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In the little more than a decade since it was launched commercially, the Internet has changed the way Canadians conduct their everyday activities, from viewing weather, news and sports to banking and paying bills. The Internet has also changed the way many Canadians obtain health information, and potentially, their relationship with physicians.
In 2005, an estimated 8.7 million adults used the Internet to search for medical or health-related information, and of those in this group who visited a family doctor that year, more than a third discussed the information they obtained from their online search.
Based on findings from the 2005 Canadian Internet Use Survey (CIUS), this article examines adults' use of the Internet to access health information. The aim is to determine how individuals who use the Internet for health information differ from other Internet users and from people who do not use the Internet at all. The CIUS also identifies the types of searches conducted by those who sought health information.
An estimated 16.8 million Canadians aged 18 or older (68%) used the Internet for personal non-business reasons during 2005. Just over 15 million of them (about 90%) accessed it from home. Almost 6 of every 10 (58%) home Internet users went online at some point that year to search for health information.
CIUS respondents were divided into three groups according to their reported pattern of Internet use (see The data). An estimated 35% (8.7 million) were defined as health users, in that they went online at home during 2005 to search for health information. Another 25% (6.2 million) who went online at home that year, but not to search for health information, were defined as other users. The 32% (7.9 million) who reported that they had never used the Internet for personal, non-business reasons, or who had used it in the past, but not in the 12 months before the survey, were classified as non-users. A residual group (around 7% or 1.8 million) who used the Internet in 2005, but not from home, were excluded from this analysis because they were not asked about specific uses.
Going online to search for health information in 2005 was related to social and economic characteristics (Table 1). Consistent with a previous study,1 proportionately more women than men were health users.
The average age of health users and other users did not differ, but non-users were older than the other two groups. In addition, health users tended to have a higher level of education than either other users or non-users, and were more likely to report a higher household income.
Provincial differences in the use of the Internet to search for health information mirrored overall Internet use, with a lower rate in Quebec compared with other provinces (data not shown). There was a slight urban-rural difference as well — people in small towns and rural areas were less likely than urban residents to use the Internet to obtain health information (28% versus 41%). However, when other factors were taken into account, this urban-rural difference disappeared.
Health users' overall online behaviour differed from that of other users (Table 2). Health users were more likely to access the Internet daily and to spend at least five hours a week online. They also reported more online activities, and were more likely to have been using the Internet for at least five years.
When selected socio-demographic and Internet use characteristics were considered together in a multivariate model, the primary predictor of whether Internet users would search for health information was the number of online activities in which they were engaged — as the "breadth of use" increased, so did their odds of seeking health information (Figure 1). Breadth of use appears to indicate a level of Internet sophistication: an individual capable of conducting a variety of activities via the Internet differs considerably from a novice learning to manage email.2
A number of demographic factors also played a significant role in determining whether an Internet user would search for health information. For women, the odds of being a health user were double those of men. Being married increased the odds of accessing health information, with odds for married individuals one and a quarter times those of unmarried individuals. The presence of children younger than 18 in the household was not a significant predictor of being a health user, a finding similar to that of other research.3
Other important predictors included the number of years an individual had been online, frequency of use, and intensity of use (see The data).
Health users most commonly searched for information on specific diseases, with 56% (nearly 5 million) using the Internet for this purpose (Figure 2). Half of health users reported searching for particulars on lifestyle factors, such as diet, nutrition and exercise. Other topics frequently investigated were specific symptoms, drugs or medications, and alternative therapies. A similar pattern in search types was found among American Internet users.4
About three-quarters of health users searched for information on three or fewer topics, while the remaining quarter searched in at least four areas.
The type of information sought by health users varied with their age and sex. Proportionately more 18- to 44-year-olds looked for information on lifestyle and the health care system, while comparatively more aged 45 or older sought information on specific diseases and on drugs or medications.
Regardless of age, female health users were more likely than male health users to seek information about specific diseases (Table 3 ). At ages 18 to 44, a higher percentage of women than men sought details about drugs or medications and about alternative therapies. At age 45 or older, men were more likely than women to look for information on the health care system or health care delivery.
Regional differences in search types were apparent (data not shown). For example, health users in Atlantic Canada were more likely to search for particulars about lifestyle (58%) and about drugs or medications (46%), compared with health users overall (50% and 41%, respectively). People in British Columbia were more likely to investigate alternative therapies (28% versus 24%). In Quebec, the proportion of health users seeking information on specific diseases (61%) exceeded the national figure (56%). By contrast, the proportion in Quebec searching for lifestyle information (44%) was significantly below the national level (50%).
More than a third (38%) of health users reported that they had discussed their findings with a family doctor or health care provider. Individuals searching for information on surgeries were particularly likely to have done so (Figure 3). In fact, over half (54%) of people who sought information on surgeries and who had contacted a doctor during 2005 reported that they had discussed their Internet findings with a family doctor or health care provider.
In 2005, more than one-third of Canadian adults used the Internet to search for health information. And of those who also visited a doctor, more than one-third discussed the results of their Internet search with their physician.
This study raises important considerations. First, it is anticipated that as more Canadians access the Internet, online searches for health information will increase. However, the accuracy and reliability of Internet information on any topic can vary widely. Internet sources of health information range from personal accounts of illnesses and patient discussion groups to clinical decision tools and peer-reviewed journal articles.
Second, the use of the Internet to search for health information appears to be unevenly distributed among Canadians. Searching for health information online is an example of what has been described as a second level digital divide among Internet users.6
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