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Research Data Show Variations in E-Health Behaviors
by Jane Sarasohn-Kahn
November 20, 2007

Behind the statistic that 160 million people in the U.S. have gone online for health information, you'll find that e-health behaviors vary based on a user's chronic conditions, insurance coverage and most markedly, income.

National Research Corporation has generated an encyclopedic data set by surveying 200,000 U.S. households for its Healthcare Market Guide. The research is available online for a fee and covers the top 200 Metropolitan Statistical Areas in the United States.

The annual Healthcare Market Guide assesses consumer satisfaction -- generally for a hospital audience -- on a wide variety of topics related to hospital visits, health systems, health plans, physician offices, retail medical clinics, community needs assessment and Internet utilization. It's this last topic that I discussed with Ginny Martin, president of the Healthcare Market Guide division.

"Other general industry surveys show that younger people tend to use the Internet more than older people. However, our survey shows that in health care, older people over 35 are actively engaged in many different aspects of health care on the Internet," Martin said. She shared a plethora of data for me to analyze on behalf of iHealthBeat readers.

"Research" and "Locate": The Two Top Verbs in E-Health
The top four online health activities conducted by U.S. residents all involve the activity of researching: prescriptions (38% of people), treatment options (37%), medical procedures (37%) and disease/wellness information (31%).

After that, people are mostly using online health sources for locating: finding directions to a hospital or facility (28% of people) and looking for doctors by searching online directories (26%).

In terms of acting on one's own health, the most popular self-care activities online are refilling prescriptions (done by 24% of adults), completing a health risk assessment (16%), asking clinicians for medical advice (14%) and using online support groups (10%). Only 9% of consumers check lab or test results online.

Consumers are less likely to embrace IT-based activities; completing online medical records attracts only 6% of consumers, and only 9% e-mail with physicians.

Microtrending the Data
Beneath these general statistics lie important distinctions between consumers. Here are a few of the gems I mined when diving further into the data.

Asking for directions: a gender gap! I smiled when I recognized the stereotypical scenario of male drivers not wanting to stop and ask for directions. In the e-health journey, more women have searched for directions to a hospital or facility in the past 12 months than men did. Otherwise, there aren't any big differences between the activities that men and women do online for health.

More money drives more e-health activity. Compared with more wealthy consumers, fewer people in lower-income households use the Internet for health activities. Between households with incomes higher than $50,000 and those with lower incomes, the greatest gaps are in:

  • Finding a doctor through online search directories (with a 14% gap between the two income groups);
  • Refilling prescriptions (a 13% gap);
  • Researching medical procedures (a 12% gap);
  • Researching treatment options (a 11% gap);
  • Obtaining directions to a hospital/facility (a 9% gap); and
  • Researching prescriptions (a 9% gap).
Older consumers engage in health online differently than younger or middle-aged people. Consumers ages 65 and older refill prescriptions online more often than those who are younger. However, a higher proportion of middle-aged people (those 45 to 64) search for disease/wellness information than younger or older people do. More middle-aged people also research prescriptions, medical procedures and treatment options more than younger or older consumers. Compared with those who are older, younger people (defined as those younger than 34) more often:

  • Look for health employment;
  • Search for directions to health facilities;
  • Identify doctors through online directories;
  • Look at Web-based birth announcements;
  • Find available research services; and
  • Go online to ask clinicians for medical advice.
People with cancer have greater use of e-health services. Across virtually all categories (except for locating a physician via online directories), more consumers with cancer use online health services than any other group -- in particular, more adults with cancer research treatment options, medical procedures, disease management programs and disease/wellness information than people who don't have any chronic illnesses. As for seeking physicians to treat cancer, these patients are looking for more than a convenient address -- they're looking for experience, outstanding quality and the highest-rated cancer programs they can find.

Headaches and insomnia compel people to go online. A greater proportion of people with headaches -- both those with chronic headaches and migraines (assessed separately in this survey) -- use more online health services than people with no chronic conditions. For headache sufferers, the most-used online services include:

  • Researching medical procedures;
  • Treatment options;
  • Prescriptions; and
  • Disease/wellness information.
Perhaps it's the influence of those million-dollar ads that feature President Lincoln and that impish beaver -- the ones that promote the prescription sleeping aid Rozerem -- but insomniacs use e-health services more than the average consumer. Researching prescriptions (evidence that direct-to-consumer advertising "works"), treatment options, medical procedures and disease/wellness information all fit into insomniacs' online health behavior.

An eating disorder in the household significantly drives e-health use. Across the board, households with a member who has been diagnosed with an eating disorder use online health services much more often than other households. These households are researching all aspects of health information, finding online support and examining services available at health facilities.

This above-average research pattern across all areas (prescriptions, treatment options and services at facilities) is also seen in households where a member has been diagnosed with attention deficit hyperactivity disorder.

Future desires for e-health
Consumers also reported their interests on using online health services in the future. Beyond the current researching and locating activities, the most desired services included refilling prescriptions (desired by 72%), scheduling appointments (69%), checking lab or test results (68%), e-mailing with physicians (68%) and pre-registering online. These all add up to leveraging the Internet for convenience. This finding speaks to the emergence of retail health care -- the latest examples of which include retail clinics, medical tourism and consumers adopting personal health records. Today, only 6% of consumers work with online medical records. With the further proliferation of consumer-facing health services, this will change.

I've studied the Internet's role in health care for more than a decade. My preliminary dig into the NRC data had many surprises (some of which I've mentioned above), and I was happy to discover them. While the data do not give ethnographic observations of consumers' use of the Internet in real time, nonetheless they go further into describing the diversity of Americans' use of the Internet for health.

The NRC data reveal that if you've seen one e-health consumer ... you've seen one (or perhaps microsegments of consumers). For Web-based health services to be adopted by significant groups of people, they must be easy to use, offer convenience to consumers and provide real value in the eyes of the consumer. We're past the tipping point of consumers going online for health care; now, with some experience under their mouse, consumers are getting more judicious with their choice and use of online health services.
 

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