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In association with Simon Fraser University & the Vancouver Coastal Health Research Institute

There is a Whole Lot of Searching Goin’ On: Health Information Seeking Practices of Canadians Presentation for the Canadian Communication Association June 3, 2005 ACTION for Health Document Status:

Published Paper Pract i t ioner’s Pointers

Working Paper Brief ing Note

Report Research Tool

Draft Overview

Presentat ion Other Prepared by: Judith Krajnak Post Doctoral Fellow University of British Columbia Document Contact: Ellen Balka School of Communication Simon Fraser University 8888 University Drive Burnaby, BC, Canada V5A 1S6 tel: +1.604.725.2756 email: ellenb@sfu.ca website: www.sfu.ca/act4hlth/ SFU Institutional Repository: http://ir.lib.sfu.ca/handle/1892/3701

There is a Whole Lot of Searching There is a Whole Lot of Searching GoinGoin’’ On: Health On: Health Information Seeking Practices of CanadiansInformation Seeking Practices of Canadians

Judith Judith KrajnakKrajnakPostdoctoral FellowPostdoctoral FellowACTION for Health ProjectACTION for Health Project

Web study results presented on behalf of the Quality ImprovementWeb study results presented on behalf of the Quality Improvement of Literacy, of Literacy, TelecareTelecare and Self Help and Self Help (QUILTS)(QUILTS) Collaboration and the BC Ministry of Health Collaboration and the BC Ministry of Health

June 3, 2005 – Canadian Communication Association

OverviewOverview

Review health information-seeking patterns of Canadians

Review findings of BC Ministry of Health self-care web site survey

Explore how might information providers communicate more effectively with health care consumers

Policy implications to consider when designing web sites

SearchinSearchin’’ StatisticsStatistics……

BC has the highest level of Internet usage in the Country71% of BC households were regular users (2003)

Up 23% from 1999

Rates similar in Alberta (69%)Ontario (68%)

Lowest rates were found in New Brunswick (53%)Quebec (66%)

Still Broad Still Broad ““Digital DivideDigital Divide””

Among households earning $70+Almost all (90%) used the Internet

In households earning less than $23,000Only about a third (35% used the Internet)

This rich/poor gap has increased from 1999 to 2003

No difference in health-seeking patterns by income once a person has online access

““CyberchondriacsCyberchondriacs”…”…what are they looking for?what are they looking for?

Top three medical conditions researched on-line are:DepressionArthritisDiabetesNext come…allergies, migraine headaches & heart conditions

Six in ten say that they feel comfortable using drugs prescribed by a physician29% percent say they would stop taking the drug if they found negative information online

Canadians are divided on the question of whether drug advertising is a “good source of information”

Quasi-sites add to this confusion…look like a health information site, but actually sponsored by drug company

NFOCF group, 2002

Reasons for Accessing Internet Reasons for Accessing Internet -- All HouseholdsAll Households

Email = 52%General browsing = 49%Accessing medical/health info =36%Travel information/arrangement = 34%Government information = 32%View news = 30%Electronic banking = 30%Find sports-related info = 25%Purchasing goods/services = 19% (Stats Can, 2004

report)

The The BC BC HealthGuideHealthGuide ProgramProgram

BC HealthGuide Handbook400 page handbook distributed free of charge to BC households (Spring 2001)

French language version (2004)First Nation Handbook (2003)

BC HealthGuide HealthFiles170 fact sheets with information on a wide range of health & safety issues

BC NurseLine (24/7 access to nurses) BC is one of 8 CDN jurisdictions providing services

BC HealthGuide Online (www.bchealthguide.org)3,000 common health concerns, including tests, procedures and other resources

Health InformationHealth Information’’s Role in Primary Care Experiences Role in Primary Care Experience

Source: QUILTS evaluation framework report

BC BC HealthGuideHealthGuide Program GoalsProgram Goals

Program goals include:

Improve consumer access to timely and accurate health information and

advice

Expand consumer knowledge in managing personal health risks and

conditions

Alleviate pressure on emergency and physician services due to

inappropriate use

Reduce costs due to inappropriate use of health care system

BC BC HealthGuideHealthGuide Research Strategy (Web Site)Research Strategy (Web Site)

4-Prong Research StrategyFocus groups

– Involved both English speakers/multi-lingual speakers – Who is using/not using?– Navigation patterns– Included physicians (both FP and ER)

Population-based telephone survey– Gauge awareness

Pop-up web survey– Develop profile of users

Key informant interviews of health care professionals– Are they aware of web site?– How do they use it, compared to their use of the printed materials?

BC BC HealthGuideHealthGuide OnLineOnLine (entry page)(entry page)

Navigating BC Navigating BC HealthGuideHealthGuide OnLineOnLine

Navigation on BC Navigation on BC HealthGuideHealthGuide OnlineOnline

BC BC HealthGuideHealthGuide Online Online

805,

535

727,

242

583,

161

829,

908

877,

607

924,

716

994,

971

1,07

2,70

9

1,04

1,42

3

1,30

9,81

6

1,10

1,01

0

1,20

7,60

4

1,01

7,07

3

1,23

5,42

2

1,29

8,30

4

1,18

6,61

7

1,25

3,84

8

1,33

4,86

6

1,52

7,41

1

1,68

4,08

6

1,63

5,40

7 1,98

8,75

3

1,78

0,77

1

273,

124

270,

460

164,

828

156,

847

223,

712

-

500,000

1,000,000

1,500,000

2,000,000

2,500,000

2001

2002

Jan-0

3Feb

-03Mar-

03Apr-0

3May

-03Ju

n-03Ju

l-03

Aug-03Sep

-03Oct-

03Nov-03Dec-0

3Ja

n-04

Feb-04

Mar-04

Apr-04

May-04

Jun-04

Jul-0

4Aug-04Sep

-04Oct-

04Nov-04Dec-0

4Ja

n-05

Feb-05

Total document views to date: 28,507,231

Source: BC Ministry of Health

Focus Group ResultsFocus Group Results

10 consumer groups held throughout the province

Included both users of the program & non-users

Navigation patternsMajority use search engine (e.g., Google, MSN, Excite)Web sites accessed included:

– Ask Jeeves, Medline, Mayo Clinic, WebMD– Low awareness for BC HealthGuide, and government-

sponsored web sites in general (about 1 in 10 were aware of the web site)

Evaluation of information foundUsing multiples sitesUsing credible sites

Use of Information During PhysicianUse of Information During Physician’’s Visits Visit

Does information affect an office visit?

Physicians are “not happy”Esp. “older physicians”

Questions competencyExpected that the physician already knows the info

Disincentive for physicians to support programs like the BC HealthGuide Less business

Consumer strategy – “hide” the written information, but bring up what

they know in the conversation

Population Based Telephone Survey ResultsPopulation Based Telephone Survey Results

Findings related to the BC HealthGuide Online:

Used by 4% of British Columbians in the last year

Utilization highest amongMenYounger persons (18-34)Higher-income households (over $30,000)

BC HealthGuide Program Component Awareness & UtilizationBC HealthGuide Program Component Awareness & Utilization

0%10%20%30%40%50%60%70%

% B

C P

opul

atio

n

Handbook

NurseLine

OnLine

HealthFiles

AwareUsed

Source: QUILTS Evaluation Team, telephone survey, Jan 04

Geographic Distribution of Awareness/Usage of Web SiteGeographic Distribution of Awareness/Usage of Web Site

IHA FHA VCH VIHA NHA

0%10%20%30%40%

50%

60%

70%

80%

% B

C P

opul

atio

n

UsedAware

Source: QUILTS Evaluation Team, telephone survey

BC HealthGuide Web SurveyBC HealthGuide Web Survey

Pop-up survey ran on web site from mid September 2004 through

February 1, 20055,800 individuals were presented with survey Completed surveys = 2,927 (50% response rate) Convenience-based sampling as users of the site self-selected into our survey

User Profile76% of respondents were femaleMost users (93.5%) were between 20 to 65 years old

– Over 65+, more evenly divided by sex

With Respect to BC PopulationWith Respect to BC Population

Over- and Under-Representation among BCHG Online Users

0

5

10

15

20

25

30

35

40

Interior Fraser Vancouver Coastal Vancouver Island Northern

Health Authority

Perc

enta

ge o

f Tot

al G

roup

BCHGOL UsersBC Pop (2003)

Users over-represented on Vancouver Island and the NorthQuestion is…what makes this so?

Source: QUILTS evaluation team, Web Survey

BC BC HealthGuideHealthGuide Online By Sex and AgeOnline By Sex and Age

Percentages of Female and Male Respondents - by Age Group

0

10

20

30

40

50

60

70

80

90

10 to 19 20 to 39 40 to 64 65 Plus

Age Group

Perc

enta

ge o

f Tot

al G

roup

FemaleMale

Source: QUILTS evaluation team, Web Survey

BC BC HealthGuideHealthGuide Online User ProfileOnline User Profile

About half of users (46%) had children under 19

14% of users were practicing health care professionals

87% had some college education or better39% had finished university

80% reported earnings of $30K or more

About 50% never visited site previously in the last 6 months So…lots of new users. Question is will they return?About 30% had visited between 1 to 3 times9% had visited 8 times +

SelfSelf--Report Quality of Health of UsersReport Quality of Health of Users

Percentages of Self Rating of Health

0

10

20

30

40

50

60

70

80

90

100

10 to 19 20 to 39 40 to 64 65 P lus

Age G roup

Perc

enta

ge o

f Tot

al G

roup

Excellent, Very G ood, and G oodFair and Poor

Source: QUILTS evaluation team, Web Survey

Types of Health Information SoughtTypes of Health Information Sought……

Types of Information Sought

0

200

400

600

800

1000

1200

1400

1600

1800

Lates

t hea

lth ne

ws

BC Hea

lthGuid

e Prog

ram

Well

ness

and d

iseas

e prev

entio

nPreg

nanc

y

Genera

l men

tal he

alth

Genera

l phy

sical

healt

h

A spec

ific he

alth p

roblem

Alterna

tive a

nd co

mplemen

tary t

herap

iesPres

cripti

on dr

ugs

OTC or no

n pres

cripti

on dr

ugs

Medica

l or la

borat

roy te

sts an

d x-ra

ysSup

port g

roups

Acces

sing h

ealth

servi

ces

Loca

tion o

f hea

lth se

rvice

s

Other

Type of Information

Res

pons

e co

unt

List of Health Problems Searched List of Health Problems Searched ……

Abdominal painBack painCancerChest painChicken poxFluHeadacheHeart problemsDiabetes , etc.

42% of all responses

Satisfaction

• Younger users (10 – 19y) least satisfied• Only 63% of this age group liked the site design

Satisfaction with Aspects of the Site - by Age Group

60

65

70

75

80

85

90

Info easy to find Info clear &understandable

Pages downloadedquickly

Liked site design Overall was satisfied

Feature

% A

gree

+ %

Str

ongl

y A

gree

10 to 1920 to 3940 to 6465 plus

Pick the Low Hanging FruitPick the Low Hanging Fruit……

Determine who is currently using your site, and design your information to target their needs in the short run

Young people/familiesHigh expectations for web sitesWork with existing health care agencies

Health care professionalsAssist those who might encounter computer access issues

Choose general “key words” to enable more users to find your web site

Pick the Low Hanging FruitPick the Low Hanging Fruit……

Untapped audiences that are using the web…

College students/young adultsHow best to reach this group as they approach entry into the “real world”?In the case of BC HealthGuide, once they move out of the parents’house, lose access to their copy of print guide

WorkersHard to targetHealthy workforce = happy employers (?)Is there interest by employers?

One day, access to health information in pharmacies (similar to blood pressure machines)

Policy ImplicationsPolicy Implications

Recognize that the Internet is not a substitute for other forms of information for all populations

Investment in other forms of information delivery aimed at less

educated, less affluent Canadians, and those with literacy barriers, is

essential to universal, equitable health care.

Targeting seniors via the Web continues to be a challenge

Rural/remote access, while there in theory, still is a challengeComputer sites in libraries are often very busyLittle privacy

“The hardest thing is to pick it [Handbook] up and read it, rather than asking the person next to you”

Quote from Focus group participant

AcknowledgementsAcknowledgements

I’d like to acknowledge the contributions and support of the following individuals:

Kevin Brown, Director of BC HealthGuide program

Irv Rootman, Leader of the BC HealthGuide evaluation

Jeanne Legare, Project Director, QUILTS collaboration