Page 79 - Health Literacy, eHealth, and Communication: Putting the Consumer First: Workshop Summary

Health Literacy, eHealth, and Communication: Putting the Consumer First: Workshop Summary

HeALtH LiteRACY, eHeALtH, AnD CoMMUniCAtion

can create an information overdose. If people access inaccurate or incor-
rect information, that too can have negative side effects. Therefore, the
issue can be seen as a matter of titrating the dosage of information. How
does one figure out the appropriate dose, frequency, and duration of the
information to provide? How can the right information be delivered to the
right people at the right time so that they can better manage their health
and make better health decisions?
Kerr White, an epidemiologist, developed the idea of the ecology of
health care and medicine (1961). His idea was to examine a population of
1,000 people to determine how people experience health and health issues
and how they use the health care system. This research was updated by
Larry Green (a family physician) and colleagues (2001).
Green and his colleagues found that in a population of 1,000 people,
on average about 800 would report symptoms of one sort or another. Of
those reporting symptoms, 217 would visit a physician’s office (includ-
ing 113 who would visit a primary care physician), 65 would visit a
complementary or alternative medicine provider, 21 would visit a hospital
outpatient clinic, 14 would choose to receive home health care, 13 would
visit an emergency department, and 8 would be hospitalized (with fewer
than 1, on average, hospitalized in an academic medical center). There is
a big difference between the number of people reporting symptoms and
the number who actually seek care.
How does use of the Internet for seeking health information fit into
this picture? Of those 1,000 people, it is known that considerably more
than the number who seek care, but probably less than the 800 who report
symptoms, will access the Internet for health information. There are dif-
ferent degrees of access to the Internet—some people have access at home,
others at work, and still others have access through a family member. The
Pew Internet and American Life Project found that 60 percent of people
with household incomes below $40,000 per year had access to the Internet
(Esterbrook et al., 2007).
More people now go online for health information every day than
visit a doctor, which is what Susannah Fox of the Pew Internet and Ameri-
can Life Project referred to as the “Dr. Google” phenomenon. That raises
the obvious question, What happens when physicians tell their patients
not to go online? When surveyed on this question, consumers said that
they either change where they are going for medical care or else just no
longer tell their physicians about it (Fox and Fallows, 2003).
If one asks consumers where they would prefer to obtain information,
they report that their first choice is from their personal physician. But
when they do see their physician, the visit is often carried out in a very
condensed timeframe with insufficient time to discuss everything they
would like to talk about. Furthermore, about 50 to 80 percent of things a

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