients in gathering information is unparalleled, and there are significant differences among older adults, not only in who is searching the internet for health information, but in the timing of this behavior in relation to doctor visits. Our results corroborate previous findings regarding sicker people's online health seeking as well as offer new insights into how psychological mechanisms affect information seeking behavior outside of doctor visits. An important next step will be to determine the outcomes associated with patients seeking health information online48
and whether these outcomes vary by the timing of or motivation for seeking. Examples of significant outcomes might be increased patient confidence in interacting with physicians, improved patient understanding of health information, and reduced visit- or disease-related anxiety. While at least one study has suggested that seeking health information online affects patients' involvement in the decision-making process,16
that has been challenged elsewhere,15
and further investigation is warranted. It will also be important to further clarify what role physicians ought to play in encouraging patients to use the internet to supplement the information exchange in visits.49