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      Access to Care and Use of the Internet to Search for Health Information: Results From the US National Health Interview Survey

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          Abstract

          Background

          The insurance mandate of the Affordable Care Act has increased the number of people with health coverage in the United States. There is speculation that this increase in the number of insured could make accessing health care services more difficult. Those who are unable to access care in a timely manner may use the Internet to search for information needed to answer their health questions.

          Objective

          The aim was to determine whether difficulty accessing health care services for reasons unrelated to insurance coverage is associated with increased use of the Internet to obtain health information.

          Methods

          Survey data from 32,139 adults in the 2011 National Health Interview Study (NHIS) were used in this study. The exposure for this analysis was reporting difficulty accessing health care services or delaying getting care for a reason unrelated to insurance status. To define this exposure, we examined 8 questions that asked whether different access problems occurred during the previous 12 months. The outcome for this analysis, health information technology (HIT) use, was captured by examining 2 questions that asked survey respondents if they used an online health chat room or searched the Internet to obtain health information in the previous 12 months. Several multinomial logistic regressions estimating the odds of using HIT for each reported access difficulty were conducted to accomplish the study objective.

          Results

          Of a survey population of 32,139 adults, more than 15.90% (n=5109) reported experiencing at least one access to care barrier, whereas 3.63% (1168/32,139) reported using online health chat rooms and 43.55% (13,997/32,139) reported searching the Internet for health information. Adults who reported difficulty accessing health care services for reasons unrelated to their health insurance coverage had greater odds of using the Internet to obtain health information. Those who reported delaying getting care because they could not get an appointment soon enough (OR 2.2, 95% CI 1.9-2.5), were told the doctor would not accept them as a new patient or accept their insurance (OR 2.1, 95% CI 1.7-2.5 and OR 2.1, 95% CI 1.7-2.5, respectively), or because the doctor’s office was not open when they could go (OR 2.2, 95% CI 1.9-2.7) had more than twice the odds of using the Internet to obtain health information compared to those who did not report such access difficulties.

          Conclusions

          People experiencing trouble accessing health care services for reasons unrelated to their insurance status are more likely to report using the Internet to obtain health information. Improving the accuracy and reliability of health information resources that are publicly available online could help those who are searching for information due to trouble accessing health care services.

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          Most cited references24

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          Influences, usage, and outcomes of Internet health information searching: multivariate results from the Pew surveys.

          This paper provides results from seven major nationally representative datasets (two in detail) from the Pew Internet and American Life Project to answer two primary questions: (1) what influences people to seek online health information and (2) what influences their perceived outcomes from having access to this information? Cross-tabulations, logistic regressions, and multidimensional scaling are applied to these survey datasets. The strongest and most consistent influences on ever, or more frequently, using the Internet to search for health information were sex (female), employment (not fulltime), engaging in more other Internet activities, more specific health reasons (diagnosed with new health problem, ongoing medical condition, prescribed new medication or treatment), and helping another deal with health issues. Internet health seeking is consistently similar to general Internet activities such as email, news, weather, and sometimes hobbies. A variety of outcomes from or positive assessments of searching for Internet health information are predicted most strongly by sex (female), engaging in other Internet activities, Internet health information seeking including more frequent health seeking, more specific health reasons, belonging to an online support group sharing health interests, and helping another deal with an illness or major health condition.
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            Using the Internet for Health-Related Activities: Findings From a National Probability Sample

            Background eHealth tools on the Internet have the potential to help people manage their health and health care. However, little is known about the distribution and use of different kinds of eHealth tools across the population or within population subgroups. Objective The purpose of this study was to examine the prevalence and predictors of participation in specific online health-related activities. Methods A secondary data analysis of the National Cancer Institute’s Health Information National Trends Survey (HINTS) 2005 was conducted to study three online behaviors among Internet users (n = 3244): searching for health information for oneself, participating in a support group for those with similar health or medical conditions, and purchasing medicine or vitamins. Results A total of 58% of Internet users reported searching for health information for themselves, 3.8% used online support groups, and 12.8% bought medicine or vitamins online in the past year. Multivariate analysis found that those seeking health information were more likely to be women (OR = 2.23, 95% CI = 1.60, 3.09), have cable or satellite Internet connections (OR = 1.73, 95% CI = 1.22, 2.45) or DSL connections (OR = 1.94, 95% CI = 1.36, 2.76), have Internet access from work (OR = 2.43, 95% CI = 1.27, 4.67) or from home and work (OR = 1.73, 95% CI = 1.31, 2.30), and report more hours of weekday Internet use (OR = 4.12, 95% CI = 2.41, 7.07). Those with a high school education or less (OR = 0.44, 95% CI = 0.31, 0.63) and those with some college (OR = 0.66, 95% CI = 0.49, 0.89) were less likely to search for health information. Online support groups were more likely to be used by those with “fair” health (OR = 3.28, 95% CI = 1.21, 8.92) and “poor” health (OR = 5.98, 95% CI = 1.49, 24.07) and those with lower incomes (OR = 2.64, 95% CI = 1.09, 6.41) and less likely to be used by those with Internet access both at home and work (OR = 0.56, 95% CI = 0.35, 0.90). Those who were age 35-49 (OR = 2.16, 95% CI = 1.43, 3.26), age 50-64 (OR = 2.44, 95% CI = 1.53, 3.89), and age 65-74 (OR = 2.18, 95% CI = 1.30, 3.67) and those who were married (OR = 1.93, 95% CI = 1.13, 3.30) were more likely to purchase medicine or vitamins online. Conclusions The Internet was most widely used as a health information resource, with less participation in the purchase of medicine and vitamins and in online support groups. Results suggest that modifying survey questions to better capture forms of online support and medications purchased could provide greater understanding of the nature of participation in these activities.
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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

                Contributors
                Journal
                J Med Internet Res
                J. Med. Internet Res
                JMIR
                Journal of Medical Internet Research
                JMIR Publications Inc. (Toronto, Canada )
                1439-4456
                1438-8871
                April 2015
                29 April 2015
                : 17
                : 4
                : e106
                Affiliations
                [1] 1Division of Health Informatics and Implementation Science Department of Quantitative Health Sciences University of Massachusetts Medical School Worcester, MAUnited States
                [2] 2Center for Healthcare Organization and Implementation Research (CHOIR) eHealth Quality Enhancement Research Initiative (QUERI) National eHealth QUERI Coordinating Center Bedford, MAUnited States
                [3] 3Division of Preventive and Behavioral Medicine Department of Medicine University of Massachusetts Medical School Worcester, MAUnited States
                [4] 4Division of Epidemiology of Chronic Diseases and Vulnerable Populations Department of Quantitative Health Sciences University of Massachusetts Medical School Worcester, MAUnited States
                Author notes
                Corresponding Author: Daniel J Amante daniel.amante@ 123456umassmed.edu
                Author information
                http://orcid.org/0000-0003-1488-9624
                http://orcid.org/0000-0002-6888-0927
                http://orcid.org/0000-0002-2462-8797
                http://orcid.org/0000-0002-3924-8391
                http://orcid.org/0000-0001-9957-7747
                Article
                v17i4e106
                10.2196/jmir.4126
                4430679
                25925943
                815a68d5-1297-4b68-b79e-24dd77ab1010
                ©Daniel J Amante, Timothy P Hogan, Sherry L Pagoto, Thomas M English, Kate L Lapane. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 29.04.2015.

                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, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.

                History
                : 17 December 2014
                : 11 February 2015
                : 18 February 2015
                Categories
                Original Paper
                Original Paper

                Medicine
                health services accessibility,health information technology,information-seeking behavior,patient protection and affordable care act

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