After becoming an essential part of life in less than two decades, the internet has fundamentally changed the way of information seeking and providing, and the nature of communication in many fields, including healthcare system. Nowadays we can see patients and carers search for health information through web-surfing, receive advice or education from on-line based health information providers, and communicate opinions on specific symptoms or newly developed treatments by exchanging e-mails, posting on the on-line message board, participating in the chat rooms (Servellen and Marram 2009). Though there are a myriad of merits on using the internet in health area, some have raised concerns about its negative effects on the vulnerable users and the relationship dynamics of face-to-face health consultation, especially with advent of the most informed patients ever. This report presents four internet sites on health information, describe positive and negative aspects of using the internet as health information source, and discuss how so-to-speak impersonal nature of the internet has affected the relationship between patients and health professionals.

Examples of health internet sites and their primary goals

Department of Health and Ageing, Australian Government

The Department of Health and Ageing(DHA) is a Department of State of Australia, operating under the Public Service Act 1999 and the Financial Management and Accountability Act 1997(2009). Its homepage provides information for both health consumers and professionals. For example, the major part of the DHA web pages consists of extensive subjects such as ageing, chronic diseases, quarantine and travel health, communicable diseases, organ donation, patient education, maternal and infant health, Medicare benefits, health product and medicines, health and ageing thesaurus, etc., which aim to support the sick, teenagers, seniors, their families and health care workers. In addition, the DHA also render information on other related web sites and useful links.

MoodGYM

The MoodGYM is a web-based interactive tool for general public, assisting identification and management of anxiety and depression. Developed by the Centre for Mental Health Research at the Australian National University, it is known as one of the most widely investigated psychic therapy application(Bell 2007). After registering one’s basic profiles, users can try its programs for free and approach to step by step questionnaires and exercises on emotions. According to the web site of MoodGYM, its therapeutical foundation derived from Cognitive Behaviour Therapy, which claims that the way a person recognise the exterior environment eventually influences his behaviour, and Interpersonal Therapy, which was designed to provide solutions on conflicting roles, to improve relationship with other people, to give consolation over deep sorrow.

Sibs: For Brothers and Sisters of Disabled Children and Adults

The Sibs is a UK rooted, not-for-profit organisation helping siblings of disabled people. While many other internet sites pertaining to the disabled conditions are focusing on the information directly relevant to the handicapped people, this charity particularly acknowledges and addresses the special needs for brothers, sisters and parents of them. Through its internet homepage, young people and adult can assess to the practical tips as to being a family member of the physically challenged. It also contains information on workshop and training run across the UK for health care professionals and supporting siblings.

Royal College of Nursing, Australia

The Royal College of Nursing, Australia (RCNA) is a national nursing membership organisation, established in Melbourne in 1949, now moved to Canberra to concentrate on the professional development and policy analysis. Its official web site provides a variety of information for nurses and nursing students, including notices on upcoming conferences, expos, and workshops. Besides, 3LP, the RCNA’s life-long education scheme, supports practice nurses with free e-training handling chronic disease, cultural variation, care plan management, self-management, and support strategies.

Pros and cons for internet health information

Through the internet we can be in contact with large volume of health information for 24/7 basis, even across national borders, by paying relatively low expense. Virtually every kinds of health information for every level and format is flowing over the internet, which means it is quite possible for you to select the very information you have searched for with little effort(Lee, Park et al. 2009). This kind of electronic accessibility is especially meaningful for some underserved groups such as the physically challenged and the scattered population in rural areas (Abrahamson, Fisher et al. 2008). In most cases the traditional mode of intervention or education hardly delivers such subdivided information conveniently with the constraints of cost-effectiveness, time and place.

The anonymous nature of the internet also plays a positive role in providing health information for the vulnerable groups such as the mentally-ill or the disabled. For example, some patients from these groups might prefer not to reveal their personal details to others while craving for the necessary knowledge about their condition. In that case, the internet makes the most desirable solution – they can approach the health information or exchange experience about illness conditions, remaining unidentified people. To sum up, the internet is seen to have great capacity for supplying versatile health information to both the general public and minor groups rapidly, widely and easily, which presumably lead to reduction of effort and time for health professionals while educating their clients.

However, the promising feature of the internet could lead to the unexpected results. Due to the extreme variety of the web-based health information, it is often pointed out that the ability to correctly understand the medical terms and context, referred to as health literacy, sometimes impedes the right use of the health websites (Abrahamson, Fisher et al. 2008). And for the underserved, the problem could be much bigger. The vulnerable including the disabled, the elderly, etc , may be less health literate and less educated about judging the quality of information (Eng, Maxfield et al. 1998), and might be at a riskier status of becoming suffered by erroneous use of the on-line health information.

Besides, the anonymity of the internet that enables rather free communication between the unidentified could result in destructive or unethical outcomes particularly for mentally weak patients. For instance, it is suggested that anonymity in a peer support website for the mentally ill might make it hard to identify whether the contents of posting of suicides and suicide attempts are real ones, therefore the members could be influenced by hoaxes to a greater extent(Hsiung 2007). In conclusion, the more information presented via the internet, the more sensitive approach and evaluation process are required, especially for the vulnerable groups lacking sound judgement capacity.

How “impersonal” nature of the Internet affects the relationships between patients and health professionals

Contrary to the traditional mode of providing health information, which involves direct communication and interactions between patients and doctors, the contemporary cyberspace generally offers one-way, impersonal communication. And this feature sometime motivates patients to search for the internet health information, because the internet seems more collectively objective source than the human being. For instance, the indirect interaction involving many unknown people lacking personal relationship, like the internet communication, may be seen to help find the impartial information(Robinson and Turner 2003).

However, after surrounded by a large volume of one-way information and feeling the need to interpret or confirm them from the perspective of personally believable sources, patients are found to seek discussion with doctors about the internet health information found. Many patients are visiting GPs with print out of internet information. Some have argued that the internet might be a threat to the role of physician as a source of health information, as the internet would narrow the disparity of medical knowledge between patient and doctors(Hein 2001). But recently it is figured out that the health consultants remain the fundamental and essential authorities in selecting process of the information from the internet (Kivits 2006). Patients indeed have needs for integrated emotional support and personalised direction to get through the complex labyrinth of medical world.

In summary, as the internet has become a convenient source of health information and substituted health professional’s role in a degree, doctors and nurses are now required to be prepared to guide patients to choose more desirable health websites, answer their questions about the information found, and personally encourage patients’ willingness to learn and overcome their diseases, which would eventually make a substantial shift from traditional health care professional-patient relationship.

Conclusion

The internet educates patients and their carers in versatile levels, enhances accessibility to the health information for the underserved effectively, and assists health professionals to save effort and time to teach basic health information to the public. But there are also possibilities for some vulnerable subgroups to misuse the internet health information, due to lack of proper understanding of medical terms or appropriate capacity to distinguish between truth and falsehood. Even the patient with sound common sense and good educational backgrounds often find the information from the internet is confusing or untrustworthy. On top of that, the internet cannot provide the interactive personal communication by which patients can understand their specific conditions in the whole context. Therefore the roles for the health professionals now in demand are to actively accept the fact that they are not the only source of health information, help patient filter the internet health information and support patients to take responsibility in understanding and conquering one’s own disease.

(2009). Annual Report 2008-2009. Canberra, Department of Health and Ageing, Australian Government.

Abrahamson, J. A., K. E. Fisher, et al. (2008). “Lay information mediary behavior uncovered: exploring how nonprofessionals seek health information for themselves and others online.” Journal of the Medical Library Association 96(4): 310-323.

OBJECTIVES: This research studied motivations for, barriers to, and effects of online health information seeking and explored lay information mediary behavior (LIMB) characteristics in the consumer health information domain. Lay information mediaries (LIMs) seek information on behalf or because of others, without necessarily being asked to do so or engaging in follow up, and have represented more than 50% of health information seekers in prior studies. METHODS: A web-based survey was posted on NC Health Info (NCHI) with 211 respondents, self-identified per the information need that brought them to NCHI as 20% LIMs (n = 43), 58% direct users (n = 122), and 22% health or information providers (n = 46). Follow-up telephone interviews were performed with 10% (n = 21). Interview analysis focused on lay participants (n = 15 LIMs and direct users combined). Interviewees were reclassified post-survey as 12 LIMs and 3 direct users when studied information behavior extended beyond NCHI search. Interview data were analyzed using grounded theory approach. RESULTS: Surveyed LIMs were 77% female (n = 33) and searched on behalf or because of family members (81%, n = 35) and people they felt “extremely close” to (77%, n = 33). LIMs reported various information seeking barriers “sometimes” to “often.” LIMs searched mostly without prompting (51%, n = 22). Interview results triangulated survey findings regarding gender, tie strength, and prompting. CONCLUSIONS: LIMB may be related to gender and relationship tie strength and appears more internally than externally motivated. Further LIMB research is warranted.

Bell, V. (2007). “Online information, extreme communities and internet therapy: Is the internet good for our mental health?” Journal of Mental Health 16(4): 445-457.

Background: Questions have been raised about the internet’s effect on mental health, although no principled review has yet tackled the issue. Aims: To examine the effect of the internet on mental health. Method: Literature review. Results: The internet is typically discussed as if it were a set of activities when it is actually a medium upon which various activities can occur. It is, therefore, neither “good” nor “bad” for mental health, although specific activities may have an influence. The standard of mental health information on the internet is probably equivalent to the mainstream media, although overall it still remains poor. The concept of “internet addiction” looks increasingly invalid, although it is likely that depressed or isolated individuals are more likely to focus on certain activities to excess. A number of “extreme communities” have formed online, such as pro-anorexia, pro-suicide, pro-amputation and likely-psychotic groups. These serve to provide support, outside a medical and social mainstream that finds their beliefs and behaviours unacceptable. A review of preliminary randomized controlled trials shows online therapy to be effective for many disorders. Conclusions: Mental health professionals are advised to lead the creation of online treatments and information. Clinical recommendations for the use of the internet are offered. Declaration of interest: None. [ABSTRACT FROM AUTHOR]

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Eng, T. R., A. Maxfield, et al. (1998). “Access to health information and support: a public highway or a private road?” JAMA: The Journal Of The American Medical Association 280(15): 1371-1375.

Information and communication technologies may help reduce health disparities through their potential for promoting health, preventing disease, and supporting clinical care for all. Unfortunately, those who have preventable health problems and lack health insurance coverage are the least likely to have access to such technologies. Barriers to access include cost, geographic location, illiteracy, disability, and factors related to the capacity of people to use these technologies appropriately and effectively. A goal of universal access to health information and support is proposed to augment existing initiatives to improve the health of individuals and the public. Both public- and private-sector stakeholders, particularly government agencies and private corporations, will need to collaboratively reduce the gap between the health information “haves” and “have-nots.” This will include supporting health information technology access in homes and public places, developing applications for the growing diversity of users, funding research on access-related issues, ensuring the quality of health information and support, enhancing literacy in health and technology, training health information intermediaries, and integrating the concept of universal access to health information and support into health planning processes.

Hein, E. C., Ed. (2001). Nursing issues in the 21st century : perspectives from the literature Philadelphia, Pa., Lippincott Williams & Wilkins.

Hsiung, R. C. (2007). “A suicide in an online mental health support group: reactions of the group members, administrative responses, and recommendations.” Cyberpsychology & Behavior: The Impact Of The Internet, Multimedia And Virtual Reality On Behavior And Society 10(4): 495-500.

Suicides in online mental health support groups are inevitable. This case report of such a suicide describes the responses of the group members and the moderator and makes recommendations. Members of a large, public, mental health message board supported each other, and the moderator, a mental health professional, managed the milieu. A member joined in February 2001 and killed herself in April 2002. The initial response of the members was grief. The moderator attempted to minimize suicide contagion by not making any special announcements and to facilitate mourning by starting a memorial thread. There were no reports of self-injury in response to the suicide, and the online ventilation of grief may in fact have had some preventative effect. One member went to the funeral, and gradually, the group moved on. The moderator later implemented a memorial page. The responses of online groups to suicide may, like those of real-life groups, have resuscitation, rehabilitation, and renewal phases. Diffusion of dependency, a searchable archive, and threaded, asynchronous discussion may facilitate mourning, but anonymity may increase vulnerability to false reports. A thread started in memory of a deceased member may function like a virtual memorial service. A memorial page may function like a virtual cemetery. Preliminary recommendations can be made regarding suicide prevention and responding to suicide in moderated online mental health support groups.

Kivits, J. (2006). “Informed patients and the internet: a mediated context for consultations with health professionals.” Journal Of Health Psychology 11(2): 269-282.

This article investigates how individuals’ use of the Internet for finding health information may affect the relationship between health professionals and patients. It explores people’s rationales for searching for information online, the information selection process and the implications for doctor-patient interactions. Qualitative interviews were conducted by email with 31 health information seekers. Study findings show the importance of the ‘everyday’ in orientating health information searches and of personal experience in navigating a multiplicity of online sources. Interviewees emphasize the primary role of the doctor-patient relationship for delivering health and medical information, their Internet searches complementing rather than opposing professional expertise.

Lee, Y. J., J. Park, et al. (2009). “Exploring antecedents of consumer satisfaction and repeated search behavior on e-health information.” Journal Of Health Communication 14(2): 160-173.

E-health information has become an important resource for people seeking health information. Even though many studies have been conducted to examine the quality of e-health information, only a few studies have explored the effects of the information seekers’ motivations on the perceived quality of e-health information. There is even less information about repeated searches for e-health information after the users’ initial experience of e-health information use. Using an online survey of information seekers, 252 e-health information users’ responses were collected. The research examines the relationship among motivation, perceived quality, satisfaction, and intention to repeat-search e-health information. The results identify motivations to search e-health information and confirm the relationship among motivation, perceived quality dimensions, and satisfaction and intention to repeat searches for e-health information.

Robinson, J. D. and J. Turner (2003). “Impersonal, interpersonal, and hyperpersonal social support: cancer and older adults.” Health Communication 15(2): 227-234.

Although cancer occurs throughout the life span, many of the most frequently occurring types of cancer increase as we grow older. In fact, only cardiovascular disease accounts for more deaths in adults 65 years of age and older. One of the ways that cancer patients cope or adapt to their illness is through socially supportive communicative interactions and relationships. Cutrona and Russell (1990) argued that social support is multidimensional and suggested that social support is most effective when the support needs of the individual are consistent with the type of social support being offered by the support provider. From the communicative perspective, the notion of optimal matching between the types of social support desired and the type of social support offered is extended to include the type of relationship between the communicants. In addition, it is argued that computer-mediated social support can be superior to face-to-face social support. This article attempts to identify some of the conditions under which this is true.

Servellen, V. and G. Marram (2009). Communication skills for the health care professional : concepts, practice, and evidence. Sudbury, Mass, Jones and Bartlett.

Hasman, L., & Zafron, M. L. (2010). An Analysis of Online Resources for Parents, Siblings, and Other Caregivers of Adults with Intellectual Disabilities. Journal of Consumer Health On the Internet , 33-41.