H Khan, C Pasapula, B Hayee, T Al-Mishlab
colo-rectal outpatients, health information, internet, survey
H Khan, C Pasapula, B Hayee, T Al-Mishlab. Survey Of Internet Use To Access Health Information Amongst Patients Attending A Colo-Rectal Clinic. The Internet Journal of Surgery. 2002 Volume 5 Number 1.
Background: Internet use to gain general information is common. Our survey aimed to confirm its use in gaining health information amongst those attending colo-rectal outpatients.
Patients / Methods: All patients attending colo-rectal outpatients in a district hospital over a 6-month period were asked to complete a questionnaire detailing their age, sex and occupation. Data regarding certain aspects of Internet use and health information were also sought.
Results: 351 questionnaires were completed (72%) Mean age was 56 and sex ratio equal. Only 31% had access to the Internet, commonly from home. Although 138 subjects were aware that health information was available on the Internet, only 35 (10%) would seek this information. There were no differences in the sexes. Very few (14) had sought any information prior to their current hospital visit. Information gained was generally regarded as being less useful compared to specialist advice.
Age group analysis showed no difference in awareness between the under forties and over sixties. However there is a significant difference in accessing this information between the two groups (p < 0.0001)
Conclusions: Although awareness of health information on the Internet is common, accessing this information is still relatively uncommon. The young are more likely to access this though there is no sex bias.
In the United Kingdom about 40% of the UK population have access to the Internet. The Internet is devoid of boundaries; therefore information hosted on servers in other countries is available throughout the United Kingdom. In the US alone there are 20,000 healthcare related web sites with about 1500 new sites created per month . In a recent survey they showed that 22 million people in the US had access to the internet  and that up to 50% of patients use the Internet to retrieve health information [2,3]. This may be a reflection of the way that health information is funded in the United States with a resultant increase in health awareness and access. The majority of this information is supplied by commercially available web services.
The purpose of this study was to investigate the uses of the Internet in our patient group attending colo-rectal outpatients and to investigate people's awareness of the Internet with respects to health information prior to consultations.
Methods and Materials
A survey was carried out into the use of the Internet to gain health information in our district general hospital. The study population consisted of all patients attending colo-rectal outpatients only as all co-authors were working within a colo-rectal speciality, within a period of 6 months from February 2000 to August of the same year.
All patients were given a questionnaire prior to their consultation and asked to return them completed after it. The questionnaire detailed patient profile such as age, sex and occupation.
Data regarding the awareness of health based Internet web sites were sought as well as the use of the Internet to access to these sites. Comparisons between the information gained via the Internet and the patient's recent consultation with the clinician were also sought in the questionnaire. All patients were asked to grade their use of the Internet as mild, moderate or frequent. The overall frequency of usage and whether age, sex or social background made a significant difference was calculated. Analysis was with the use of odds ratio and Fishers Exact test for non-parametric data and the student t test for parametric data. A p value of 0.05 was considered significant. All results were analysed with the SPSS commercially available software using Excel as the data source.
Of the 486 questionnaires issued 351 were completed. This represented a 72% completion rate. Mean age of the study population was 56 (S.D. 18.02). Sex ratio of the respondents was equally distributed. Overall 31% of patients had access to the Internet, most commonly from home (69%). Work was the second most common site to access the internet (22%).
39% of patients were aware that health information was available on the Internet. There was no statistical difference in the awareness when comparing sexes. There was no statistical difference when comparing different age groups.
However there was a difference in patients accessing health information. Whilst there was no statistical significance when comparing 40-60 year olds to the over 60s and under 40s, there was a difference in comparing the <40 year olds to the >60s. The younger age group (20-40 year olds) was accessing health information more (53% Vs 12%; P<0.0001). This access was from work (25%) as well as home (58%).
However, very few patients accessed the Internet prior to their current visit. Only 14 patients of any age sought any information prior to their consultation. The average age of this group was 43 (CI 32.09-54.02). This was significantly younger than the mean age of the study population (56; P<0.0001). All except one patient were classified into social class 3 or less.
None of these patients found the Internet more informative than the consultation or specialist advise. All patients preferred consultations with a clinician to the information gained from the internet.
In the new millennium, the Internet has become the dominant medium for sharing information. As such, in the US the Internet has surpassed newspapers and magazines in annual capital media consumption. 
Despite the demonstrated education potential for the use of the Internet in other parts of the world and the increase usage the Internet is underused as a medium to access health information  as demonstrated in our study.
Accessibility and awareness of information are important factors in evaluating the effectiveness of any medium of communication. Our study revealed that there was an access problem with 31% having access only. Also there is a lack of awareness of information on the Internet. This may be due to the lack of resources and education on the patient behalf but the Internet is a constantly evolving medium, web site addresses frequently change and it is up to the host to constantly upgrade sites and advertise them. This must be done to maintain the appeal to the individual consumer or user.
There are also issues of reliability and confidentiality and security for interactive web sites. There is limitation of our study in its application to all patients in all regions. More information needs to be available, maybe to be advertised by the NHS with regards to good web sites. This will increase the overall education of the country. When comparing the use of the Internet in the United Kingdom to the US there is an increased self-education and awareness of Internet use in the United States. This may reflect the variation in the way that health service is funded in the U.S. where cost is incurred to the patient forcing them to educate themselves.
In conclusion although our study was limited to a single department in a single region we do conclude that there needs to be an increased usage of the Internet and both access and awareness needs to be targeted to achieve this. The Internet will be an increasingly used medium but despite this it is not a substitute for consultations where one to one access and up to date information and doctor patient relationship can be established.
Dr Hamed Khan
Clinical Research Fellow
University of Nottingham