Patients directed to online tools don't necessarily use them

Submitted by: Joan MacKenzie 04/05/2012

A study finds that health information on the Web is read less often than the same material on paper.

February 15, 2012- Even as patient reliance on the Internet for health information grows, physicians might want to hold on to their patient education pamphlets.

Researchers from the Fox Chase Cancer Center in Philadelphia compared the efficacy of paper-based colorectal screening intervention information to Web-based intervention material.

The study showed that 42% of patients given paper-based resources reviewed them, while only 24.6% of patients given access to Web-based information reviewed it. The study was published online Jan. 4 in the Journal of Health Communication (

From June 2006 to August 2009, 391 women older than 50 seen for routine obstetrics/gynecology follow-up were given information on colorectal cancer intervention. Of those, 130 were given log-in information to a website that provided colorectal cancer screening information. Other women were sent the same information in printed form through the mail. All the women lived in rural Pennsylvania.

Of the few who logged in, the vast majority did so only once, and activity correlated with age -- the younger the patient, the more likely she was to go online. Of the women selected to receive the printed material, more than 30% said they reviewed it at least twice.

The Pew Internet & American Life Project found in its November 2011 report that 80% of Internet users look up health information online. However, researchers said their study shows that patients aren't guaranteed to use resources just because they're online.

"From a health education perspective, you want to go where the people are," said Linda Fleisher, MPH, PhD, assistant vice president of the Office of Health Communications and Health Disparities at Fox Chase and co-author of the JHC study. She said she and her fellow researchers set out to find whether patients are using those tools as much as patient educators think. And it turned out, they weren't.

"We were very surprised by this," Fleisher said. Not only did the women have access to the website, they also agreed to participate.

What this study means to physicians, Fleisher said, is that they shouldn't assume patients will access an online tool. Also at question is how effective online tools would be for certain populations.

There were discrepancies between those who said they went online when they actually didn't, and those who said they had not gone online when they had. Researchers said the discrepancy could have been caused by a variety of factors, including evaluation apprehension, social desirability, cognitive limitations and mere forgetfulness. Almost 70% of the women who used the website didn't remember doing so four months later. Researchers said more study is needed to determine how effective certain content is to certain populations, especially those who do not actively seek out information.

"There's a lot of variability in people's use of some of these Web-based interventions in a more natural setting," Fleisher said. Perhaps patients need to be introduced to these tools by their physician or patient advocates, or offered a variety of resources from which they can choose what best suits them, she said.

"You really need multiple channels, and you need to give people options that work best for them," she said.

Although more research is needed to determine whether one tool is more engaging than another, or whether there are characteristics of certain patients that make them more likely to use online tools, physicians still should assume a primary role in patient education, researchers said.