This study examined the prevalence of participation in online health activities and whether participation in these activities is predicted by sociodemographic, health status, and Internet use factors. We found that participation in these activities varied and that different sets of variables predicted who was likely to engage in these different activities.
Almost 60% of the Internet users surveyed reported searching for health information for themselves in the previous year. Fox and Rainie [7
] identified the search for health information as the most common online health-related activity, and the present study found it to be the most prevalent of the three studied behaviors. This finding has several critical implications for both information providers and seekers. First, health agencies can use findings such as these to justify making health information available online because many people are using this channel, often before talking to their clinicians. Although people may prefer to go to their clinicians first, they have reported that they actually go online first for health information [27
However, just making information available is not sufficient. Health agencies need to take responsibility for understanding how best to meet the needs of online information seekers. The rate of Internet use and broadband adoption has continued to increase among those with less than a high school education [28
], suggesting that the number of users with lower literacy levels will grow [29
]. Although this study found that respondents with higher education were more likely to search for health information, people with low literacy have identified health information as one of the primary types of information for which they would search [30
]. Given that much of the health information on the Internet has been written at too high a level for many population segments [1
], the development of materials that can be used and understood by audiences with lower literacy levels will be critical.
Another implication of online health information seeking relates to whether consumers can assess the quality of online health information. Despite the existence of reputable health portals, most users begin their search from a search engine [7
] and rarely go beyond the first page of returned results [31
]. Consumers must possess the skills to sort through and critically evaluate online information if the Internet is to realize its full potential in helping people meet their information needs.
Health status has been associated with health-related Internet use in previous studies [3
], but these studies have reported conflicting evidence on whether having a chronic condition predicted health information seeking on the Internet. This study found that neither health status nor having been diagnosed with cancer were associated with greater Internet use for health information seeking. However, on the HINTS survey, respondents who indicated that they had been diagnosed with cancer could currently be in remission and not actively coping with a current cancer diagnosis. Thus, the use of this variable as a proxy measure of health status may not truly distinguish healthier versus less healthy individuals.
Health information seeking was also predicted by Internet use variables. Although almost all (90%) users had Internet access from home, this study found that those with access primarily from work or from both home and work were more likely to search for health information for themselves. People were more likely to use the Internet to search for health information if they used the Internet for an hour or more on typical weekdays and, as in previous research [9
], had faster connections.
Having Internet access in the home has been considered an important indicator of equitable access among population groups [32
], but the current results suggest that work access may be a critical factor in using the Internet for health information seeking. Frequency of use on weekdays and not weekends was related to searching for health information, again suggesting use on typical workdays. Accessing the Internet from work may offer some users faster connections. Given that most contact with medical professionals occurs during traditional work hours, receiving a phone call at work with a new diagnosis or lab results may provide a cue to action for an Internet search for those with the means to immediately begin searching. Those with access from both home and work may simply have more opportunities to search for health information.
The use of online support groups for people with a similar health or medical condition occurred with the lowest prevalence, with only 3.8% of participants reporting participation in such a group. Online support group use appears to be an infrequent activity, and the low rate of participation in health-related support groups may coincide with the general decline in online chat room participation reported by Fallows [16
]. However, this finding may also result from the survey methodology. The HINTS survey question asked only about participation in online support groups; however, people may use Internet forums, bulletin boards, online communities, mailing lists, chat rooms, wikis, and blogs as means of providing or receiving online support or to share information. Users may not identify experiences with these different varieties of online communication as “participation in an online support group,” so this study may be underestimating the prevalence of Internet use for social support. Future surveys should first ask generally about use of the Internet for health-related social support and follow up with questions asking about specific mechanisms (eg, message boards, blogs) for getting support.
The present study found that those reporting “fair” or “poor” health were more likely to use online support groups than those with “excellent” health. This suggests that those with greater health needs appear to be taking greater advantage of the Internet to help them cope with their conditions, even though online support groups usage was limited overall.
Those with lower incomes were also more likely to use online support groups, although previous studies found that those with higher incomes were more likely to search for health information [10
] or purchase medications online [19
]. Possibly, those with higher incomes have other means of support, while those with lower incomes are turning to the Internet for assistance. An implication of this finding may be that people with limited incomes are replacing medical care with online support groups, which may put them at risk if they do not get needed assessments and treatment. However, this finding could also be the result of statistical error based on the low rate of participation in this activity overall as well as the high number who did not report their income.
Respondents with Internet access only from their home were more likely to use online support groups than those with access at both home and work, suggesting that those who were “less connected” may have greater need for online support. Continued research on the impact of location of Internet access and use of online social support tools is needed to understand and validate this relationship.
Almost 13% of respondents reported purchasing medications or vitamins online, which is much higher than the 4% and 5% reported in previous studies [18
] and the 9% in the 2003 HINTS survey [33
]. Given the potential for negative outcomes if poor oversight and regulation of this activity occur, research on the impact of the online purchase of medications and vitamins could be expanded so that we better understand the nature of this behavior. In contrast to Fox’s [19
] finding that income and years of Internet experience predicted online medication purchase, this study found only age and marital status to be significant predictors. This activity may have increased recently because of national discussions about prescription drugs and increased interest in complementary and alternative medicine. It may also reflect the increase in use of the Internet for e-commerce in general [34
Across online health-related activities, this study examined the relative importance of specific sociodemographic variables. One of the variables most connected with these activities was gender. The current research found that women were more likely than men to engage in a search for health information for themselves. They were equally as likely as men to participate in online support groups and to purchase medications and vitamins. However, married participants were more likely to purchase medications and vitamins online, indicating that women may have additional influence on this behavior.
Traditionally, men have been less likely than women to engage in health information seeking and preventive health behaviors. Since men do use the Internet for so many other activities, perhaps the Internet provides an opportunity to provide non-traditional health education opportunities directed toward men. A comparative content analysis of existing websites for men’s and women’s health is needed to determine gaps in such resources. Continued formative research could also help determine the types of health-related sites or online formats that would better appeal to male audiences.
Despite implications from other Internet intervention studies [11
], racial and ethnic minorities appeared to engage in health-related activities at rates similar as white users. These results may suggest that use of the World Wide Web is different than use of Internet-based systems on which these studies have been conducted. Even though African American and Hispanic populations have long shown lower rates of Internet adoption as compared to white users [32
], the current research suggests that once online, they are as likely as white users to engage in health-related activities. Ongoing research is needed to understand the patterns of use by different subpopulations.
This study was limited by its examination of only three select online activities. People may be engaging in many other online activities, such as searching for health information for others, using online behavior change or disease management programs, locating a health care provider, or researching health insurance plans. The Internet also offers several new ways to interact with other people via social media not captured by the current HINTS survey. Further examination of these additional activities would provide a larger window into the use of the Internet for health purposes. A second limitation of this study was that it only included data from those who were online. Comparing those who are online to those who are offline could further identify subgroup differences and differential information needs.
This study was also limited by nature of the HINTS data. The response rate, which has declined from the 2003 HINTS survey, may mean that systematic differences exist between those who responded and those who did not. In addition, the data are based on self-report, which can be biased by social desirability.
In conclusion, this study found that, in the context of health, the Internet is still most widely used as an information resource, with much less use for the purchase of medications and vitamins and participation in online support groups. As the types of tools and activities available to Internet users expand, the tools to monitor their use must also expand. Modifying and adding survey items would enable better measurement of Internet participation, especially in online support and social media mechanisms that could not be determined in the current research. Added items would also reveal the types of medications and vitamins people obtained online and show whether additional consumer safety and patient education information needs exist.
This study found that having access to the Internet from both home and work increased the likelihood of searching for personal health information and decreased the likelihood of participating in online support groups, indicating the need to understand more about the impact of work access. Future studies using HINTS data could determine the importance of other predictive variables. For example, these data could be used to examine whether people who use online support groups are less likely to be employed or if people who are employed are less likely to use support groups overall. This kind of research has the potential to distinguish the role of employment status from having access to the Internet at work.
Women continue to be the most likely audience for health-related online activities, while racial and ethnic minorities had rates higher than expected. Further research should be conducted into strategies to reach other audiences or to determine which channels may better serve those who do not use the Internet for health. Now that HINTS has been administered in 2003 and 2005 and another administration is being completed, future research will be possible to identify trends in participation in these and new online health behaviors.