Wednesday, December 07, 2011

Misleading titles for $10,000: "Surprising decline in consumers seeking health information"

In one of those all-too-frequently overhyped announcements, the Center for Studying Health System Change drew attention to their new tracking report, published November 11, and now making rounds on consumer health oriented sites and medical/consumer health library listservs. I have to wonder if the same author wrote the content and the title of the announcement, because the content is solid - and because there really IS a good story here - well worth further study - but it got missed in the hype. Takeaways from this study include the following:
  • Resource media type shifts: Reported use of print, television, and radio as resources for health information has dropped between 2007-2010. Meanwhile, online source use has risen only slightly, leading the study authors to speculate about cause. However, question construction and sampling changes may have had some effect upon results (see below).
  • Change in health information seeking by those over 65: Seniors' use of online health information increased from 17% to 24% during the same period.
  • Without more complete transparency, comparison of responses across the 3 studies (2001, 2007, and 2010 - the basis for the authors' conclusions) is problematic.
Overall, there is an obvious downward trend of health information seeking behavior, but my own takeaway is that numbers and statistics about information sources are never the whole story. The question should also be whether what was found proved satisfactory in answering health concerns.The report may also reflect a flattening trend, as the prior study found huge leaps in the use of online resources. None of the studies asked what specific resources were used, whether information was located, or whether the information located matched their questions.


Bolding is my own:
In 2010, 50 percent of American adults sought information about a personal health concern, down from 56 percent in 2007, according to a new national study from the Center for Studying Health System Change (HSC). The likelihood of people seeking information from the Internet and from friends and relatives changed little between 2007 and 2010, but their use of hardcopy books, magazines and newspapers dropped by nearly half to 18 percent.
What you need to know: the study questions permitted overlap, so that respondents could check any and all information sources (see Table 1, footnote). In other words, some of what we may be seeing is that people who used to seek their health information in hardcopy and online are now using paper less frequently.
In 2007, there were three leading sources of health information—books, magazines and newspapers in print format; friends and relatives; and the Internet—each used by roughly one-third of adults to seek health information for themselves. By 2010, the use of friends/relatives and the Internet remained relatively steady, but the use of print media fell sharply—33 percent to 18 percent—accounting for much of the drop in overall information seeking. 

The previous tracking report, published in 2008, announced a Striking Jump in Consumers Seeking Health Care Information. In fact, the earlier study (2001), against which the data is compared, used a different participant selection method. While the authors were commendably transparent in their methodologies for the all-too-brief summation made publicly available, the 2001 study used cluster sampling, while the 2007 update employed stratified random selection:
Although both surveys are nationally representative, the sample for the 2000-01 survey was largely clustered in 60 representative communities, while the 2007 survey was based on a stratified random sample of the nation (section on Data source:
Data provided in the online report is insufficient to make this call, but it is not out of the question that sampling methods used in the 2001 study were changed for the 2007 and 2010 studies because they were problematic in some way. In cluster sampling (used in 2001), it's important to know whether within-cluster responses are homogeneous, but what I don't know from reading the summative report is how this was tested in practice.

The authors speculate that differences in source usage may be due to negative or frustrating experiences in health information seeking, frustration and confusion caused by (online) information overload, or even to a decline in health visits due to the economic downturn.
The decline in health information seeking may reflect, in part, consumers’ reactions to their previous experiences with health information ('Implications,' para. 2,

The real question to ask here is whether we are seeing a flattening-out of health information seeking activities, with saturation of use from those who now regularly use online sources?  Might the flattening-out also reflect a decreasing tendency to seek information from multiple sources, as people find preferred sites and (in the case of chronic health conditions) online communities? 

Mentioning as a leading source of reliable health information, the report concludes, in part:
Such resources can be valuable consumer tools; however, the consumers best positioned to locate these resources and use them constructively likely are already informed, sophisticated consumers. As a result, the gap between the haves and have-nots among health information consumers is likely to continue growing.
In efforts 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 in consumers and to make information accessible and actionable to consumers across a broader range of health literacy skills. 
These reports don't just highlight the gap between haves and have-nots, they also identify a rich opportunity for research about what sources are used and why there appears to be a decline in resource types. For those who are concerned with supporting the health information needs of health consumers, this is a call for our involvement.

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