Transcript Consumer Health OnlineInstructor: Bette Anton [email protected] An Infopeople Workshop February-April 2004 This Workshop Is Brought to You By the Infopeople Project Infopeople is a federally-funded grant.

Consumer Health Online
2004
Instructor:
Bette Anton
[email protected]
An Infopeople Workshop
February-April 2004
This Workshop Is Brought to You By the
Infopeople Project
Infopeople is a federally-funded grant project
supported by the California State Library. It
provides a wide variety of training to
California libraries. Infopeople workshops are
offered around the state and are open
registration on a first-come, first-served basis.
For a complete list of workshops, and for
other information about the Project, go to the
Infopeople Web site at infopeople.org.
Introductions
Name
Library
Position




How much health-related reference do you do?
How much time do you generally spend answering
reference questions?
Are there health-related questions that you are
frequently asked?
Other?
Workshop Overview
Background
Finding information on specific health topics

General information sites

Government sites
Evaluation Techniques
Therapies
Special populations/topics
“Health Seekers”
Half of American adults have searched online for
health information.
“Fully 80% of adult Internet users, or about 93 million
Americans, have searched for at least one of 16
major health topics online. This makes the act of
looking for health or medical information one of the
most popular activities online, after email (93%) and
researching a product or service before buying it
(83%).”
Source: Fox S, Fallows D. Internet Health Resources. Washington, DC: Pew
Internet & American Life Project; 2003.
“About 6 million Americans go online for medical advice on
a typical day. That means more people go online for
medical advice on any given day than actually visit health
professionals, according to figures provided by the
American Medical Association.”
Source: Fox S, Rainie L. Vital decisions: how Internet users decide what
information to trust when they or their loved ones are sick. Pew Internet &
American Life Project; 2002
Pew Internet & American Life Project Reports
People Want…
93% - a particular illness or condition.
65% - nutrition, exercise or weight control
64% - prescription drugs
55% - before visiting a doctor
48% - alternative or experimental treatments or medicines
39% - mental health issue such as depression or anxiety
33% - sensitive health topic that is difficult to talk about
32% - particular doctor or hospital (report cards)
Source: Fox S, Rainie L. Vital decisions: how Internet users decide what information
to trust when they or their loved ones are sick. Pew Internet & American Life Project;
2002
How Californians Compare to the Rest
of the Nation
Pew Internet & American Life Project; 2003 says:
 Californians living in low income households
[<$30,000/yr] are significantly more likely to go
online than their counterparts in the rest of the
country.
 83% of California Internet users have used the
Internet to search for health information
specific disease
 medical procedure
 nutrition
 other

Health Topics More Popular
in California
Alternative treatments or medicines
Health insurance
Experimental treatments or medicines
Problems with drugs or alcohol
7 out of 10 Californians (all income groups) say the
Internet has improved the health & medical
information & services they receive
Source: Fox S. Wired for Health: How Californians compare to
the rest of the nation. Pew Internet & American Life Project; 2003.
http://www.pewinternet.org/reports/toc.asp?Report=105
Evidence-Based Health Care
“Evidence-based medicine is the
conscientious, explicit and judicious use
of current best evidence in making
decisions about the care of individual
patients.”
Source: Sackett DL, et al. Evidence based medicine: what it is and what it isn’t.
BMJ 1996; 312(7023):71-72.
How is Lyme Disease
diagnosed and treated?
Specific Disease/Conditions
Some searching tips:

Become familiar with the general health information finding
tools that you believe to be reliable

When you have found sites that look relevant, use evaluation
criteria to help decide whether information is credible,
timely and useful.
Always get a “second opinion”
Even the best “evidence” may not pertain to a
particular individual.
Information on Specific Disease
or Condition
Background
Definitions
 Overview

What kinds of information?
Etiology (cause or origin)
 Diagnosis
 Treatment
 Prognosis (course & outcome)

Bookmarks
Go to: bookmarks.infopeople.org
Look for the class bookmark file
[consumer_health_bk.html]
Click on it so it shows on the screen
With the class bookmark file showing in Internet
Explorer, click the Favorites menu, choose Add to
Favorites…
Notice the name in the Name: box so that you can use
the Favorites list to get back to the class bookmarks
for the rest of the day.
Government Information
California Department of Health Services


Gateway with link to city/county health
organizations
Phone numbers for local health departments
Healthfinder.gov


Gateway to the best government and non-profit
health agency information
Provides basic information & links to more
detailed information
Authoritative & up-to-date information
From NLM & NIH
Encyclopedia & dictionary
Drug information
Clinical trial information
Updated daily
No advertising
PubMed



Over 14 million citations, 1950’s Links to many sites providing full text articles and other
related resources
http://pubmed.gov
Loansome Doc


Is a method of ordering PubMed articles
The borrower must make an agreement with a local
health science library
PubMed Central
NLM's digital archive of life sciences journal
articles
Open access archive
Can search the full text of articles in PMC
Searching is similar to searching in PubMed
Directory of open access journals:
http://www.doaj.org
What Do We Know
About Searching Behavior?
Consumers use search engines rather than medical
portals or sites of medical societies or libraries.
When assessing the credibility, they primarily
looked for the source, professional design,
scientific or official touch, language, and ease of
use.
Under observation, none checked “about us”
sections, disclaimers, or disclosure statements.
Source: Eysenbach, G, Köhler, C. How do consumers search
for and appraise health information on the world wide web?
BMJ. 2002 March 9; 324 (7337): 573–577.
Good, Bad or Ugly?
http://focusas.com
¡¡Evaluate, Evaluate, Evaluate!!
Source
Currency
Accuracy of content
Purpose
Links
Design
Verify information - get a “second opinion”
¡¡Evaluate, Evaluate, Evaluate!!
“Contributes to”, “is linked to”, “associated
with” is not the same as “causes”
“Doubles the risk” is meaningful depending
upon what risk was in the first place
“Significant” is not the same as
“statistically significant”
Are there Drug Site-Specific
Evaluation Issues?
“May” v. “will”
“Proves” - one study alone infrequently proves
something
“Breakthroughs” rarely happen
“Significant” v. “statistically significant”
Beware of miraculous cures
Use the same criteria as for evaluation of
other health web sites
Direct-to-Consumer Advertising
Education or emotion promotion?
Misleading?
Success rate of drug
 Duration of use
 Alternative treatments

Patient misconceptions:
Only best/safest can be advertised
 FDA reviews ads

Is there any evidence
that glucosamine sulfate
can help arthritis?
Complementary &
Alternative Medicine (CAM)
“Diverse medical & health care systems,
practices, and products …not presently
considered to be part of conventional
medicine.”
Source: http://nccam.nih.gov/health/whatiscam/
Less evidence of efficacy of treatments and
safety.
36% of adults over age 18 use some form of
alternative medicine
Source: CDC 2002 Nat’l Health Interview Survey
Integrative Medicine
Combines mainstream medical therapies
and CAM therapies for which there is some
high-quality scientific evidence of safety
and effectiveness.
Special Populations
Ethnic groups:

According to the latest U.S. census data, 41%
of Californians over the age of 5 speak a
language other than English at home.
Age
Gender
Even pets!
Health Literacy
Health literacy is the ability
to read, understand, and act
on health care information.
Source: Center for Healthcare Strategies,
Inc.http://www.chcs.org/resource/pdf/hl1.pdf
Who Has
Health Literacy Problems?
People of all backgrounds, especially
those with chronic health problems
Older people, immigrants & those with
low incomes are disproportionately
more likely to have trouble reading &
understanding health-related
information.
Internet Filtering
See No Evil: How Internet Filters Affect the
Search for Online Health Information
Report finds


Pornography can effectively be blocked without blocking
most health information
This is true only if not used at most restrictive settings
Further information at
http://www.kff.org/entmedia/20021210a-index.cfm
Finding Hospitals & Doctors
“Report Cards”
Who created the Report Card?
 What questions were asked?
 Who gave the answers? How many people
were surveyed?
 Is the information reported of interest to me?
 Is terminology defined?
 How old is the information?

Support Groups
Look for groups in disease-specific, general
health & directory sites
E-mail support:
Listserv
 Chat groups

Pros and cons?
In Summary
Quality of medical information
available on the Internet is uneven
Many people still lack access
Health seekers frequently have difficulty finding,
understanding and using this information
NEVER provide medical advice.
Send patrons to their health care providers for
interpretation of health information.