Web-Based Consumer Health Information: Public Access, Digital Division, and Remainders

Daniel Lorence, PhD, JD; Heeyoung Park, MHA, MS

In This Article


Sample and Definition

The December 2002 tracking survey study of the Pew Internet & American Life Project served as the source data for this study. The survey contained an extensive set of questions about the demographic profile of the participants and the use of the Internet for healthcare information. For online health information seekers, the survey additionally questioned consumers about the topics of health information, the frequency of successful online health information retrieval, and information-seeking behaviors. For general (not health-related) information seekers, the survey assessed the reasons why they did not search information on the Web. Comparative data collected in March 2000 by the Pew Internet & American Life Project (N = 2721) were also used to investigate whether the disparity in the use of computers, the Internet, and online health information narrowed, remained constant, or widened between March 2000 and December 2002.

A randomly selected group of 2463 US adults aged 18 years or older participated in the Pew Internet & American Life Project telephone survey in December 2002. Of the 2463 survey respondents, 1950 reported a valid annual income level. The data of these 1950 participants were used in this study. The annual incomes of respondents were classified into 3 levels: (1) less than $30,000, (2) from $30,000 to $75,000, and (3) over $75,000. The 3 levels are subsequently referred to as low-, medium-, and high-income groups, respectively. Resulting group sizes were 33.33% (N = 650), 42.56% (N = 830), and 24.10% (N = 470) of participants, respectively. Most participants were healthy (86.06%), middle-aged (42.08%), and white (75.64%). The resulting group of 1950 respondents was stratified into "computer user," "Internet user," and "online health information seeker" (Figure). The computer users were defined as those who occasionally used computers; 73.95% (N = 1442) of participants belonged to the computer user group. The computer user was classified into "Internet user" and "not-Internet user." The Internet users were defined as the people reporting that they went online to access the Internet. All others were classified as not-Internet users. The 84.33% (N = 1216) and 15.67% (N = 228) of computer users were referred to as "Internet user" and "not-Internet user," respectively. The Internet users were again divided into "online health information seeker" and "not-online health information seeker." The information seeker was defined as an Internet user who searched any kind of health information on the Web; 67.68% (N = 823) and 32.32% (N = 393) of 1216 Internet users were classified into online health information seekers and not-health information seekers, respectively (see Figure 1).

Figure 1.

Stratification of participants.

Data Analysis

An initial exploratory analysis used Pearson's chi-square test and Mantel-Haenszel chi-square tests to examine the association of the level of household annual income with key variables and the homogeneity of probability of each cell in a contingency table. The key variables included the place where the users connected to the Internet, the frequency of the Internet access, the types of online activities, the topics of online health information, the attitude to the online health information, and the reasons why Internet users do not explore health information on the Web.

In addition, binary logistic regression analyses were conducted to estimate odds ratios with a 95% confidence interval (CI), as well as the probability of each income group reporting a specific event, such as the use of a computer, the Internet, or online health information. The odds ratios illustrate how much the odds increased or decreased by changing the level of income. In the estimation of odds ratios, the high-income group (over $75,000) was used as a benchmark reference point for comparison purposes. All statistical analyses for this study were performed at the .05 level of significance and generated with SAS software, Version 8.02 of the SAS system for Windows.


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