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PubMed2004

Doctors on-line: using diffusion of innovations theory to understand internet use.

BACKGROUND AND OBJECTIVES: Family physicians must be aware of the latest and best evidence for a broad range of clinical and public health topics. The Internet is an important source of this information, but not all family physicians use the Internet. This study used "diffusion of innovations" theory to identify strategies for increasing Internet use by family physicians. METHODS: We conducted a mail survey of 58 family physicians in a midsized Northeastern metropolitan area in the United States to assess Internet use and identify sources from which physicians obtain medical information. We then used diffusion of innovations theory to describe the process by which physicians learn and develop skills at using the Internet. RESULTS: Internet use begins when physicians are not constrained by a heavy patient volume and are able to learn about and observe the benefits of Internet use. When they experience its usefulness, their Internet browsing and searching develop and become more effortless and less time-consuming. CONCLUSIONS: The innovation attributes of diffusion of innovations theory act as predictors of Internet use among family physicians. Internet use by family physicians might be increased by providing them time to learn about how to use it and to experience its benefits. Integration of continuing medical education courses created for the purpose of developing and enhancing Internet usage skills into their schedule may be a workable solution. Demographic factors such as gender and training recency have no influence on Internet use by family physicians.

Adult↗

PubMed2000

The Internet as a potential source of information about radiological procedures for patients.

The purposes of this study were to determine what percentage of patients in a typical radiology outpatient setting own or have access to a computer with internet capabilities and how many of these patients would find an educational radiology website useful. During a 3-month period, surveys were given to all adult outpatients undergoing computed tomography. The survey asked 4 questions: (1) Do you own a computer?, (2) If you own a computer, does it have Internet access?, (3) If you do not own a computer, do you have access to a computer with Internet capabilities?, and (4) If we provide helpful information regarding preparation for and the conduct of various radiological procedures on the Internet, would you use it? Four hundred surveys were collected. Two hundred one of the respondents (50.3%) owned a computer; 189 of the 201 (94.0%) had Internet access on their computer or had access to another computer with Internet capabilities. One hundred ninety-nine of the 400 respondents (49.8%) did not own a computer, 57 of these (28.6%) had access to a computer and the Internet. Of the 246 of those with Internet access, 205 (83.3%) indicated that they would use a website that provided helpful information regarding radiological examinations. The Internet is an excellent resource for educational information for patients about various radiological procedures. This study showed that 61.5% of patients had access to the Internet, and 83.3% of these would use such a site. It is likely that these numbers will increase with the rapid growth of the Internet and the steadily increasing number of homes with computers.

Adult↗

PubMed2002

[What is the value of the internet as a source of information for patients with inguinal hernias? First results of an observational study].

INTRODUCTION: The increasing use of the internet has led to a variety of medical web pages and an increasing amount of information about hospitals. Little is known about the extent to which this new medium is already used by patients as a source of information. For patients with inguinal hernia, for example, a frequent surgical symptom with large method variety, the value of the internet as a source of information should be examined. METHODS: One hundred patients facing an elective inguinal hernia repair at the Surgical Department Charité Berlin took part in a prospective observation study (a questionnaire with 10 questions) between July 1999 and March 2001. The questions referred to the possibility of PC/internet access, other sources of information (e.g., general practitioner, friends, internet) as well as the criteria by which the clinic was chosen. Patients were asked to answer basic questions about the development and treatment of inguinal hernia and to give a self-assessment of their knowledge of inguinal hernia (0 = no knowledge; 10 = maximum knowledge). RESULTS: The questionnaire revealed that 39% of the patients (average age 47 +/- 16 years) had a PC in their homes, 24% of those with internet access; 11% had internet access at other places. It also showed that 53% of the patients sought medical information from their general practitioner, 29% from friends, and 18% from the internet. Young patients (median age 29 years), employees and patients with private internet access use the internet with significantly more frequency. Their medical knowledge as well as their self-assessment of medical knowledge was significantly higher (median 19 versus 7 points and median 8.6 versus 5.7, respectively) and they chose the clinic because of the information from their research on the internet. CONCLUSION: At present, the internet still plays a subordinate role as a source of information for patients with an inguinal hernia. The increasing presence of this medium as well as the higher internet acceptance of future patients indicates that it has a promising future as a source of medical information.

Adult↗

PubMed2005

Patterns of Internet use and impact on patients with melanoma.

BACKGROUND: Patients with cancer and their families frequently, and increasingly, turn to outside sources for information, particularly the World Wide Web. Our objective was to examine the use of the Internet and its impact among patients with melanoma. METHODS: A prospective survey was obtained from 1613 consecutive patients with cutaneous melanoma seen at our institution between August 2001 and February 2003. Main outcome measures included the ability to access the Internet, Internet use to search for melanoma information, and responses to such Internet searches. Further analysis of whether there were differences based on age, sex, or disease severity was performed. RESULTS: Of patients with melanoma, 39% indicated that they had used the Internet to research their disease, 30% themselves and 9% had someone else do it for them. Nearly half (47%) of patients younger than 40 years researched melanoma on the Internet compared with only 12% of patients 60 years or older. Neither sex nor disease severity impacted Internet use. The vast majority of patients (94%) thought the Internet was useful, 67% believed it helped them better understand their condition, and 45% said they would recommend using the Internet to others to find information about medical conditions. Roughly a third thought it decreased their anxiety, whereas a similar proportion believed the Internet made them more anxious. Increased anxiety correlated with decreasing age and increasing disease severity. CONCLUSIONS: The use of the Internet is common among patients with melanoma. Anxiety attributed to online information about their disease suggests that clinicians caring for patients with melanoma should familiarize themselves with online melanoma information, and be proactive in assisting their patients in using this resource.

Adolescent↗

PubMed2003

A multi-institutional study of Internet utilization by radiation oncology patients.

PURPOSE: Studies describing the use of the Internet by radiation oncology patients are lacking. This multi-institutional study of cancer patients presenting to academic (AC), community (CO), and veterans (VA) radiation oncology centers was designed to analyze the use of the Internet, demographic factors related to utilization, and barriers to access to the Internet. METHODS AND MATERIALS: A questionnaire evaluating the use of the Internet was administered to 921 consecutive patients presenting to radiation oncology centers at AC, CO, and VA medical centers. The study included 436 AC patients (47%), 284 CO patients (31%), and 201 VA patients (22%). A computer was available at home to 427 patients (46%), and 337 patients (37%) had E-mail access. The mean age of the patient population was 64 (range = 14-93). Males represented 70% of the patient population. The most common diagnoses included prostate cancer (33%), breast cancer (13%), and lung cancer (11%). RESULTS: Overall, 265/921 patients (29%) were using the Internet to find cancer-related information. The Internet was used by 42% of AC patients, 25% of CO patients, and only 5% of VA patients (p < 0.0001). A computer was available at home in 62% AC vs. 45% CO vs. 12% VA patients (p < 0.0001). Patients < 60 years were much more likely to use the Internet than older patients (p < 0.0001). Most of the Internet users considered the information either very reliable (22%) or somewhat reliable (70%). Unconventional medical therapies were purchased over the Internet by 12% of computer users. CONCLUSIONS: A significant number of cancer patients seen in radiation oncology departments at academic and community medical centers utilize the Internet to obtain information about cancer. Radiation oncologists must familiarize themselves with this resource because of the large number of patients using the Internet. Veterans lack the computerized access to this information and are thus underserved by this important resource.

Academic Medical Centers↗

PubMed2006

Perceptions of how the Internet has impacted on dentistry.

OBJECTIVES: This study sought to identify how patient information on the Internet has influenced the delivery of oral care and the use practitioners themselves make of the Internet. METHODOLOGY: Data were collected via a self completed 18 item postal questionnaire, sent to a random sample of 620 dentists on the GDC register in Wales. RESULTS: In total 457 (74%) of the questionnaires were returned. One half of all practitioners stated that patients had asked them about material of relevance to dentistry obtained from the Internet, although in the majority of cases this happened less frequently than once a month. The most common topics enquired after were cosmetic procedures, dental amalgam and implants. A minority of dentists, 47 (11%) viewed the Internet as a threat to the dentist-patient relationship. However, 169 (39%) agreed information gained from the Internet had led to patients demanding inappropriate care or more complex treatment (135/31%). Having to take time to discuss Internet material was viewed as a burden by 93 practitioners. The potential of the Internet to widen inequalities in access to oral health information was agreed upon by one third of respondents. Concerns over the quality and reliability of Internet derived information, together with a lack of knowledge of appropriate sites, prevented dentists using the Internet as an oral health education resource. However, only 18.7% claimed never to use the Internet for their own Continuing Professional Development. Access for CPD purposes was mainly from home. Of those working in general practice, 54 had their own practice website, and a further 103 said this was something they were considering. Email was used to communicate with patients by 42 dentists, mainly to make appointments. CONCLUSIONS: Views on the impact of the Internet were generally positive, but there is a long way to go before its full potential is realised.

Appointments and Schedules↗

PubMed2001

Dietitians and the internet: are dietitians embracing the new technology?

BACKGROUND: Internet use is increasing and in the future it will become a valuable tool for health professionals seeking and communicating health, diet and nutritional information. This study aimed to explore the use of the Internet by dietitians in the UK. METHODS: A cross-sectional study was carried out on a random sample of 200 dietitians selected from the British Dietetic Association database. A self-completion questionnaire was distributed to determine access to the Internet and the views of dietitians on the use of the Internet for the provision of health and nutrition information. RESULTS: Of the 156 respondents to the questionnaire, 96% were female and 4% were male. The results revealed that 66% of respondents had access to the Internet at work, with 39% using the Internet once a week or more. The main reported uses of the Internet were searching for health information, research and communication. Thirteen per cent of respondents reported seeing information obtained from the Internet by patients. Concerns about the use of the Internet for the provision of health information centred on creating unrealistic patient expectations. CONCLUSION: The research revealed that the Internet does have a role in augmenting current services. A substantial proportion of the dietitians studied were already using the Internet routinely in their work, with the real potential for its use beginning to be realized.

Adult↗

PubMed2006

Relationship of Internet health information use with patient behavior and self-efficacy: experiences of newly diagnosed cancer patients who contact the National Cancer Institute's Cancer Information Service.

This study examines the relationship of Internet health information use with patient behavior and self-efficacy among 498 newly diagnosed cancer patients. Subjects were classified by types of Internet use: direct use (used Internet health information themselves), indirect use (used information accessed by friends or family), and non-use (never accessing Internet information). Subjects were recruited from callers of the National Cancer Institute's (NCI's) Cancer Information Service, Atlantic Region. They were classified by type of Internet use at enrollment and interviewed by telephone after 8 weeks. There were significant relationships among Internet use and key study variables: subject characteristics, patient task behavior, and self-efficacy. Subjects' Internet use changed significantly from enrollment to 8 week follow-up; 19% of nonusers and indirect users moved to a higher level of Internet use. Significant relationships also were found among Internet use and perceived patient-provider relationship, question asking, and treatment compliance. Finally, Internet use was also significantly associated with self-efficacy variables (confidence in actively participating in treatment decisions, asking physicians questions, and sharing feelings of concern). The results of this study show that patients who are newly diagnosed with cancer perceive the Internet as a powerful tool, both for acquiring information and for enhancing confidence to make informed decisions.

Adolescent↗

PubMed2005

Psychological barriers to Internet usage among older adults in the UK.

The Internet is an important tool in assisting the older population to lead independent and social lives. However, the majority of Internet users are under 55. This study investigated the following psychological barriers to Internet use by older adults: perceived usefulness, perceived ease of use, Internet efficacy, perceived complexity of navigation and perceived complexity of terminology. Twenty-three subjects (aged 55 - 75 years) were interviewed in the UK. The influences of age, computer and Internet experience, and training on these psychological barriers were explored. The results showed that the majority of the older adults who had a positive perception of usefulness, ease of use, and efficacy of the Internet or e-mail, used the Internet or e-mail more often. In addition, it was found that computer or Internet experience increased perceptions of ease of use and efficacy of the Internet and reduced perceived complexity of navigation. There was no difference between the two age groups (55 - 65 and 66 - 75 years) in these psychological barriers. It was concluded that increased marketing of the Internet (aimed at the older user), more simple and uniformly designed Internet pages, more user-friendly online help and error message terminology, and increased provision of training for the older user would assist uptake of the World Wide Web.

Adaptation, Psychological↗

PubMed2006

Internet use by the socially fearful: addiction or therapy?

The Internet has often been argued to have adverse psychological consequences, such as depression or anxiety symptoms, among "over-users." The present study offers an alternative understanding, suggesting the Internet may be used as a forum for expanding social networks and consequently enhancing the chance of meaningful relationships, self-confidence, social abilities, and social support. An online sample of 188 people was recruited over the Internet, while paper and pencil tests were administered to an offline sample group of 27 undergraduate university students, who were regular Internet users. Subjects completed the Zung Depression Scale (ZDS), Depression, Anxiety and Stress Scales (DASS), Eysenck Personality Questionnaire?Revised Short Scale (EPQ-R Short), Fear of Negative Evaluation (FNE) scale, Internet Use Questionnaire (IUQ), and an Internet Effects Questionnaire (IEQ). Results suggested that there was no relationship between time spent online and depression, anxiety, or social fearfulness. Those who primarily used the Internet for online chat believed that the Internet is psychologically beneficial to them, but also believed that frequent Internet users are lonely and that the Internet can be addictive. It is argued that "chat" users who are socially fearful may be using the Internet as a form of low-risk social approach and an opportunity to rehearse social behavior and communication skills, which, may help them improve interaction with offline, face-to-face, social environments.

Adolescent↗

PubMed2005

Guiding users to quality information about osteoarthritis on the Internet: a pilot study.

This pilot study explored the feasibility of and user satisfaction with an Internet User's Guide (IUG) to assist patients in sourcing relevant, valid information about osteoarthritis on the Internet. Twelve people with osteoarthritis participated in focus groups that involved searching the Internet for information relating to their condition with the aid of the IUG. Participants were asked to perform an initial search of the Internet for information on osteoarthritis, followed by a second search with the aid of the IUG. User satisfaction with the IUG and subsequent online searches was obtained during and following the Internet simulations. A total of 92% of all participants had previously used the Internet to search for health information in the past. However, only a third used the Internet to further source information on their condition. Prior to using the IUG, participants cited efficiently searching the Internet for relevant and credible information as the primary obstacle in their continued use of the Internet. All participants reported that the use of the IUG increased their ability to source quality online medical information. The provision of an IUG may support and increase user awareness about searching for relevant, quality medical information on the Internet. Further quantitative and qualitative research is required to identify how best to empower consumers who wish to use the Internet as a medical resource.

Aged↗

PubMedDate not supplied

A review of weight loss programs delivered via the Internet.

The escalating obesity epidemic has prompted healthcare professionals to seek interventions that can reach large numbers of individuals in a timely and cost-effective manner. The Internet, with its growing audience, seems an obvious solution. Commercial weight loss programs already abound on the Internet. The purpose of this review is to describe the efficacy of weight loss programs delivered via the Internet in the United States. A search for clinical trials evaluating weight loss via Internet programs was conducted using PubMed, CINAHL, Cochrane Library, Academic Search Premier, the National Institutes of Health Clinical Trials Database, and the Internet as well as a cross-check of reference lists. Eight published studies that met the inclusion criteria were reviewed. Data were extracted on study design, sample characteristics, attrition, weight loss, duration of treatment, and maintenance of weight loss. Of the 8 studies, 3 evaluated the Internet as a means to maintain long-term weight loss. All studies examining weight loss via Internet programs reported positive results, except for one investigating a commercial program. Results from the 3 weight loss maintenance programs conducted on the Internet were equivocal. Because the subjects of all these studies were predominately white, educated women, generalization of findings is limited. Data from the reviewed studies suggest that the Internet may be an alternative to traditional face-to-face weight loss programs. Questions still remain as to the efficacy of using the Internet for long-term weight loss maintenance. Findings from these studies provide beginning guidelines for healthcare providers who may choose to use Internet-based weight loss interventions. Future research is still needed to determine the applicability of such interventions in diverse age, ethnic, and socioeconomic groups.

Adult↗

PubMedDate not supplied

Use of the Internet for health information by older adults with arthritis.

BACKGROUND: Despite the information available on the Internet and the increasing number of older adults who use the Internet, little is known about Internet use for health information by elders with arthritis. PURPOSE: The purposes of this study were (1) to examine the use of computers and the Internet by elders with arthritis and (2) to describe demographic and illness-related characteristics of elders who use the Internet to find health information. SAMPLE: Seventy-one elders with arthritis completed survey questionnaires. FINDINGS: Twenty-eight percent had a computer in their home, of whom 95% had Internet access. Thirty-nine percent sought arthritis information on the Internet. People with more education were more likely to use the Internet. However, age and functional disability resulting from arthritis were not associated with Internet use. IMPLICATIONS: Health professionals need to be aware of Internet resources and assist elders in finding appropriate Internet-based arthritis information.

Activities of Daily Living↗

PubMedDate not supplied

Clinical trial resources on the internet must be designed to reach underrepresented minorities.

PURPOSE: Internet-based clinical trial information services are being developed to increase recruitment to studies. However, there are limited data that evaluate their ability to reach elderly and underrepresented minority populations. This study was designed to evaluate the ability of an established clinical trials registry to reach these populations based on expected Internet use. PATIENTS AND METHODS: This study compares general Internet users to participants who enrolled in an Internet based colorectal cancer clinical trials registry established by OncoLink (www.oncolink.org) and the National Colorectal Cancer Research Alliance. Observed rates of demographic groupings were compared to those established for general Internet users. RESULTS: Two thousand, four hundred and thirty-seven participants from the continental United States used the Internet to register for the database. New England, the Mid-Atlantic region, and the Southeast had the highest relative frequency of participation in the database, whereas the Upper Midwest, California, and the South had the lowest rates. Compared to general Internet users, there was an overrepresentation of women (73% vs. 50%) and participants over 55 years old (27% vs. 14%). However, there was an underrepresentation of minorities (10.3% vs. 22%), particularly African Americans (3.1% vs. 8%) and Hispanics (2.8% vs. 9%). DISCUSSION: The Internet is a growing medium for registry into clinical trials databases. However, even taking into account the selection bias of Internet accessibility, there are still widely disparate demographics between general Internet users and those registering for clinical trials, particularly the underrepresentation of minorities. Internet-based educational and recruitment services for clinical trials must be designed to reach these underrepresented minorities to avoid selection biases in future clinical trials.

Black or African American↗

PubMed2005

Proposed diagnostic criteria of Internet addiction for adolescents.

The aims of the present study were to develop diagnostic criteria of Internet addiction for adolescents and to examine the discriminating potential and validity of diagnostic criteria by an empirical community study among adolescent populations. We developed 13 candidate diagnostic criteria for characteristic symptoms of Internet addiction in adolescents. A total of 468 adolescents completed the Chen Internet Addiction Scale (CIAS) and were systematically assessed for Internet-using behaviors by seven psychiatrists using the diagnostic interview schedule. The sensitivity, specificity, and diagnostic accuracy of the 13 candidate diagnostic criteria were analyzed with references to the interviewers' global clinical impressions and CIAS results. The cutoff point of the diagnostic criteria to differentiate the Internet-addicted subjects with nonaddicted ones was then determined by the best diagnostic accuracy and the receiver operating characteristic curve. This study selected nine of the 13 candidate diagnostic criteria to construct the diagnostic criteria of Internet addiction for adolescents, which were composed of three main criteria: characteristic symptoms of Internet addiction, functional impairment secondary to Internet use, and exclusive criteria. The diagnostic criteria had high diagnostic accuracy, specificity, negative predictive value, accepted sensitivity, and accepted positive predictive rate. The validity of the diagnostic criteria proposed in this study was further confirmed by comparing the demographic and Internet-using characteristics between those with and without Internet addiction. The diagnostic criteria for Internet addiction can provide health care professionals with a means to communicate and make comparisons of clinical cases.

Adolescent↗

PubMed2005

Out of necessity: oncology nurses' experiences integrating the internet into practice.

PURPOSE/OBJECTIVES: To understand the experiences of oncology nurses who use the Internet in their practice when their patients use the Internet for cancer care. RESEARCH APPROACH: Heideggerian hermeneutics branch of phenomenology. SETTING: Oncology nurses were interviewed at their practice settings (n = 13), the researcher's office (n = 5), or their homes (n = 2). PARTICIPANTS: 20 nurses recruited from local and national Oncology Nursing Society meetings. Their practice sites were cancer centers, hospitals, clinics, veterans centers, communities, and Internet companies. METHODOLOGIC APPROACH: Data were collected by informal interviews that provided the narrative stories for hermeneutic analysis. MAIN RESEARCH VARIABLES: Internet use for cancer care, nurse-patient relationships, and Internet use for nursing practice. FINDINGS: Five related themes emerged: (a) varying degrees of Internet integration in the practice environment, (b) changing schools of thought, (c) developing Internet use for professional practice, (d) redefining relationships, and (e) new nursing skills. The two constitutive patterns are (a) integrating Internet into practice out of necessity and (b) reflecting historical changes in practice patterns influenced by technology. CONCLUSIONS: Nurses who use the Internet are developing new practice patterns that incorporate technology and foster nurse-patient partnerships. Practice environments either foster or hinder technology use. Nurse computer competency is essential. INTERPRETATION: Findings reflect the influence of adapting technology on practice. Internet use is a catalyst for redefining nurse-patient relationships into partnerships. The movement suggests a need for nurse Internet competencies, environmental support, and consideration for patient access (digital divide). Evaluation of content in nursing curricula and of patient competencies is advised. Further research on patient experiences is recommended.

Adult↗

PubMed2003

Patient use of the internet for information in a lung cancer clinic.

STUDY OBJECTIVES: To determine how frequently patients attending a lung cancer clinic use the Internet for their own health information, to determine whether there are demographic differences between Internet users and nonusers, and to determine how patients compare the quality of Internet information with other sources of lung cancer information. DESIGN: Sequentially administered patient questionnaire. One hundred eighty-four patients were surveyed, and 139 patients (75.5%) completed the questionnaire. SETTING: A multidisciplinary thoracic oncology clinic in a Midwestern University hospital. PATIENTS OR PARTICIPANTS: Patients attending the multidisciplinary thoracic oncology clinic over a 3-month period. MEASUREMENTS AND RESULTS: The Internet was the most commonly used nonphysician source of information among our patients. Sixteen percent of the patients sought information on the Internet, but 60% expressed interest in using the Internet for information. Users were on average of higher income level and educational attainment but did not differ from nonusers by community size. Internet users rated the quality of information available on the Internet of similar quality to information from all sources. CONCLUSIONS: Older patients are increasing using the Internet for self-education in lung cancer. While certain barriers continue to exist, patients from rural areas use the Internet to the same degree, as do patients from urban areas. Patients do, however, overrate the quality of information on the Internet.

Adult↗

PubMed2002

Internet use among people living with HIV/AIDS: association of health information, health behaviors, and health status.

The telecommunications revolution provides open access to health information that can inform and empower people living with chronic illnesses. However, many people living with HIV may not access the Internet and are not benefiting from available health information. This study investigated Internet access among people living with HIV/AIDS and its relation to health. Results of a survey of men (n = 175) and women (n = 84) living with HIV/AIDS recruited from infectious disease clinics and community-based AIDS services showed that 51% (n = 116) of participants reported ever using the Internet, of which 59% (n = 68) had used the Internet to access health-related information. As expected, Internet users were significantly more likely to be better educated and of higher incomes. Internet users, including those who used the Internet for general purposes and those who reported health-related use, also demonstrated significantly greater knowledge of HIV disease and greater confidence in their ability to adhere to medications. Persons who used the Internet for general purposes were more likely to have an undetectable viral load compared to persons who had not used the Internet. The disparities in Internet use identified in this study suggest that individuals who access the Internet, particularly for health information, are among the better resourced and healthier persons living with HIV/AIDS.

Adult↗