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Original Contribution  |   August 2011
Health-Related Internet Use Among Patients of Osteopathic Physicians
Author Notes
  • From the Department of Family Medicine at the University of Medicine and Dentistry of New Jersey-School of Osteopathic Medicine in Stratford. 
  • Address correspondence to Danielle L. Cooley DO, 42 E Laurel Rd, Suite 2100A, Stratford, NJ 08084-6447. E-mail: cooleydl@umdnj.edu 
Article Information
Gastroenterology / Obstetrics and Gynecology / Preventive Medicine / Professional Issues / Pulmonary Disorders / Urological Disorders
Original Contribution   |   August 2011
Health-Related Internet Use Among Patients of Osteopathic Physicians
The Journal of the American Osteopathic Association, August 2011, Vol. 111, 473-482. doi:10.7556/jaoa.2011.111.8.473
The Journal of the American Osteopathic Association, August 2011, Vol. 111, 473-482. doi:10.7556/jaoa.2011.111.8.473
Abstract

Context: Using the Internet has transformed communication and improved access to health-related information for patients and physicians.

Objective: To determine why patients use the Internet for health-related information, where patients find answers to their questions, and whether patient use of the Internet impacts the patient-physician relationship. This study focused on patients of osteopathic physicians to confirm previously published data in a more specific population.

Methods: An anonymous 25-item survey was distributed to patients in a primary care setting. The survey elicited information regarding demographics, health-related Internet use, and discussion of Web-based health information during the clinical visit.

Results: Two hundred eighty-five patient surveys were collected. Data based on sex, age, education level, and ethnicity were evaluated. Two hundred fifty of 280 patients (89%) reported that they use the Internet to find health-related information, and 134 of 250 patients (54%) indicated that they changed their health-related behaviors based on information they found. Seventy-three of 133 patients (55%) who changed their behaviors reported these findings to their physicians. This finding differed by age and ethnicity. Patients aged 50 to 64 years (22 responses, 73%) were the most likely group to report behavioral changes to their physicians (P=.048). No patients who identified themselves as of Asian/Pacific Islander descent indicated that they reported behavioral changes to their physician (P=.043). Two hundred forty-two of 261 patients (93%) reported that their personal physician is the most reliable source for health information.

Conclusion: Most patients use the Internet to find health-related information, but many of them are not reporting potentially important health-related behavioral changes to their physicians. However, most patients still consider their physician as the most reliable source for health-related information. Physicians should ask patients about Internet use and counsel them about where to find reliable, accurate, high-quality health information.

Technologic advances and increased accessibility of the Internet have facilitated easier and quicker access to healthcare-related information for patients and physicians.1-13 Increased use of this resource for healthcare concerns is evident by the volume of Web-based searches by consumers and healthcare professionals alike. Eighty percent of US adult Internet users access health-related information online,14 with approximately 7% retrieving such information on a daily basis.15 In 2010, the Pew Report noted that 75% of US adults accessed the Internet, 80% of whom sought health-related information.14 
Compared to conventional information vehicles such as newspapers and books, the Internet is often easier to access. In addition, the Internet allows patients to use many of the same resources as physicians, including scientific studies, medical databases, and online forums.7 With access to these online resources, patients are readily transitioning into informed consumers and using Internet-derived information in their healthcare decisions and in their encounters with healthcare professionals.8 This growing trend has been termed the e-patient revolution.3 
Healthcare professionals view the e-patient revolution as both an advantage and, at times, a hindrance to patient care.16 Because of the e-patient revolution, patients have improved satisfaction and reduced concern when physicians validate the information obtained from their Internet search efforts.4 Patients may research their symptoms or conditions online before a clinical encounter to become better educated on their condition, to self-diagnose their condition, or to seek treatment options for their condition.16 An interesting consideration is exactly how this patient-Web-physician triad impacts the dynamics of the patient-physician relationship.2,17 
In the present study, we sought to investigate the reasons why patients use the Internet for health-related information, the Web sites where patients find answers to their questions, and patient perceptions on how Internet use affects interactions with their physicians. We focused on patients of osteopathic physicians to confirm previously published data in a more specific population. We anticipate that this information can be used by members of the osteopathic community to achieve one of the core competency goals of the American Osteopathic Association: interpersonal and communication skills.18 
Methods
We developed a survey on use of the Internet for health information (Table 1). The survey was approved by the University of Medicine and Dentistry of New Jersey-School of Osteopathic Medicine's institutional review board. The survey was distributed from August 2009 through November 2009 to all new and follow-up patients aged 18 years or older at 5 participating osteopathic family medicine offices in the suburbs of a major metropolitan area in New Jersey. The anonymous questionnaire was distributed to patients before their office visit and was collected by the office receptionists before the patients' departure. To avoid duplicate surveys, office staff only distributed the survey to participants who indicated they had not completed the survey previously. Staff for each participating office forwarded the completed surveys to the study investigators. 
Table 1
Responses to Patient Survey on Health-Related Use of the Internet (N=285)
Survey Question No. (%)
1. What is your age?
        □ a. 18-29 y 60 (21)
        □ b. 30-49 y 133 (47)
        □ c. 50-65 y 64 (22)
        □ d. >65 y 28 (10)
    – Total No. respondents 285
2. What is your highest level of education completed?
        □ a. 0-11 y 6 (2)
        □ b. High school diploma/GED 128 (45)
        □ c. College degree 102 (36)
        □ d. Master's degree 45 (16)
        □ e. Doctoral degree 4 (1)
    – Total No. respondents 285
3. What is your gender?
        □ a. Male 102 (36)
        □ b. Female 183 (64)
    – Total No. respondents 285
4. What is your ethnicity? (Check all that apply.)
        □ a. Caucasian 217 (75)
        □ b. African American 42 (15)
        □ c. Asian/Pacific Islander 11 (4)
        □ d. Native American 2 (1)
        □ e. Hispanic 9 (3)
        □ f. Other 7 (2)
    – Total No. respondents 288
5. Where do you access the Internet? (Check all that apply.)
        □ a. Home 267 (93)
        □ b. Work 143 (50)
        □ c. School 30 (10)
        □ d. Public library 38 (13)
        □ e. Other (please specify) 10 (3)
    – Total No. respondents 288
6. How many days per week do you use the Internet?*
        □ a. 1 d 18 (7)
        □ b. 2-3 d 26 (9)
        □ c. 4-5 d 41 (15)
        □ d. Daily 189 (69)
    – Total No. respondents 274
7. Have you ever used the Internet to search for health information? (If “no,” go to Question #8; if “yes,” skip to Question #9.)
        □ a. Yes 250 (89)
        □ b. No 30 (11)
    – Total No. respondents 280
8. Why haven't you used the Internet to search for health information? (Then, go to Question #23.)
        □ a. I am already adequately informed. 6 (20)
        □ b. I use other resources. 9 (30)
        □ c. I am uncomfortable with using the Internet. 4 (13)
        □ d. I don't trust information obtained on the Internet. 0
        □ e. I do not have a specific reason for not using the Internet. 11 (37)
    – Total No. respondents 30
9. If you answered yes to #7, who do you look up [health] information for/about? (Check all that apply.)
        □ a. Self 237 (95)
        □ b. Spouse 114 (46)
        □ c. Parent 94 (38)
        □ d. Children 126 (50)
        □ e. Other (please specify) 39 (16)
    – Total No. respondents 250
10. How many times in the past 6 months have you used the Internet to find health-related information?
        □ a. <5 times 134 (54)
        □ b. 6-10 times 61 (24)
        □ c. 11-15 times 17 (7)
        □ d. >16 times 38 (15)
    – Total No. respondents 250
11. When do you access the Internet for health information? (Check all that apply.)
        □ a. Before doctor's visit 196 (78)
        □ b. During doctor's visit 21 (8)
        □ c. After doctor's visit 154 (62)
    – Total No. respondents 250
12. Are you able to find answers to your health questions online?
        □ a. Yes 95 (38)
        □ b. Somewhat 151 (60)
        □ c. No 4 (2)
    – Total No. respondents 250
13. Have you changed your thinking or behavior about a health-related issue as a result of your research on the Internet?
        □ a. Yes 134 (54)
        □ b. No 116 (46)
    – Total No. respondents 250
14. If so, did you inform your physician about these changes?
        □ a. Yes 73 (55)
        □ b. No 60 (45)
    – Total No. respondents 133
15. Do you follow the recommended treatment outlined by your physician? Did you follow the advice of your physician before using the Internet?
        □ a. Always 146 (58)
        □ b. Usually 83 (33)
        □ c. Sometimes 16 (7)
        □ d. Rarely 0
        □ e. Never 5 (2)
    – Total No. respondents 250
16. For some issues, do you prefer to use the Internet rather than visit your doctor? (If no, skip to question #19.)
        □ a. Yes 55 (22)
        □ b. No 195 (78)
    – Total No. respondents 250
17. If yes, which health conditions do you look for information on? (Check all that apply.)
        □ a. Common conditions (eg, urinary tract infection, common cold, muscle injury, ear infection, etc) 42 (76)
        □ b. Chronic conditions (eg, high blood, pressure diabetes, chronic obstructive pulmonary disease, asthma, etc) 20 (36)
        □ c. Disease prevention/health maintenance issues (eg, vaccines, colonoscopy, mammogram, pap smears, etc) 30 (55)
        □ d. Cancer diagnosis and treatment 9 (16)
        □ e. Support groups for illnesses/diseases 8 (15)
        □ f. Autoimmune disease (eg, rheumatoid arthritis, lupus, thyroid disease, celiac disease, etc) 13 (24)
        □ g. Genitourinary complaints (eg, vaginal discharge, penile discharge, prostate issues, erectile dysfunction, sexually transmitted disease, pregnancy, etc) 15 (27)
        □ h. Other (please specify) 0
    – Total No. respondents 55
18. Why did you choose to use the Internet rather than see your physician?§
        □ a. Too embarrassing 3 (5)
        □ b. Too hard to get an appointment 7 (13)
        □ c. To be better informed before seeing the doctor 39 (71)
        □ d. For the ability to reference this information at a later date 20 (36)
        □ e. To ensure you are getting appropriate medical care 11 (20)
    – Total No. respondents 55
19. Which of the following Web sites have you used for health information? (Check all that apply.)
        □ a. Search engines (eg, Google, Yahoo, MSN, etc) 193 (77)
        □ b. News sites (eg, CNN, MSNBC, Fox News, etc) 34 (14)
        □ c. Health sites (eg, eMedicine, WebMD, iVillage, etc) 179 (72)
        □ d. Government health sites (eg, cdc.gov, mypyramid.gov, etc) 61 (24)
        □ e. Pharmaceutical company sites (eg, Merck, Schering Plough, Sanofi, Glaxo Smith Kline, etc) 32 (13)
        □ f. Pharmacy sites (eg, CVS, Drugstore.com, RiteAid, Walgreens, etc) 25 (10)
        □ g. Drug Web sites (eg, nexium.com, lipitor.com, plavix.com, etc) 42 (17)
        □ h. Other (Please specify) 0
    – Total No. respondents 250
20. Have you ever brought information you obtained from the Internet to a doctor visit?
        □ a. Yes 59 (24)
        □ b. No 189 (76)
    – Total No. respondents 248
21. If yes, what did you bring with you? (Check all that apply.)
        □ a. Printout from Web site 34 (58)
        □ b. Reference article 13 (22)
        □ c. Checklist related to illness/specific complaint 16 (27)
        □ d. Medication Information 16 (27)
        □ e. Advertisement 2 (3)
        □ f. Other (please specify) 8 (14)
    – Total No. respondents 59
22. If yes, do you feel your doctor responded well to that information?
        □ a. Yes 55 (93)
        □ b. No 4 (7)
    – Total No. respondents 59
23. What do you view as the most reliable source of health information? (Please choose only 1 answer.)
        □ a. My physician 242 (93)
        □ b. Internet 15 (6)
        □ c. Newspaper 0
        □ d. TV show 2 (0.5)
        □ e. TV advertisement 0
        □ f. News broadcast 2 (0.5)
        □ g. Other (please specify) 0
    – Total No. respondents 261
24. Has your doctor discussed health-related Internet use with you or referred you to specific Web sites?#
        □ a. Yes 17 (6)
        □ b. No 246 (94)
    – Total No. respondents 263
25. If yes, which site did your doctor refer you to?**
        Medical sites 1 (8.3)
        Medtronics 1 (8.3)
        Chantix.com 1 (8.3)
        Web MD 5 (42)
        cdc.gov 1 (8.3)
        eMedicine 1 (8.3)
        AMA 1 (8.3)
        Support groups 1 (8.3)
    – Total No. respondents 12
 *  Eleven respondents did not answer question 6, which likely represents patients who did not use the Internet.
   Six respondents who left question 6 blank answered “no” to question 7.
   One respondent who answered “yes” to question 13 did not answer question 14.
 §  Some patients chose more than 1 answer to question 18.
   Two respondents who answered “yes” to question 8 did not answer question 20.
   Twenty-four respondents did not answer question 23.
 #  Twenty-two respondents did not answer question 24.
 **  Question 25 was open-ended.
Table 1
Responses to Patient Survey on Health-Related Use of the Internet (N=285)
Survey Question No. (%)
1. What is your age?
        □ a. 18-29 y 60 (21)
        □ b. 30-49 y 133 (47)
        □ c. 50-65 y 64 (22)
        □ d. >65 y 28 (10)
    – Total No. respondents 285
2. What is your highest level of education completed?
        □ a. 0-11 y 6 (2)
        □ b. High school diploma/GED 128 (45)
        □ c. College degree 102 (36)
        □ d. Master's degree 45 (16)
        □ e. Doctoral degree 4 (1)
    – Total No. respondents 285
3. What is your gender?
        □ a. Male 102 (36)
        □ b. Female 183 (64)
    – Total No. respondents 285
4. What is your ethnicity? (Check all that apply.)
        □ a. Caucasian 217 (75)
        □ b. African American 42 (15)
        □ c. Asian/Pacific Islander 11 (4)
        □ d. Native American 2 (1)
        □ e. Hispanic 9 (3)
        □ f. Other 7 (2)
    – Total No. respondents 288
5. Where do you access the Internet? (Check all that apply.)
        □ a. Home 267 (93)
        □ b. Work 143 (50)
        □ c. School 30 (10)
        □ d. Public library 38 (13)
        □ e. Other (please specify) 10 (3)
    – Total No. respondents 288
6. How many days per week do you use the Internet?*
        □ a. 1 d 18 (7)
        □ b. 2-3 d 26 (9)
        □ c. 4-5 d 41 (15)
        □ d. Daily 189 (69)
    – Total No. respondents 274
7. Have you ever used the Internet to search for health information? (If “no,” go to Question #8; if “yes,” skip to Question #9.)
        □ a. Yes 250 (89)
        □ b. No 30 (11)
    – Total No. respondents 280
8. Why haven't you used the Internet to search for health information? (Then, go to Question #23.)
        □ a. I am already adequately informed. 6 (20)
        □ b. I use other resources. 9 (30)
        □ c. I am uncomfortable with using the Internet. 4 (13)
        □ d. I don't trust information obtained on the Internet. 0
        □ e. I do not have a specific reason for not using the Internet. 11 (37)
    – Total No. respondents 30
9. If you answered yes to #7, who do you look up [health] information for/about? (Check all that apply.)
        □ a. Self 237 (95)
        □ b. Spouse 114 (46)
        □ c. Parent 94 (38)
        □ d. Children 126 (50)
        □ e. Other (please specify) 39 (16)
    – Total No. respondents 250
10. How many times in the past 6 months have you used the Internet to find health-related information?
        □ a. <5 times 134 (54)
        □ b. 6-10 times 61 (24)
        □ c. 11-15 times 17 (7)
        □ d. >16 times 38 (15)
    – Total No. respondents 250
11. When do you access the Internet for health information? (Check all that apply.)
        □ a. Before doctor's visit 196 (78)
        □ b. During doctor's visit 21 (8)
        □ c. After doctor's visit 154 (62)
    – Total No. respondents 250
12. Are you able to find answers to your health questions online?
        □ a. Yes 95 (38)
        □ b. Somewhat 151 (60)
        □ c. No 4 (2)
    – Total No. respondents 250
13. Have you changed your thinking or behavior about a health-related issue as a result of your research on the Internet?
        □ a. Yes 134 (54)
        □ b. No 116 (46)
    – Total No. respondents 250
14. If so, did you inform your physician about these changes?
        □ a. Yes 73 (55)
        □ b. No 60 (45)
    – Total No. respondents 133
15. Do you follow the recommended treatment outlined by your physician? Did you follow the advice of your physician before using the Internet?
        □ a. Always 146 (58)
        □ b. Usually 83 (33)
        □ c. Sometimes 16 (7)
        □ d. Rarely 0
        □ e. Never 5 (2)
    – Total No. respondents 250
16. For some issues, do you prefer to use the Internet rather than visit your doctor? (If no, skip to question #19.)
        □ a. Yes 55 (22)
        □ b. No 195 (78)
    – Total No. respondents 250
17. If yes, which health conditions do you look for information on? (Check all that apply.)
        □ a. Common conditions (eg, urinary tract infection, common cold, muscle injury, ear infection, etc) 42 (76)
        □ b. Chronic conditions (eg, high blood, pressure diabetes, chronic obstructive pulmonary disease, asthma, etc) 20 (36)
        □ c. Disease prevention/health maintenance issues (eg, vaccines, colonoscopy, mammogram, pap smears, etc) 30 (55)
        □ d. Cancer diagnosis and treatment 9 (16)
        □ e. Support groups for illnesses/diseases 8 (15)
        □ f. Autoimmune disease (eg, rheumatoid arthritis, lupus, thyroid disease, celiac disease, etc) 13 (24)
        □ g. Genitourinary complaints (eg, vaginal discharge, penile discharge, prostate issues, erectile dysfunction, sexually transmitted disease, pregnancy, etc) 15 (27)
        □ h. Other (please specify) 0
    – Total No. respondents 55
18. Why did you choose to use the Internet rather than see your physician?§
        □ a. Too embarrassing 3 (5)
        □ b. Too hard to get an appointment 7 (13)
        □ c. To be better informed before seeing the doctor 39 (71)
        □ d. For the ability to reference this information at a later date 20 (36)
        □ e. To ensure you are getting appropriate medical care 11 (20)
    – Total No. respondents 55
19. Which of the following Web sites have you used for health information? (Check all that apply.)
        □ a. Search engines (eg, Google, Yahoo, MSN, etc) 193 (77)
        □ b. News sites (eg, CNN, MSNBC, Fox News, etc) 34 (14)
        □ c. Health sites (eg, eMedicine, WebMD, iVillage, etc) 179 (72)
        □ d. Government health sites (eg, cdc.gov, mypyramid.gov, etc) 61 (24)
        □ e. Pharmaceutical company sites (eg, Merck, Schering Plough, Sanofi, Glaxo Smith Kline, etc) 32 (13)
        □ f. Pharmacy sites (eg, CVS, Drugstore.com, RiteAid, Walgreens, etc) 25 (10)
        □ g. Drug Web sites (eg, nexium.com, lipitor.com, plavix.com, etc) 42 (17)
        □ h. Other (Please specify) 0
    – Total No. respondents 250
20. Have you ever brought information you obtained from the Internet to a doctor visit?
        □ a. Yes 59 (24)
        □ b. No 189 (76)
    – Total No. respondents 248
21. If yes, what did you bring with you? (Check all that apply.)
        □ a. Printout from Web site 34 (58)
        □ b. Reference article 13 (22)
        □ c. Checklist related to illness/specific complaint 16 (27)
        □ d. Medication Information 16 (27)
        □ e. Advertisement 2 (3)
        □ f. Other (please specify) 8 (14)
    – Total No. respondents 59
22. If yes, do you feel your doctor responded well to that information?
        □ a. Yes 55 (93)
        □ b. No 4 (7)
    – Total No. respondents 59
23. What do you view as the most reliable source of health information? (Please choose only 1 answer.)
        □ a. My physician 242 (93)
        □ b. Internet 15 (6)
        □ c. Newspaper 0
        □ d. TV show 2 (0.5)
        □ e. TV advertisement 0
        □ f. News broadcast 2 (0.5)
        □ g. Other (please specify) 0
    – Total No. respondents 261
24. Has your doctor discussed health-related Internet use with you or referred you to specific Web sites?#
        □ a. Yes 17 (6)
        □ b. No 246 (94)
    – Total No. respondents 263
25. If yes, which site did your doctor refer you to?**
        Medical sites 1 (8.3)
        Medtronics 1 (8.3)
        Chantix.com 1 (8.3)
        Web MD 5 (42)
        cdc.gov 1 (8.3)
        eMedicine 1 (8.3)
        AMA 1 (8.3)
        Support groups 1 (8.3)
    – Total No. respondents 12
 *  Eleven respondents did not answer question 6, which likely represents patients who did not use the Internet.
   Six respondents who left question 6 blank answered “no” to question 7.
   One respondent who answered “yes” to question 13 did not answer question 14.
 §  Some patients chose more than 1 answer to question 18.
   Two respondents who answered “yes” to question 8 did not answer question 20.
   Twenty-four respondents did not answer question 23.
 #  Twenty-two respondents did not answer question 24.
 **  Question 25 was open-ended.
×
The questionnaire consisted of 25 questions with a brief explanation of the purpose of the survey. Introductory text also informed participants that participation was voluntary and that consent was implied by completing the questionnaire. The survey was distributed in an English-language format only. 
The data collected included patient demographics, frequency of Internet use, history of Internet use for health information, changes to behavior as a result of Internet findings on health information, and communication with physicians regarding use of the Internet for health information. Answers to each question were evaluated according to respondents' demographic information to determine whether responses differed among populations. Microsoft Office Excel 2007 software (Microsoft Corporation, Redmond, Washington) and Fisher exact test (α<.05) were used to compile and analyze the collected data. 
Results
We distributed approximately 500 surveys, of which 285 were completed and returned to the investigators. Surveys containing more than 1 omitted question were considered incomplete and excluded from our data analysis. According to the survey results, 60 of the 285 respondents (21%) were aged 18 to 29 years, 133 (47%) were aged 30 to 49 years, 64 (22%) were aged 50 to 64 years, and 28 (10%) were aged 65 years or older. One hundred eighty-three respondents (64%) indicated they were female and 102 (36%) indicated they were male. The majority of respondents (217 of 288 [75%]) identified themselves as Caucasian. The remainder of respondents indicated they were African American (42 [15%]), Asian/Pacific Islander (11 [4%]), Hispanic (9 [3%]), or Native American (2 [<1%]). Seven respondents (2%) selected “Other” under ethnicity. Six respondents (2%) reported completing less than 12 years of formal education, 128 (45%) reported earning a high school diploma or certificate of general educational development (ie, GED), 102 (36%) reported earning a college degree, 45 (16%) reported earning a master's degree, and 4 (1%) reported earning a doctoral degree. 
The reported demographics of our study population were compared with US Census Bureau data available for New Jersey19 to determine if our sample matched geographic area demographics. Our data were slightly skewed toward women when compared with data for New Jersey, which reported 51% women. When compared to New Jersey state data, our results are comparable in regards to the percentage of participants who reported being Caucasian, African American, and Native American. Our study population under-represents Asian and Hispanic populations when compared to data for the state of New Jersey. When comparing our data to that of the state, the survey respondents' education level is inflated. 
Two hundred fifty of 280 respondents (89%) indicated they have used the Internet to search for health-related information. Of these 250 patients, 134 (54%) reported changing some aspect of their health-related behaviors based on what they read. Interestingly, only 73 of 133 patients (55%) reported behavioral changes to their physician. None of the 4 patients who identified themselves as Asian/Pacific Islander reported behavioral changes to their physician (Table 2). 
Table 2
Health-Related Internet Use Among Patients of Osteopathic Physicians: Survey Responses According to Ethnicity
Responses, No. (%)
Survey Question Caucasian African American Hispanic Asian/Pacific Islander Other All
13. Have you changed your behavior as a result of information found on the Internet? (n=250)
        □ a. Yes 100 (51) 22 (67) 3 (50) 4 (50) 3 (50) 134 (54)
        □ b. No 96 (49) 11 (33) 3 (50) 4 (50) 3 (50) 116 (46)
    – P value* .7 .19 .60 .57 .60 NA
14. Have you discussed these changes with your physician? (n=133)‡
        □ a. Yes 62 (62) 8 (36) 1 (33) 0 2 (50) 73 (55)
        □ b. No 38 (38) 14 (64) 2 (67) 4 (100) 2 (50) 60 (45)
    – P value* .29 .11 .59 .043† .59 NA
20. Have you ever brought information obtained from the Internet to your office visit? (n=248)
        □ a. Yes 54 (28) 3 (9) 1 (17) 0 1 (13) 59 (24)
        □ b. No 140 (72) 31 (91) 5 (83) 8 (100) 6 (87) 189 (76)
    – P value* .37 .049† .57 .20 .69 NA
 *  Compared to total population.
   Statistically significant.
   One patient who answered “yes” to question 13 did not respond to question 14.

Abbreviation: NA, not applicable.

Table 2
Health-Related Internet Use Among Patients of Osteopathic Physicians: Survey Responses According to Ethnicity
Responses, No. (%)
Survey Question Caucasian African American Hispanic Asian/Pacific Islander Other All
13. Have you changed your behavior as a result of information found on the Internet? (n=250)
        □ a. Yes 100 (51) 22 (67) 3 (50) 4 (50) 3 (50) 134 (54)
        □ b. No 96 (49) 11 (33) 3 (50) 4 (50) 3 (50) 116 (46)
    – P value* .7 .19 .60 .57 .60 NA
14. Have you discussed these changes with your physician? (n=133)‡
        □ a. Yes 62 (62) 8 (36) 1 (33) 0 2 (50) 73 (55)
        □ b. No 38 (38) 14 (64) 2 (67) 4 (100) 2 (50) 60 (45)
    – P value* .29 .11 .59 .043† .59 NA
20. Have you ever brought information obtained from the Internet to your office visit? (n=248)
        □ a. Yes 54 (28) 3 (9) 1 (17) 0 1 (13) 59 (24)
        □ b. No 140 (72) 31 (91) 5 (83) 8 (100) 6 (87) 189 (76)
    – P value* .37 .049† .57 .20 .69 NA
 *  Compared to total population.
   Statistically significant.
   One patient who answered “yes” to question 13 did not respond to question 14.

Abbreviation: NA, not applicable.

×
Patients aged 50 to 64 years were more likely than the total survey population to report behavioral changes to their physician (22 [73%], P=.048) (Table 3). No statistically significant difference was found between men and women in reporting these changes in any age group (Table 4). 
Table 3
Health-Related Internet Use Among Patients of Osteopathic Physicians: Survey Responses According to Age in Years
Responses, No. (%)
Survey Question 18-29 30-49 50-64 65+ All
13. Have you changed your behavior as a result of information found on the internet? (n=250)
        □ a. Yes 28 (47) 63 (52) 31 (62) 12 (63) 134 (54)
        □ b. No 31 (53) 59 (48) 19 (38) 7 (36) 116 (46)
    – P value* .38 .74 .35 .47 NA
14. Have you discussed these changes with your physician? (n=133)
        □ a. Yes 12 (43) 34 (54) 22 (73) 5 (42) 73 (55)
        □ b. No 16 (57) 29 (46) 8 (27) 7 (58) 60 (45)
    – P value* .39 .71 .048 .55 NA
 *  Compared to total population.
   Statistically significant.
   One patient who answered “yes” to question 13 did not respond to question 14.

Abbreviations: NA, not applicable.

Table 3
Health-Related Internet Use Among Patients of Osteopathic Physicians: Survey Responses According to Age in Years
Responses, No. (%)
Survey Question 18-29 30-49 50-64 65+ All
13. Have you changed your behavior as a result of information found on the internet? (n=250)
        □ a. Yes 28 (47) 63 (52) 31 (62) 12 (63) 134 (54)
        □ b. No 31 (53) 59 (48) 19 (38) 7 (36) 116 (46)
    – P value* .38 .74 .35 .47 NA
14. Have you discussed these changes with your physician? (n=133)
        □ a. Yes 12 (43) 34 (54) 22 (73) 5 (42) 73 (55)
        □ b. No 16 (57) 29 (46) 8 (27) 7 (58) 60 (45)
    – P value* .39 .71 .048 .55 NA
 *  Compared to total population.
   Statistically significant.
   One patient who answered “yes” to question 13 did not respond to question 14.

Abbreviations: NA, not applicable.

×
Table 4
Health-Related Internet Use Among Patients of Osteopathic Physicians: Survey Responses According to Sex
Responses, No. (%)
Survey Question Men Women All
13. Have you changed your behavior as a result of information found on the Internet? (n=250)
        □ a. Yes 49 (56) 85 (52) 134 (54)
        □ b. No 38 (44) 78 (48) 116 (46)
    – P value* .71 .84 NA
14. Have you discussed these changes with your physician? (n=133)
        □ a. Yes 27 (55) 46 (42) 73 (55)
        □ b. No 22 (45) 38 (58) 60 (45)
    – P value* .56 .56 NA
 *  Compared to total population.
   One patient who answered “yes” to question 13 did not respond to question 14.

Abbreviation: NA, not applicable.

Table 4
Health-Related Internet Use Among Patients of Osteopathic Physicians: Survey Responses According to Sex
Responses, No. (%)
Survey Question Men Women All
13. Have you changed your behavior as a result of information found on the Internet? (n=250)
        □ a. Yes 49 (56) 85 (52) 134 (54)
        □ b. No 38 (44) 78 (48) 116 (46)
    – P value* .71 .84 NA
14. Have you discussed these changes with your physician? (n=133)
        □ a. Yes 27 (55) 46 (42) 73 (55)
        □ b. No 22 (45) 38 (58) 60 (45)
    – P value* .56 .56 NA
 *  Compared to total population.
   One patient who answered “yes” to question 13 did not respond to question 14.

Abbreviation: NA, not applicable.

×
Fifty-nine of 248 patients (24%) responded that they had previously brought information from the Internet to a doctor visit. Of those, 55 of 59 patients (93%) found their physician “responded well” to the information presented. African American patients surveyed were less likely than patients of other ethnicities to bring information with them to their office visits (3 of 34 [9%] vs 59 of 248 [24%], P=.049). These findings are outlined in Table 2. 
Of the 250 patients who reported using the Internet to answer health-related questions, 196 (78%) reported searching the Internet prior to their physician encounter, and 154 (62%) reported searching after their visit. In addition, 21 patients (8%) reported using the Internet during the office visit (Table 1). Patients were allowed to select more than 1 answer choice for this survey item. 
Our results indicate that patients use the Internet to search for information about the health of various people in their lives. Of 250 respondents who have used the Internet to search for health information, 237 (95%) indicated they look up health-related information for themselves, 126 (50%) search for health-related information for their children, 114 (46%) search for health-related information for their spouses; and 94 (38%) search for health-related information for their parents. Thirty-nine (16%) patients indicated they looked up information about people not listed, including grandchildren, boyfriend or girlfriend, coworkers, siblings, nieces or nephews, and friends (Table 1). Patients were allowed to select more than 1 answer choice for this survey item. 
Patients reported using various Internet sources to obtain health-related information (Table 1). The most common sources cited by patients included search engines (193 [77%]), health Web sites (179 [72%]), government Web sites (61 [24%]), drug Web sites (42 [17%]), news Web sites (34 [14%]), pharmacy Web sites (25 [10%]), and pharmaceutical company Web sites (32 [13%]). Patients were allowed to select more than 1 answer choice for this survey item. 
Of the 55 respondents who indicated that they prefer to use the Internet rather than a physician for certain issues, the issues indicated were common conditions (42 [76%]), health maintenance issues/disease/illness prevention (30 [55%]), chronic conditions (20 [36%]), genitourinary conditions (15 [27%]), autoimmune diseases (13 [24%]), and cancer diagnosis and treatment (9 [16%]) (Table 1). Patients were allowed to select more than 1 answer choice for this survey item. 
Fifty-five out of 250 survey respondents (22%) stated they would rather use the Internet than see their physician for some health issues, 20 (36%) used the Internet for the ability to reference the information at a later date, and 11 (20%) used it to ensure they were receiving the proper care. Seven respondents (13%) indicated they used the Internet for information because they had trouble getting an appointment with their physician, while 3 (5%) indicated they were too embarrassed to talk about the subject they researched with their physician (Table 1). Some patients chose more than 1 reason for using the Internet instead of consulting a physician. 
In general, respondents were able to use the Internet to find answers to their questions at least to some degree. One hundred fifty-one of 250 respondents (60%) reported being “somewhat” able to find the answer to their question online, while 95 (38%) reported being able to find the answer. Only 4 respondents (2%) reported being unable to find what they were looking for on the Internet (Table 1). 
Patients were asked if their physician ever discussed health-related Internet use with them. Only 17 of 263 (6%) reported this to be the case. Patients were also asked which sites (if any) they were directed to by their physician. Responses included: WebMD.com (5 of 12 [42%]), Medtronics.com (1 [8.3%]), Chantix.com (1 [8.3%]), cdc.gov (1 [8.3%]), eMedicine.com (1 [8.3%]), and support groups (1 [8.3%]) (Table 1). 
When asked about the most reliable source of health-related information, 242 of 261 patients (93%) responded that they consider their personal physician to be the most reliable source. Only 15 (6%) rated the Internet as their single most reliable source of health related information. Another 2 (0.5%) rated news programs as the most reliable (Table 1). 
Comment
We investigated why patients used the Internet for certain health issues rather than consult their physician. For this study, we focused on patients of osteopathic physicians to confirm previously published data in a more specific population. Thirty-nine of 55 respondents (71%) used the Internet to search for health-related information to be better informed before seeing their doctor, 20 (36%) did so to have information to reference at a later date, and 11 (20%) wanted to ensure that they were getting appropriate medical care. It is reassuring to see that patients are using the Internet in an effort to be a more educated consumer rather than questioning their physician's plan of care. 
Another goal of the present study was to identify which Web sites patients consult to find answers to their medical questions. The majority of the patients in our study used either general search engines (77%) or health sites such as iVillage.com, WebMD.com, and eMedicine.com (72%). The major concern for this type of independent Internet research is that patients may be obtaining information from unvalidated and unreliable resources. This provides an opportunity for patient education on where to find evidence-based information on the Internet. 
Eighty-nine percent of patients in our study population reported using the Internet to find health-related information—more than the rate of 80% cited by previous studies.14,15 This finding may be in part a result of the geographic location of the present study, suburban southern New Jersey, where Internet access is readily available. The benefits of this trend have been debated in the medical literature. For example, realistic concerns have been expressed about the quality, reliability, and validity of health information obtained from searching the Internet.3,6,7,9,12,20-22 According to a 2006 national survey,14 75% of patients seeking online information “never,” “hardly ever,” or “sometimes” inquired about the data and source encountered during an Internet search.17 However, Web domains containing health-related information are easy to create, and this information is not always subjected to the traditional editorial review process that is standard for information published in medical journals and textbooks.6,16,23 In addition, many health-related sites do not provide a source of origin or authorship.10,24 Creators of such Web sites may not possess the appropriate professional qualifications, and the information provided may not be evidence-based.6 
Another problem with online healthcare information is bias. The results of the present study indicate that patients use a variety of different types of Web sites, including commercial Web sites. Many sites provide information based on marketing initiatives and not on evidencebased recommendations.6 As a consequence, the quality of Internet-obtained health information can range from current peer-reviewed evidence to unsubstantiated views, opinions, and anecdotes.6,10,15,20,25,26 
Seventy-seven percent of our study population indicated that they use general search engines to obtain health related information. This is consistent with findings of other studies; a 2006 poll15 found that about 2 of 3 health-related searches originate from general search engines. In light of this trend, it should be noted that general search engines require careful navigation in order to obtain high-quality advice.1,13,23 Performed in this manner, the task of obtaining quality healthcare information is painstaking—even for the knowledgeable clinician. Thus, even extremely motivated healthcare consumers may fall short of their health-related research goals and rely on inaccurate information that may be detrimental if used to self-diagnosis or self-treat a condition.2 In a recent survey by Iverson et al,20 67% of Internet users reported being able to find answers to their health questions online, 29% were somewhat able, and 2% were unable. The results of our study were comparable to these results with 60% of patients reported being “somewhat” able to find answers to their questions on the World Wide Web, 38% “able” to find answers, and 2% “unable” to find answers. 
Fifty-five percent of our study population indicated they report behavioral changes because of information found on the Internet to their physician. A 2009 survey by Iverson et al20 concluded that 73% of patients reported behavioral changes to their physician. The reasons for this difference are unknown but would be a good topic for further research. Certain groups were less likely than the rest of the survey population to report these changes to their physician. Our results showed that patients of Asian/Pacific Islander descent were less likely to tell their physicians about behavioral changes that resulted from health-related Internet research. Patients aged 50 to 64 years were more likely to report behavioral changes to their physician. This finding is not consistent with other studies; the same study by Iverson et al20 concluded patients aged 31 to 45 years were more likely to share their behavioral changes that resulted from personal Internet searches with their physician. Reasons for this difference are unknown but would be an interesting topic for further research. 
Only 7% of the patients in our study who reported bringing information from the Internet to an office visit perceived a negative reaction from their physician after doing so. This finding resonates with our other results related to patients' perceptions of their physicians; 93% of patients reported feeling that their physician was the most reliable source of health information. Similar findings have been reported in other studies, most recently by Khoo et al9 and Cutilli.27 In addition, a study by Murray et al28 found that only 8% of physicians felt a negative impact on the physician-patient relationship after a patient brought information obtained from the Internet to their office visit. 
Limitations
The present study did have some possible biases and limitations. First, it was difficult to compare our data in regards to age distribution with that from the US Census Bureau because the Bureau's data only contain 3 possible age categories (1 of which is younger than 18 years), whereas our data contained 4 age categories. While the distribution of race and ethnicity in our study population is fairly consistent with that of New Jersey, we have an underrepresentation of Hispanic patients in our sample size. This underrepresentation may have occurred because the survey was only distributed in the English language; Hispanic patients may have been more comfortable completing the survey in a Spanish language format. This could be an area for future research. We also had a small sample size of patients of Asian/Pacific Islander descent, which may make some data difficult to interpret. 
Our population also had increased education levels compared to the state population. In New Jersey, 82% of the population holds a high school diploma, whereas in our sample, 98% of patients polled had achieved at least a high school level of education. This difference may be explained by the fact that our study population was surveyed in private family medicine offices instead of a clinic setting. This can create a bias in the fact that more educated people may be more computer savvy than their counterparts with less education. They may also have more access to computers in their workplace or homes. 
Our study's impact was also limited by a small sample size. Our data would have been more powerful if our sample size was larger. Another limitation to this study was the small geographical area included in the study, which may limit its relevance to other more distant geographical locations. 
Implications for Clinical Practice
Physicians should view patient Internet research as an opportunity for communication with the patient and also as an opportunity to enhance patient education.6 
Certain demographic groups were less likely to disclose changes in behavior because of Internet findings with their physician. Physicians should be aware of these potential differences and tailor their approaches to discussion of health-related information to the subgroups of the populations delineated in these results. 
Study participants in the present study reported using a variety of Web sites, including commercial Web sites that may contain biased information because they are meant to market or sell a product. It is important that physicians ask their patients about sources of information when discussing Web-based research during the patient encounter. 
Based on our findings, the majority of patients who bring Internet findings to physician visits have a positive experience. Physicians should use this to their advantage in the patient-physician relationship by asking patients about Internet use and counseling them about where to find reliable, accurate, high-quality health-related information that will assist patients in becoming better-informed healthcare consumers. 
Considerations for Future Research
This survey did not inquire as to how patients changed their behavior because of Internet research. This would be an interesting topic for future studies. This survey did not address potential harms or benefits to patients based on their Internet research. Future studies could also investigate how to best educate patients on health-related Internet use. 
Conclusion
Our findings indicated that 89% of patients surveyed use the Internet to search for health-related information. Statistically significant portions of those patients change their health-related behavior based on these findings without informing their physician. However, a majority of patients surveyed still identify their personal physician as the most reliable source of health information. 
Physician awareness of our study's findings will help improve the education of patients, limit confusing and overwhelming information, and ultimately strengthen the sacred patient-physician relationship by increasing information exchange between both parties. All of this information, when taken together, can help physicians better understand their patients and therefore will improve interpersonal communication, a core competency of the American Osteopathic Association.18 
   Financial Disclosures: None reported.
 
References
Siempos II, Spanos A, Issaris EA, Rafailidis PI, Falagas ME. Non-physicians may reach correct diagnosis by using Google: a pilot study. Swiss Med Wkly. 2008:138(49-50):741-745. [PubMed]
Ahmad F, Hudak PL, Bercovitz K, Hollenberg E, Levinson W. Are physicians ready for patients with Internet-based health information? J Med Internet Res. 2006;8(3)P:22e. [CrossRef]
Wald HS, Dube CE, Anthony DC. Untangling the Web—the impact of Internet use on health care and the physician-patient relationship. Patient Educ Couns. 2007;68(3):218-224. [CrossRef] [PubMed]
Bylund CL, Guegue JA, Sabee CMet al. Provider-patient dialogue about Internet health information: an exploration of strategies to improve the provider-patient relationship. Patient Educ Couns. 2007;66(3):346-352. [CrossRef] [PubMed]
Siva C, Smarr KL, Hanson KDet al. Internet use and e-mail communications between patients and providers: a survey of rheumatology outpatients. J Clin Rheumatol. 2008;14(6):318-323. [CrossRef] [PubMed]
Ayantunde AA, Welch NT, Parsons SL. A survey of patient satisfaction and use of the Internet for health information. Int J Clin Pract. 2007;61(3):458-462. [CrossRef] [PubMed]
Khechine H, Pascot D, Prémont P. Use of health-related information from the Internet by English-speaking patients. Health Informatics J. 2008;14(1):17-28. [CrossRef] [PubMed]
Khazaal Y, Chatton A, Cochand Set al. Internet use by patients with psychiatric disorders in search for general and medical informations. Psychiatr Q. 2008;79(4):301-309. [CrossRef] [PubMed]
Khoo K, Bolt P, Babl FE, Jury S, Goldman RD. Health information seeking by parents in the Internet age. J Pediatr Child Health. 2008;44(7-8):419-423. [CrossRef]
Smalligan RD, Campbell EO, Ismail HM. Patient experience with MedlinePlus.gov: a survey of internal medicine patients. J Investig Med. 2008;56(8):1019-1022. [PubMed]
Hay MC, Strathmann C, Lieber E, Wick K, Giesser B. Why patients go online: multiple sclerosis, the internet, and physician-patient communication. Neurologist. 2008;14(6):374-381. [CrossRef] [PubMed]
Peterson NB, Dwyer KA, Mulvaney SA. Computer and internet use in a community health clinic population [published ahead of print September 23, 2008]. Med Decis Making. 2009;29(2):202-206. [CrossRef] [PubMed]
Morris D, Drake E, Saarimaki A, Bennett C, O’Connor A. Can people find patient decision aids on the Internet? Patient Educ Couns. 2008;73(3):557-560. [CrossRef] [PubMed]
Pew Research Center’s Internet and American Life Project. Health Topics. Washington, DC: Pew Research Center; 2011. http://www.pewinternet.org/~/media//Files/Reports/2011/PIP_HealthTopics.pdf. Accessed August 15, 2011.
Pew Research Center’s Internet and American Life Project. Online Health Search 2006. Washington, DC: Pew Research Center; 2006. http://www.pewinternet.org/~/media//Files/Reports/2006/PIP_Online_Health_2006.pdf.pdf. Accessed August 15, 2011.
Dilliway G, Maudsley G. Patients bringing information to primary care consultations: a cross-sectional (questionnaire) study of doctors’ and nurses’ views of its impact. J Eval Clin Pract. 2008;14(4):545-547. [CrossRef] [PubMed]
Benigeri M, Pluye P. Shortcomings of health information on the Internet. Health Promot Int. 2003;18(4):381-386. [CrossRef] [PubMed]
American Osteopathic Association. The Basic Documents for Postdoctoral Training. Chicago, IL: American Osteopathic Association; 2010. http://www.osteopathic.org/inside-aoa/Education//interns-residents/Documents/basic-documents-for-postdoctoral-training.pdf. Accessed May 31, 2011.
U.S. Census Bureau. State & county QuickFacts: New Jersey. U.S. Census Bureau Web site. http://quickfacts.census.gov/qfd/states/34000.html. Update November 4, 2010. Accessed April 27, 2011.
Iverson SA, Howard KB, Penney BK. Impact of internet use on health-related behaviors and patient-physician relationship: a survey-based study and review. J Am Osteopath Assoc. 2008;108(12):699-711. [PubMed]
Perez E. E-Health: how to make the right choice. Nurs Forum. 2009;44(4): 277-282. [CrossRef] [PubMed]
Hartzband P, Groopman J. Untangling the Web—patients, doctors, and the Internet. N Engl Med. 2010;362(12):1063-1066. [CrossRef]
Trotter MI, Morgan DW. Patients’ use of the Internet for health related matters: a study of Internet usage in 2000 and 2006. Health Informatics J. 2008;14(3):175-181. [CrossRef] [PubMed]
Sillence E, Briggs P, Harris PRet al. How do patients evaluate and make use of online health information? Soc Sci Med. 2007;64(9):1853-1862. [CrossRef] [PubMed]
Potts HW, Wyatt JC. Survey of doctors’ experience of patients using the Internet. J Med Internet Res. 2002;4(1):e5. [CrossRef] [PubMed]
Lowrey W, Anderson WB. The impact of internet use on the public perception of physicians: a perspective from the sociology of professionals literature. Health Commun. 2006;19(2):125-131. [CrossRef] [PubMed]
Cutilli CC. Seeking health information: what sources do your patients use? Orthop Nurs. 2010;29(3)214-219. [PubMed]
Murray E, Lo B, Pollack Let al. The impact of health information on the Internet on health care and the physician-patient relationship: national U.S. survey among 1.050 U.S. physicians. J Med Internet Res. 2003;5(3):e17. doi:10.2196/jmir.5.3.e17. [CrossRef] [PubMed]
Table 1
Responses to Patient Survey on Health-Related Use of the Internet (N=285)
Survey Question No. (%)
1. What is your age?
        □ a. 18-29 y 60 (21)
        □ b. 30-49 y 133 (47)
        □ c. 50-65 y 64 (22)
        □ d. >65 y 28 (10)
    – Total No. respondents 285
2. What is your highest level of education completed?
        □ a. 0-11 y 6 (2)
        □ b. High school diploma/GED 128 (45)
        □ c. College degree 102 (36)
        □ d. Master's degree 45 (16)
        □ e. Doctoral degree 4 (1)
    – Total No. respondents 285
3. What is your gender?
        □ a. Male 102 (36)
        □ b. Female 183 (64)
    – Total No. respondents 285
4. What is your ethnicity? (Check all that apply.)
        □ a. Caucasian 217 (75)
        □ b. African American 42 (15)
        □ c. Asian/Pacific Islander 11 (4)
        □ d. Native American 2 (1)
        □ e. Hispanic 9 (3)
        □ f. Other 7 (2)
    – Total No. respondents 288
5. Where do you access the Internet? (Check all that apply.)
        □ a. Home 267 (93)
        □ b. Work 143 (50)
        □ c. School 30 (10)
        □ d. Public library 38 (13)
        □ e. Other (please specify) 10 (3)
    – Total No. respondents 288
6. How many days per week do you use the Internet?*
        □ a. 1 d 18 (7)
        □ b. 2-3 d 26 (9)
        □ c. 4-5 d 41 (15)
        □ d. Daily 189 (69)
    – Total No. respondents 274
7. Have you ever used the Internet to search for health information? (If “no,” go to Question #8; if “yes,” skip to Question #9.)
        □ a. Yes 250 (89)
        □ b. No 30 (11)
    – Total No. respondents 280
8. Why haven't you used the Internet to search for health information? (Then, go to Question #23.)
        □ a. I am already adequately informed. 6 (20)
        □ b. I use other resources. 9 (30)
        □ c. I am uncomfortable with using the Internet. 4 (13)
        □ d. I don't trust information obtained on the Internet. 0
        □ e. I do not have a specific reason for not using the Internet. 11 (37)
    – Total No. respondents 30
9. If you answered yes to #7, who do you look up [health] information for/about? (Check all that apply.)
        □ a. Self 237 (95)
        □ b. Spouse 114 (46)
        □ c. Parent 94 (38)
        □ d. Children 126 (50)
        □ e. Other (please specify) 39 (16)
    – Total No. respondents 250
10. How many times in the past 6 months have you used the Internet to find health-related information?
        □ a. <5 times 134 (54)
        □ b. 6-10 times 61 (24)
        □ c. 11-15 times 17 (7)
        □ d. >16 times 38 (15)
    – Total No. respondents 250
11. When do you access the Internet for health information? (Check all that apply.)
        □ a. Before doctor's visit 196 (78)
        □ b. During doctor's visit 21 (8)
        □ c. After doctor's visit 154 (62)
    – Total No. respondents 250
12. Are you able to find answers to your health questions online?
        □ a. Yes 95 (38)
        □ b. Somewhat 151 (60)
        □ c. No 4 (2)
    – Total No. respondents 250
13. Have you changed your thinking or behavior about a health-related issue as a result of your research on the Internet?
        □ a. Yes 134 (54)
        □ b. No 116 (46)
    – Total No. respondents 250
14. If so, did you inform your physician about these changes?
        □ a. Yes 73 (55)
        □ b. No 60 (45)
    – Total No. respondents 133
15. Do you follow the recommended treatment outlined by your physician? Did you follow the advice of your physician before using the Internet?
        □ a. Always 146 (58)
        □ b. Usually 83 (33)
        □ c. Sometimes 16 (7)
        □ d. Rarely 0
        □ e. Never 5 (2)
    – Total No. respondents 250
16. For some issues, do you prefer to use the Internet rather than visit your doctor? (If no, skip to question #19.)
        □ a. Yes 55 (22)
        □ b. No 195 (78)
    – Total No. respondents 250
17. If yes, which health conditions do you look for information on? (Check all that apply.)
        □ a. Common conditions (eg, urinary tract infection, common cold, muscle injury, ear infection, etc) 42 (76)
        □ b. Chronic conditions (eg, high blood, pressure diabetes, chronic obstructive pulmonary disease, asthma, etc) 20 (36)
        □ c. Disease prevention/health maintenance issues (eg, vaccines, colonoscopy, mammogram, pap smears, etc) 30 (55)
        □ d. Cancer diagnosis and treatment 9 (16)
        □ e. Support groups for illnesses/diseases 8 (15)
        □ f. Autoimmune disease (eg, rheumatoid arthritis, lupus, thyroid disease, celiac disease, etc) 13 (24)
        □ g. Genitourinary complaints (eg, vaginal discharge, penile discharge, prostate issues, erectile dysfunction, sexually transmitted disease, pregnancy, etc) 15 (27)
        □ h. Other (please specify) 0
    – Total No. respondents 55
18. Why did you choose to use the Internet rather than see your physician?§
        □ a. Too embarrassing 3 (5)
        □ b. Too hard to get an appointment 7 (13)
        □ c. To be better informed before seeing the doctor 39 (71)
        □ d. For the ability to reference this information at a later date 20 (36)
        □ e. To ensure you are getting appropriate medical care 11 (20)
    – Total No. respondents 55
19. Which of the following Web sites have you used for health information? (Check all that apply.)
        □ a. Search engines (eg, Google, Yahoo, MSN, etc) 193 (77)
        □ b. News sites (eg, CNN, MSNBC, Fox News, etc) 34 (14)
        □ c. Health sites (eg, eMedicine, WebMD, iVillage, etc) 179 (72)
        □ d. Government health sites (eg, cdc.gov, mypyramid.gov, etc) 61 (24)
        □ e. Pharmaceutical company sites (eg, Merck, Schering Plough, Sanofi, Glaxo Smith Kline, etc) 32 (13)
        □ f. Pharmacy sites (eg, CVS, Drugstore.com, RiteAid, Walgreens, etc) 25 (10)
        □ g. Drug Web sites (eg, nexium.com, lipitor.com, plavix.com, etc) 42 (17)
        □ h. Other (Please specify) 0
    – Total No. respondents 250
20. Have you ever brought information you obtained from the Internet to a doctor visit?
        □ a. Yes 59 (24)
        □ b. No 189 (76)
    – Total No. respondents 248
21. If yes, what did you bring with you? (Check all that apply.)
        □ a. Printout from Web site 34 (58)
        □ b. Reference article 13 (22)
        □ c. Checklist related to illness/specific complaint 16 (27)
        □ d. Medication Information 16 (27)
        □ e. Advertisement 2 (3)
        □ f. Other (please specify) 8 (14)
    – Total No. respondents 59
22. If yes, do you feel your doctor responded well to that information?
        □ a. Yes 55 (93)
        □ b. No 4 (7)
    – Total No. respondents 59
23. What do you view as the most reliable source of health information? (Please choose only 1 answer.)
        □ a. My physician 242 (93)
        □ b. Internet 15 (6)
        □ c. Newspaper 0
        □ d. TV show 2 (0.5)
        □ e. TV advertisement 0
        □ f. News broadcast 2 (0.5)
        □ g. Other (please specify) 0
    – Total No. respondents 261
24. Has your doctor discussed health-related Internet use with you or referred you to specific Web sites?#
        □ a. Yes 17 (6)
        □ b. No 246 (94)
    – Total No. respondents 263
25. If yes, which site did your doctor refer you to?**
        Medical sites 1 (8.3)
        Medtronics 1 (8.3)
        Chantix.com 1 (8.3)
        Web MD 5 (42)
        cdc.gov 1 (8.3)
        eMedicine 1 (8.3)
        AMA 1 (8.3)
        Support groups 1 (8.3)
    – Total No. respondents 12
 *  Eleven respondents did not answer question 6, which likely represents patients who did not use the Internet.
   Six respondents who left question 6 blank answered “no” to question 7.
   One respondent who answered “yes” to question 13 did not answer question 14.
 §  Some patients chose more than 1 answer to question 18.
   Two respondents who answered “yes” to question 8 did not answer question 20.
   Twenty-four respondents did not answer question 23.
 #  Twenty-two respondents did not answer question 24.
 **  Question 25 was open-ended.
Table 1
Responses to Patient Survey on Health-Related Use of the Internet (N=285)
Survey Question No. (%)
1. What is your age?
        □ a. 18-29 y 60 (21)
        □ b. 30-49 y 133 (47)
        □ c. 50-65 y 64 (22)
        □ d. >65 y 28 (10)
    – Total No. respondents 285
2. What is your highest level of education completed?
        □ a. 0-11 y 6 (2)
        □ b. High school diploma/GED 128 (45)
        □ c. College degree 102 (36)
        □ d. Master's degree 45 (16)
        □ e. Doctoral degree 4 (1)
    – Total No. respondents 285
3. What is your gender?
        □ a. Male 102 (36)
        □ b. Female 183 (64)
    – Total No. respondents 285
4. What is your ethnicity? (Check all that apply.)
        □ a. Caucasian 217 (75)
        □ b. African American 42 (15)
        □ c. Asian/Pacific Islander 11 (4)
        □ d. Native American 2 (1)
        □ e. Hispanic 9 (3)
        □ f. Other 7 (2)
    – Total No. respondents 288
5. Where do you access the Internet? (Check all that apply.)
        □ a. Home 267 (93)
        □ b. Work 143 (50)
        □ c. School 30 (10)
        □ d. Public library 38 (13)
        □ e. Other (please specify) 10 (3)
    – Total No. respondents 288
6. How many days per week do you use the Internet?*
        □ a. 1 d 18 (7)
        □ b. 2-3 d 26 (9)
        □ c. 4-5 d 41 (15)
        □ d. Daily 189 (69)
    – Total No. respondents 274
7. Have you ever used the Internet to search for health information? (If “no,” go to Question #8; if “yes,” skip to Question #9.)
        □ a. Yes 250 (89)
        □ b. No 30 (11)
    – Total No. respondents 280
8. Why haven't you used the Internet to search for health information? (Then, go to Question #23.)
        □ a. I am already adequately informed. 6 (20)
        □ b. I use other resources. 9 (30)
        □ c. I am uncomfortable with using the Internet. 4 (13)
        □ d. I don't trust information obtained on the Internet. 0
        □ e. I do not have a specific reason for not using the Internet. 11 (37)
    – Total No. respondents 30
9. If you answered yes to #7, who do you look up [health] information for/about? (Check all that apply.)
        □ a. Self 237 (95)
        □ b. Spouse 114 (46)
        □ c. Parent 94 (38)
        □ d. Children 126 (50)
        □ e. Other (please specify) 39 (16)
    – Total No. respondents 250
10. How many times in the past 6 months have you used the Internet to find health-related information?
        □ a. <5 times 134 (54)
        □ b. 6-10 times 61 (24)
        □ c. 11-15 times 17 (7)
        □ d. >16 times 38 (15)
    – Total No. respondents 250
11. When do you access the Internet for health information? (Check all that apply.)
        □ a. Before doctor's visit 196 (78)
        □ b. During doctor's visit 21 (8)
        □ c. After doctor's visit 154 (62)
    – Total No. respondents 250
12. Are you able to find answers to your health questions online?
        □ a. Yes 95 (38)
        □ b. Somewhat 151 (60)
        □ c. No 4 (2)
    – Total No. respondents 250
13. Have you changed your thinking or behavior about a health-related issue as a result of your research on the Internet?
        □ a. Yes 134 (54)
        □ b. No 116 (46)
    – Total No. respondents 250
14. If so, did you inform your physician about these changes?
        □ a. Yes 73 (55)
        □ b. No 60 (45)
    – Total No. respondents 133
15. Do you follow the recommended treatment outlined by your physician? Did you follow the advice of your physician before using the Internet?
        □ a. Always 146 (58)
        □ b. Usually 83 (33)
        □ c. Sometimes 16 (7)
        □ d. Rarely 0
        □ e. Never 5 (2)
    – Total No. respondents 250
16. For some issues, do you prefer to use the Internet rather than visit your doctor? (If no, skip to question #19.)
        □ a. Yes 55 (22)
        □ b. No 195 (78)
    – Total No. respondents 250
17. If yes, which health conditions do you look for information on? (Check all that apply.)
        □ a. Common conditions (eg, urinary tract infection, common cold, muscle injury, ear infection, etc) 42 (76)
        □ b. Chronic conditions (eg, high blood, pressure diabetes, chronic obstructive pulmonary disease, asthma, etc) 20 (36)
        □ c. Disease prevention/health maintenance issues (eg, vaccines, colonoscopy, mammogram, pap smears, etc) 30 (55)
        □ d. Cancer diagnosis and treatment 9 (16)
        □ e. Support groups for illnesses/diseases 8 (15)
        □ f. Autoimmune disease (eg, rheumatoid arthritis, lupus, thyroid disease, celiac disease, etc) 13 (24)
        □ g. Genitourinary complaints (eg, vaginal discharge, penile discharge, prostate issues, erectile dysfunction, sexually transmitted disease, pregnancy, etc) 15 (27)
        □ h. Other (please specify) 0
    – Total No. respondents 55
18. Why did you choose to use the Internet rather than see your physician?§
        □ a. Too embarrassing 3 (5)
        □ b. Too hard to get an appointment 7 (13)
        □ c. To be better informed before seeing the doctor 39 (71)
        □ d. For the ability to reference this information at a later date 20 (36)
        □ e. To ensure you are getting appropriate medical care 11 (20)
    – Total No. respondents 55
19. Which of the following Web sites have you used for health information? (Check all that apply.)
        □ a. Search engines (eg, Google, Yahoo, MSN, etc) 193 (77)
        □ b. News sites (eg, CNN, MSNBC, Fox News, etc) 34 (14)
        □ c. Health sites (eg, eMedicine, WebMD, iVillage, etc) 179 (72)
        □ d. Government health sites (eg, cdc.gov, mypyramid.gov, etc) 61 (24)
        □ e. Pharmaceutical company sites (eg, Merck, Schering Plough, Sanofi, Glaxo Smith Kline, etc) 32 (13)
        □ f. Pharmacy sites (eg, CVS, Drugstore.com, RiteAid, Walgreens, etc) 25 (10)
        □ g. Drug Web sites (eg, nexium.com, lipitor.com, plavix.com, etc) 42 (17)
        □ h. Other (Please specify) 0
    – Total No. respondents 250
20. Have you ever brought information you obtained from the Internet to a doctor visit?
        □ a. Yes 59 (24)
        □ b. No 189 (76)
    – Total No. respondents 248
21. If yes, what did you bring with you? (Check all that apply.)
        □ a. Printout from Web site 34 (58)
        □ b. Reference article 13 (22)
        □ c. Checklist related to illness/specific complaint 16 (27)
        □ d. Medication Information 16 (27)
        □ e. Advertisement 2 (3)
        □ f. Other (please specify) 8 (14)
    – Total No. respondents 59
22. If yes, do you feel your doctor responded well to that information?
        □ a. Yes 55 (93)
        □ b. No 4 (7)
    – Total No. respondents 59
23. What do you view as the most reliable source of health information? (Please choose only 1 answer.)
        □ a. My physician 242 (93)
        □ b. Internet 15 (6)
        □ c. Newspaper 0
        □ d. TV show 2 (0.5)
        □ e. TV advertisement 0
        □ f. News broadcast 2 (0.5)
        □ g. Other (please specify) 0
    – Total No. respondents 261
24. Has your doctor discussed health-related Internet use with you or referred you to specific Web sites?#
        □ a. Yes 17 (6)
        □ b. No 246 (94)
    – Total No. respondents 263
25. If yes, which site did your doctor refer you to?**
        Medical sites 1 (8.3)
        Medtronics 1 (8.3)
        Chantix.com 1 (8.3)
        Web MD 5 (42)
        cdc.gov 1 (8.3)
        eMedicine 1 (8.3)
        AMA 1 (8.3)
        Support groups 1 (8.3)
    – Total No. respondents 12
 *  Eleven respondents did not answer question 6, which likely represents patients who did not use the Internet.
   Six respondents who left question 6 blank answered “no” to question 7.
   One respondent who answered “yes” to question 13 did not answer question 14.
 §  Some patients chose more than 1 answer to question 18.
   Two respondents who answered “yes” to question 8 did not answer question 20.
   Twenty-four respondents did not answer question 23.
 #  Twenty-two respondents did not answer question 24.
 **  Question 25 was open-ended.
×
Table 2
Health-Related Internet Use Among Patients of Osteopathic Physicians: Survey Responses According to Ethnicity
Responses, No. (%)
Survey Question Caucasian African American Hispanic Asian/Pacific Islander Other All
13. Have you changed your behavior as a result of information found on the Internet? (n=250)
        □ a. Yes 100 (51) 22 (67) 3 (50) 4 (50) 3 (50) 134 (54)
        □ b. No 96 (49) 11 (33) 3 (50) 4 (50) 3 (50) 116 (46)
    – P value* .7 .19 .60 .57 .60 NA
14. Have you discussed these changes with your physician? (n=133)‡
        □ a. Yes 62 (62) 8 (36) 1 (33) 0 2 (50) 73 (55)
        □ b. No 38 (38) 14 (64) 2 (67) 4 (100) 2 (50) 60 (45)
    – P value* .29 .11 .59 .043† .59 NA
20. Have you ever brought information obtained from the Internet to your office visit? (n=248)
        □ a. Yes 54 (28) 3 (9) 1 (17) 0 1 (13) 59 (24)
        □ b. No 140 (72) 31 (91) 5 (83) 8 (100) 6 (87) 189 (76)
    – P value* .37 .049† .57 .20 .69 NA
 *  Compared to total population.
   Statistically significant.
   One patient who answered “yes” to question 13 did not respond to question 14.

Abbreviation: NA, not applicable.

Table 2
Health-Related Internet Use Among Patients of Osteopathic Physicians: Survey Responses According to Ethnicity
Responses, No. (%)
Survey Question Caucasian African American Hispanic Asian/Pacific Islander Other All
13. Have you changed your behavior as a result of information found on the Internet? (n=250)
        □ a. Yes 100 (51) 22 (67) 3 (50) 4 (50) 3 (50) 134 (54)
        □ b. No 96 (49) 11 (33) 3 (50) 4 (50) 3 (50) 116 (46)
    – P value* .7 .19 .60 .57 .60 NA
14. Have you discussed these changes with your physician? (n=133)‡
        □ a. Yes 62 (62) 8 (36) 1 (33) 0 2 (50) 73 (55)
        □ b. No 38 (38) 14 (64) 2 (67) 4 (100) 2 (50) 60 (45)
    – P value* .29 .11 .59 .043† .59 NA
20. Have you ever brought information obtained from the Internet to your office visit? (n=248)
        □ a. Yes 54 (28) 3 (9) 1 (17) 0 1 (13) 59 (24)
        □ b. No 140 (72) 31 (91) 5 (83) 8 (100) 6 (87) 189 (76)
    – P value* .37 .049† .57 .20 .69 NA
 *  Compared to total population.
   Statistically significant.
   One patient who answered “yes” to question 13 did not respond to question 14.

Abbreviation: NA, not applicable.

×
Table 3
Health-Related Internet Use Among Patients of Osteopathic Physicians: Survey Responses According to Age in Years
Responses, No. (%)
Survey Question 18-29 30-49 50-64 65+ All
13. Have you changed your behavior as a result of information found on the internet? (n=250)
        □ a. Yes 28 (47) 63 (52) 31 (62) 12 (63) 134 (54)
        □ b. No 31 (53) 59 (48) 19 (38) 7 (36) 116 (46)
    – P value* .38 .74 .35 .47 NA
14. Have you discussed these changes with your physician? (n=133)
        □ a. Yes 12 (43) 34 (54) 22 (73) 5 (42) 73 (55)
        □ b. No 16 (57) 29 (46) 8 (27) 7 (58) 60 (45)
    – P value* .39 .71 .048 .55 NA
 *  Compared to total population.
   Statistically significant.
   One patient who answered “yes” to question 13 did not respond to question 14.

Abbreviations: NA, not applicable.

Table 3
Health-Related Internet Use Among Patients of Osteopathic Physicians: Survey Responses According to Age in Years
Responses, No. (%)
Survey Question 18-29 30-49 50-64 65+ All
13. Have you changed your behavior as a result of information found on the internet? (n=250)
        □ a. Yes 28 (47) 63 (52) 31 (62) 12 (63) 134 (54)
        □ b. No 31 (53) 59 (48) 19 (38) 7 (36) 116 (46)
    – P value* .38 .74 .35 .47 NA
14. Have you discussed these changes with your physician? (n=133)
        □ a. Yes 12 (43) 34 (54) 22 (73) 5 (42) 73 (55)
        □ b. No 16 (57) 29 (46) 8 (27) 7 (58) 60 (45)
    – P value* .39 .71 .048 .55 NA
 *  Compared to total population.
   Statistically significant.
   One patient who answered “yes” to question 13 did not respond to question 14.

Abbreviations: NA, not applicable.

×
Table 4
Health-Related Internet Use Among Patients of Osteopathic Physicians: Survey Responses According to Sex
Responses, No. (%)
Survey Question Men Women All
13. Have you changed your behavior as a result of information found on the Internet? (n=250)
        □ a. Yes 49 (56) 85 (52) 134 (54)
        □ b. No 38 (44) 78 (48) 116 (46)
    – P value* .71 .84 NA
14. Have you discussed these changes with your physician? (n=133)
        □ a. Yes 27 (55) 46 (42) 73 (55)
        □ b. No 22 (45) 38 (58) 60 (45)
    – P value* .56 .56 NA
 *  Compared to total population.
   One patient who answered “yes” to question 13 did not respond to question 14.

Abbreviation: NA, not applicable.

Table 4
Health-Related Internet Use Among Patients of Osteopathic Physicians: Survey Responses According to Sex
Responses, No. (%)
Survey Question Men Women All
13. Have you changed your behavior as a result of information found on the Internet? (n=250)
        □ a. Yes 49 (56) 85 (52) 134 (54)
        □ b. No 38 (44) 78 (48) 116 (46)
    – P value* .71 .84 NA
14. Have you discussed these changes with your physician? (n=133)
        □ a. Yes 27 (55) 46 (42) 73 (55)
        □ b. No 22 (45) 38 (58) 60 (45)
    – P value* .56 .56 NA
 *  Compared to total population.
   One patient who answered “yes” to question 13 did not respond to question 14.

Abbreviation: NA, not applicable.

×