Authored by Parivash Badar
According to the World Health Organization, health has been
defined as “a state of complete physical, mental and social wellbeing
and not merely the absence of disease or infirmity” [1]. Health
websites are an internet-based source providing information
regarding all aspects of medicine. In recent years, with increasing
numbers of people using the Internet, health websites have gained
tremendous popularity. An article published in 2009 says, 51%
of adults in the ages of 18-64 in the US had used the Internet to
look up health information [2]. An article published in the Health
Informatics Journal that compared the use of information on
the internet during 2000 and 2006 states that there has been a
dramatic and significant increase in the number of people using
using the internet for information regarding their health by 39%
[3] According to an article, “more than 70,000 websites disseminate
health information” with over “50 million people seeking health
information online” [4]. People are making use of health websites
for various reasons including academic, health awareness and
general knowledge. Patients use health websites to learn more
about their illnesses. A joint report released by the Council on
Ethical and Judicial Affairs (CEJA) says that “Informational websites
often provide a wide range of information including information
related to physicians’ practices, or information regarding certain
medical conditions or specific treatment options” [5].
According to a research analysis conducted by the Pew and
American Life Project Fully 80% of adult Internet users, have
searched for at least one of 16 major health topics online [6]. People
have access to causes and symptoms of different diseases, types
of medicines, and other treatment plans. There are now websites
that cater to specific diseases that have been setup by different
sources such as patients or charities [7]. Furthermore, patients can
find answers to the daily health issues they are facing such as side
effects or complications of medical therapy [8].
The proportion of internet users in Pakistan is on a steep rise.
During the years 2009 to 2013, 10 out of every 100 individuals,
according to the World Bank [9], are internet users. Thus more
people have access to health websites but no significant local
research has been done regarding it. One study carried out in
Pakistan focused only on Pakistani Health Websites found that
the number of websites that provide health information and the
number of people using and supporting them have increased in
recent years [10] We felt that further exploration of this aspect
of online consumer health information is becoming increasingly
relevant. Donald Mackay wrote, “It includes information on specific
illnesses and conditions, on good health and the prevention of ill
health in general, and information to enable us to make informed
choices about medical treatment” [11]. According to the CEJA
report, “Health-related websites offer a wide range of information
and services and are used by health professionals, patients, and
the public with increasing frequency” [12]. With such convenient
access the use of health websites, may have several disadvantages
including self-medication, access to inaccurate information fall in
the number of patient visits to physicians.
A. To assess the pattern of usage of health websites among
individuals.
B. To assess the frequency of usage of health websites in
patients with long-term diseases.
C. To find out the frequency of self-medication in frequent
users of health websites.
We conducted a cross sectional study using a web based survey.
We assessed the patterns of use of health websites usage among
individuals. We also assessed the association of health website
usage to the frequency of visits to different health websites in a
year. The sample was selected by convenience sampling. A total of
512 samples were included in the study. The respondents answered a
self-administered questionnaire on the Internet. Data collected
was analyzed using SPSS 20 software. Participants who have used
health websites more than 3 times in the past year, for any reason
were included in the study. The questionnaire consists of __ number
of questions. Questions regarding demographic variables, Internet
accessibility, reasons for usage of health websites, perception of
information of health websites, general opinion of health websites
and abuse of health websites were asked. The questionnaire was
in English. Consent was taken before the respondents fill the
questionnaire.
A total of 512 respondents participated in the survey. Out of
512, 10 people did not give their consent so were excluded from the
study. The demographic variables of the other 502 respondents are
given in Table 1. All the respondents were asked about the usage
of health websites. 43% (n=217) of the respondents reported that
they do not use health websites Figure 1 for varying reasons such
as having no need to do so. Out of the 57% (n=285) who used
health websites, the majority (31%) reported that they accessed
health websites less than once a month. 95% (n=271) of these
respondents found health websites beneficial and 75% (n=214)
of them said that they changed their health behavior after reading
information on health websites.
From the 285 respondents who use health websites, 271 of
them (95%) found that their experience on the health website
was helpful. The younger age groups were seen to access Health
Websites more frequently than the older age groups with 26%
(n=131) aged between eighteen and twenty four years and 16%
(n=81) aged between twenty five and thirty four years. It is seen
that people who have received a higher education were more
likely to access health websites, 18.7% (n=94) having done their
Bachelors and 16.9% (n=85) did their masters and further.
The main reason respondents were using health websites
was for their personal health education (28%). Figure 2. Some
wished to learn more about certain diseases for the benefit of
family members suffering from said diseases, others were students
carrying out research for their own knowledge, and some just
visited health websites for General reading (16%). From the 502
consenting respondents, 412 of them were not suffering from a
chronic disease. 90 respondents were suffereing from one of the
below mentioned chronic diseases. Out of 90, 27(30%) did not use health
websites, whereas 63(70%) of the respondents did use them
Figure 3. 90 respondents suffered from a chronic disease such as
Hypertension (20%), Diabetes (10%), Asthma (12%) and various
other diseases. 78% (n=70) of these 90 respondents said that
Health Websites helped them better understand their disease.
There was a significant proportion of people using health
websites for self medication with the majority of them (75%) doing
so one to three times in the previous year Figure 4. Results were
insignificant for different age groups. Out of the 502 respondents,
59% (n=295) believe that people are more likely to resort to self
medication after reading information on health websites. 357
(71%) of the respondents said that they did not discontinue any
drug after learning about its adverse effects on a health website.
121 of the 502 (42%) consenting respondents visited health
websites before consulting a physician. Some of these experienced
a change in their anxiety level whereas some felt no change at
all Figure 5a. Out of those who visited health websites before
visiting consultants, 71% (n=86) shared the information that they
discovered online with their physicians Figure 5b. From these
25 respondents felt a decrease in anxiety level, 24 an increase in
anxiety level, and 37 of the respondents felt no change at all.
The use of health websites in a wide scope is distinctive [6]. It
is a convenient tool that combines diverse pieces of information for
specific and personal use and hence we see the trend of consumer
use and demand to increase rapidly over a small amount of time [7,
9]. The focus of these websites is on the information structure that
aims to empower consumers to manage their own health without
the need to visit a licensed practitioner [9]. Its prime objective is
therefore, to reduce the knowledge gap between a professional
and a layman [7, 13]. An overburdened practitioner and medical
facilities now have the opportunity to link with other institution
that can fill the roles of information providers for their patients [14,
15]. The invent of health websites during the past few years have
led to an increase in social awareness amongst the masses and it is
seen that people have started to take more interest in their health
related issues [13]. People now have a wide access to hundreds
of medical journals and experts advice from all over the world
combined and put together in one single website as compared to the
past where a licensed physician was their only source of knowledge
[15]. This mass demand has led to the embellishment of these
websites into various types: general health information provision
sites, disease-specific sites, interactive patient group websites,
scientific databases, and many other web tools [7]. However, the
central focus of these websites is to serve a layman, they have
progressively become more need-specific and hence allowing easy
and convenient access to people [5].
Physician consultation time for a specific patient is calculated
within about eight to eleven minutes on average due to the
increasing burden on the doctors [16], this has lead to the sudden
urge for more information by the patients [14]. The cost and time
of visiting a licensed medical practitioner may seem unaffordable
for many patients especially those in the rural areas of Pakistan,
if they do not consider the illness or condition serious enough
[17]. Managed care and other health providers see consumer
health information as one tool to help improve patient satisfaction
and reduce costs [18]. It also aims to support education, decision
making, communication, and many other aspects of professional
activity between the patient and the physician [13] It is easier to
be situated at the comfort of your house and looking up certain
condition and getting simple answer, convenience being the major
advantage of health websites [9].
However, the information provided by these websites is not
reviewed by an expert and lacks comprehensive coverage, some
of these websites are not even updated regularly and thus fails to
provide current information [10, 12]. An ordinary man is likely to
fall prey to misdiagnosis when he is made to believe that a particular
condition is treatable when it is not, or a particular disease is not
treatable when it in fact it is [9]. It is therefore often considered
as misleading and outdated [11]. This is only a great advantage
to the physician as he is protected from medical malpractice and
incompetence in the future [7]. Regardless, of the large number of
people resorting to health websites as an alternative there are still
quite a few number of people who still consider their physicians the
only reliable source and hence it is essential that their physicians
should ask them about Internet use and counsel them about where
to find reliable, accurate, high-quality health information and
facilitating mutual support [15, 13].
The agencies marketing these websites have a few basic
agendas upon which they hope to sell this product to its consumers
[15] The major aim is to satisfy the need of a curious, ordinary
man and hence, a sense of responsibility has been seen to emerge
within the masses to take an active role in their healthcare [18, 15].
The use of these websites have therefore, started to raise issues of
‘consumerization’ and ‘responsibilisation’ [7]. The question arises;
Is an ordinary man cajoled into this? This has made very easy to
label people as ‘hypochondriacs’ who affiliate themselves with
signs and symptoms they may not even have just by reading the
detailed reports present online [11]. These are some social and
ethical issues that may be posing some detrimental personal issues
within the consumers [19].
In Pakistan, obtaining drugs from a pharmacy without a
prescription is quite easy. And hence the list of over the counter
drugs is large and amendable according to ease. The only aspect
holding people back is possibly the correct drug name. This is no
longer difficult since health websites provide proper treatment
plans with dosage and frequencies to their consumers. And hence,
the biggest potential hazard imposed by the increasing use of
health websites is the increasing trend of self-medication amongst
the masses. The recreational use of certain medications such as
sleeping pills and ADHD drugs by the youngsters has also led to an
uprising of major social issues of dependence and liability amongst
the youngsters.
WHO defines self-medication, as “medication that does
not requires a medical prescription and which are produced,
distributed and sold to consumers for use on their own initiative”
[17]. Promotional messages through the internet sell medicines
as just another consumer product however the patient may be
mislead into buying a medicine that he/she may not have the full
knowledge of [7]. A group of evaluation studies done to estimate
the type of information wanted by the consumers stated that it
appeared that the consumers did not know what to ask and how to
ask it, spell it, abbreviate it or what is the logic or general to specific
[3]. A layman reading pharmacokinetics and pharmacodynamics
of a drug will not be able to comprehend the different interactions
a drug is likely to have with other medications or the diet the
patient may be taking, safety in pregnancy and lactation, use in
children and the elderly, driving, working conditions compared to
the more controlled prescription given out by the doctor [17] This
failure to recognize contraindications, interactions, warnings and
precautions may lead to the severe side effects and an increase in
the levels of drug induced diseases in a community [18].
Health websites are definitely a very convenient and purposeful
source of information, and they have played a great role in reducing
the patient physician knowledge gap. They have allowed a layman
to take an active role in regulating his personal health and thus
reducing the burden of malpractice or incompetence on the
medical practitioners. However, in the shadow of its ease the health
websites have carved paths misdiagnosis and self-medication, increased over the counter drugs consumption and dependence
and liability in the masses. These are some emerging threats that
are detrimental to the masses, socially and personally
With increased access to the Internet and online health
information, there is a rise in the number of patients having
acquired knowledge about their ailments, diseases and treatments.
However, whether this knowledge is beneficial or harmful is still
up for debate. Our research showed that 75% of the respondents
found the use of Health Websites to be valuable.
None.
No conflict of interest.
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