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      European citizens' use of E-health services: A study of seven countries

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          Abstract

          Background

          European citizens are increasingly being offered Internet health services. This study investigated patterns of health-related Internet use, its consequences, and citizens' expectations about their doctors' provision of e-health services.

          Methods

          Representative samples were obtained from the general populations in Norway, Denmark, Germany, Greece, Poland, Portugal and Latvia. The total sample consisted of 7934 respondents. Interviews were conducted by telephone.

          Results

          44 % of the total sample, 71 % of the Internet users, had used the Internet for health purposes. Factors that positively affected the use of Internet for health purposes were youth, higher education, white-collar or no paid job, visits to the GP during the past year, long-term illness or disabilities, and a subjective assessment of one's own health as good. Women were the most active health users among those who were online. One in four of the respondents used the Internet to prepare for or follow up doctors' appointments. Feeling reassured after using the Internet for health purposes was twice as common as experiencing anxieties. When choosing a new doctor, more than a third of the sample rated the provision of e-health services as important.

          Conclusion

          The users of Internet health services differ from the general population when it comes to health and demographic variables. The most common way to use the Internet in health matters is to read information, second comes using the net to decide whether to see a doctor and to prepare for and follow up on doctors' appointments. Hence, health-related use of the Internet does affect patients' use of other health services, but it would appear to supplement rather than to replace other health services.

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          Most cited references19

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          Trust and sources of health information: the impact of the Internet and its implications for health care providers: findings from the first Health Information National Trends Survey.

          The context in which patients consume health information has changed dramatically with diffusion of the Internet, advances in telemedicine, and changes in media health coverage. The objective of this study was to provide nationally representative estimates for health-related uses of the Internet, level of trust in health information sources, and preferences for cancer information sources. Data from the Health Information National Trends Survey were used. A total of 6369 persons 18 years or older were studied. The main outcome measures were online health activities, levels of trust, and source preference. Analyses indicated that 63.0% (95% confidence interval [CI], 61.7%-64.3%) of the US adult population in 2003 reported ever going online, with 63.7% (95% CI, 61.7%-65.8%) of the online population having looked for health information for themselves or others at least once in the previous 12 months. Despite newly available communication channels, physicians remained the most highly trusted information source to patients, with 62.4% (95% CI, 60.8%-64.0%) of adults expressing a lot of trust in their physicians. When asked where they preferred going for specific health information, 49.5% (95% CI, 48.1%-50.8%) reported wanting to go to their physicians first. When asked where they actually went, 48.6% (95% CI, 46.1%-51.0%) reported going online first, with only 10.9% (95% CI, 9.5%-12.3%) going to their physicians first. The Health Information National Trends Survey data portray a tectonic shift in the ways in which patients consume health and medical information, with more patients looking for information online before talking with their physicians.
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            Patients' use of the Internet for medical information.

            To determine the percentage of patients enrolled in a primary care practice who use the Internet for health information, to describe the types of information sought, to evaluate patients' perceptions of the quality of this information, and to determine if patients who use the Internet for health information discuss this with their doctors. Self-administered mailed survey. Patients from a primary care internal medicine private practice. Randomly selected patients ( N=1,000) were mailed a confidential survey between December 1999 and March 2000. The response rate was 56.2%. Of the 512 patients who returned the survey, 53.5% (274) stated that they used the Internet for medical information. Those using the Internet for medical information were more educated ( P <.001) and had higher incomes ( P <.001). Respondents used the Internet for information on a broad range of medical topics. Sixty percent felt that the information on the Internet was the "same as" or "better than" information from their doctors. Of those using the Internet for health information, 59% did not discuss this information with their doctor. Neither gender, education level, nor age less than 60 years was associated with patients sharing their Web searches with their physicians. However, patients who discussed this information with their doctors rated the quality of information higher than those who did not share this information with their providers. Primary care providers should recognize that patients are using the World Wide Web as a source of medical and health information and should be prepared to offer suggestions for Web-based health resources and to assist patients in evaluating the quality of medical information available on the Internet.
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              Help seeking behavior and the Internet: a national survey.

              Health-related websites have the potential to powerfully influence the attitudes and behavior of consumers. Access to reliable disease information online has been linked to reduced anxiety, increased feelings of self-efficacy, and decreases in utilization of ambulatory care. Studies report that Internet health information seekers are more likely to have health concerns; adult seekers are more likely to rate themselves as having poor health status and adolescent seekers are more likely to demonstrate clinical impairment or depressive symptomatology compared to non-seekers. Although more and more Americans are using the Internet for healthcare information, little is known about how this information affects their health behaviors. The current study extends the literature by examining characteristics associated with help seeking, either from a healthcare provider or from peers, as a direct result of health information found online. Medical care seekers appear to be using the Internet to enhance their medical care; they report using the information online to diagnose a problem and feel more comfortable about their health provider's advice given the information found on the Internet. Support seekers tend to be of slightly lower income compared to non-support seekers. They are also significantly more likely to have searched for information about a loved one's medical or health condition, signaling that many of these consumers may be caretakers.
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                Author and article information

                Journal
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                2007
                10 April 2007
                : 7
                : 53
                Affiliations
                [1 ]Norwegian Centre for Telemedicine, University Hospital of Northern Norway, Tromsø, Norway
                [2 ]Department of Family Medicine, Wroclaw Medical University, Wroclaw, Poland
                [3 ]Foundation for Research and Technology, Heraklion, Greece
                [4 ]Chair of Medical Informatics, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
                [5 ]Health Promotion State Agency, Riga, Latvia
                [6 ]Universidade de Aveiro, Aveiro, Portugal
                [7 ]Danish Centre for Health Telematics, Odense, Denmark
                [8 ]Department of Clinical Psychiatry, University of Tromsø, Tromsø, Norway
                Article
                1471-2458-7-53
                10.1186/1471-2458-7-53
                1855923
                17425798
                5af70424-a929-429f-a960-a4cc647191da
                Copyright © 2007 Andreassen et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 3 July 2006
                : 10 April 2007
                Categories
                Research Article

                Public health
                Public health

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