Striking Jump in Consumers Seeking Health Care Information

Striking Jump in Consumers Seeking Health Care Information

Tracking Report No. 20
August 2008
Ha T. Tu, Genna R. Cohen

By 2007, 56 percent of American adults -- over 122 million individuals -- had sought information about a personal health concern, a substantial increase from 38 percent in 2001, according to a national study by the Center for Studying Health System Change (HSC). Use of every information source increased significantly, with the Internet leading the way: online health information seeking doubled to 32 percent over the six-year period. Consumers across all categories of age, education, income, race/ethnicity, and health status increased their information seeking substantially, though education level remained the single strongest predictor of whether someone would seek health information. Despite a sharp increase in health information seeking among elderly Americans (65 and older), they still trailed younger adults by a considerable margin, particularly in using Internet sources. Among consumers who actively researched health concerns, the reported impacts were strongly positive: over half said the information changed their overall approach to health maintenance, and four in five said it helped them better understand how to treat an illness or condition.

Healthy Growth in Information Seeking

In 2007, roughly 56 percent of all American adults -- more than 122 million people -- reported seeking information about a personal health concern during the previous 12 months, a significant jump from 38 percent -- approximately 72 million people -- in 2001, according to findings from HSC's nationally representative 2007 Household Health Tracking Survey. The survey asked adults whether, over the preceding year, they had looked for or obtained information about a personal health concern from various sources other than their doctor, including books, magazines, or newspapers; television or radio; friends or relatives; and the Internet.

Doubling of Online Health Seekers

Consumers expanded their use of all information sources during the six-year period, but the Internet emerged as the fastest-growing channel for health information. Thirty-two percent of consumers -- approximately 70 million adults -- conducted online health searches in 2007, up from 16 percent in 2001. This doubling of online health seekers was enabled by substantial growth in overall Internet access and the rapid expansion of residential broadband connections during this timeframe. Additionally, the number of health-related websites available to consumers expanded dramatically over these years.

Consumer use of the Internet for health information had reached parity with more established sources such as books, magazines, and newspapers (33%) and friends or relatives (31%), both of which also rose significantly since 2001. These information channels are neither mutually exclusive nor independent. For instance, consumers who find health information online may become resources for people in their own social networks, potentially prompting those individuals to seek additional information directly from the Internet. And health information originally published in one medium -- such as a print journal -- can quickly become accessible to far more consumers through other channels, including health-specific and general news websites. These interconnections among sources may partly explain consumers' growing tendency to use multiple information sources (35% in 2007 versus 21% in 2001).

Education Level Remains Key

The large increase in information seeking between 2001 and 2007 was not confined to any single demographic segment. Every category of age, education, income, race/ethnicity, and health status experienced substantial growth in overall information seeking, Internet-based searching, and use of multiple sources.

In 2001, a consumer's level of education stood out as the personal characteristic most strongly associated with the propensity to seek health information. Six years later, information seeking still increased sharply with rising education levels. In 2007, 72 percent of people with graduate education sought health information, compared with 42 percent of those without a high school diploma, and the gap was even wider for Internet use (52% versus 10%).

While education exerts the strongest influence on information-seeking behavior, other characteristics also matter. People with chronic conditions are more likely to seek health information. After adjusting for other personal characteristics, women are more likely than men, younger consumers more likely than older ones, whites and African Americans more likely than Hispanics, and higher-income individuals more likely than those with the lowest incomes to seek health information. These differences, unlike education, tend to be modest to moderate in magnitude.

Some groups least inclined to seek information in 2001 showed the sharpest increases by 2007. For example, elderly consumers and those with less education both increased their Internet health information seeking by approximately 2.5 times. As a result, gaps between the elderly and the young and between people with low and high education levels narrowed somewhat. However, because baseline information-seeking levels were so low for older and less-educated consumers, the absolute age and education gaps remain formidable. Seniors, for instance, were still only half as likely as consumers aged 18 to 49 to use the Internet for information about a personal health concern (18% versus 36%).

Impact of Information Seeking

More than half of all adults who sought health information subsequently discussed it with their doctor or another health care professional. Two consumer characteristics had a particularly strong effect on the likelihood of sharing health information with care providers: education level and the number of chronic conditions -- the same factors most closely linked to seeking information in the first place. Compared with healthy individuals, people with chronic conditions have more reason to research condition-specific information for discussion with their physicians, and they also have more frequent office visits.

Among consumers who sought health information for themselves, half reported that the information altered their overall approach to maintaining their health. This effect was relatively uniform across demographic subgroups, with one notable exception: African American and Hispanic consumers were considerably more likely than white consumers to report this impact on health behavior, after adjusting for other personal characteristics.

The most notable finding on the impact of health information is that four out of five information seekers discovered information that helped them better understand how to treat an illness or condition. This positive effect on health knowledge was consistently high across demographic groups. African American and Hispanic information seekers were again more likely than their white counterparts to report that the information had a beneficial effect on their understanding. One possible explanation is that minority consumers are more likely to lack a regular doctor or care provider, so information obtained from other sources may carry greater impact on their health knowledge and behaviors.

Unlike the initial inclination to seek health information, which varied widely by education level, the perceived impacts of the information were much more evenly distributed. It appears that once consumers are sufficiently motivated to actively seek health information, even those with less education are likely to find useful sources.

Information Seeking for Others

Consumers were active in searching for health information not only for themselves but also on behalf of others. In 2007, 42 percent of adults sought information for other adults, with 27 percent doing so online. Additionally, 29 percent of children had health information sought on their behalf by a parent in 2007 -- a moderate but statistically significant increase from 22 percent in 2001.

Consistent with patterns in personal information seeking, education was a key driver of seeking information for others. Consumers with graduate education were nearly four times as likely to conduct Internet health searches for other adults as those without a high school diploma. Children of younger, more educated, and higher-income parents were more likely to have information sought on their behalf.

Unsurprisingly, people inclined to research their own health concerns also tended to be more active in seeking information for others. Among those who sought information for other adults, approximately four in five had also sought information about their own health concerns in the past year. Women were more likely than men to seek information on behalf of other adults, likely reflecting the greater frequency with which women serve as caregivers and care coordinators for family members, including spouses and elderly parents.

Implications

In recent years, consumers have shouldered a growing financial burden from escalating health care expenses. The costs of medical services and insurance premiums have outpaced income growth, driving rising uninsurance rates. Many insured consumers also face higher cost-sharing requirements. Consumers' increasing financial responsibility for health care likely plays a significant role in motivating them to seek more health information, particularly about treatment options and costs.

Beyond financial pressures, consumers increasingly encounter difficulties obtaining timely appointments with their physicians and have limited time to discuss health concerns during office visits. Some consumers -- especially well-informed ones -- may also recognize that their physicians are unlikely to have enough time and resources to stay current with the overwhelming volume of new medical literature. Even consumers facing few cost or access barriers may be motivated to research health concerns independently. Additionally, consumers are now more likely to encounter information from public health campaigns, employer-led wellness programs, and direct-to-consumer pharmaceutical and medical device advertising. All these factors have likely contributed to increased consumer motivation to obtain health information from sources beyond their doctors. And, as noted earlier, consumer access to health information has expanded greatly with the spread of broadband Internet and the proliferation of health-related websites.

Despite the dramatic growth in Internet-based information seeking, at least 50 million Americans who sought health information for themselves or others did not conduct any searches online. These consumers may find themselves increasingly left behind as many new, valuable health information sources -- such as hospital and physician quality reports -- are released solely through online channels. While offline information seekers may still encounter Internet-only material through media coverage or friends and family, the information they receive would not be as complete or current after being filtered through intermediary sources.

Among consumers who obtain health information, it is encouraging that so many across all age, education, income, and racial/ethnic groups report positive effects -- including improved understanding of conditions and treatments and changed approaches to maintaining their health. One caveat, however, is that these subjective, self-reported assessments may not correspond to actual improvements in health behaviors or knowledge. Additionally, some consumers may not take a sufficiently critical approach to the information they encounter or may have difficulty processing information correctly. Previous research has found that many consumers lack basic health literacy and numeracy skills. While most information seekers feel empowered by the health information they find, some may be misled by less valid or credible sources. This is a particular concern for consumers who use information to self-diagnose and self-treat health problems without consulting a medical professional.

Policy makers have important roles to play in supporting consumers' health information efforts. For health information initiatives they sponsor directly, policy makers can work to ensure the information presented is accurate, timely, relevant, and accessible to consumers across a wide range of health literacy and numeracy levels. For example, some current price and quality transparency programs sponsored by federal and state agencies report data not applicable to many consumers and present health information in ways likely to be meaningful only to more sophisticated audiences.

Policy makers can also provide resources to help consumers navigate the growing number of third-party health information sources and identify material that is both accurate and appropriate to their needs. Some of these efforts are already underway. For instance, the Office of Disease Prevention and Health Promotion in the U.S. Department of Health and Human Services added Health Communication as a focus area in Healthy People 2010 and produced several guides to assist people seeking health information, including lists of recommended resources.

Data Source

This Tracking Report draws on findings from the 2000-01 Community Tracking Study Household Survey and the 2007 Health Tracking Household Survey. Both surveys include nationally representative samples of the civilian, noninstitutionalized population. The sample size was approximately 60,000 people for the 2000-01 survey and roughly 18,000 for the 2007 survey. Response rates were 59 percent in 2000-01 and 43 percent in 2007. In both surveys, population weights adjust for differences in nonresponse based on age, sex, race/ethnicity, and education. Although both surveys are nationally representative, the 2000-01 sample was largely clustered in 60 representative communities, while the 2007 survey used a stratified random sample of the nation. These differences in sample design are reflected in the standard errors of estimates and statistical tests of change between survey years. Questionnaire design, survey administration, and question wording for all measures in this study were similar across both surveys.

Sources and Further Reading

HHS Office of Disease Prevention and Health Promotion — Federal health communication and health literacy initiatives referenced in this study, including Healthy People 2010 objectives.

NIH MedlinePlus — The National Library of Medicine's consumer health information resource, a key example of federally sponsored health information for the public.

AHRQ Health Literacy Resources — Agency for Healthcare Research and Quality research on health literacy, numeracy skills, and making health information accessible across education levels.

KFF Employer Health Benefits Survey — Kaiser Family Foundation data on rising premiums, cost-sharing, and the financial pressures motivating consumers to seek health information.

Commonwealth Fund: Health Literacy Research — Research on health literacy disparities, consumer engagement, and strategies for making health information useful to diverse populations.