Internet use for searching information on Health and Medicine:

An Exploratory study among Indonesian customers

 

Susi Ari Kristina¹*, Marlita Putri Ekasari¹, Muvita Rina Wati^1,2

¹Department of Pharmaceutics, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia

 

ABSTRACT:

Internet now considered as major source to search for health-related information worldwide. The objectives of this study were to explore the use of internet for searching for health and medicines information among Indonesian pharmacies customers. Descriptive study was conducted. Pharmacy customers in 10 pharmacies in Yogyakarta province were conveniently invited to participate. A set of questionnaire consisted of 21 questions including sociodemographic, health status and use of medicines, internet use profile, trust and importance on information sources. Among 674 respondents, 646 (95.56%) of them reported the use of internet to search for health information. Majority of them were women (51.7%), 18-24 years old (63.93%), single status (74.30%) and higher degree of education (50.31%). Respondents most frequently sought for information on the both medicine and health related topic (83.13%). However, they most trusted on information provided by physician and pharmacist with mean score 4.38 ± 0.72 and 4.17 ± 0.75 respectively. Respondent also rated physician and pharmacist as the most important sources to provide health information (4.5 ± 0.72 and 4.21 ± 0.76 respectively). The results highlight the need for educational interventions to increase skills in retrieving high-quality information and advising patients about appropriate use of internet for health purposes.

 

 

 

INTRODUCTION:

The use of internet now considered as major source worldwide to search for health-related information. Conventionally, health professionals have been the main source of health information, providing information to patient by face to face counseling¹. To date, people have been exposed a greater access to health information^2,3, therefore internet allows them to manage symptom and healthcare^4,5.

 

People using internet for health-related searches are estimated to be up to more than 70% of internet user worldwide⁶. However, it is infrequent for people in developing countries to get access to the internet.

 

For example, in Southeast Asia, which has a population of 600 million, less than 50% had good access to the internet in 2000, and of this number about 80% were in Indonesia. The proportion ratio of people who have access to the internet to those who do not is about 1 to 5000, while in the United States or European countries the ratio is 1 to 6.5^7-9.

 

As internet is overwhelmed with a vast of health information that lacks of monitoring on its contents, attention about the reliability, accuracy and credibility of provided information are raising^10,11. Wide gap in the accuracy and readability of this online information still exist. Questions of online health information, which included improper or misleading information, risk promoting messages and retrieval of unorganized collections of medical information, are identified^12,13. To meet standard of quality, detailed crosscheck of internet contents and of the skills in selecting information of their users is needed¹⁴. Models and types of online health information seeking has become a considerable research interest.

 

 

While health information seeking on internet is increasing, sparse information however exists so far about internet use to search for medical information in developing countries^7,15. Health information seeking behavior is influenced by many factors, including demographics, socioeconomic factors, education, employment, health conditions, and previous experiences in using internet^16-18. Various studies have investigated the demographic characteristics of online health information seekers^19-21, but there have been no studies to date that explore the online health information seeking patterns and behavior among Indonesian pharmacies customer. The objectives of this study were to explore the utilization of internet for searching for information on health and medicines among Indonesian pharmacies customers and to assess the level of trust and importance of online information.

 

MATERIALS AND METHODS:

The study was a descriptive survey. Participants were pharmacy customers who were selected conveniently from ten pharmacies in Yogyakarta Province and invited to participate in the study from September 2017 to November 2017. The selection of pharmacies was based on the representativeness of five districts. The inclusion criteria for recruited participants were being aged ≥10 years, who had started accessing health information using internet source and considered able to response the survey questions. Consumers with communication difficulties in Bahasa Indonesia were excluded from the study. Consent was given for the agreement to participate. Those who did not completed the survey were not included in the analysis. This study was approved by Medical and Health Research Ethics Committee (MHREC), Universitas Gadjah Mada with approval number KE/FK/0366/FK/2017.

 

The validated questionnaire was developed based on extensive literature review 22-24 and followed by focus group discussion among non-respondents aimed to assess their perspective toward internet use for health information. Content validity process was obtained from three experts in behavioural pharmacy field, with a CVI (content validity index) score was 0.93. Pharmacy customers who agreed to participate filled out a self-administered questionnaire consisted of 4 sections of the following data: (1) Sociodemographic data: age, gender, level of education, employment, and marital status, (2) Health status and use of medicines in the previous 3 months, (3) Internet use profile: searching of information about health and medicines, (4) Trust and importance on information sources. The questionnaire composed of 21 questions. Some of the above aspects were questioned with answer options on a five point Likert scale (1 stood for not important and 5 for important).

 

Descriptive statistics were used to explain the demographics of the respondents, as well as the prevalence and patterns of online health information seeking. Percentage or mean score were presented for data presentation appropriately. Microsoft excel 2016 software was used for data analysis.

 

RESULTS:

Overall, of 674 respondents, 646 (95.56%) reported prior use of the internet to search for information about medicines or health related issues. Use of the internet for this purpose was much more common among women in comparison to men (51.7% vs. 48.3%), and it was highest prevalence in the age range of 18-24 and lowest in the age range of ≤17 and ≥55 (63.93% users vs. 4.18% and 1.08%, respectively). Higher use of internet search was reported by single participants in comparison to married one (74.30% and 25.39%, respectively) and use of online search increased with years of education (50.31% with a university degree) (Table 1).

 

Respondents most frequently sought for information on both medicine and health related topic (83.13%). All of the respondents declared that they sought information on several unspecified health topic. Among medicine related topic searched, information most frequently searched was about medicine indications and name of medicine (80.65% and 68.58% respectively). Respondent also sought the side effects of medicines (67.03%). For diseases related topics, most of them were search topic about mild diseases (65.17%), while the others used internet to search hypertension and diabetes information (30.50% and 35.14) (Table 2).

 

Of 646 respondents using internet, most of them were rely on internet (92.26%), physician (82.35%), and friends (69.04%). However, they most trusted on information provided by physician and pharmacist with mean score 4.38±0.72 and 4.17±0.75 respectively. Respondent also rated physicians and pharmacists as the most important sources to provide health information (4.5±0.72 and 4.21±0.76 respectively) (Table 3).

 

The results of the present survey, involving participants in Yogyakarta pharmacies, show that the utilization of the internet to search for information on health and medicine is extensive. Nearly 96% of respondents used internet to search for information about health related topics. This present exploratory study suggested that women tend to search online health information than men. Age and education stages are variables that prone to affect health information seeking pattern. The highest proportion of internet user occurred in the 18-24 years age group and among group with university degree, who typically searched for health and medicine information. This higher prevalence may also reflect greater health awareness of this group.

Respondents with lower education and were at older age groups (age >55), were fewer to search for online health information. These findings are in line with previous studies^23-25 and reflect the matter of the digital divide. That gap exists between those with ready and not ready access to the tools of information and communication technologies. The ‘not-ready’ are the people with lower income, lower education attainment or disabilities and older age^25,26. Nevertheless, despite the limitation of those people that contribute to the digital divide, among those in lower social economic status were found to be willing to seek online health information when training skills were given²⁷. E-health literacy skill training and support to that group of people can improve their self-efficacy and ability related to their health needs^{23, 28}. 

 

Internet (92.96%) and physician/health care providers (82.35%) proved to be the major sources of health information among respondents. These findings are consistent with previous studies in developing countries where internet was still the major sources in gathering the health information^29,30. However, a recent study ascertained that much low quality information continued to appear on health websites¹². It is thus substantial to develop reliable ways to help people find accurate online medical and health information.

 

Table 1. Demographic characteristics of internet user

Characteristics (N=646)	N (%)
Age group (years)
10 - 17	27 (4.18)
18 - 24	413 (63.93)
25 - 34	109 (16.87)
35 - 44	37 (5.73)
45 - 54	53 (8.20)
> 55	7 (1.08)
Gender
Male	312 (48.30)
Female	334 (51.70)
Educational level
<Bachelor degree	319 (49.38)
Bachelor degree	327 (50.62)
Marital status
Single	480 (74.30)
Widowed	2 (0.31)
Married	164 (25.39)
Household average monthly income (million IDR)
< 0.5	76 (11.76)
0.5 – <1	51 (7.89)
1 – <2.5	104 (16.10)
2.5 – <5	90 (13.93)
5 and more	157 (24.30)
No answer	168 (26.01)
Health Status
Bad	9 (1.39)
Neither good nor bad	120 (18.58)
Good	413 (63.93)
Very good	104 (16.10)
Reasons for searching online
information was free	396 (61.30)
Information was quickly acquired	548 (84.83)
Privacy/avoiding embarrassment/sensitive issues	174 (26.93)
Easy to find	408 (63.16)
Wide availability of information an	378 (58.51)
Others	33 (5.11)

 

Table 2: Topics sought on the internet

Characteristics of topic sought (N=646)	n(%)
Topic
Medicine	22 (3.41)
Disease	87 (13.47)
Both	537 (83.13)
Medicine information
Name and ingredients	443 (68.58)
Indication	521 (80.65)
Dosage and application	376 (58.20)
Side effect	433 (67.03)
Drug interaction with other drugs and foods	264 (40.87)
Price	296 (45.82)
Disease information
Mild diseases like cough, fever, common cold	421 (65.17)
Hypertension	197 (30.50)
Diabetes	227 (35.14)
Hyper cholesterol	164 (25.39)
Joint pain	189 (29.26)
Headache	286 (44.27)
Asthma	143 (22.14)
Others	237 (36.69)

 

 

Table3. Use of various sources for medicine and disease information

Sources of health and medicine information (N=646)	Sources (n,%)	Trust (mean, SD)	Importance (mean, SD)
Physician	532 (82.35)	4.38 (0.72)	4.5 (0.72)
Pharmacist	311 (48.14)	4.17 (0.75)	4.21 (0.76)
Television	205 (31.73)	3.06 (0.71)	3.07 (0.82)
Friend / Family	446 (69.04)	3.21 (0.56)	3.32 (0.68)
Internet	596 (92.26)	3.40 (0.63)	3.54 (0.72)
Radio	40 (6.19)	2.95 (0.65)	2.96 (0.73)
Newspaper	63 (9.75)	2.99 (0.67)	2.98 (0.74)

 

DISCUSSION:

Our finding highlighted that most of participants preferred physicians as source of health information. Takahashi et al. revealed that health surfers in Japan chose physician as their source of health information because of accessibility and credibility³¹. These findings support the results of previous studies that internet surfers would contact doctors/health care providers for more information of treatment of their health issues^32,33. It is obvious that health surfers use the internet to enhance their knowledge in addition to other health information sources. However, this study raised questions about whether access to online health information will enhance appropriate use of medical care³⁴. It appears that many individuals use several sources including the health care providers and the internet for health information. This active involve of consumers highlights the importance of doctor’s role in educating patients about reliable healthcare websites, as well as how to interpret and integrate information found online.

 

The findings, that obtaining information on medicine and health conditions was the most prevalent reason for seeking online health information, are consistent with previous studies^35,36. Hypertension and diabetes were found to be among the top 5 topics sought, in addition to the mild diseases. This findings was similar to previous studies by Medlock et al., 2015; Shah and Winit-watjana, 2011^24,37. The use of internet to search for medical information in Netherland populations, most often for symptoms and therapy options, whereas health professionals were asked for additional information on medications, side effects, coping, and practical treatment.

 

It is important to keep in mind that a convenience sampling was used in the present study. Furthermore, the sample was recruited among pharmacy customers, potentially leading to a selection bias toward people preferentially purchasing medicines through conventional means. Therefore, the respondents may not be representative and may affect the selection bias; and thus the results may not be generalized to the population. In addition, we did not perform inferential statistics since we explored the prevalence and pattern of internet usage as preliminary evidence. For further analysis, association between sociodemographic factors and internet usage may be useful.

 

The present study provides evidences on the utilization of internet for searching information on medicines and health in among Indonesian population. The internet is the main sources of health- and medical-related information. It is therefore of importance to assess information searching behaviors and patterns, as well as the relevant associated factors, to allow the promotion of a safer use of the internet for health purposes. Our study provides evidence about prevalence of the health-related topics most commonly sought based on gender, age, economic status, and level of education. Such results can be used to support educational interventions aimed at improving the ability of Internet users to select and preferentially retrieve high-quality information, as well as the ability of health professionals to assist and advise their patients about the appropriate use of Internet for health-related purposes. Implication of the study is enforcing authorities to regulating the contents of the health websites by formulating guidelines and recommendations. Our findings provide important insights to how the internet is transforming health care system in Indonesia.

 

ACKNOWLEDGEMENT:

The authors wish to thank Ivan Zulfikar, B.Sc for her help in designing questionnaire and the works of as field surveyor. Finally we wish to express our gratitude to pharmacists in Yogyakarta Province for the mutual collaboration during the survey implementation.

 

CONFLICT OF INTEREST:

Authors declare no conflict of interests

 

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Received on 21.05.2019           Modified on 30.06.2019

Accepted on 25.07.2019         © RJPT All right reserved