|Year : 2019 | Volume
| Issue : 11 | Page : 1467-1474
Assessment of internet usage for health-related information among clients utilizing primary health care services
NC Bilgin1, MT Kesgin2, S Gucuk3, B Ak4
1 Department of Obstetrics and Gynecology Nursing, Faculty of Health Sciences, Bolu Abant Izzet Baysal University, Bolu, Turkey
2 Department of Public Health Nursing, Faculty of Health Sciences, Bolu Abant Izzet Baysal University, Bolu, Turkey
3 Department of Family Medicine, Faculty of Medicine, Bolu Abant Izzet Baysal University, Bolu, Turkey
4 Department of Pediatric Nursing, Faculty of Health Sciences, Bolu Abant Izzet Baysal University, Bolu, Turkey
|Date of Submission||01-Jul-2018|
|Date of Acceptance||30-May-2019|
|Date of Web Publication||13-Nov-2019|
Dr. N C Bilgin
Department of Obstetrics and Gynecology Nursing, Faculty of Health Sciences, Bolu Abant Izzet Baysal University, Golkoy Campus, Bolu
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Objective: This study aimed to identify the frequency and goals of Internet usage to access health-related information among primary health care service clients. Methods: The study was conducted in a primary health care centre with a sample of 788 adults. The data were collected through a questionnaire developed by the researchers. Results: The results showed that 81% (n = 640) of the participants used the Internet. All Internet user participants reported that they used the Internet to access health-related information. Of the participants, 67% reported that they used the Internet primarily to obtain information about diseases with 94% reporting that they found the online information reliable and 92% reported that they did not confirm the information they obtained online. The frequency of Internet use to obtain health-related information increased with increase in the level of education of participants. Participants with higher education found the online information to be more reliable and comprehensible. The results showed that while the use of Internet to obtain health-related information was high, the information presented online was not always checked for accuracy. Conclusion: Hence, provision of current and evidence-based information on health-related websites is crucial to preserve community health care.
Keywords: Health-related information, health research, internet, use of Internet
|How to cite this article:|
Bilgin N C, Kesgin M T, Gucuk S, Ak B. Assessment of internet usage for health-related information among clients utilizing primary health care services. Niger J Clin Pract 2019;22:1467-74
|How to cite this URL:|
Bilgin N C, Kesgin M T, Gucuk S, Ak B. Assessment of internet usage for health-related information among clients utilizing primary health care services. Niger J Clin Pract [serial online] 2019 [cited 2020 Oct 1];22:1467-74. Available from: http://www.njcponline.com/text.asp?2019/22/11/1467/270858
| Introduction|| |
The twenty- first century's most significant contribution to humanity is the convenience of Internet use. The rapid advances in IT sector have granted instant access to information. With about 3.2 billion people worldwide searching the answers to their questions using the Internet, the Internet is also widely used to access health-related information. Previous studies reported beneficial outcomes as a result of obtaining information from reliable websites or online health-related information systems.,, IT is widely used for many purposes, such as obtaining information about medication, health, and diseases as well as making appointments to attend health care institutions.,,,, The information technology has brought in several innovations in the Healthcare sector that have led to the improvement of lives by providing health follow-up for individuals, recording the activities that affect their health, such as diet and exercise, and providing e-coaching. IT also facilitates the presentation of low-cost preventive health services.
Although there are many advantages of using IT in health services, the increasing trend to obtain health-related information without conferring with health institutions may negatively affect the communication and interaction between patients and health care personnel., In addition, the possibility that unreliable health-related information could be obtained online is a significant disadvantage of using IT to obtain health-related information., Information that is obtained by individuals who lack health literacy or the sufficient knowledge of IT may lead to irreversible damage and ethical issues. Therefore, having sound knowledge about health information sources could guide health care professionals in planning the health care services. In Turkey, primary health care services were provided by primary health care centers. Therefore, this study aimed to identify the frequency of Internet usage of primary health care service clients to access health-related information and to determine their goals in using Internet. The following research questions guided the framework of the study:
- RQ1. What is the rate of Internet use to obtain health-related information among the participants?
- RQ2. What are the participants' goals in using the Internet to obtain health-related information?
- RQ3. Are there differences in the participants' frequency of Internet use for health care purposes according to sociodemographic characteristics (such as age, gender, level of education, marital status) and chronic diseases?
- RQ4. Are there differences in the participants' perceptions of the reliability and comprehension of online health-related information according to sociodemographic characteristics, such as age, gender, level of education, and marital status?
| Methods|| |
Study setting and sample
This descriptive, cross-sectional study was conducted in a primary health care center located in a province in Northwest Turkey. The study population was composed of 2,864 adults who consulted primary care physicians annually in the primary health care center where the study was conducted. Tables prepared by World Health Organization (WHO) were utilized to determine the sample size. According to the Turkish Statistical Institute, the prevalence of household access to Internet was 69.5%. To predict the real value of this ratio with an accuracy of 99% within a score of 0.04, the required size of the sample was determined to be 871. The data were collected between August 2015 and August 2016. Although 871 individuals were recruited for the study, only 788 (90.5%) participants answered the surveys appropriately. All participants were literate, spoke Turkish well, volunteered to take part in the study, and had no communication concerns.
The questionnaire instrument used to collect the data was developed by the researchers based on the relevant literature.,,,,,, The survey was approved by the views of health professionals. Following the pilot study (20 participants), the questionnaire was finalized. The questionnaire included questions about demographic characteristics (age, gender, profession, level of education, marital status), Internet use (Internet usage status, Internet access location, frequency of use, medium used to access the Internet), and Internet use to obtain health-related information (goals of using the Internet for health, finding online health-related information reliable and comprehensible, frequency of Internet use for health, for whom is the research, checking the accuracy of information, effect of online information access on services received from health institutions). The reliability of health information was evaluated as reliable, partially reliable, and unreliable. The frequency of using the Internet to obtain health-related information was rated as “always” (i.e. once a week or more) and “sometimes” (i.e. no more than once a month or less). After explaining the purpose of the study, the survey forms were distributed to participants who were patients of primary care physicians and who met the criteria for participation in the study. After completion of the survey, the participants returned the forms to their primary care physicians.
Descriptive statistics (number, percentage, means), significance tests (Chi-square test and Fisher's exact test), and Phi Cramer's V tests were applied to determine the correlations. The statistical significance was acceptable at P < 0.05.
The study was conducted according to the Principles of the Helsinki Declaration. The study was approved by the Social Sciences Ethics Committee for Human Research of Abant İzzet Baysal University (protocol no: 2015/92) and the institutional permission was granted by the Bolu Province Community Health Province Community Health Directorate (protocol number: 78102020/010.99 dated 29 January 2015). All participants gave their written consent to be included in the study.
| Results|| |
The distributions of the participants according to sociodemographic and individual characteristics are included in [Table 1]. Of the study's participants, 58.2% were males and 41.8% were females. The mean age of the participants was 35.79 ± 13.78 (min. 18 years, max. 76 years). Slightly less than half of the participants (47.3%) had a university or higher education. Of the participants, 61.2% were married, 25.6% were civil servants, 23.6% were housewives, 77.5% did not have a chronic disease, and 50.6% chose to go to hospital first while 29.7% chose to go to primary health care centre when they had health problems.
|Table 1: The distributions of the participants according to sociodemographic and individual characteristics|
Click here to view
The distributions of the participants according to Internet use and Internet use to obtain health-related information are shown in [Table 2]. As shown, 81.2% (n = 640) of the participants used the Internet. Of these, 72.2% were identified as using the Internet more than once a week with 67.3% accessing the Internet mainly at home and 54.2% using their mobile phones to access the Internet. All the participants who reported that they used the Internet also used it for health reasons with 67.7% of the participants always using the Internet to obtain health-related information and slightly more than half of the participants (56.4%) doing their own health research. Most participants expressed that they found the online information comprehensible (96.7%) and reliable (94.4%). However, they did not check the accuracy of the online information (92.2%), and their access to online information did not affect the services they received from health institutions (76.6%).
|Table 2: The distributions of the participants according to Internet use and Internet use to obtain health-related information|
Click here to view
The participants' reasons for using the Internet to obtain health-related information are provided in [Table 3]. As the table shows, Internet was most frequently used to obtain information about diseases (67.3%), to make appointments (61.1%), and to learn about medications (41.6%). It was used least frequently to obtain information on health care personnel (18.9%) and the services offered by health care institutions (15.6%).
|Table 3: The participants' reasons for using the Internet to obtain health-related information|
Click here to view
The relationships between the sociodemographic characteristics, the existence of chronic diseases of the participants, and the frequency of Internet usage for health reasons are presented in [Table 4]. The analysis of the relationship between the sociodemographic characteristics of the participants and their use of Internet for health reasons showed a weak correlation between the level of education and the use of the Internet to obtain health-related information (Cramer's V = 18.2%). The results showed that when the level of education increased, the frequency of Internet use for health reasons also increased (P < 0.001). No relationships were detected between the use of Internet for health reasons and age, gender, marital status, and chronic diseases (P > 0.05) [Table 4].
|Table 4: The relationships between the sociodemographic characteristics, the existence of chronic diseases of the participants, and the frequency of Internet usage for health reasons|
Click here to view
[Table 5] shows the relationship between the sociodemographic characteristics of the participants and their perceptions of the reliability and comprehensibility of the health-related information they obtained from the Internet. However, a weak relationship was found between the level of education and the perception of online information as reliable and comprehensible (P < 0.01; Cramer's V = 14.9% and 14.7%). The results showed that increased levels of education correlated with higher perceptions of online information as reliable and comprehensible. However, there was no association between the sociodemographic characteristics and the perception of online information as reliable and comprehensible (P > 0.05) [Table 5].
|Table 5: The relationship between the sociodemographic characteristics of the participants and their perceptions of the reliability and comprehensibility of the health-related information they obtained from the Internet|
Click here to view
| Discussion|| |
The rapid advances in IT have eased information access by removing the barriers of time and space. Moreover, Internet use is rapidly increasing across the globe. It was reported that 52% of the world's population has access to the Internet with North America (88%) and Europe (80%) having the highest levels of access  and Central Africa (11%) having the lowest level of access. In 2000, the rate of Internet use in America was 52%, which had increased to 84% by 2015. Similarly, in 2004, the rate of Internet use in Turkey was 19%, which had reached 67% in 2017. According to that study, the rate of Internet use in Turkey was above average (81.2%), which was similar to that in Europe. The study found that about two thirds of individuals used the Internet a few times a week. The province where the study was conducted was ranked third highest in the Better Life Index in Turkey, which could explain the higher rates of Internet use found in the study. Furthermore, recent increases in mobile phone use may have affected the findings because half of the study participants were found to use their mobile phones to access online health-related information.
Throughout the world, 4.5% of the daily research on the Internet pertains to health topics. In the United States, about six million people search for health-related information on the Internet each day. According to the World Internet Project Report, at least 70% of Internet users in almost every country have access to online health-related information. Previous studies have shown that Internet use for health-related information ranges from 46% to 80%.,,,,, The results of the present study also showed that all participants who accessed the Internet (81.2%) did so to obtain information on health-related topics. The high level of Internet use for health-related information could be explained by the willingness of the participants to preserve and improve their health status.
Our results showed that the participants used the Internet the most often to obtain information on diseases. This finding aligns with the findings presented in the literature., However, the findings of some previous studies showed that individuals also used the Internet to obtain a second opinion, to obtain information about health care professionals and treatments, and to satisfy their curiosity. The frequent use of the Internet to obtain information about diseases and treatments is associated with the lack of sufficient information provided by health care personnel, including physicians. Patients also found that the information they found on the Internet helped them to understand the treatment.
Having access to sound online information may positively affect the relationship between health care personnel and patients.,,, However, it is necessary to share and discuss this information with health care personnel to ensure that positive relationships exist between health care personnel and patients.
In contrast, some studies found that individuals did not feel the need to go to doctor when they obtain online health-related information. They did not consider the advice of health care professionals, and they did not share the health-related information they obtained online with the health care professionals.,, However, Baker, Wagner, Singer, and Bundorf  and Takahashi et al. found that the majority of participants reported that the health-related information they obtained online did not affect their visits to the doctor. Our study findings are consistent with the literature., Takahashi et al. found that although Internet use increased the access to health-related information, it did not change basic health-related habits, such as face-to-face meetings with doctors. Online access to health-related information may result in increasing the awareness of individuals with high levels of health literacy., This awareness may lead individuals to realize the inadequacy of online information in preserving and improving their health as well as the significance of the health care services provided by health care institutions.
This study found that two thirds of the participants always used the Internet to obtain health-related information whereas one third of the participants sometimes used the Internet for this purpose. According to the World Internet Project, at least half of the Internet users in eight countries sometimes went online to obtain health-related information. Another study determined that slightly less than half of the participants always or frequently used the Internet to obtain health-related information. The varying results of these studies may be related to health literacy. In their study, Estacio, Whittle, and Protheroe. found that the participant groups with higher health literacy levels used the Internet more often to obtain health-related information.
Similar to the results of this study, on examination of the association of frequency of Internet usage for health information with other variables, the frequency of Internet use was influenced by the level of education , but was not influenced by age, marital status, and existence of chronic diseases. It is possible that individuals with chronic diseases may not need to seek health-related information on the Internet because they are under medical supervision and have regular follow-ups.
Contrary to the findings of the current study, previous studies demonstrated that gender affected the use of the Internet to access health-related information as females were more inclined than males to seek health-related information., The reason for the variance in these previous results may be that females undertake health-related Internet searches for family members and others, such as friends, and therefore have better health-related information. Although it was found that gender did not affect the frequency of Internet use for health, the use of Internet by the women was high. In our society, in general, women have more responsibilities in their households and the rates of going to health institutions and receiving services are lower. An attempt to access information for the health of their children and family members may have resulted in the increased use of Internet by the women.
Internet searches related to health issues require sufficient knowledge and health literacy and unaccredited and unreliable online information is risky for Internet users., A previous study identified that individuals with low health literacy who used the Internet required support. Therefore, it is crucial to have access to comprehensible online health-related information. Almost all the participants in this study reported that they found online health-related information to be comprehensible. Similarly, Scvhwartz et al. found that 98.7% of the participants perceived that online health-related information was comprehensible.
Because health-related information is available on several websites, there are discrepancies in its reliability. In the present study, 94.4% of the participants reported that they found the online health-related information to be reliable and 92.2% reported that they did not validate the online health-related information from different sources. These findings are in line with those of previous studies that demonstrated that individuals found online health-related information to be reliable., However, AlGhamdi and Moussa  and Ozel et al. reported that individuals did not perceive that online health-related information was reliable. The variance in the results may be related to the degree of health literacy and the type of website that is accessed to obtain health-related information.
In the present study, only the variable “level of education” affected whether online health-related information was perceived as reliable and comprehensible. The participants with higher educational levels perceived online health-related information to be more reliable and comprehensible than did the participants with lower educational levels. This finding may be related to increased health literacy levels due to higher levels of education and the access to a greater number of reliable websites.
Increased rates of access to the Internet to obtain online health-related information are unavoidable in today's world. However, it should be remembered that online health-related information may not always be reliable  and the society may not always distinguish accurate and valid information. Hence, supervision of the validity and accuracy of online health-related information is crucial. Health care professionals and institutions are responsible for creating and updating evidence-based websites that allow access to reliable and comprehensible health-related information.
A limitation of this study is that it was conducted in a single primary health care center. Moreover, the reasons why the participants perceived online health-related information to be reliable and compressible were not determined. In addition, the websites that the participants accessed to obtain health-related information were not investigated. Nevertheless, the findings of this study could be used to guide future studies in this area of research.
In conclusion, the study showed that the participants had high levels of Internet use to access online health-related information. Moreover, Internet was used most frequently to access online information about diseases. The participants perceived online health-related information to be reliable and comprehensible, but they did not attempt to confirm the accuracy of this information. Hence, it is important to ensure that individuals have access to accurate, reliable, and comprehensible online health-related information on updated, evidence-based websites, which would enable them to preserve their health and well-being and adopt life-affirming habits, thereby improving their quality of life.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Tekin A, Kaya E, Demirel M, Yazici SO. The effect of the internet on patient-physician relationship within the context of empowerment. J Selcuk Commun 2009;6:23-36.
Rider T, Malik M, Chevassut T. Haematology patients and the internet: The use of on-line health information and the impact on the patient-doctor relationship. Patient Educ Couns 2014;97:223-38.
Beck F, Richard JB, Nguyen-Thanh V, Montagni I, Parizot I, Renahy E. Use of the internet as a health information resource among French young adults: Results from a nationally representative survey. J Med Internet Res 2014;16:e128.
Sillence E, Hardy C, Briggs P, Harris PR. How do people with asthma use internet sites containing patient experiences? Patient Educ Couns 2013;93:439-43.
Schwartz KL, Roe T, Northrup J, Mez J, Seifeldin R, Neale AV. Family medicine patients' use of the Internet for health information: A MetroNet study. J Am Board Fam Med 2006;19:39-45.
Ozel HE, Genc S, Ozdogan F, Selcuk A. The effect of patients' habits of internet use for health consultations on the physician-patient relationship. Nobel Med 2017;13:16-20.
Iverson SA, Howard KB, Penny BK. Impact of Internet use on health-related behaviors and the patient-physician relationship: A survey-based study and review. J Am Osteopathic Assoc 2008;108:699-711.
Lentferink AJ, Oldenhuis HK, de Groot M, Polstra L, Velthuijsen H, van Gemert-Pijnen JE. Key components in eHealth interventions combining self-tracking and persuasive eCoaching to promote a healthier lifestyle: A scoping review. J Med Internet Res 2017;19:e277.
Neuenschwander L, Abbott A, Mobley AR. Assessment of low-income adults' access to technology: Implications for nutrition education. J Nutr Educ Behav 2012;44:60-5.
Baker DW, Wolf MS, Feinglass J, Thompson JA, Gazmararian JA, Huang J. Health literacy and mortality among elderly persons. Arch Intern Med 2007;167:1503-9.
Lee K, Hoti K, Hughes JD, Emmerton LM. Consumer use of “Dr Google”: A survey on health information-seeking behaviors and navigational needs. J Med Internet Res 2015;17:e288.
O'Neill B, Ziebland S, Valderas J, Lupiáñez-Villanueva F. User-generated online health content: A survey of internet users in the United Kingdom. J Med Internet Res 2014;16:e118.
Neter E, Brainin E. eHealth literacy: Extending the digital divide to the realm of health information. J Med Internet Res 2012;14:e19.
Lemeshow S, Hosme DW, Klar J, Lwanga SK. Under the Title Adequacy of Sample Size in Health Studies by World Health Organization. Ankara: Hacettepe Taş; 2000.
Craigie M, Loader B, Burrows R, Muncer S. Reliability of health information on the Internet: An examination of experts' ratings. J Med Internet Res 2002;4:e2.
Sommerhalder K, Abraham A, Zufferey MC, Barth J, Abel T. Internet information and medical consultations: Experiences from patients' and physicians' perspectives. Patient Educ Couns 2009;77:266-71.
Bass SB, Ruzek, SB, Gordon TF, Fleisher L, McKeown-Conn, Moore D. Relationship of Internet health information use with patient behavior and self-efficacy: Experiences of newly diagnosed cancer patients who contact the National Cancer Institute's cancer information service. J Health Commun 2006;11:219-36.
Turkish Statistical Institute. Household information technology use survey. [Hane halkı bilişim teknolojileri kullanım araştırması. Bilgi toplumu istatistikleri (2004-2017)]. 2017. Available from: http://www.tuik.gov.tr/PreTablo.do?alt_id=1028
. [Last accessed on 2018 Jan 21].
Turkish Statistical Institute. Well-being index for provinces, 2015. [İllerde yaşam endeksi, 2015]. 2016. Press release. Number: 24561. Available from: www.turkstat.gov.tr/PreHaberBultenleri. do?id=24561. [Last accessed on 2018 Mar 16].
Kanthawala S, Vermeesch A, Given B, Huh J. Answers to health questions: Internet search results versus online health community responses. J Med Internet Res. 2016;18:e95.
Kontos E, Blake KD, Chou WS, Prestin A. Predictors of eHealth usage: Insights on the digital divide from the Health Information National Trends Survey 2012. J Med Internet Res 2014;16:e172.
Zajac IT, Flight IH, Wilson C, Turnbull D, Cole, Young G. Internet usage and openness to internet-delivered health information among Australian adults aged over 50 years. Australas Med J 2012;5:262-7.
Nguyen A, Mosadeghi S, Almario, CV. Persistent digital divide in access to and use of the Internet as a resource for health information: Results from a California population-based study. Int J Med Inform 2017;103:49-54.
Adams S, de Bont A, Berg M. Looking for answers, constructing reliability: An exploration into how Dutch patients check web-based medical information. Int J Med Inform 2006;75:66-72.
AlGhamdi KM, Moussa NA. Internet use by the public to search for health-related information. Int J Med Inform 2012;81:363-73.
Takahashi Y, Ohura T, Ishizaki T, Okamoto S, Miki K, Naito M, et al
. Internet use for health-related information via personal computers and cell phones in Japan: A cross-sectional population-based surve. J Med Internet Res 2011;13:1-13.
Oliveira JF. The effect of the internet on the patient-doctor relationship in a hospital in the city of Sao Paulo. J Inf Syst Technol Manag 2014;11:327-44.
Tan SSL, Goonawardene N. Internet health information seeking and the patient-physician relationship: A systematic review. J Med Internet Res 2017;19:e9.
Zülfikar H. The internet usage behaviour and access patterns of the patients to the health information on the internet. Florence Nightingale J of Nursing 22:46-52. 2014. Available from: http://dergipark.gov.tr/fnjn/issue/30811/333287
. [Last accessed on 2018 Feb 09].
Russ H, Giveon SM, Catarivas MG, Yaphe J. The effect of the Internet on the patient-doctor relationship from the patient's perspective: A survey from primary care. Isr Med Assoc J 2011;13:220-4.
Baker L, Wagner TH, Singer S, Bundorf MK. Use of the internet and e-mail for health care information results from a national survey. JAMA 2003;289:2400-6.
Estacio EV, Whittle R, Protheroe J. The digital divide: Examining socio-demographic factors associated with health literacy, access and use of Internet to seek health information. J Health Psychol 2017;1-8.
Reifegerste D, Bachl M, Baumann E. Surrogate health information seeking in Europe: Influence of source type and social network variables. Int J Med Inform 2017;103:7-14.
Nutbeam D. Defining and measuring health literacy: What can we learn from literacy studies? Int J Public Health 2009;54:303-5.
Starman JS, Gettys FK, Capo JA, Fleischli, JE, Norton HJ, Karunakar MA. Quality and content of Internet-based information for ten common orthopaedic sports medicine diagnoses. J Bone Joint Surg Am 2010;92:1612-8.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]