Practicing what they preach: health behaviors of those who provide health advice to extensive social networks

As a way of identifying a conduit to disseminate health information, this study aims to explore health behaviors and attitudes of a unique group of extensively socially-networked individuals who regularly are asked for their health advice. Respondents from a population-based consumer opinion panel (n = 2,639) were categorized as "extensively socially-networked" (75+ friends and acquaintances, and almost daily giving friends advice on general issues) vs. "non-networked." The networked respondents were further divided into "health-networked" (regularly asked for health advice) versus "only-socially-networked" groups (asked for general advice, not health). Chi-square analyses, ANOVA tests, and multivariate regressions controlling for sociodemographic variables compared health behaviors and attitudes between groups. Results indicated that health-networked individuals reported more positive health behaviors (e.g., fruit and vegetable consumption) and attitudes than only-socially-networked and non-networked individuals. Future research is warranted to elucidate how providing health advice to a large network contributes to the positive health of health-networked individuals. Exploratory analyses revealed that doctors and health/fitness magazines were main sources of health and nutrition information for health-networked respondents. Through their advice and word-of-mouth, health-networked individuals have the potential to influence the health information of large groups of people and, therefore, may serve as valuable change agents to disseminate health and nutrition information.

Incidental health information use on the Internet

This study investigates the correlates of incidental or nonpurposive health information use on the Internet. Through a secondary analysis of the Health Information National Trends Survey II data, this study reveals that incidental health information use on the Internet is positively associated with overall Internet use, active health information seeking on the Internet, and incidental health information use from traditional media. Thus, this study extends the notion of media complementarity to incidental media usage in a health communication context. This study also reveals that adults who have been diagnosed with cancer are more likely to have incidental health information use from traditional media but not the Internet. More important, this study suggests that incidental health information use on the Internet is positively associated with health knowledge. The findings have important implications for health information campaigns on the Internet.

Research use and support needs, and research activity in social care: a cross-sectional survey in two councils with social services responsibilities in the UK

The purpose of this study was to investigate the level of research activity, research use, research interests and research skills in the social care workforce in two UK councils with social service responsibilities (CSSRs). A cross-sectional survey was conducted of the social care workforce in two CSSRs (n = 1512) in 2005. The sample was identified in partnership with the councils, and included employees with professional qualifications (social workers and occupational therapists); staff who have a role to assess, plan and monitor care; service managers; commissioners of services; and those involved with social care policy, information management and training. The survey achieved a response rate of 24% (n = 368). The Internet was reported as an effective source of research information; conversely, research-based guidelines were reported to have a low impact on practice. Significant differences were found in research use, by work location, and postgraduate training. Most respondents saw research as useful for practice (69%), and wanted to collaborate in research (68%), but only 11% were planning to do research within the next 12 months. Having a master's degree was associated with a greater desire to lead or collaborate in research. A range of research training needs, and the preferred modes of delivery were identified. Support to increase research activity includes protected time and mentorship. The study concludes that a range of mechanisms to make research available for the social care workforce needs to be in place to support evidence-informed practice. Continual professional development to a postgraduate level supports the use and production of evidence in the social care workforce, and promotes the development of a research culture. The term research is used to include service user consultations, needs assessment and service evaluation. The findings highlight a relatively large body of the social care workforce willing to collaborate and conduct research. Councils and research support systems need to be developed to utilise this relatively untapped potential.

Energy, climate, food and health

On June 3-5, 2008, international organizations and heads of state met in Rome to discuss the critical situation in global food supplies and prices during the World Food Crisis Summit. The intent of this column is to provide approaches to identifying the complex issues that impact public health, public safety, and nutrition on a global basis. The Web sites selected provide a background for the complex issues involved (energy, climate and environment, agriculture, and politics) and reveal controversial and competing agendas with many far-reaching implications.

Perceptions of traditional information sources and use of the world wide web to seek health information: findings from the health information national trends survey

As medical information becomes increasingly available and individuals take a more active role in managing their personal health, it is essential for scholars to better understand the general public's information-seeking behavior. The study reported here explores the use of the World Wide Web to seek health information in a contemporary information-media environment. Drawing from uses and gratifications theory and the comprehensive model of health information seeking, perceptions of traditional information sources (e.g., mass media, one's health care provider, etc.) are posited to predict use of the Web to seek health information and perceptions of information acquired from searches. Data from the Health Information National Trends Survey (HINTS; N = 3982) were analyzed to test study hypotheses. Trust in information-oriented media, entertainment-oriented media, and one's health care provider all predicted Web use behavior and perceptions. The implications of the findings for research on information seeking and the role of the Web in patient empowerment are discussed.

Assessing the content and quality of information on the treatment of postmenopausal osteoporosis on the World Wide Web

OBJECTIVE

To evaluate the content and quality of currently available Internet-based information on the treatment of postmenopausal osteoporosis.

DESIGN

A sample was obtained comprising the 75 top sites retrieved with the Google search engine using 'treatment of postmenopausal osteoporosis' and then evaluated according to predefined general and specific criteria, content type, language and quality. Using a systematic scoring tool, each site was assessed for factual information provided and site quality.

RESULTS

The sites studied were heterogeneous in content and quality. The most frequent type of website corresponded to non-profit organizations (n = 40), followed by commercial sites (n = 19), professional sites (n = 8) and government sites (n = 8). There were no significant differences in the popularity index, medical content score or quality score among the four groups of sites. Twelve websites were papers published in peer-reviewed medical journals. Few sites provided comprehensive medical and complete information on the treatment of postmenopausal osteoporosis oriented towards consumers. The consumer-oriented webpage with the most balanced and complete information was that of the National Osteoporosis Foundation which, at the same time, had the highest popularity index of all the resources studied.

CONCLUSION

The content and quality of websites concerning the treatment of postmenopausal osteoporosis are highly varied and sometimes biased. The most frequent high-quality information corresponds to peer-reviewed medical journals. It is necessary to increase the number of resources, with rigorous language that is understandable for consumers, in relation to the treatment of postmenopausal osteoporosis.

Sources of health information among Vietnamese American men

Vietnamese American men face multiple health disparities compared to white men. Our study objective was to determine the sources of health information used by Vietnamese men in the United States. A population-based, in-person survey was conducted among Vietnamese men in Seattle during 2002. Our survey was completed by 509 Vietnamese men (79% response rate). The most commonly reported sources of health information included Vietnamese newspapers/magazines (73%), Vietnamese and English language television (64% and 67%, respectively), Vietnamese radio (51%), and friends and family members (51% and 63%, respectively). We found that sources of health information varied significantly among sociodemographic subgroups of the Vietnamese male population. Sources of health information among Vietnamese American men differ considerably from other racial/ethnic groups. Research findings should be used to guide the development of health education interventions for Vietnamese men and subgroups within the Vietnamese male population.

Knowledge in the Palm of your hands: PDAs in the clinical setting

OBJECTIVE

To explore the impact of hand-held computers on patient care by identifying: (i) how often clinical staff accessed resources on hand-held computers to inform their clinical decision making; (ii) Which hand-held resources were thought to be most useful in the clinical setting; (iii) the barriers to using hand-held resources to support patient care.

DESIGN

A descriptive study comparing aspects of Personal Digital Assistant (PDA) resource use in two phases, between August 2002 and December 2003. There was variability in the way that resources were accessed between the two studies.

SETTING

University Hospitals of Leicester NHS Trust, an acute teaching hospital, and one primary care practice.

PARTICIPANTS

A purposive sample of 14 clinical and librarian staff participated in phase one and 14 in phase two of the study. Participants consisted of consultants, nurses, pharmacist, junior doctors, clinical librarians, and a general practitioner.

MAIN OUTCOME MEASURES

Baseline Data Questionnaire to identify the participants' level of knowledge and use of hand-helds on entering the study. End-of-phase questionnaire with self-reported measures of use of the hand-held and PDA resources during the study.

RESULTS

All of the participants used hand-helds in their clinical setting to support evidence-based practice and education, but with varying frequency. More staff reported using the hand-held to answer specific patient questions in phase two than phase one of the study. UK resources were preferred to American resources. The 'plug-in and go' method using Secure Digital (SD) cards was preferred to downloading resources from the Internet.

CONCLUSIONS

Hand-held technology is emerging as an effective clinical tool to aid evidence-based practice and support the educational needs of clinical staff. The hand-held can provide a critical mass of information that is relevant, quickly accessible and in a coherent format: delivering clinical information at the point of need with a resulting benefit to patient safety.

Information resource preferences by general pediatricians in office settings: a qualitative study

Background

Information needs and resource preferences of office-based general pediatricians have not been well characterized.

Methods

Data collected from a sample of twenty office-based urban/suburban general pediatricians consisted of: (a) a demographic survey about participants' practice and computer use, (b) semi-structured interviews on their use of different types of information resources and (c) semi-structured interviews on perceptions of information needs and resource preferences in response to clinical vignettes representing cases in Genetics and Infectious Diseases. Content analysis of interviews provided participants' perceived use of resources and their perceived questions and preferred resources in response to vignettes.

Results

Participants' average time in practice was 15.4 years (2–28 years). All had in-office online access.

Participants identified specialist/generalist colleagues, general/specialty pediatric texts, drug formularies, federal government/professional organization Websites and medical portals (when available) as preferred information sources. They did not identify decision-making texts, evidence-based reviews, journal abstracts, medical librarians or consumer health information for routine office use.

In response to clinical vignettes in Genetics and Infectious Diseases, participants identified Question Types about patient-specific (diagnosis, history and findings) and general medical (diagnostic, therapeutic and referral guidelines) information. They identified specialists and specialty textbooks, history and physical examination, colleagues and general pediatric textbooks, and federal and professional organizational Websites as information sources. Participants with access to portals identified them as information resources in lieu of texts.

For Genetics vignettes, participants identified questions about prenatal history, disease etiology and treatment guidelines. For Genetics vignettes, they identified patient history, specialists, general pediatric texts, Web search engines and colleagues as information sources. For Infectious Diseases (ID) vignettes, participants identified questions about patients' clinical status at presentation and questions about disease classification, diagnosis/therapy/referral guidelines and sources of patient education. For ID vignettes, they identified history, laboratory results, colleagues, specialists and personal experience as information sources.

Conclusion

Content analysis of office-based general pediatricians' responses to clinical vignettes provided a qualitative description of their perceptions of information needs and preferences for information resource for cases in Genetics and Infectious Diseases. This approach may provide complementary information for discovering practitioner's information needs and resource preferences in different contexts.

Endometriosis: internet resources

Endometriosis is a puzzling disease characterized by pelvic pain, infertility, allergies, fatigue, and bowel problems. It is a non-lethal medical condition that disables only women and frustrates physicians who are frequently limited in their treatment success. Recently endometriosis has been linked with endocrine, environmental, genetic, and immune factors. The public health impact of endometriosis is significant in terms of suffering, lost income, infertility, stress on families, and medical costs. Resources for endometriosis on the Internet include search engines, medical sources, advocacy sources, U.S. government sources, personal Web sites, public library databases, and social science sources.

Prevalence of internet usage and access to health information among dental school outpatients

The aim of this study was to investigate the prevalence of Internet access and use among dental school outpatients to evaluate the type of information they seek and their views regarding health-related information. A total of 400 consecutive outpatients were surveyed. A questionnaire was used to collect data on demographic characteristics and Internet use. Users were asked about the frequency and location of their Internet access. Access to health-related information and medical and dental topics of interest was recorded. Participants expressed their opinions on the usefulness of the information and the improvements that might be needed. A total of 33.0% of the participants were Internet users. Those in the 15- to 24-year age group were male, unmarried, and at school and were much more likely to use the Internet than their counterparts. Twelve percent of the users were seeking online health information. Dental information was sought by 16.7% (n = 8) of online health seekers. Those in the 25- to 34-year age group were married, employed, and who have a university degree and were much more likely to seek health information on the Internet than their counterparts. Currently, persons seeking online health information in this population in Turkey are a small minority. It is important to respond to the specific health needs of the Internet users to post accurate information.

Meeting the public's cancer information needs: characteristics of callers to the National Cancer Information Center of the American Cancer Society

BACKGROUND

In this study, we describe the characteristics of the callers of the American Cancer Society's National Cancer Information Center (NCIC), why they called, how they learned about NCIC, and their satisfaction.

METHODS

A random sample of callers (N = 19,487) completed a telephone survey.

RESULTS

The majority were female, White, 45 to 74 years old, had incomes greater than 35,001 dollars, and were college educated. They learned about the NCIC through TV advertisements and requested information about specific cancers, local programs, or making donations.

CONCLUSIONS

These findings validate the usefulness of the NCIC and are helpful in identifying and targeting persons who do not routinely use this service.

The Information Requirements of People With Cancer

Information is crucial for people with cancer for both successful treatment and rehabilitation and to facilitate user involvement and informed decision making. Research has tended to concentrate on biomedical sources, such as hospital-produced information. There have been few inductive investigations of patients' use of information available outside this environment, despite the media and Internet being identified as pervasive sources of cancer information. This article reports on a study that utilized naturalistic inquiry to explore the extent and manner in which the media and Internet are utilized as information sources by people with cancer. Results confirm that the media was used considerably by the study sample and was an important contributor to knowledge and facilitator for decision making. Participants were not passive receivers of media messages but interpreted it depending on their particular needs or their rating of the media source. Consumption of media-produced information was constrained by certain factors, such as the participants' physical inability to access sources, and needs were not always satisfied because media discourse and "newsworthiness" restricted the reporting of what was sought. The study highlights the importance of the media and Internet as an information source for people with cancer and calls for a greater awareness of this phenomenon.

Guide of internet sites for the study of cardiology

OBJECTIVE

To increase the offer of didactic resources for medical students, physicians, and health care professionals, stimulating the use of the Internet for academic purposes or cardiological updating.

METHOD

Electronic addresses with academic content in the areas of anatomy, biophysics, physiology, semiology, electrocardiography, and image diagnosis were researched and selected. The selection criteria included the following: relevance of the content, neatness of presentation, and richness of animation resources. The sites obtained were classified in regard to their contents and academic level.

RESULTS

The sites obtained were as follows: 5 sites of anatomy and anatomical pathology, one of biophysics, 3 of physiology, 8 of semiology, 7 of image diagnosis, and 2 of electrocardiography. The sites were also organized according to academic level to provide an alternative access. The set of addresses resulted in a simplified and hierarchic guide of contents for the study of cardiac morphology and image diagnosis in cardiology.

CONCLUSION

The resulting list of sites is an example of the potential of the Internet as a learning instrument to be used in association with other conventional pedagogical methods.

Prospective evaluation of an internet-linked handheld computer critical care knowledge access system

Introduction

Critical care physicians may benefit from immediate access to medical reference material. We evaluated the feasibility and potential benefits of a handheld computer based knowledge access system linking a central academic intensive care unit (ICU) to multiple community-based ICUs.

Methods

Four community hospital ICUs with 17 physicians participated in this prospective interventional study. Following training in the use of an internet-linked, updateable handheld computer knowledge access system, the physicians used the handheld devices in their clinical environment for a 12-month intervention period. Feasibility of the system was evaluated by tracking use of the handheld computer and by conducting surveys and focus group discussions. Before and after the intervention period, participants underwent simulated patient care scenarios designed to evaluate the information sources they accessed, as well as the speed and quality of their decision making. Participants generated admission orders during each scenario, which were scored by blinded evaluators.

Results

Ten physicians (59%) used the system regularly, predominantly for nonmedical applications (median 32.8/month, interquartile range [IQR] 28.3–126.8), with medical software accessed less often (median 9/month, IQR 3.7–13.7). Eight out of 13 physicians (62%) who completed the final scenarios chose to use the handheld computer for information access. The median time to access information on the handheld handheld computer was 19 s (IQR 15–40 s). This group exhibited a significant improvement in admission order score as compared with those who used other resources (P = 0.018). Benefits and barriers to use of this technology were identified.

Conclusion

An updateable handheld computer system is feasible as a means of point-of-care access to medical reference material and may improve clinical decision making. However, during the study, acceptance of the system was variable. Improved training and new technology may overcome some of the barriers we identified.

Sources of evidence in HIV/AIDS care: pilot study comparing family physicians and AIDS service organization staff

BACKGROUND

The improvement of the quality of the evidence used in treatment decision-making is especially important in the case of patients with complicated disease processes such as HIV/AIDS for which multiple treatment strategies exist with conflicting reports of efficacy. Little is known about the perceptions of distinct groups of health care workers regarding various sources of evidence and how these influence the clinical decision-making process. Our objective was to investigate how two groups of treatment information providers for people living with HIV/AIDS perceive the importance of various sources of treatment information.

METHODS

Surveys were distributed to staff at two local AIDS service organizations and to family physicians at three community health centres treating people living with HIV/AIDS. Participants were asked to rate the importance of 10 different sources of evidence for HIV/AIDS treatment information on a 5-point Likert-type scale. Mean rating scores and relative rankings were compared.

RESULTS

Findings suggest that a discordance exists between the two health information provider groups in terms of their perceptions of the various sources of evidence. Furthermore, AIDS service organization staff ranked health care professionals as the most important source of information whereas physicians deemed AIDS service organizations to be relatively unimportant. The two groups appear to share a common mistrust for information from pharmaceutical industries.

CONCLUSIONS

Discordance exists between medical "experts" from different backgrounds relating to their perceptions of evidence. Further investigation is warranted in order to reveal any effects on the quality of treatment information and implications in the decision-making process. Possible effects on collaboration and working relationships also warrant further exploration.

Do the leading children's hospitals have quality web sites? A description of children's hospital web sites

Background

Although leading children's hospitals are recognized as preeminent in the provision of health care to children, the quality of their Web sites has not been described.

Objective

To describe technical characteristics of the Web sites of leading children's hospitals.

Methods

This is a cross-sectional descriptive infodemiology study. Two reviewers independently reviewed and analyzed the Web sites of 26 nationally prominent children's hospitals in June 2003, using objective criteria based on accessibility (based on age and language), attribution, completeness, credibility, currency, disclosure, readability, and other technical elements.

Results

One-third of Web sites included content for children and adolescents. Twenty-four (92%) of the Web sites had health and disease-specific information. One-third contained only English, while two-thirds included other languages. All 26 Web sites included a disclaimer, although none had a requirement to read the disclaimer before accessing health and disease specific information. Twenty-four (92%) had search options. Although most (85%) listed a copyright date, only 10% listed the date last updated.

Conclusions

This is the first study to examine the Web sites of leading children's hospitals. Although the Web sites were designed for children's hospitals, only a few sites included content for children and adolescents. Primary care physicians who refer patients to these sites should be aware that many have limited content for children, and should assess them for other limitations, such as inconsistent documentation of disclaimers or failure to show the date of the last Web site update. These Web sites are a potentially useful source of patient information. However, as the public increasingly looks to the Internet for health information, children's hospitals need to keep up with increasingly high standards and demands of health-care consumers.

Primary sources of health information: comparisons in the domain of health attitudes, health cognitions, and health behaviors

The recent growth in consumer autonomy in health care accompanied by the surge in the use of new media for health information gathering has led to an increasing scholarly interest in understanding the consumer health information search construct. This article explores consumer health information seeking in the realm of the primary sources of health information used by consumers. Based on an analysis of the 1999 HealthStyles data, the paper demonstrates that active communication channels such as interpersonal communication, print readership, and Internet communication serve as primary health information sources for health-conscious, health-information oriented individuals with strong health beliefs, and commitment to healthy activities. On the other hand, passive consumption channels such as television and radio serve as primary health information resources for individuals who are not health-oriented. Media planning implications are drawn from the results, suggesting that broadcast outlets with an entertainment orientation are better suited for prevention campaigns. Such channels provide suitable sites for entertainment-education. On the other hand, print media, interpersonal networks, and the Internet are better suited for communicating about health issues to the health-active consumer segment.

Identifying and communicating the contributions of library and information services in hospitals and academic health sciences centers

OBJECTIVE

This article introduces a systematic approach to identifying and communicating the value of library and information services (LIS) from the perspective of their contributions to achieving organizational goals.

METHODS

The contributions of library and information services (CLIS) approach for identifying and communicating the value of LIS draws on findings from a multimethod study of hospitals and academic health sciences centers.

RESULTS

The CLIS approach is based on the concept that an individual unit's value to an organization can be demonstrated by identifying and measuring its contributions to organizational goals. The CLIS approach involves seven steps: (1) selecting appropriate organizational goals that are meaningful in a specific setting; (2) linking LIS contributions to organizational goals; (3) obtaining data from users on the correspondence between LIS contributions and LIS services; (4) selecting measures for LIS services; (5) collecting and analyzing data for the selected measures; (6) planning and sustaining communication with administrators about LIS contributions; and (7) evaluating findings and revising selected goals, contributions, and services as necessary.

CONCLUSIONS

The taxonomy of LIS contributions and the CLIS approach emerged from research conducted in hospitals and academic health sciences centers and reflect the mission and goals common in these organizations. However, both the taxonomy and the CLIS approach may be adapted for communicating the value of LIS in other settings.

What questions do patients undergoing lower extremity joint replacement surgery have?

BACKGROUND

The value of the Internet to deliver preoperative education would increase if there was variability in questions patients want answered. This study's goal was to have patients consulting an orthopedic surgeon about undergoing either a total hip arthroplasty (THA) or a total knee arthroplasty (TKA) rate the importance of different questions concerning their care.

METHODS

We assembled questions patients might have about joint replacement surgery by analyzing the literature and querying a pilot group of patients and surgeons. Twenty-nine patients considering undergoing THA and 19 patients considering TKR completed a written survey asking them to rate 30 different questions, with a 5 point Likert scale from 1 (least important)--5 (most important).

RESULTS

For patients considering THA or TKR, the 4 highest rated questions were: Will the surgery affect my abilities to care for myself?, Am I going to need physical therapy?, How mobile will I be after my surgery?, When will I be able to walk normally again? The mean percentage disagreement was 42% for questions answered by TKR patients and 47% for the THA group. Some patients gave a high rating to questions lowly rated by the rest of the group.

CONCLUSIONS

Although there was enough agreement to define a core set of questions that should be addressed with most patients considering THA or TKA, some of the remaining questions were also highly important to some patients. The Web may offer a flexible medium for accommodating this large variety of information needs.

Searching for and selecting a nursing facility

In this study, the authors present findings from 306 resident interviews matched with 306 family member interviews examining factors associated with both the search for and selection of a nursing facility. For many elders transitioning into a nursing facility, the facility becomes their home, and the average cost of residing in that home is high. As such, searching for and selection of a facility has important consequences. The authors found that residents are not very influential in these processes. Second, they found very few proactive nursing facility choices were made by either residents or family members. Third, the choices made were seldom based on the quality of the facility. Fourth, prior knowledge of the chosen facility was limited. Finally, the authors also show that the time taken to choose a facility was in most cases extremely limited.

Internet resources for neurologists

This fourth and final review in the JNNP internet series summarises the essential internet resources for adult and paediatric clinical neurology, neuroradiology, and neurophysiology. This article is freely available on the JNNP website (www.jnnp.com), where-within seconds-the complete list of recommended websites can be easily downloaded and incorporated into your web browser as a Bookmark/Favorite file. The further progress of clinical neurology on the world wide web will be monitored in JNNP Neuronline fillers and JNNP Neurology in Practice supplements.

Ethnic differences in choices of health information by cancer patients using complementary and alternative medicine: an exploratory study with correspondence analysis

This study examined patterns in the use of health information among Caucasian, Japanese, and non-Japanese Asian Pacific Islander cancer patients in Hawaii and explored the relation of ethnicity and educational level to choices of health information sources. Information from 140 cancer patients, most of whom were users of complementary and alternative medicine (CAM), was analyzed using correspondence analysis. Three clusters of health information pertinent to the three ethnic groups emerged from the data. The results of this study revealed that Caucasian patients preferred objective, scientific, and updated information obtained through medical journals or newsletters from research institutions, telephone information services, and the internet. Japanese patients relied on media and commercial sources including television, newspapers, books, magazines and CAM providers. Non-Japanese Asians and Pacific Islanders used information sources involving person-to-person communication with their physicians, social groups, and other cancer patients. A higher educational level was closely related to a cluster of health information stressing objective, scientific and updated information, while a lower educational level was associated with interpersonally communicated information. The three ethnicity-specific patterns of health information use remained relatively stable at different educational levels, implying that the effect of patients' ethnicity overrides their educational level in shaping their choices of health information. The results of this study indicate the importance of recognizing cancer patients' culturally developed world views when understanding their health information-seeking behavior. For medical practice, these findings indicate the need for healthcare providers to assist cancer patients to obtain accurate health information in a culturally sensitive way.

Societal dimensions of third-party evaluation of Internet health content

Rating and certification of Internet health content have been suggested as strategies to guide citizens to high quality information. Attempts to rate Internet content, however, have been criticised for being unfeasible or undesirable. We created and tested a novel concept and technology to evaluate online health resources. In this paper, we view various societal issues and suggest solutions whenever possible. Rating and certification of Internet content should be preceded by a consideration and discussion that has many societal dimensions.

HealthCyberMap: a semantic visual browser of medical Internet resources based on clinical codes and the human body metaphor

OBJECTIVES

HealthCyberMap (HCM-http://healthcybermap.semanticweb.org) is a web-based service for healthcare professionals and librarians, patients and the public in general that aims at mapping parts of the health information resources in cyberspace in novel ways to improve their retrieval and navigation.

METHODS AND SERVICE DESCRIPTION

HCM adopts a clinical metadata framework built upon a clinical coding ontology for the semantic indexing, classification and browsing of Internet health information resources. A resource metadata base holds information about selected resources. HCM then uses GIS (Geographic Information Systems) spatialization methods to generate interactive navigational cybermaps from the metadata base. These visual cybermaps are based on familiar medical metaphors.

CONCLUSIONS

HCM cybermaps can be considered as semantically spatialized, ontology-based browsing views of the underlying resource metadata base. Using a clinical coding scheme as a metric for spatialization ('semantic distance') is unique to HCM and is very much suited for the semantic categorization and navigation of Internet health information resources. Clinical codes ensure reliable and unambiguous topical indexing of these resources. HCM also introduces a useful form of cyberspatial analysis for the detection of topical coverage gaps in the resource metadata base using choropleth (shaded) maps of human body systems.

Consulting the Internet before visit to general practice. Patients' use of the Internet and other sources of health information

OBJECTIVES

To describe where patients in Danish general practice get information about health and disease, particularly how patients prepare for a visit to their GP, with special reference to use of the lnternet.

DESIGN

Structured interviews.

SETTING

Four Danish general

PATIENTS

93 consecutive patients after visiting their GP.

MAIN OUTCOME MEASURES

The patient's report about we of the Internet and different mass media in preparation for the consultation.

RESULTS

Only two patients never looked for health information. Of all patients, 20% had used the Internet to get health information, 8% because of the current visit, i.e. a third of all with Internet access had used it because of the current visit. Women used the sources of information more than men did. Personal contact with family, friends or neighbours was the most commonly used source.

CONCLUSION

The Internet is used in direct preparation for a visit to the general practitioner. The vast majority of patients use the mass media for information. In general practice, the main source of information on a health-related subject is personal contact with family and friends.

The Internet as a communication tool for academic orthopaedic surgery departments in the United States

BACKGROUND

The Internet's appeal as an affordable, accessible medium for information transfer makes it a potentially useful tool for practicing physicians. In the past several years, Internet-based health-care companies have proliferated, and many medical centers have established individual web sites. The purpose of the present study was to evaluate academic orthopaedic surgery departments in the United States with respect to Internet visibility and content.

METHODS

We reviewed existing web sites for the 154 departments or divisions of orthopaedic surgery currently accredited for resident education by the Accreditation Council for Graduate Medical Education. The study sample consisted of the 113 departments that had a web page listed in the FREIDA (Fellowship and Residency Electronic Interactive Database) database. Each web site was assessed with regard to its informational value in the categories of clinical services, resident education, and physician recruitment. In addition, three commonly employed browsing engines were used to search for individual web sites and to determine their ease of accessibility.

RESULTS

In the category of clinical services, sixty-five (57.5%) of the 113 sites provided faculty listings and forty-nine (43.4%) provided office telephone numbers and locations. Only thirteen sites provided information on common orthopaedic conditions, and five had links to other patient-education sites. In the category of resident education, twenty-four sites (21.2%) had online academic schedules, but only two provided access to complete conferences or teaching files. In the category of physician recruitment, ninety-one provided a description of their residency program and fifty-four had information on the application process, but only twenty-six web pages offered detailed departmental statistics. In terms of accessibility, fifty-three programs (46.9%) were identified by one of three popular search engines, seventeen (15%) were identified by more than one search engine, and two (1.8%) were identified by all three.

CONCLUSIONS

Academic orthopaedic surgery departments in the United States underutilize the Internet as a source of clinical and educational services. In addition, existing orthopaedic web sites are difficult to access with use of popular search engines. Thus, academic orthopaedic surgery departments in the United States are missing a valuable opportunity to promote awareness of their institutions and to become educational resources for the community.

A descriptive study of personal, institutional, and media sources of preventive health care information

Wellness can be defined as a set of attitudes and behaviors indicating a person's perception of their ability to have some control over their physical well-being. One such behavior associated with wellness is the search and use of preventive health care information. Preventive health care information is the oral and written knowledge available to consumers concerning preventive health care issues. This study examines various demographic characteristics and their association with the propensities to be knowledgeable, seek, and to experience lifestyle changes resulting from preventive health care information. It also examines the relative importance to respondents of three broad sources of preventive health care information.

HMO Web sites: what do they tell consumers?

Despite the growth of managed care, little is known about health plans' web sites. This paper reports on a review of the web sites of the 25 largest HMOs in the United States to identify whether their content included information deemed important by consumers: quality, price, provider network, personal health information, and customer service features. Findings show variation in the content of HMO web sites, with sites emphasizing customer service features, the provider network, and personal health information. Two-thirds of HMOs offer information on quality; however, pricing information is offered by only four plans. Implications for future differentiation of HMO web sites are discussed.

A metadata vocabulary for self- and third-party labeling of health web-sites: Health Information Disclosure, Description and Evaluation Language (HIDDEL)

We describe HIDDEL (Health Information Disclosure, Description and Evaluation Language), formerly known as medPICS (platform for Internet content selection in medicine), a metadata vocabulary designed to enhance transparency, trust and quality of health information on the web. The vocabulary may be used (1) by webmasters to self-describe their contents and policies; (2) by infomediaries (e.g. Healthfinder, NHS Direct/NeLH), e.g. third party evaluators, rating or portal services, to annotate other websites; (3) and by users, to describe their preferences. As an XML application it conforms to the W3C's RDF Specification. The metadata vocabulary is primarily intended to enable descriptions of whole health websites or health information providers. The vocabulary is designed to provide a computer-readable electronic "label" of a health website, telling users who is behind the website, how the website is sponsored, what the con-tent, aim and target audience is, how the information was compiled, what risks the service bears, or what people say about the resource. Client-software can "read" this label automatically, compare it to the user s own set of preferences and needs, and alert and advise users.

Which are the best information sources for identifying emerging health care technologies? An international Delphi survey

The purpose of this survey was to assess potential information sources for identifying new health care technologies. A three-round Delphi study was conducted, involving 38 selected experts who suggested and assessed potential sources by applying agreed criteria. Twenty-six potential information sources were considered. Timeliness, time efficiency, and sensitivity were important criteria in determining which were the most important sources. The eight recommended sources were: pharmaceutical journals, pharmaceutical and biotechnology companies, specialist medical journals, key medical journals, medical engineering companies, private health care providers, newsletters and bulletins from other health technology assessment agencies, and groups of expert health professionals. There is a need to use a combination of sources because the most useful sources will vary according to the type of technology under consideration.

Patient sources of information and decision factors in selecting cosmetic surgeons

This paper presents the results of an exploratory study designed to examine influential information sources and decision factors in the selection of plastic surgeons for cosmetic versus medical procedures. Physician referrals were found to be the most influential sources of information for both groups. Word-of-mouth and magazine and newspaper articles were also important information sources for cosmetic patients. Primary selection factors were significantly different between groups, with board certification the most influential for cosmetic patients and recommendation by physician most influential for medical patients.

Providing cost data to physicians helps contain costs

Findings of a survey of 1,200 physicians suggest that healthcare organizations that provide physicians with pricing information can reduce resource utilization and control costs more effectively than organizations that do not provide such information. These findings also suggest that healthcare financial managers who are aware of physicians' responses to cost information--and who furnish them with effective cost information--may gain a timely competitive advantage.

Health marketing information: an assessment of past and future utilization patterns

A sample of 108 members of the Academy of Health Services Marketing provided bibliographic citations of 629 sources of information which have been important to them in their jobs. The results indicate that the propensity to rely upon a source is dependent upon the topic of the information sought. The sources under scrutiny were consultants, books, journals, magazines, seminars, conferences, video tapes, and audio tapes. The topics considered included the variables of the marketing mix as well as market planning and marketing research. The discussion provides insight about where seekers of health care marketing knowledge go for specific kinds of information. It also suggests types of media that information-providers should consider for dissemination of their material.

Assessing consumer health information needs in a community hospital

A study was conducted by the Oakwood Hospital Library in Dearborn, Michigan, to document health information needs and opinions among staff physicians and area health consumers. The study sought to discover which community sources, besides the hospital library, consumers were consulting for health information and how helpful these sources were; what types of health information physicians were providing to patients in their offices; and whether and how physicians and health consumers might differ in their perceptions of health information. Study results, along with suggested opportunities for additional investigation, are presented.

Hospital and corporate information services: introducing a new column

Successful hospital and corporate libraries offer customized resources and services to meet the needs of their dynamic organizations. Concepts such as customer-driven, service-oriented and value-added are central to these libraries. Serving decision makers and integrating the library into the decision-making process of the organization is critical. Future articles in this new column will further explore the underlying philosophies and the specialized resources and services that characterize these libraries.

Consumer perceptions of medical information sources: an application of multidimensional scaling

Multidimensional scaling is widely used in marketing research to characterize the perceived relationships among a set of consumer products. The technique is also well suited to study a number of issues that are of interest to health care marketers. This paper explains multidimensional scaling and provides an illustrative example of a health care application. In the research study reported here, the perceptions of various sources of medical information give important insights to a health care organization that is designing a new medical information service for consumers. Other potential applications of the technique for health care marketing are also explored.

The influence of older consumers' information search activities on their use of health care innovations

Research has yet to consider the relationship between the older consumers' information search and their use of health care innovations, despite suggestions that such a characterization may prove useful to marketing practitioners. In this investigation of a national sample of autonomous elderly consumers, distinct patterns of information search behavior are observed which distinguish adopters from nonusers of a pair of health care innovations. Implications for marketing health care innovations are discussed.

Information search and decision making in the selection of family health care

Two studies on consumer information search and decision strategies involved in the selection of family health care providers are reported. The first study examined the selection process for both adults and children within the family. Factors associated with dissatisfaction with provider were identified. The second study explored differences among individuals in self-reported presence of a regular health care provider and use of recent innovations in health care such as walk-in clinics and HMOs.

Survey of health professionals' information habits and needs. Conducted through personal interviews

Interviews with 402 randomly selected health professionals identified the information habits health professionals used to stay abreast of current advances in medicine. The use of various information sources was related to such factors as their type of practice, specialty, location of practice, professional's age, and the size of their primary hospital. In addition to medical literature, the most common source, the typical responder spent one to five hours each week in discussions with colleagues. He or she also spent five to ten hours each year at local professional meetings, five to ten hours per year at state meetings, ten to 15 hours per year at national meetings, and ten to 15 hours per year at educational courses sponsored by various medical schools. Unsolicited medical literature was used extensively, particularly by those in rural, solo practice.