|Year : 2020 | Volume
| Issue : 1 | Page : 33-38
Effect of internet use on health-related behaviors and patient–physician relationship
Mahmoud E Abu Salem1, Nagwa N Hegazy2, Marwa A Akram Ali3
1 Department of Public Health and Community Medicine, Menoufia University, Menoufia Governorate, Egypt
2 Department of Family Medicine, Faculty of Medicine, Menoufia University, Menoufia Governorate, Egypt
3 Department of Family Medicine, Tanta Health Administration, Gharbia Governorate, Egypt
|Date of Submission||17-Jul-2018|
|Date of Decision||23-Aug-2018|
|Date of Acceptance||28-Aug-2018|
|Date of Web Publication||25-Mar-2020|
Marwa A Akram Ali
Tanta City, Gharbia Governorate
Source of Support: None, Conflict of Interest: None
This work aimed to understand the relationship between internet use and health-related behaviors. Furthermore, the relationship between internet use and the quality of patient–physician relationship was assessed.
The rise of the internet has been one of the most striking developments. First, it was quite different from all other media. Second, its presence also influenced communication systems, including interpersonal relationships. Most internet users use the internet to find information about health. They take knowledge gained from the internet to their physicians' consulting rooms.
Patients and methods
The study was a cross-sectional study. It was conducted on 600 patients. All participants were interviewed using a predesigned questionnaire included socioeconomic status, health behavior, and doctor–patient relationship.
Overall, 31.8% of internet users were in the age group 31–40 years. Regarding socioeconomic standard, most cases were from high social background (57.3%). Regarding internet use, more than half of the studied group used the internet (87.8%). Regarding health behavior, there was a significant difference in internet use (P ≤ 0.001) and access to the internet at home and work (P ≤ 0.001). Regarding doctor–patient relationship, there was significant difference in age of patient (P = 0.004) and internet use (P ≤ 0.001).
This study explained that the internet use was an important factor in changing in the communication system, and its effect on physician and patient relationship. With the increasing years of internet use, the doctor–patient relationship became better.
Keywords: behavior, doctor–patient relationship, health information, internet
|How to cite this article:|
Abu Salem ME, Hegazy NN, Akram Ali MA. Effect of internet use on health-related behaviors and patient–physician relationship. Menoufia Med J 2020;33:33-8
|How to cite this URL:|
Abu Salem ME, Hegazy NN, Akram Ali MA. Effect of internet use on health-related behaviors and patient–physician relationship. Menoufia Med J [serial online] 2020 [cited 2020 Jun 6];33:33-8. Available from: http://www.mmj.eg.net/text.asp?2020/33/1/33/281275
| Introduction|| |
One of the most striking developments in the realm of culture and media in the past two decades has been the rising of internet as a mass medium. The internet was interesting for two reasons. First, it was quite different from all other existing media. Second, its presence affected communication systems, including relationships between people, such as contacts between physicians and their patients.
The internet differed from traditional media in one main way: the direction of the communication process was different. The internet is one of the most important sources of health information, not only for a small group of internet users but now also for the general public. The internet has made information and knowledge easily accessible for anyone with a computer and an internet connection. It has also made possible interactivity in the shape of direct feedback and real-time communication, and contact between people independent of time and space.
An important aspect of internet is its potential to provide power by putting more control in the user's hand, as compared with other media. Most people found the health information they were looking for when they searched the internet. According to a study by the Pew Internet and American Life Project, roughly 80% of the health seekers found the information they need. Frequent users of health sites on the internet are patients who have long-term illnesses, as they are able to search for reliable information about their specific diseases.
This study focuses on the effect of information found on the internet on the relationship between doctor and patient. As more people use the internet to collect information, many were addressing their own health-related needs. At the same time, physicians remained in doubt about the advantages of using the internet in their practices. They were also worried that patients who turned to internet for information might not consult a doctor when serious health problems occurred.
This work aimed to understand the relationship between internet use on health-related behaviors. Furthermore, the relationship between internet use and the quality of patient–physician relationship was assessed.
| Patients and Methods|| |
The present study was conducted in one of Tanta City Primary Health Center and one of Tanta City Tertiary Health Care Facility. All patients who visited El Menshawy Hospital and Saed Health Center (during the period from 9:00 a.m. till 2:00 p.m. on random days, where data were collected from every 10th patient cutting a ticket) were requested to participate in the study at the time of the study. It had been conducted from 1 February 2016 to the end of August 2016. The participant's numbers were 400 from El Menshawy Hospital and 200 patients from Saed Health Center. For every case, a predesigned questionnaire was used after taking his/her consent.
The study was approved by the ethical committee of the Faculty of Medicine, Menoufia University. An official permission letter was obtained and directed to the administrators in El Menshawy Hospital and Saed Health Center. All participants of the study were volunteers. Oral consents were granted by all the participants in the study after illustration of the purposes of this study. It was emphasized that all data collected was strictly confidential, and the data were used for scientific purpose only.
The questionnaire consists of three parts:
- The first part included socioeconomic standard, which was determined according to the scoring system of Fahmy et al. (a high level was indicated as at least 70%, a medium level as 40 to <70%, and a low level as <40%). It consists of 10 questions about sociodemographic data to obtain name, age, sex, education level of person, computer usage, income, family size, crowding index, sewage disposal, and sanitation
- The second part analyzed the effect of the internet on health behavior and consists of 14 questions (skills of searching the internet, changing the way of think about health, able to find the answer, and the amount of information obtained from the internet)
- The third part included the physician–patient relationship and consists of 17 questions (informing the doctor about making any changes in health practice, willingness to talk to the doctor about finding, before the internet how much did they follow doctor's recommendation, bringing to the doctor the information found, listening of the doctor to the patient, receiving sufficient explanation, acting on the information found instead of consulting the doctor, and the doctor's action on the information).
A pilot study was conducted on ten attendees to the primary health care center (not included in the final results of the study) for the following:
- Evaluate the adequacy of the study tools (questionnaire and sheets); content, language, and time consumption; availability of the needed data; and feasibility of the research methods
- Determine the time needed for filling the questionnaire
- Explore the potential obstacles and difficulties that confront the execution and flow of work.
Statistical analysis of the study was conducted by statistical package for the social science, version 20, on IBM compatible computer (SPSS Inc., Chicago, Illinois, USA). Two types of statistics were done: descriptive statistics (data were expressed as numbers and percentage) and analytic statistics as χ2 test and Pearson's (r) correlation. P value of less than 0.05 was considered as statistically significant.
| Results|| |
The total number of the studied cases was 600, of which 31.8% were in the age group 31–40 years, followed by the age group 20–30 (30.7%) years. Regarding socioeconomic standard, most cases were from high standard, which represented 57.3%. Regarding education, ∼46.3% of the mothers had intermediate education (primary, preparatory, and secondary education) and ∼56.7% of the fathers had intermediate education (primary, preparatory, and secondary education). Regarding internet use, more than half of the studied group used the internet (87.8%), and ∼42.9% of the group had chronic illness [Table 1].
Regarding health behavior, there was a nonsignificant difference with respect to age of the patients (P = 0.074), mother's education (P = 0.479), and father's education (P = 0.310). There was a significant difference in internet use (P ≤ 0.001), father's and mother's job (P ≤ 0.001), computer use, and access to the internet at home and work (P ≤ 0.001) [Table 2].
|Table 2: Behavior score in mean and SD versus sociodemographics of the study participants|
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Regarding patient–physician relationship, there was a nonsignificant difference with respect to father's education (P = 0.157), and there is a significant difference in age of patient (P = 0.004), internet use (P ≤ 0.001), mother's education (P = 0.035), father's job (P ≤ 0.001), mother's job (P = 0.003), computer use (P ≤ 0.001), chronic illness (P = 0.027), access to the internet at home (P ≤ 0.001), and access to the internet at work (P = 0.022) [Table 3].
|Table 3: Patient-physician relationship score in mean and SD versus sociodemographics of study participants|
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There was a statistically significant positive correlation between patient–physician relationship and number of years of using internet. It indicated that the more the years of using the internet, the better relation between patient and their doctors [Figure 1].
|Figure 1: Patient–physician relationship score versus years of using internet.|
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There was a nonsignificant correlation between health behavior and number of years of using internet. It indicated that increasing the years of using the internet does not affect the health behavior of the patient [Figure 2].
| Discussion|| |
This study had found that 31.8% of the studied group aged 31–40 years. This finding was supported by ZDnet research, which found that 83.4% of the most active internet users are aged between 20 and 40 years, but this result was against Pastore, who found that the most active online users were aged 18–34 years.
The current study found that 87.8% were internet users, and this agreed with Nua's Internet survey, which found 605.60 million people worldwide were online as of September 2002, up from 580.7 million in May 2002. The number of internet users had increased significantly. World Internet Use and Population Statistics updated in November 2015 published that internet users had grown to almost three and a half billion, which is 46.4% of the world's total population. Between 2000 and 2015, the rate of growth of the internet use was 832.5%. Internet had become more accessible, whether in the work, at home, at the school, or in other public places.
The current study found that 59.8% had intermediate education and 51.5% had higher education. This result agreed with the result of Household Use of Information Technology, which found that education played an important role in internet use. In 2014-2015, 96% of those with a bachelor degree or above were internet users and 77% of those educated to year 12 or below were internet users.
The current study found that 55.3% were using computer a lot of time, and this was supported by Unsal and colleagues, who found that during the past years, the way people lived and worked had been changed owing to the developments in the communication and information systems. The wide distribution of computers was the main reason.
This study found that there was a significant relation between health behavior and internet use, father's and mother's job, computer use, and chronic illness.
This current study found significant relation between internet use and health behavior, and this agreed with Lovich and colleagues who mentioned that the arising of the internet as a source of health care advice had increased the opportunities for patients to be more actively involved in their own treatment and care. It also seemed that patients using the internet for health information were more involved and active in dealing with their problems and in communication with their doctor compared with those who did not seek advice from the internet. Moreover, Ball and Lillisand Mittman and Cain found that if patients had more information as a result of searching from health sites and health communities, they might be better prepared and likely to ask more important and critical questions when they met their doctors. The internet has made it easy for patients to find information about their health conditions, diagnosis or treatments, and medical decision making,.
This current study found significant relation between computer use and health behavior, and this was result supported by Unsal et al., who found that during the past years, the way people have lived and worked has changed owing to the developments in the communication and information systems, and the wide distribution of computers was the main reason.
This current study found a significant relation between chronic illness and health behavior. This result was supported by Poensgen and Larsson, who found that the most users of health sites on the internet were patients (especially who had long-term disease) who were searching for information about their specific diseases.
This study found that there was no significant relation between age and health behavior, and this agreed with Pew Research Center, which found that some users browse the internet without any specific reason; 67% of them are young adults who looked like teens in their tendency to use sites, where 72% of them are on social networking, days and nights.
This study found that there was a significant relation between doctor–patient relationship and age, internet use, mother's education, father's and mother's job, computer use, and chronic illness.
This study found significant relation between internet use and doctor–patient relationship. This is supported by Mittman and Cain who mentioned that there were several researchers who had analyzed the effect of the patient's greater information (gained from online sources) about health on the doctor–patient relationship. Primarily, these studies focused on how the relation has changed, taking up the earlier improvement on power in the doctor–patient relationship. Additionally, they detected some chances of the changes to these relationships. Wald et al. found that more informed patients were more likely to develop a sense of partnership and cooperation with their doctors. Wald and colleagues explained that the treatment of pre-informed patients was more efficient as it saved time needed to provide them with background information. Furthermore, a more partner-like relationship would result in a more trusting relationship and higher-quality care.
This study found that there was a relation between age and internet use as the most of studied group aged 20–40 years, and 87.8% were internet users. This result is supported by Khan et al. who found that age had a significant relationship with the amount of internet used on daily basis, as with increasing age, the internet usage by people drops, thus showing that people from 11 to 30 years of age used more internet, and the average daily usage kept falling with increasing age. Moreover, it agreed with Akman and Mishra who found that the age of users had a significant relation with the average usage of daily internet in Turkey. A similar result was obtained by Koyuncu and Lien, who found that age promoted online activities and recorded significant positive effects for age. Teo and Lim and Hills and Argyle found that majority users of internet were young.
Jackson et al. also supported this result; younger Chinese children used internet and computer more and were better at it than older ones. Middleton et al. found age to be strongly associated with internet use, whereas the scope of use declined with age. The Future of the Internet Economy: a Statistical Profile and Jackson and colleagues reached to the conclusion that elderly people were not used to the penetration of internet into their daily lives as much as the younger generation, thus supporting the result that age had a negative relation with average usage of internet. The result also carried a notable trend in the society where the younger generation was more prone to using advancing technology, and World Wide Web was integrated to almost all of these in the present era; thus, it made the younger lot a major consumer of internet and made age a significant variable of the study. Moreover, Chan and Fang supported this result; young generation has become more active on the internet media. Communication is an essential aspect of integrates transference of information in the society and internet plays a vital role in communication. Communication includes exchange of knowledge, engaging with new and old members, entertainment, etc. The internet is a new world for different age groups with both good and bad consequences.
According to Eastman and Iyer, older adults were the fastest growing group of new internet users; penetration of internet use among older adults had been lower than expected in developed countries and lower still in developing countries. According to the data from 2012, only half of the older adults in the USA had internet access, compared with the rates of more than 70% for the rest of the population and more than 90% for the youngest cohorts.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Van Woerkum CM. Printed in USA. © 2003 American Society for clinical nutrition. Am J Clin Nutr 2003; 77
Marton C, Wei Choo C. A review of theoretical models of health information seeking on the web. J Doc 2012; 68
Walch J. In the net: an internet guide for activists
. London: Zed Books; 1999.
Fox S, Rainie L. The online health care revolution: how the web helps Americans take better care of themselves
. Washington, DC: Pew Internet and American Life Project; 2000.
Poensgen A, Larsson S. Patients, physicians, and the internet: myth, reality, and implications
. Boston, MA: Boston Consulting Group; 2001.
Fahmy SI, Nofald LM, Shehatad SF, El Kadyb HM, Ibrahim HK. Updating indicators for scaling the socioeconomic level of families for health research. J Egypt Public Health 2015; 90
ZDnet Research (2006). Internet activities by age group. Available from: www.zdnet.com/blog/itfacts/internet-activities-by-age-group/10025
. [Last accessed on 2012 Jun 15].
Internet World Stats. (2015). Available from: www.internetworldstats.com/stats.htm
. [Last accessed on 2016 Jun 23].
Australian Bureau of Statistics. Household use of information technology, Australia, 2014–2015. Available from: www.abs.gov.au/ausstats/abs@.nsf/mf/8146.0
. [Last accessed on 2016 Jun 28].
Unsal F, Ruzgar NS, Ruzga B. (2008). An empirical study of internet usage, online shopping, and online banking behavior of Turkish University Students. International Trade and Finance Association: International Trade and Finance Association Working Papers 2008. Available from: http://services.bepress.com/itfa/18th/art22
. [Last accessed on 2012 Jun 15].
Lovich D, Silverstein MB, Lesser R. Vital signs update: the E-health patient paradox
. Boston, MA: Boston Consulting Group; 2001.
Ball MJ, Lillis J. E-health: transforming the physician/patient relationship. Int J Med Inform 2001; 61
Mittman R, Cain M. The future of the internet in health care: a five-year forecast. In: Rice RE, Katz JE, (eds.), The internet and health communication: experiences and expectations
. Thousand Oaks, CA: Sage Publications. Trade and Finance Association Working Papers; 2001. 22.
Pew Research Center (2010). Generations online in 2010. Available from: www.pewinternet.org/2010/12/16/generations-2010/. [Last accessed on 2012 May 21].
Wald HS, Dube CE, Anthony DC. Untangling the web—the impact of internet use on health care and the physician–patient relationship. Patient Educ Couns 2007; 68
Khan AS, Rahman AUR, Taskeen L. Qazi business & economic review: Vol. 8, Special Edition: 2016 pp. 67–82. doi: dx.doi.org/10.22547/BER/8.SE.5
Akman I, Mishra A. Gender, age and income differences in internet usage among employees in organizations. Comput Human Behav 2010; 26
Koyuncu C, Lien D. E-commerce and consumer's purchasing behaviour. Appl Econ 2003; 35
Teo TS, Lim VK. Gender differences in internet usage and task preferences. Behav Inform Technol 2000; 19
Hills P, Argyle M. Uses of the internet and their relationships with individual differences in personality. Comput Human Behav 2003; 19
Jackson LA, Zhao Y, Qiu W, Kolenic A, Fitzgerald HE, Harold R, von Eye A. Culture, gender and information technology use: a comparison of Chinese and US children. Comput Human Behav 2008; 24
Middleton CA, Veenhof B, Leith J. (2010). Intensity of internet use in Canada: understanding different types of users. Statistics Canada. Business Special Surveys and Technology Statistics Division. Catalogue no. 88F0006X, no. 2.
Chan K, Fang W. Use of internet and traditional media among young people. Young Consumers 2007; 8
Eastman J, Iyer R. The impact of cognitive age on internet use of the elderly: An introduction to the public policy implications. Int J Consumer Stud 2005; 29
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]