The Internet And Health : Controversies and opportunities

The Internet and Health:Controversies and Opportunities

The Internet and Health:

Controversies and Opportunities

Ignacio BasagoitiDirector de Campusalud www.campusalud.com

Proyecto Webs Médicas de Calidad www.pwmc.org


g limit the importance of topic

g incite questions

g promote considerations

g suggest, propose solutions

Objetives

Internet

Quality

Experience

Proposals

2

I am going to exclusively speak of the health information, leaving aspects like the electronic mail, the communication between health profesionals and patients, the forums and spaces of interaction and other important emergent elements like health blogs, drugs commerce and the children in the Internet


Objetives

Internet

Quality

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3

An educated health care consumer is likely to getbetter care.A “citizen-centered health system” that promotes health, requires informed patients capables to take their own decisions about your health.

tree of Knowledge

The Internet as theTree of Knowledge


Objetives

Internet

Quality

Experience

ProposalsNov 2002

0 20 40 60 80

UE

Belgica

Dinamarca

Alemania

Grecia

España

Francia

Irlanda

Italia

Luxemburgo

Holanda

Austria

Portugal

Finlandia

Suecia

Reino Unido

Nº de individuosFuente:EGM, 2003

31

43

Connected users

4


Objetives

Internet

Quality

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Proposals

ciudadanos conectados (América Latina)

http://global-reach.biz/globstats/refs.php3Octubre 2003

0 1 2 3 4 5

Total

Venezuela

Uruguay

Puerto Rico

Peru

Paraguay

Panama

Mexico

Nicaragua

Honduras

Guatemala

El Salvador

Ecuador

Rep Dominicana

Cuba

Colombia

Chile

Brasil

Bolivia

Argentina

22,8

Algunos datos

14,3

5


Objetives

Internet

Quality

Experience

Proposals

Citizen conected

22,8 + 14,3 =37,1

17

Algunos datos

44,1 millones (39,8 spanish speakers)

Nov 03

74,8 millones (60,5 spanish speakers)

20,7

6


Who, What and Why access to medical information?

Objetives

Internet

Quality

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Proposals

7

“Health seekers” — Internet users whosearch online for information on

health topics, whether they are acting asconsumers, caregivers, or e-patients



Objetives

Internet

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Eurobarometro 2003 (58.0)

Use of Internet to lookfor health information

0

5

10

15

20

25

30

35

40

45

50

UE B DK D GR E FR IR IT LX NL A P FIN S UK

8

Who?



Objetives

Internet

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9

18%

23%

28%

0% 5% 10% 15% 20% 25% 30%

2003

2004

2005

Spanish Health-Seekers os all those online, years 2003-2005.

Source: SIBIS 2004, INE 2003 & 2005

Who?Spain


Objetives

Internet

Quality

Experience

Proposals

g Number of spanish health-seekers has a continuousincrease. 28% of citizens online search the internet forhealth information.

10



Objetives

Internet

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11

Who?Spain

0

2000

4000

6000

8000

10000

12000

14000

16000Millares

Total 15-24 25-34 35-44 45-54 55-64 65-74 >74

Global use of the Internet vs search health information, last tree months, by age.

Total 15.131.420 4.207.916 4.799.150 3.382.589 1.791.724 780.737 144.617 24.685

Salud 4.255.720 867.193 1.467.377 1.161.245 516841 202288 35286 5489

Total 15-24 25-34 35-44 45-54 55-64 65-74 >74

Source: INE 2005


Objetives

Internet

Quality

Experience

Proposals


g Main number of the Internet users and health- seekersare between 25 and 34 years.

12



Objetives

Internet

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13

Who?Spain

28,13 25,8430,9

0

5

10

15

20

25

30

35

Percentage of the Internet users that search health information last tree month of whole poblation and online poblation, by gender.

% de poblacion total 4,87 9,85 9,45

% de usuarios de Internet 28,13 25,84 30,9

Total Hombres Mujeres


Objetives

Internet

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Proposals



g Women online search health information more thanmen (30,9 vs 25,8)

14



Objetives

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15

Who?Spain

0

5

10

15

20

25

30

35

Percentage users who search health information last tree years of whole population and online population by age groups.

% de poblacion total 4,87 16,15 19,07 16,3 9,15 4,36 0,92 0,16

% de usuarios de Internet 28,13 20,61 30,58 34,33 28,85 25,91 24,4 22,24

Total 15-24 25-34 35-44 45-54 55-64 65-74 >74


Objetives

Internet

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Proposals




g 34% of online users betwwen 35-44 years, searchedthe web for health information in last tree months.

16



Objetives

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17

Who?Spain

Percentage of use the Internet for search health information last tree month of all online users, by educational level.

28,13

0

16,6522,47

26,47 27,2

35,18

0

5

10

15

20

25

30

35

40

% salud 28,13 0 16,65 22,47 26,47 27,2 35,18

Todas Analfabetos E.Primaria E.Secundaria 1ª

E.Secundaria 2ª FP Superior E.Superior


Objetives

Internet

Quality

Experience

Proposals




g 34% of online users betwwen 35-44 years, search theweb for health information in last tree months.

g A higher educational level correlates a higher search forhealth information

18



Objetives

Internet

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19

Who?SpainPercentage of use the Internet for search health information last

tree month of all online users, by work situation.

28,13 29,3 26,321,8

34,19 35,23 35,22

0

5

10

15

20

25

30

35

40

% salud 28,13 29,3 26,3 21,8 34,19 35,23 35,22

Todas Activos ocupados

Activos parados Estudiantes Labores

hogar Pensionistas Otras


Objetives

Internet

Quality

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Proposals




g 34% of online users betwwen 35-44 years, search theweb for health information in last tree months.

g A higher educational level correlates a higher search forhealth information

g Housewife and pensioners online are the two groupswith highest percentages of health-seekers

20

Who, What and Why access to medical information?Who?Spain



Objetives

Internet

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21

What?



Objetives

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22

What?USA

Source: Pew Internet & American Life Project November 2004

10* 5 How to quit smoking

9 7 Problems with alcohol or drugs

13 9 Medicare or Medicaid

11 11 Sexual health information

17 15 Immunizations or vaccinations

18 18 Environmental health hazards

24 21 Experimental treatments or medicines

26* 19 Depression, anxiety, stress, mental health issues

30 27 A particular doctor or hospital

33 27 Alternative treatments or medicines

31 30 Health insurance

43 36 Prescription drugs or over-the-counter drugs

45 40 Exercise or fitness

59* 43 Diet, nutrition, vitamins, nutritional supplement

57* 46 Certain medical treatment or procedure

71* 60 Specific disease or medical problem

% of online women% of online menTopics

Health topics searched for by internet users



Objetives

Internet

Quality

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What?USA



Objetives

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24

What?USA

44% of Internet users have searched online for information aboutdiet, nutrition, vitamins, or nutritional supplements

36% have searched online for information about exercise or fitness. Internet users between the ages of 18 and 29 are the most likely to have searched for this type of information – 51%, compared to 35% of 30-49 year-olds, 28% of 50-64 year-olds, and just 13% of Internet users age 65 or older.

34% users have ever searched online for information aboutprescription or over-the-counter drugs

25% have searched online for information related to health insurance.



Objetives

Internet

Quality

Experience

Proposals

25

What?USA

80% internet users have looked online for information on at least one of 16 health topics, with increased interest since 2002 in diet, fitness, drugs, health insurance, experimental treatments, and particular doctors and hospitals.

Some demographic groups showed notable interest in specific topics – 59% of online women have read up on nutrition information online, for example, compared with 43% of online men. Thirty-eight percent of online parents have checked online for health insurance information, compared with 26% of internet users who do not have children living at home.

Pew Internet & American Life Project May 2005.



Objetives

Internet

Quality

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Proposals

26

Why?USA

Among other things, Internet users:� Research a diagnosis or prescription.� Prepare for surgery or find out how best to recover

from one.� Get tips from other caregivers and e-patients about

dealing with a particular symptom.� Give and receive emotional support.� Keep family and friends informed of a loved one’s

condition.� Find humor and even joy in a bad situation

More than half of those who recently conducted searches did so on behalf of someone else — a spouse, child, friend, or other loved one — not for themselves.



Objetives

Internet

Quality

Experience

Proposals

27

Why?USA

parents, women, healthy people, and the middle aged between 30 and 49 years old.

small group of Internet users who are living with a disability, handicap, or chronic disease.

who take care of someone living in their household

57% of those who recently conducted searches did so on behalf of someone else — a spouse, child, friend, or other loved one —not for themselves.



Objetives

Internet

Quality

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Proposals

28

Why?USA

38% of online parents have checked online for health insurance information, compared with 26% of internet users who do not have children living at home.

Caregivers who live with someone who is chronically ill or disabled, a group of searchers who make through and frequent use the Internet for health issues, are particularly likely to have searched for information about a specific treatment – 62% have done so

44% of Internet users have searched online for information about diet, nutrition, vitamins, or nutritional supplements. Some of these searches are certainly for weight management


Health Care InformationObjetives

Internet

Quality

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Proposals

29

Advantages

Accesibility to information: one of the most important aspects of online health advice is the fact that it is available at any hour of the day or night, from wherever users are able to log on.

InstantaneousComfortableConectivity (interaction space)Personalization: allows consumers to customize the

portal interface and information preferences

Anonimity: is important that Internet users can get

health information anonymously



Internet

Quality

Experience

Proposals

30

ProblemsAccesibility

oConectionoSpecial needs

All we can = noiseNot only can nearly everyone use the information, but publishing your own Web site is just as easy. This has resulted in an unprecedent proliferation of information sources on a global scale

A new religionAbsolutely trues, solution for whole problems, virtual sustitute...User mustaccept the considerable discrepancy (‘asymmetry’) in knowledge between themselves and health professionals.

CredibilityInformation sources, scientific references

Information excess–Organization chaos Where is Wally?

“Plain language” Information must be comprehensible

Cybercondriacs



Internet

Quality

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Proposals

31

ProblemsAccesibility

oConectionMore than 70% world population have no access to a telephoneline.

0

1000

2000

3000

4000

5000Millares

Home Internet conection in Spain by kind and year

2003 3.599.054 2.683.193 1.275.7902004 4.544.751 2.405.420 2.029.6522005 4.982.199 2.124.647 2.956.752

Whole homes online Phone line traditional Broadband



Internet

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Proposals

32

Problems

AccesibilitySpecial needs

oPhísicalsoCognitivesoEducacionals

Technical adaptation to ageing changes is necessary for better usability. Additionally, cognitive, psychological and social factors are just as important for optimizing access and usage of computers by the elderly population.

Low health literacy limits many users’ ability to understand what is available online



Internet

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Proposals

33

Problems

30 march 2006

Health .................... 4.220.000.000

Salud ....................... 136.000.000

Medicine................. 1.170.000.000

Searching for information has become more difficult, and the quality of search results is often disappointing



Internet

Quality

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Proposals

34

Problems

Plain language” Information must be comprehensible.

Consumer health information should be written at a comprehensible reading level; often patients want pragmatic information sauch as how long their illsnesswill prevent them from working, before scientific details



Internet

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Proposals

35

ProblemsCyberchondriacs

FREQUENCY OF ACCESSING HEALTH INFORMATION ONLINE: 1998-2005"How often do you look for information online about health topics – often, sometimes, hardly ever or never?"Base: Have access to Internet

72747880757471

Total who have ever looked for health or medical information

58505453464342

Total who have looked for health or medical information sometimes or often

29262220252629Never

14242327303129Hardly ever

33313735303030Sometimes

25191718161312Often

%%%%%%%

2005200420032002200119991998



Internet

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35

Problems

Cyberchondriacs

•Although the total number of adults who have looked Health information online there are decreased, the frequency with which the North American users consult the pages Web that offer health contents increases.

•Thus, 58% of the interviewed people whom they have access to Internet recognize that it looks for this class of information "some times" or "often", 50% as opposed to that it consulted these news year the past.

Adults who now look for medical data or on sanitary cares assiduously do it more than in previous years.



Internet

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36

Solutions

accesibility

□The European Commission has been active in establishing quality criteria for Health related websites and accessibility of web sites. Patients who seek online health information may have a variety of physical impairments, and its important to develop resources that are usable by individuals with disabilities. □The Web Accesible initiative (WAI) and the spanish UNE 139803, provides guidelines for assuring broad accesibility to Internet Based Information.



Internet

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37

Solutions

credibility

Self- regulaing policiesThey are the rules and guiding principles a health site follows with respect to privacy, security, editorial, and advertising. Their main problema are that often are posted as footnotes –so consumers may be unaware of their existence- , are self-proclaimed, and are not standardized.

Source disclosure.By using high-quality sources, a health site can demonstrate it has the ability to gather, organize, and present quality health information and add value for consumers. If consumers trust most of the sources used by a health portal, they are likely to transfer that trust to the portal itself.



Internet

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Proposals

38

Solutions

The search engines, on the heels of the Web, realized that they have a real stake in making sure the results of their searches are relevant, reliable and trustworthy. Rather search engines (not specialized) promoting trustworthy health and medical sites such as Kosmix.com, mamashealth.com, Webmd.com and Healthline.com whith “touts sites that have been accredited by online Web ethics committees like the Health on the Net Foundation.”

Acredited Search Engines


g Authority, Transparency and Honesty

g Contents: gtrustworthy, gupdated, glegible, gadapted to the receiver

g Orientación:g receiver information,g segmentation(patients vs profesionals)g disclaimers,g contact facilities,g usability

• eHealth

• Hon Code

• Discern

• IHC

• pWMC

• WMA

iniciativas

Objetives

Internet

Quality

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39


iniciativesObjetives

Internet

Quality

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Proposals

40

WMA

PWMC

HON PRINCIPLES (*)

eEUROPE 2002 QUALITY CRITERIA (*)

1 2 3 4 5 6 7 8

1 2 3 4 5 6

PWMC

eEurope: Transparency and Honesty / Authority/ Privacy / Updating / Accountability / Accesibility

HON: Authority / Complementarity / Confidentiality / Attribution / Justifiability / Authorship / Sponsorship / Editorial policy .

WMA


una duda ...

Who must assume responsability offer health information online to citizen?

g goverment institutions

g medical societies and organizations

g patient associations(asoc. enfermos, autoayuda...)

g profesional staff

Objetives

Internet

Quality

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41


...What sources of information trust european citizens?

Objetives

Internet

Quality

Experiences

Proposals84,4

67,2

65,5

39,3

23,4

22,9

10,7

0 20 40 60 80 100

Medical societies

Org consumidores

Universities

Mass Media

Goverment

Org religious

Political org

Eurobarometro 2003 (58.0)

una duda ...

42


Objetives

Internet

Quality

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Proposals

En la mejora de calidad ...

proyect Webs Médicas de Calidad (pWMC)

43


proyecto Webs Médicas de Calidad (pWMC)Objetives

Internet

Quality

Experience

Proposals

An inter-institutional iniciative with an importantPresence of scientific organizations (TSB, AEP...)

An rigurous acreditation of the Internet resources, since ethic and usability perspective

Is ....

Look for ...

Seal

44


Internet presence

Objetives

Internet

Quality

Experience

Proposals

Online education?

E-journal ?Campusalud vs

TSBsalud

web TSB

45

Campusalud Prof

Educaensalud ?

Experts group NTSpWMC

Accesibility plans


Objetives

Internet

Quality

Experience

Proposals

46

A Patients Virtual Library

Access to credible and comprehensible health informationEvidence based informationDocuments offers by prestige organizationsUser friendly and accesible toolsFree log inPattern standard defined by BIREME-PAHO/WHO

A reference site where obtain trustworthy health information for citizens who consume that like for professionals who must provide it


Objetives

Internet

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Proposals

Conclusion

47

Finding relevant information and ascertaining its

trustworthiness are two inseparable concepts necessary

for the web to flourish as an unpredecedent source of

knowledge and continue in helping ill patient or citizen to

stay healthy


Thank you!!

Health & Medicine

The Internet And Health : Controversies and opportunities