Surprising Decline in Consumers Seeking Health Information

Tracking Report No. 26

November 2011

Ha T. Tu

In 2010, half of American adults searched for information about a personal health concern, a decline from 56 percent in 2007, according to a new national study from the Center for Studying Health System Change (HSC). The likelihood of people turning to the Internet or to friends and family for health information changed little between 2007 and 2010, but their reliance on printed books, magazines, and newspapers dropped by nearly half, to 18 percent. While the decreased tendency to seek health information spanned virtually all demographic categories, it was especially pronounced among older Americans, people with chronic conditions, and those with lower levels of education. Across all individual characteristics, a person's education level continued to be the factor most strongly tied to their inclination to seek health information. Those who actively researched health concerns widely reported beneficial outcomes: roughly three in five said the information influenced their overall approach to maintaining their health, and a similar proportion said it helped them better understand how to treat an illness or condition.

Overall Health Information Seeking Declines

In 2010, half of all American adults reported seeking information about a personal health concern during the previous 12 months, according to findings from HSC's nationally representative 2010 Health Tracking Household Survey. The share of consumers researching health information fell from 56 percent in 2007, though it still represents a substantial increase over the previous decade, up from 38 percent in 2001. The survey asked adults whether, in the past 12 months, they had sought or obtained information about a personal health concern from sources other than their doctor, including books, magazines, or newspapers; television or radio; friends or relatives; and the Internet.

Beyond searching for information about their own health, nearly two in five adults reported looking for health information on behalf of someone else during the prior 12 months. However, because there was significant overlap between those seeking information for themselves and for others, the combined proportion of people seeking any health information was 58 percent.

Print Media Use Falls Sharply

In 2007, there were three leading sources of health information -- printed books, magazines, and newspapers; friends and relatives; and the Internet -- each used by roughly one-third of adults seeking health information for themselves. By 2010, use of friends and family and the Internet remained relatively stable, but reliance on print media plunged from 33 percent to 18 percent, accounting for much of the overall decline in information seeking.

This downward trend in print-based health information seeking is partly explained by shrinking circulation of print newspapers and magazines and declining sales of physical books. Print newspapers in particular have been caught in a downward spiral, as falling circulation and advertising revenue prompted many papers to raise subscription and newsstand prices well above inflation, which in turn drove further circulation losses. The economic downturn likely contributed by making increasingly expensive print media unaffordable for more consumers. Despite these media industry and broader economic trends, the scale of the decline in print media as a health information source over just three years is striking.

Nearly as unexpected is the finding that Internet-based health information seeking showed only a modest increase, from 31 percent in 2007 to 33 percent in 2010. During this same period, residential broadband (high-speed) Internet access continued to expand rapidly -- from 47 percent to 66 percent of households -- yet online health information seeking failed to keep up with this growth.

Education Level Remains Key

The decline in health information seeking between 2007 and 2010 was not confined to any single segment of American consumers. Indeed, across nearly every demographic category -- including age, education, income, race/ethnicity, and health status -- health information seeking decreased. However, the reduced tendency to seek information was most pronounced among older Americans, those with chronic conditions, and people with less education -- some of the more vulnerable groups who could potentially benefit most from health information.

Historically, a consumer's education level has been the factor most strongly associated with health information seeking, and that remains the case. Information seeking rises sharply with increasing education. After accounting for other personal characteristics, people with graduate-level education are twice as likely as those without a high school diploma to seek health information (67% vs. 33%) -- a gap that has widened since 2007. The disparity is even larger for Internet use (52% vs. 11%).

Although education exerts the strongest influence on information-seeking behavior, other characteristics also play a role. As expected, people with more chronic health conditions are more likely to seek health information. Women are more likely than men, younger consumers more likely than older ones, and whites more likely than African Americans and Hispanics to seek health information. These differences, unlike education, are generally modest to moderate in magnitude once other personal characteristics are taken into account. Income-based differences in overall information seeking shrink dramatically -- and in some cases vanish entirely -- once education and other personal characteristics are controlled for.

Elderly Americans -- those aged 65 and older and the age group least inclined to seek health information despite experiencing the most health problems -- saw a substantial drop in overall information seeking (50% to 42%), largely driven by their use of print media being cut in half (35% to 18%). They did, however, show notable growth in Internet use -- though from a modest starting point (17% to 24%). This contrasts with younger age groups, who had already reached much higher rates of Internet-based health information seeking earlier in the decade but saw their Internet use plateau from 2007 to 2010. It is possible that since elderly people have historically been more dependent on print media for health information, the declining availability of such resources is pushing more of them to explore Internet-based sources.

The socioeconomic profile of health information seekers differed markedly depending on the types of sources they used. The 22 percent of adults who sought health information from both Internet and non-Internet sources were the most affluent and educated group. Not far behind in income and education were the 9 percent who sought health information exclusively from the Internet -- the youngest group. Trailing substantially behind both groups in income and education were the 18 percent who relied solely on non-Internet sources and the 50 percent who sought no health information about personal concerns at all.

Impact of Information Seeking

A majority of consumers who actively investigated health concerns reported positive effects from their information searches: 56 percent said the information influenced their overall approach to maintaining their health, and 60 percent said it enhanced their understanding of how to treat an illness or condition. Among other types of impact the survey explored:

38 percent said the information affected how they coped with a chronic condition or managed pain; 43 percent said it affected a decision about whether to see a doctor; 51 percent said it affected whether they asked their doctor a question; 20 percent said it affected a decision about seeking a second opinion; and 50 percent said it affected their approach to diet, exercise, or stress management.

For most of these measures, the reported level of impact was relatively consistent across demographic subgroups. Across age groups, for instance, elderly people are less likely to seek health information in the first place, but once they do, they appear at least as likely as younger consumers to find the information useful and empowering. However, education stands out as the notable exception to this pattern of relatively uniform impact across demographic characteristics. The self-reported positive impact of health information rises steeply with education level. This finding suggests that more educated consumers may be better equipped both to locate useful information sources and to apply stronger health literacy skills to derive greater benefit from the information they find.

Consumers who used the Internet for health information -- whether as their only source or in combination with other sources -- were significantly more likely to report positive outcomes than those relying solely on non-Internet sources. However, once personal characteristics -- particularly education -- were accounted for, the gap in impact between Internet and non-Internet groups narrowed considerably, becoming statistically insignificant in some cases. This reinforces the idea that consumers' education levels, which are closely linked to health literacy skills, play a pivotal role in determining how engaged or "activated" they are as patients and how valuable and actionable they find the health information they obtain.

Implications

Since 2007, consumers have continued to shoulder a growing burden from rising health care expenses. The economic downturn not only expanded the ranks of the uninsured but also affected costs borne by those with insurance. Insured consumers saw premium contributions and cost-sharing requirements continue to outpace income growth, in both conventional insurance products and consumer-driven health plans. Given these increased financial pressures -- which provide motivation for consumers to seek health information, particularly about treatment options and costs -- the decline in information seeking since 2007 is unexpected.

Health care demand fell between 2007 and 2010 -- with physician visits declining by 4 percent -- a trend largely attributed to the economic downturn. Reduced demand for care, in turn, eased some health system-related barriers, as significantly fewer people reported problems such as obtaining timely doctor appointments or reaching a doctor's office by telephone. This reduction in system-related barriers may have decreased some consumers' need or motivation to seek health information on their own. At the same time, one would expect other consumers -- those cutting back on health care due to cost concerns -- to increase their health information seeking as a substitute for getting information from clinicians.

The decline in health information seeking may partly reflect consumers' reactions to past experiences with health information. Many people searching for health information have reported frustrating or negative encounters. For instance, the National Cancer Institute's Health Information National Trends Survey found that nearly half of those who had sought cancer-related information expressed frustration with the search process itself, nearly three in five expressed concerns about information quality, and nearly two in five said the information they found was too difficult to understand. One plausible -- even likely -- consequence for at least some consumers experiencing these frustrations is to stop looking for information altogether.

The sheer abundance of health information sources -- particularly online -- may itself be contributing to information overload, anxiety, and confusion for some consumers. This phenomenon, which tends to be amplified when different sources provide conflicting information, may cause some consumers to opt out of information seeking entirely.

Numerous public resources exist to help consumers navigate and evaluate the abundance of health information sources, especially online. One prominent example is MEDLINEplus, produced by the National Library of Medicine for the National Institutes of Health. It provides detailed guidance on topics such as "Evaluating Health Information" and "Healthy Web Surfing," designed to help the public assess the reliability and accuracy of online sources. Such resources can be valuable tools; however, the consumers best positioned to find these resources and use them constructively are likely those who are already well-informed and sophisticated. As a result, the gap between informed and uninformed health information consumers is likely to continue widening.

To address this disparity, policy makers -- including the Institute of Medicine and the Office of Disease Prevention and Health Promotion in the U.S. Department of Health and Human Services -- have implemented initiatives both to improve health literacy among consumers and to make health information accessible and actionable for people with a broader range of health literacy skills.

No matter how effectively these initiatives are carried out, however, transforming a significant number of currently disengaged Americans into active, informed health information consumers will remain challenging. Most of these individuals will likely continue to rely as best they can on their physicians, who have limited time available for patient education. This is an area where patient-centered medical homes hold promise, with other health professionals in the practice working with patients managing chronic conditions to help them learn about and better manage their health.

Data Source

This Tracking Report presents findings from the HSC 2007 and 2010 Health Tracking Household Surveys and the 2001 Community Tracking Study Household Survey. All three telephone surveys used nationally representative samples of the civilian, noninstitutionalized population. For the first time, the 2010 survey incorporated a cell phone sample due to declining percentages of households with landline phones. Sample sizes included approximately 60,000 people for the 2001 survey, about 18,000 for the 2007 survey, and roughly 17,000 for the 2010 survey. Response rates were 59 percent in 2001, 43 percent in 2007, and 46 percent and 29 percent, respectively, for the landline and cell phone samples in the 2010 survey. Population weights adjust for probability of selection and nonresponse differences based on age, sex, race or ethnicity, and education. The weights also account for the increased probability of selection among households using both landline and cell phones.

Adult respondents in all three surveys were asked: "During the past 12 months, did you look for or get information about a personal health concern?" and were then presented a list of information sources to which they could respond yes or no; respondents could also name other sources not on the list. In the 2010 survey, adult respondents were additionally asked: "During the past 12 months, did you look for or get information about a health concern for someone else, such as a friend or family member?" Because of significant question wording differences between the 2007 and 2010 surveys, tracking estimates are not available for information-seeking on behalf of others or for the impact of information seeking on respondents themselves.

Sources and Further Reading

NIH MedlinePlus — The National Library of Medicine resource for evaluating health information, referenced in this study as a key tool for consumer health literacy.

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

NCI Health Information National Trends Survey (HINTS) — The National Cancer Institute survey on consumer health information seeking behaviors and frustrations cited in this article.

AHRQ Health Literacy Resources — Agency for Healthcare Research and Quality tools and research on health literacy, patient activation, and making health information accessible.

KFF: Americans' Challenges with Health Care Costs — Kaiser Family Foundation research on rising consumer cost-sharing, premium contributions, and their effects on health care demand.