Introduction How Older Adults Use the Internet to Look for Health Information
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How Older Adults Use the Internet to Look for Health Information Introduction • Many patients want more information than their physicians have time to provide • Considerable enthusiasm for Internet’s potential to transform communication • Concern about disparities in use Discussions of differential use have focused on social position Wide variation in use even among those of “similar” social position Far less attention to implications of psychological heterogeneity Kathryn Flynn Maureen Smith Jeremy Freese Duke University University of Wisconsin University of Wisconsin Harvard University Objective • Unclear when patients are using the Internet to search for health information in relation to their outpatient doctor visits Wisconsin Longitudinal Study (WLS) To determine how psychological differences are related to the use and timing of Internet health searches among older adults • 1/3 random sample of Wisconsin high school graduates from spring 1957 (n=10,317) • Surveys conducted in 1957 (in school), 1964 (mail to parents), 1975 (phone), 1992-3 (phone & mail), and 2003-4 (phone & mail) • High response rates (>80%) • WLS graduate sample is age homogeneous education truncated ethnically homogeneous Sample characteristics 80% 55% Explanatory variables 89% • Personality 55% 9% Openness Conscientiousness Extraversion Agreeableness Neuroticism • Cognitive ability High school IQ Female High School Married Private Insurance Fair/Poor Health • Self-reported effort to stay healthy • Preferences Want to be told all treatment options Want MD to know entire medical history Want treatment choices Want to make treatment decisions Source: Wisconsin Longitudinal Study Graduate Survey 2004, N=6,125 1 Control variables • • • • • • Gender Marital status # children Rural or farm origin Educational attainment Length of relationship with usual provider of care • SF-12 Physical Mental • Health insurance • # prescription meds taken regularly • Common conditions Asthma Cancer Diabetes IBS Heart disease Stroke Hypertension Joint problems State-of-the-art computing, 1957 Analysis • Multinomial logistic regression Regress searching behavior on explanatory variables Predict adjusted probability of each behavior by explanatory variable with all other variables held at population mean Internet use in WLS sample, 2004 No home PC 23% PC, but no net 35% 6% Net, but not used 9% Use net, but not for health 27% Use net for health Source: 2004 WLS Graduate Survey, N=6125 Internet use in WLS sample, 2004 Timing of last health-related search 2% have used net for health, but don’t have home PC 12% No home PC 23% PC, but no net No health searches 6% 1% Unrelated to visit 35% 6% Net, but not used 9% 27% 16% Instead of visit 65% Before visit Use net, but not for health After visit Use net for health Source: 2004 WLS Graduate Survey, N=6125 Source: 2004 WLS Graduate Survey, N=6125 2 Timing of last health-related search Graduate School High School Timing of last health-related search High cognitive ability 9% 15% Low cognitive ability 8% 13% 3% 4% 5% 7% 16% 16% 52% 62% 20% 72% 72% 26% * * * Source: 2004 WLS Graduate Survey, adjusted for all variables in the full model, *odds ratio significant at p<0.05 Timing of last health-related search Low Openness High Openness 9% * Timing of last health-related search Low Neuroticism High Neuroticism 10% 4% 12% 4% 6% 16% 5% 18% * * * Timing of last health-related search Don’t work hard to stay healthy 10% 2% 11% 6% 66% 68% Source: 2004 WLS Graduate Survey, adjusted for all variables in the full model, *odds ratio significant at p<0.05 Work hard stay healthy 17% 60% 22% * Source: 2004 WLS Graduate Survey, adjusted for all variables in the full model, *odds ratio significant at p<0.05 Timing of last health-related search Want many treatment choices Don’t want many choices 10% 3% 11% 6% 15% 20% 15% 21% 63% 62% 72% 73% * * Source: 2004 WLS Graduate Survey, adjusted for all variables in the full model, *odds ratio significant at p<0.05 12% 71% * * Source: 2004 WLS Graduate Survey, adjusted for all variables in the full model, *odds ratio significant at p<0.05 * * Source: 2004 WLS Graduate Survey, adjusted for all variables in the full model, *odds ratio significant at p<0.05 3 Timing of last health-related search No Cancer • Those with increased educational attainment, cognitive ability, and greater openness more likely to search for health information online Cancer 10% Conclusions 15% 4% • Relatively few older patients are preparing for visits by seeking health information online 6% 19% Those that do tend to be more “health-conscious” or neurotic 67% 16% 63% • People diagnosed with cancer are more likely to search for health information online after a doctor visit * • Understanding how patients use non-physician sources of health information is important to facilitating shared decision making within doctor visits Source: 2004 WLS Graduate Survey, adjusted for all variables in the full model, *odds ratio significant at p<0.05 4
