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PubMed2004

Internet versus mailed questionnaires: a controlled comparison (2).

BACKGROUND: Low response rates among surgeons can threaten the validity of surveys. Internet technologies may reduce the time, effort, and financial resources needed to conduct surveys. OBJECTIVE: We investigated whether using Web-based technology could increase the response rates to an international survey. METHODS: We solicited opinions from the 442 surgeon-members of the Orthopaedic Trauma Association regarding the treatment of femoral neck fractures. We developed a self-administered questionnaire after conducting a literature review, focus groups, and key informant interviews, for which we used sampling to redundancy techniques. We administered an Internet version of the questionnaire on a Web site, as well as a paper version, which looked similar to the Internet version and which had identical content. Only those in our sample could access the Web site. We alternately assigned the participants to receive the survey by mail (n=221) or an email invitation to participate on the Internet (n=221). Non-respondents in the mail arm received up to three additional copies of the survey, while non-respondents in the Internet arm received up to three additional requests, including a final mailed copy. All participants in the Internet arm had an opportunity to request an emailed Portable Document Format (PDF) version. RESULTS: The Internet arm demonstrated a lower response rate (99/221, 45%) than the mail questionnaire arm (128/221, 58%) (absolute difference 13%, 95% confidence interval 4%-22%, P<0.01). CONCLUSIONS: Our Internet-based survey to surgeons resulted in a significantly lower response rate than a traditional mailed survey. Researchers should not assume that the widespread availability and potential ease of Internet-based surveys will translate into higher response rates.

Adult↗

PubMed2005

What Internet services would patients like from hospitals during an epidemic? Lessons from the SARS outbreak in Toronto.

BACKGROUND: International health organizations and officials are bracing for a pandemic. Although the 2003 severe acute respiratory syndrome (SARS) outbreak in Toronto did not reach such a level, it created a unique opportunity to identify the optimal use of the Internet to promote communication with the public and to preserve health services during an epidemic. OBJECTIVE: The aim of the study was to explore patients' attitudes regarding the health services that might be provided through the Internet to supplement those traditionally available in the event of a future mass emergency situation. METHODS: We conducted "mask-to-mask" surveys of patients at three major teaching hospitals in Toronto during the second outbreak of SARS. Patients were surveyed at the hospital entrances and selected clinics. Descriptive statistics and logistic regression models were used for the analysis. RESULTS: In total, 1019 of 1130 patients responded to the survey (90% overall response rate). With respect to Internet use, 70% (711/1019) used the Internet by themselves and 57% (578/1019) with the help of a friend or family member. Of the Internet users, 68% (485/711) had already searched the World Wide Web for health information, and 75% (533/711) were interested in communicating with health professionals using the Internet as part of their ongoing care. Internet users expressed interest in using the Web for the following reasons: to learn about their health condition through patient education materials (84%), to obtain information about the status of their clinic appointments (83%), to send feedback to the hospital about how to improve its services (77%), to access screening tools to help determine if they were potentially affected by the infectious agent responsible for the outbreak (77%), to renew prescriptions (75%), to consult with their health professional about nonurgent matters (75%), and to access laboratory test results (75%). Regression results showed that younger age, higher education, and English as a first language were predictors of patients' interest in using Internet services in the event of an epidemic. CONCLUSION: Most patients are willing and able to use the Internet as a means to maintain communication with the hospital during an outbreak of an infectious disease such as SARS. Hospitals should explore new ways to interact with the public, to provide relevant health information, and to ensure continuity of care when they are forced to restrict their services.

Attitude to Health↗

PubMed2006

Characterizing Internet searchers of smoking cessation information.

BACKGROUND: The Internet is a viable channel to deliver evidence-based smoking cessation treatment that has the potential to make a large population impact on reducing smoking prevalence. There is high demand for smoking cessation information and support on the Internet. Approximately 7% (10.2 million) of adult American Internet users have searched for information on quitting smoking. Little is known about these individuals, their smoking status, what type of cessation services they are seeking on the Internet, or how frequently these searches for cessation information are conducted. OBJECTIVE: The primary goal of this study was to characterize individuals who search for smoking cessation information on the Internet to determine appropriate triage and treatment strategies. The secondary goal was to estimate the incidence of searches for cessation information using publicly available search engine data. METHODS: We recruited individuals who clicked on a link to a leading smoking cessation website (QuitNet) from within the results of a search engine query. Individuals were "intercepted" before seeing the QuitNet home page and were invited to participate in the study. Those accepting the invitation were routed to an online survey about demographics, smoking characteristics, preferences for specific cessation services, and Internet search patterns. To determine the generalizability of our sample, national datasets on search engine usage patterns, market share, and keyword rankings were examined. These datasets were then used to estimate the number of queries for smoking cessation information each year. RESULTS: During the 10-day study period, 2265 individuals were recruited and 29% (N = 655) responded. Of these, 59% were female and overall tended to be younger than the previously characterized general Internet population. Most (76%) respondents were current smokers; 17% had quit within the last 7 days, and 7% had quit more than 7 days ago. Slightly more than half of active smokers (53%) indicated that they were planning to quit in the next 30 days. Smokers were more likely to seek information on how to quit and on medications; former smokers were more interested in how to cope with withdrawal. All participants rated withdrawal information and individually tailored information as being more useful, while displaying little interest in telephone counseling, expert support, or peer support. Publicly available data from large search engines suggest that 4 million Americans search for resources on smoking cessation each year. CONCLUSIONS: This study adds to the limited data available on individuals who search for smoking cessation information on the Internet, supports the prior estimates of the size of the population, and indicates that these individuals are in appropriate stages for both active cessation interventions and aggressive relapse prevention efforts. Continued development and evaluation of online interventions is warranted, and organizations seeking to promote cessation should carefully evaluate the Internet as a possible modality for treatment and as a gateway to other traditional programs.

Adolescent↗

PubMedDate not supplied

Comparison of oncology nurse and physician use of the Internet for continuing education.

BACKGROUND: In the past 10 years, there has been a dramatic increase in published literature on the topic of Internet use by healthcare professionals. Learners and organizations providing grants to the continuing education (CE) division of a medical education and publishing company have expressed increasing interest in the area of Internet CE. To quantify and analyze this trend, the company began using surveys to evaluate this growing area of interest. METHOD: Since 1998, annual surveys at the annual meetings of the Oncology Nursing Society and the American Society of Clinical Oncology were used to determine trends in educational use of the Internet for CE. FINDINGS: Internet use and frequency of use, including use of the Internet for CE among both nurses and physicians, have been increasing. When asked what would make these professionals more likely to use the Internet for CE, both indicated making the activities low cost or free and easier access. CONCLUSIONS: Nurses and physicians are looking to the Internet for quick access to reliable information, thus challenging CE educators to develop ways to implement Internet CE activities quickly. Ongoing needs assessment of target audiences and evaluation of the effectiveness of Internet CE is essential to optimizing the role of this educational format for healthcare professionals.

Attitude of Health Personnel↗

PubMed1999

Internet availability of prescription pharmaceuticals to the public.

BACKGROUND: The Internet holds great but uncertain promise for increased access and cost control in health care. OBJECTIVE: To determine access to and cost of prescription pharmaceuticals over the Internet. DESIGN: An Internet search conducted during February and March 1999. SETTING: The Philadelphia region. MEASUREMENTS: Data were collected on availability and cost of medications and physician Internet visits, requirements for physician prescriptions, and geographic location of Web-based companies and consulting physicians. Costs of comparable physician visits were obtained from Medicare and managed care organizations in the Philadelphia region. Costs of medications came from five Philadelphia community pharmacies. RESULTS: Forty-six Web sites were identified. Thirty-seven sites (33 based in the United States and 4 based outside the United States) required a prescription from a personal physician or from an Internet physician consultation. Nine sites based outside of the United States did not require a prescription or physician consultation. The median cost of an Internet physician visit was $70 (range, $20 to $90), more than 15% higher than that for a general practice visit in the Philadelphia region. Quality of physician consultation, physician qualifications and specialty, and geographic location were unknown. Median price per pill of the two most commonly offered medications was 10% higher on the Internet (before shipping charges) than at Philadelphia pharmacies ($5.49 and $4.50 for sildenafil; $1.94 and $1.83 for finasteride). CONCLUSIONS: The Internet may expand patient access to health-related services but at overall increased cost. In addition, the quality of physician Internet care is uncertain, and potential for serious abuse exists. Patients can easily provide incorrect or false information to obtain medications. Furthermore, conflict of interest exists for Web-based firms because they profit from selling medications and physician consultations.

Conflict of Interest↗

PubMed1998

Introducing the Internet to medical practitioners.

The benefits of using the Internet to medical practitioners are growing rapidly, as the Internet becomes easier to use and ever more biomedical resources become available on net. The Internet is the largest computer network in the world that connects millions of computers in a web and makes almost immediate communication possible, irrespective of the location of its users. There are various ways to be connected with Internet and once connected, it is easy to take advantage from this space of unlimited potentials. Several Internet applications are available today that will bring more information to the doctors' desk. Although, it is difficult to predict the future of medicine on the Internet, but the net has opened up many new possibilities for medical professionals, which were not available through previous technologies. It is now up to them to realize the Internet's full potential. A non-technical overview of Internet, a glimpse of electronically available information and the methods available to access, manipulate and disseminate biomedical data from the Internet are discussed. These methods are useful for beginners as well as beneficial for experienced physicians.

Communication↗

PubMed2002

The internet--friend or foe? A questionnaire study of orthopaedic out-patients.

OBJECTIVE: To examine patients' use of the Internet to obtain medical information, their opinions on the quality of medical Web sites, and their attitudes towards Internet-based consultations. DESIGN: Questionnaire study. PARTICIPANTS AND SETTING: 398 patients, aged 10-95 years, visiting the orthopaedic outpatient clinics of a London district general hospital over a 2-week period. MAIN OUTCOME MEASURES: (i) The rate of Internet use by patients; (ii) the perception of the quality of medical web sites; (iii) future intentions and attitudes towards Internet-based consultations; and (iv) concurrence between information obtained from Web sites and advice given by the orthopaedic surgeon in the clinic. RESULTS: From 369 respondents (response rate 93%), 55.3% of patients had accessed the Internet. Of these, 52.0% had obtained medical information from this source. Access was linearly correlated with age (r2 = 0.975, P < 0.01) and was also related to social status. Of the 12.3% of patients who had researched their particular orthopaedic condition, 20% reported that the advice received from the surgeon in the clinic contradicted that obtained from the Internet. A total of 35.7% of patients would undergo an Internet-based consultation, whilst a further 25.5% would consider this, depending on the medical condition in question. CONCLUSIONS: Over half of the patients studied were willing to access the Internet for medical information, with younger patients more likely to undertake this activity. Moreover, a significant proportion of respondents were willing to undergo an Internet-based consultation. The increased use of medical Web sites by patients raises important issues regarding the need for quality control, and impacts significantly upon the surgeon-patient relationship.

Adolescent↗

PubMed2004

Taiwanese adolescents' perceptions and attitudes regarding the internet: exploring gender differences.

The purpose of this study was to explore adolescents' perceptions and attitudes regarding the Internet, by gender. Data were collected from 636 high school students in Taiwan. It was found that male adolescents perceived the Internet more as a "toy," while female adolescents perceived the Internet more as a "technology," "tool" or "tour." Results indicated that females held more pragmatic views of the Internet, whereas males believed they could obtain more enjoyment from the Internet. In addition, males expressed significantly more positive attitudes than did females on two aspects of the Internet: usefulness and perceived control. However, no significant gender differences were found in terms of the affection and behavior aspects of using the Internet. More importantly, females tended to show higher Internet self-efficacy than did males. It is suggested that gender differences regarding the Internet might be narrowing because female adolescents are acquiring more experience with it.

Adolescent↗

PubMed2005

Use of the Internet among dental students in Turkey.

The extent to which dental students in Suleyman Demirel University (Turkey) use the Internet during their undergraduate dental training and their attitudes towards the Internet in general were assessed in this study. Ninety-three percent of the students use the Internet in various frequencies. Seven percent stated that they do not know how to use the Internet and, in this regard, the gender proportion was higher in the female students (p=0.026). In general, male students use the Internet more often than their female counterparts (p<0.001). Although a similar proportion of students (approximately 55 percent) use the Internet to retrieve information for general and dental topics, dental topics were searched in the Internet less frequently. To obtain information on dental topics, students generally referred to lecture handouts or textbooks (76 percent) while 32 percent accessed the Internet. Students who use the Internet to obtain information on dental topics most commonly preferred the university sites (71 percent), followed by search engines by performing key word searches (47 percent). The texts are the most commonly accessed materials (83 percent). Clinical photographs were accessed by 53 percent and histopathologic and radiographic materials by 14 percent of the students.

Chi-Square Distribution↗

PubMed1997

The Internet as an information source for geriatricians.

Electronic storage of and access to medical data is becoming increasingly common. Advances in computer technology and telecommunications have made it possible to store vast amounts of information in databases and transmit this information rapidly to any place on the globe. At the forefront of this technology is the Internet, a worldwide computer network that links together over 10 million computers in more than 80 countries. The Internet is an unprecedented information resource. There are tens of thousands of computers on the Internet that are freely accessible to the general public. Commercial organisations, academic institutions and government agencies are just some of the entities that can be accessed through the Internet. There are a large number of medical resources at these sites including electronic journals, online databases and search services, teaching materials, and methods for obtaining online continuing medical education credits. The Internet offers a variety of services such as electronic mail, discussion groups and the ability to log on to and run programs on remote computers. The one service, however, that has been responsible for the phenomenal growth of the Internet is the World Wide Web, the primary focus of this article. The World Wide Web allows a user to view documents that contain text, graphics, images, and movie and sound clips. In addition, any of these elements can be linked to other documents or services anywhere on the Internet. This article gives a general overview of the Internet and the medical resources it contains, with an emphasis on material related to geriatrics and aging. The Internet is in a state of continual evolution, and it is likely that dramatic new capabilities will become available in the near future.

Aged↗

PubMed2003

Factors influencing internet addiction tendency among middle school students in Gyeong-buk area.

PURPOSE: This study was conducted to understand the degree of internet addiction tendency and to find out the factors influencing this addiction tendency among middle school students in Gyeong-buk area. METHODS: A total of 450 middle school students in the Daegu and Gyeong-buk area were surveyed in this study. Data collection was conducted through the use of questionnaires. RESULTS: Internet addiction among middle school students was relatively low (Average user). In the overall ratio distribution, however, students who were classified as either addicted or at risk of addiction accounted for a high percentage, 27%. A positive correlation was found between Internet addiction and Internet expectation, depression and parent control over Internet use. A negative correlation was found between Internet addiction and interpersonal relationship, parent support and self-control. Multiple regression analysis revealed that the most powerful predictor of Internet addiction tendency was depression. CONCLUSION: Through the above results, it would be necessary to develop an Internet addiction prevention program for adolescents taking into account for the psychological factors such as depression and Internet use habits. In the future study, the need assessment will be useful for developing this prevention program.

Journal Article↗

PubMed1997

[Application of Internet technology in public health].

Recent advances in telecommunication technology have been enormous. Application of this technology in public health has the potential to markedly improve global health through better surveillance and information systems. With this assumption the GHNet was established in 1994 by representatives from academia, WHO, Pan American Health Organization, the World Bank, NASA, IBM, and AT & T. The GHNet consists of seven components: 1) promotion of networking with the Internet among people in public health; 2) disease tele-monitoring; 3) distance learning system with the internet; 4) connection of non-governmental health organizations; 5) training cyberdocs who are educated in both public health and telecommunications; 6) establishment of an electronic scientific research server; and 7) a home page on the World Wide Web (WWW). In order to effectively incorporate the Internet into the field, connectivity and knowing how to use it are of critical concern. More and more facilities are connected to the Internet in Japan. However, few courses teaching how to utilize the Internet are provided for people in this field. An Internet training course for people in public health was held as joint venture of the World Health Organization (WHO) and the Global Health Network (GHNet) on October 31, 1996, at the 55th Annual Meeting of Japanese Society of Public Health. Most of the participants for the course were from local public health departments and very few had previous experience with the Internet before the course. During this course participants learned how to use e-mail, how to find health resources on the WWW, how to construct a home page, and how the Internet could be utilized to improve public health, with their computers actually hooked to the Internet. From this experience, we found that this kind of course is feasible and beneficial and hope that this course would serve as a model for training people in public health.

Computer Communication Networks↗

PubMed2000

Growth and determinants of access in patient e-mail and Internet use.

OBJECTIVES: To measure the rate of access to and use of the Internet and e-mail, to determine sociodemographic predictors of access, and to measure the change in Internet and e-mail access over a 1-year interval. DESIGN: Survey study. Comparison of data with those from a similar survey from 1998. SETTING: Emergency department of a large urban pediatric teaching hospital. PARTICIPANTS: Primary caretakers of pediatric patients or the patients themselves if aged 16 years or older. MAIN OUTCOME MEASURES: Use of and access to the Internet or e-mail. RESULTS: We surveyed 214 individuals: 72.8% use or have access to the Internet, e-mail, or both, an increase from 52.2% in the 1998 survey (P<.001), and 48.5% regularly use the Internet or e-mail, compared with 43.1% in 1998 (P = .32). Outside the home, access is primarily at work (52.2%), schools (8.9%), public libraries (11.5%), and friends' and relatives' houses (16.7%). Internet use and access are linearly correlated with income (r = 0.43; P<.001). White patients are more likely to have access (odds ratio, 2.6; 95% confidence interval, 1.3-5.4; P<.001) than black or Asian patients, whereas those of Hispanic ethnicity are less likely to have access (odds ratio, 0.20; 95% confidence interval, 0.09-0.43; P<.001). However, after adjustment for race and Hispanic ethnicity, only income was a significant predictor of family access to the Internet and e-mail. CONCLUSIONS: During the past year, many patients have gained access to the Internet and e-mail, although rates of regular use have remained steady. This access is often from outside the home. Furthermore, access is directly related to income and is unevenly distributed across racial and ethnic groups.

Adolescent↗

PubMed2002

Analysis of cases of harm associated with use of health information on the internet.

CONTEXT: There is concern about the potential harm associated with the use of poor quality health information on the Internet. To date, there have been no systematic attempts to examine reported cases of such harm. METHODS: We conducted a systematic review of the peer-reviewed literature, to evaluate the number and characteristics of reported cases of harm associated with the use of health information obtained on the Internet. Using a refined strategy, we searched MEDLINE (from 1966 to February 2001), CINAHL (from 1982 to March 2001), HealthStar (from 1975 to December 2000), PsycINFO (from 1967 to March 2001), and EMBASE (from 1980 to March 2001). This was complemented with searches of reference lists. Two authors separately reviewed the abstracts to identify articles that describe at least 1 case of harm associated with the use of health information found on the Internet. Articles of any format and in any language deemed possibly relevant by either researcher were obtained and reviewed by both researches. RESULTS: The search yielded 1512 abstracts. Of these 186 papers were reviewed in full text. Of these, 3 articles satisfied the selection criteria. One article described 2 cases in which improper Internet searches led to emotional harm. The second article described dogs being poisoned because of misinformation obtained on the Internet. The third article described hepatorenal failure in an oncology patient who obtained misinformation about the use of medication on the Internet. CONCLUSIONS: Despite the popularity of publications warning of the potential harm associated with using health information from the Internet, our search found few reported cases of harm. This may be due to an actual low risk for harm associated with the use of information available on the Internet, to underreporting of cases, or to bias.

Health Education↗

PubMed2003

Internet sales of cigarettes to minors.

CONTEXT: There is growing concern that the Internet might become a source of tobacco products for minors. Although researchers have studied tobacco sales to minors at retail outlets for more than a decade, there are no published studies of tobacco sales to minors via the Internet. OBJECTIVE: To determine the proportion of Internet cigarette vendors that will sell cigarettes to minors. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study conducted in April-July 2001. Under adult supervision, 4 adolescents aged 11 to 15 years attempted to purchase cigarettes via 55 Internet cigarette vendors located in 12 states. These minors made a total of 83 purchase attempts, paying by credit card (n = 47) and by money order (n = 36). MAIN OUTCOME MEASURE: Proportion of Internet cigarette vendors that sold cigarettes to minors. RESULTS: Minors successfully received cigarettes for 93.6% of credit card purchase attempts and for 88.9% of money order purchase attempts. Age was never verified for any of these deliveries. Internet vendors sent a total of 1650 packs of cigarettes to the underage adolescents in this study. CONCLUSION: Minors appear to have easy access to cigarettes via the Internet because many Internet vendors have weak or nonexistent age verification procedures.

Adolescent↗

PubMed2006

Reliability and validity of an Internet traumatic stress survey with a college student sample.

The reliability and validity of Internet-based questionnaires were assessed in a sample of undergraduates (N = 411) by comparing data collected via the Internet with data collected in a more traditional format. A 2 x 2 x 2 repeated measures factorial design was used, forming four groups: Paper-Paper, Paper-Internet, Internet-Paper, and Internet-Internet. Scores on measures of trauma exposure, depression, and posttraumatic stress symptoms formed the dependent variables. Statistical analyses demonstrated that the psychometric properties of Internet-based questionnaires are similar to those established via formats that are more traditional. Questionnaire format and presentation order did not affect rates of psychological symptoms endorsed by participants. Researchers can feel comfortable that Internet data collection is a viable--and reliable--means for conducting trauma research.

Adolescent↗

PubMed1999

World Wide Web and Internet: applications for radiologists.

Global exchange of information is one of the major sources of scientific progress in medicine. For management of the rapidly growing body of medical information, computers and their applications have become an indispensable scientific tool. Approximately 36 million computer users are part of a worldwide network called the Internet or "information highway" and have created a new infrastructure to promote rapid and efficient access to medical, and thus also to radiological, information. With the establishment of the World Wide Web (WWW) by a consortium of computer users who used a standardized, nonproprietary syntax termed HyperText Markup Language (HTML) for composing documents, it has become possible to provide interactive multimedia presentations to a wide audience. The extensive use of images in radiology makes education, worldwide consultation (review) and scientific presentation via the Internet a major beneficiary of this technical development. This is possible, since both information (text) as well as medical images can be transported via the Internet. Presently, the Internet offers an extensive database for radiologists. Since many radiologists and physicians have to be considered "Internet novices" and, hence, cannot yet avail themselves of the broad spectrum of the Internet, the aim of this article is to present a general introduction to the WWW/Internet and its applications for radiologists. All Internet sites mentioned in this article can be found at the following Internet address: http://www.univie.ac. at/radio/radio.html (Department of Radiology, University of Vienna)

Humans↗

PubMed2004

[Disease-oriented Internet use in outpatients with inflammatory rheumatic diseases].

OBJECTIVE: On behalf of the "systemic inflammatory rheumatic diseases network" comprehensive, nationwide horizontal and vertical cross-linking of research and care is to be developed for the first time. The quality of scientific work and patient care is to be increased in the medium term through this improved communication and co-operation. Our objective was to determine what hardware and software are available to the patients involved, with a view to the Internet being used as a basis for communication. The ultimate aim was to provide patients with an adequate source of information on care. METHODS: A survey was carried out among 400 patients attending our outpatient clinics. Data on the hardware and software used and on Internet access and patterns and degree of utilization were collected using a unilateral questionnaire. RESULTS: 326 patients filled in the questionnaire. 163 of those responding had Internet access, with younger and better educated patients using the Internet significantly more frequently. No dependency was noted on gender or marital status. Mean time duration for Internet use was longer in men. 55.8% of the internet users searched for medical questions. Major search topics included up to date therapeutic options (46.6%) and information on specific diseases (28.8%). CONCLUSION: Internet is an important information medium for patients. Technical requirements and high motivation make communication practicable for about 50% of patients. To ensure acceptance, the Internet platform of the systemic inflammatory rheumatic diseases network needs to be aligned to patients' requirements, bearing in mind the need for extensive high-value, reliable scientific information to be offered on the website.

Adult↗