Internet Health Seeking Behavior of Individuals Visiting a Tertiary Care Teaching Hospital in South India.
Ambarish Mishra,
Final year postgraduate trainee, Master in hospital administration program, Prasanna School of Public Health, Manipal Academy of higher education.
Dr.Rajesh Kamath,
Assistant Professor, Prasanna School of Public Health, Manipal Academy of higher education, Karnataka – 576104. Email: [email protected] Mobile: 7760218342
Dr.Kamath Madhusudana,
former Associate professor, Department of Ayurveda, Manipal Academy of Higher Education, Manipal, Karnataka, India.
Rajib Mandal,
Principal, Netrajyothi Institute of Allied Health Sciences, Udupi, Karnataka, India.
ABSTRACT
here are various motivating factors for health information searching on the Internet. Aside from trying to learn more about a symptom or disorder specifically relevant to the person searching, half of online health information research is on behalf of a friend or relative. Additionally, searching is often used to track specific health-related factors. For example, 60% of adults reported tracking their weight diet or exercise routine online, and 33%
reported tracking specific health indicators or symptoms such as blood pressure, blood sugar, headaches, or sleep patterns. A total of 233 (78%) were found to be regular internet users. 185(79%) used the internet resources for health-related enquires. The focus of the study also included the source of the internet being used. 50 (21%) people answered that they used their mobile phones, while 46 (20%) used their laptops. Whereas 105 (45%) says they use more than one device. One of the chief findings included the purpose of internet usage and it was found that 110 (47%) of users accessed the online resources for gaining information on diseases and health, whereas 19 (8%) searched for hospitals best suited for their needs and 7 (3%) searched for the availability of various treatment facilities.
Only 9 (4%) of the study population was found to search for doctors, while the least percentage of people, 4 (2%) used the internet to compare costs. A similar study was also conducted and the findings were almost similar.
Only 1-5% people were found to search for cost comparison. (7) A search engine was the most common starting point for 99 (42%) of the study population to search for their health-related queries. (7) Our study also shows that 169 (73%) don’t use any regular site or specific application for their searches. One clear reason for this widespread practice can be attributed to the fact that there are a lot of sources which provide false claims which can misguide some users. This also manifests the intelligence of the users as to how aware they are with respect to such information. The study focuses specifically on the resources available on the internet which satisfies the users and it was found that 162 (70%) were satisfied while 71 (30%) were not satisfied.
Keywords: Internet health seeking behavior
Introduction
Cline et al observed that consumers increasingly engage in health information seeking via the Internet. The number of consumers using the internet for health information is large and growing.
More than 70,000 websites provide health information. Estimates of Internet health-information seeking vary widely, but are uniformly high, evidencing `exponential' growth. By 1997, nearly
half of Internet users in the US had sought health information. Annual estimates grew from 43%
in 1997 to 63% in 2000 (Pew Internet and American Life Project, 2001). Expressed in raw numbers, an estimated 18 million adults in the US sought health information online. Recent estimates range from 60 to 100 million people doing.1
An example illustrates the growth. When the National Library of Medicine (NLM) made Medline available to the public via the Internet, use exploded to more than 250 000 inquiries a day Searches increased from 7 million in 1997 to more than 120 million in 1998; more than one-third of the latter were consumers. In response, NLM developed a site designed specifically for consumers, Medline Plus. Consumers can access online health information directly from credible scientific and institutional sources (e.g. Medline, Health finder) as well as un-reviewed sources of unknown credibility (e.g. well-informed individuals along with quacks and charlatans). The majority of consumers (77%) seeking health information for themselves want disease information for consultation with their physicians, many (54%) seek information for others. Searches often are triggered by a diagnosis and desire for treatment information. As more than 90% of health- information seekers search for material related to physical. In turn, information found may influence medical decision making and help consumers to manage their own care. About 47% of those seeking health information for themselves reported that their findings influenced treatment.
The most common topics are the leading causes of death (heart disease and cancer); children's health also is a common topic.
Consumers also use the Internet to access performance reports regarding providers and hospitals and information about managed care organizations. Information may be used to select providers, identify specialists and make decisions regarding employment-related health care benefits. One study found that users rated online support groups more helpful than physicians in numerous ways (e.g. convenience, emotional support, cost-effectiveness, and in-depth information. Relative advantages of online groups are their 24-hr availability, anonymity, selectivity in responding, capacity for immediate and time-delayed reactions, an unlimited volume of participants (including professionals), and exposure to an increased number of opinions, expertise, and experience
Disparities in access to both computers and the Internet are growing. A Department of Commerce study reported that 40% of US households have personal computers; however, data indicate a growing divide based on both education and income levels. Although 82% of US households with incomes in excess of $75 000 have Internet access, only 38% of those with incomes below $30 000 do so (Pew Internet and American Life Project, 2001), figures that translate to about 20 times greater likelihood of access among the higher than the lower income group.
According to Dickerson Suzanne, Reinhart Amber M, Feeley Thomas Hugh (2004), approximately 53% of respondents reported using Web or e-mail in the past year and 68% (33%
of total sample) of those who accessed the Web used it to search for health information. The two most commonly cited search areas included information about a physical illness and nutrition/fitness. Education and race significantly predicted online health-seeking behavior when considering all factors in the study. Many patients (22%) relied on friends and family to navigate the Web, and 45% of patients reported that the information that they sought was unrelated to their clinical visit.2
According to Lwoga Edda Tandi, Mosha Neema Florence, Health information needs of parents and caregivers were mainly associated with health care (example, nutrition, treatment), and health education. Parents and caregivers of children with mental illness had access to and used the internet as the main source of information about their children's health, which was followed by verbal discussions with family/friends, and television. Health information seeking behavior appeared similar across gender categories, but there were differences on the use of print and electronic information sources according to age and level of education. The main factors that hindered access to health information included a low level of education, lack of funds and health information illiteracy.3
According to Pal Sanjay Kumar, Pandey GS, Kesari A, et.al (2003), A recent survey has shown that 40-45% of the patient’s access medical information via the internet and this information affect their choice of treatment. In a Canadian cohort consisting of 312 patients indicates that 29% had used the internet to obtain information about their prostate cancer, with 17% doing so after diagnosis but before deciding on treatment. 28 patients stated that internet information influenced their decision about treatment. The patient who used the internet were younger and from a higher education level. Many clinicians now report that a third or more of their patients are asking them about health information they have found in the internet asking them to recommend the best websites for their condition and asking for their email addresses. A growing number of patients are asking their clinician how soon they will be offering doctor-patient email, consumer websites, online appointment scheduling and prescription refills, online self-care guidelines, online support groups, and other online patient services. The growing demand for online patient services poses a dilemma for many clinicians. Some are still uncomfortable with computers or unfamiliar with the internet. Some doctors are not pleased when the patient bring in printouts from the internet. If they refuse to read them, their patients take it as an offense. But if they attempt to review and discuss them they may precipitate long, inconclusive discussions. A recent literature search turned up 100 studies that attempt to rate the accuracy and completeness of health information on the www, the rating ranges from about 15-85%.4
According to Martin Janet M. Morahan, (2004) Worldwide, about 4.5% of all Internet searches are for health-related information. Most users of online health information are looking for information about specific health conditions because they or someone they know was diagnosed with a medical condition. They typically use general search engines to find online health information and enter short phrases, often misspelled. They seldom go beyond the first page of a search. Both their search and evaluation skills are limited although they are concerned about the quality of online health information. They avoid sites with overt commercialism, but often do not pay attention to indicators of credibility. Online health information is used to fill an information void which can enhance coping and self-efficacy, affects health-related decisions and behavior of users and their friends and family, and is often discussed with health care providers. There are cross-cultural differences in the types of sites used as well as how online information is used.5 According to Ziebland, Sue, Chapple Alison, Dumelow Carol, et.al,(2004) Cancer patients used the internet for a wide range of information and support needs, many of which are unlikely to be met through conventional health care. Internet use, either directly or via friend or family, was widespread or reported by patients at all stages of cancer care, from early investigations to follow up after treatment. Patients used the internet to find second opinions, seek support and experiential information from other patients, interpret symptoms, seek information about tests and treatments,
help interpret consultations, identify questions for doctors, make anonymous private inquiries, and raise awareness of cancer. Patients also used it to check their doctors’ advice covertly and to develop expertise in their cancer.6
According to SM Akerkar, M Kanitkar, LS Bichile (2005) Eight eighty of the 900 subjects (range: 18-70 years, mean: 41.7+13.27 years) approached filled up the questionnaire. 281 (32%) of the respondents acknowledged surfing the internet. 85 (30%) surf the internet every alternate day and 146 (52%) patients spent an average of 1-3 hour surfing the internet per week.7 75%
(212/281) of these patients acknowledged the use of the internet for medical information (24% of the total patients). A search engine was the most common (196/212; 92%) starting point in their search for medical information. Only 3 patients indicated that they looked for a specific site for the particular information. While most (188, 70%) looked up the internet on their own, only 20 (9%) respondents were asked by their physician to search the internet for medical information.
Ease of locating information on the internet: 171 (81%) respondents found it easy locate the information they required on the internet and 195 (92%) found the search engine took them to correct site.
Perceived usefulness and reliability of the health information on the internet: Almost every patient (211/212) felt that the information on the internet served the purpose and 201 (95%) found the information reliable as well.Influence of the net based information: Information obtained from the internet includes 131 (62%) patients to ask questions to their physicians and stimulate 59 (28%) even to see a second opinion based on their information. 194(69%) patients came across sites giving information about various ‘wonder cures’.Awareness of quality standard: Only 21 (7%) patients were aware of the presence of any quality standards pertaining to health information sites;
however none could name any accreditation standards.
8According to SA Iverson, KB Howard, Bk penny (2008) Of 154 patient responses received, 89 patients (58%) reported using the Internet to find health information. Slightly more than half of these individuals (49 [55%]) reported a change in the way they think about their health as a result of that information. In addition, most of these individuals (41 [46%]) reported making subsequent health-related behavioral changes. The largest segment of this population was aged 31 to 45 years (17 [57%]). They reported asking more questions during office visits (27 [66%]), following physician advice more closely (22 [54%]), and making self-directed dietary changes (22 [54%]).
By and large, these patients informed their physicians of these changes (30 [73%]), especially as they believed physicians were willing to discuss the health information they obtained online (75 [84%])
According to Fiksdal S Alexander, Kumbamu Ashok, JadhavAshutosh s, Cocos Cristia, et.al, (2014), almost all participants reported using the Internet to gather health information. They described a common experience of searching, filtering, and comparing results in order to obtain information relevant to their intended search target. Information saturation and fatigue were cited as main reasons for terminating searching. This information was often used as a resource to enhance their interactions with health care providers.9
Many participants viewed the Internet as a valuable tool for finding health information in order to support their existing health care resources. Although the Internet is a preferred source of health information, challenges persist in streamlining the search process. Content providers should continue to develop new strategies and technologies aimed at accommodating diverse populations,
vocabularies, and health information needs. Recent studies have shed light on why and how consumers search for health information on the Internet. In a recent 2013 survey conducted by the Pew Internet Project, 72% of respondents reported using the Internet to look for health information within the past year, with the most commonly researched topics being focused on specific diseases or conditions, treatments or procedures, and searching for doctors or other health professionals.
Although many people (35% of those surveyed by Pew) use the Internet to learn more about a specific symptom or medical condition they or someone else might have, clinicians and/or family and friends remain a central resource when help is needed regarding a serious health issue. The elderly in particular are more likely to trust “living sources” of information, rather than the Internet.
Even among Internet users, health information is often understood in a social context. For example, 26% of Internet users reported watching or reading content related to someone else’s personal experience with a medical or health-related issue within the last 12 months.
There are various motivating factors for health information searching on the Internet. Aside from trying to learn more about a symptom or disorder specifically relevant to the person searching, half of online health information research is on behalf of a friend or relative.
Additionally, searching is often used to track specific health-related factors. For example, 60% of adults reported tracking their weight diet or exercise routine online, and 33% reported tracking specific health indicators or symptoms such as blood pressure, blood sugar, headaches, or sleep patterns.
Research Methodology
This chapter discusses in detail the research methodology selected by the investigator in order to study the “Health seeking behavior by the individual: A study of internet usage by an individual to gather health information” in a tertiary care teaching hospital in Karnataka.
The objective of the study:
a) To find out the percentage of individuals using the internet for Medical related information.
b) To analyze the type of information sort by individual Source of data:
This was the primary source of data and the fresh and first time, Source of data is the Staff, Student, Health check lounge patient, General Public at a tertiary care teaching hospital in South India.
Method of Data collection:
➢ The data collected through structured questionnaire.
➢ Stratified sampling.
➢ Method of sample collection-convenient sampling.
Study Type:
The research approach adopted in the study was Descriptive on the basis of analysis of data. The Research approach includes a collection of information, attitude and opinion directly from the
staff, student, health check lounge patient, and the general public through a structured open and closed questionnaire.
Questionnaire:
The questionnaire consists the following:
➢ Demographic data consisted of personal information of the respondents relating to Gender, age, Education, Income, and place.
➢ A questionnaire regarding the needs which influence the usage of the internet for health- related inquiry.
➢ The study was conducted by collecting information from staff, Student, Health check lounge patent and General public. A structured open and close-ended questionnaire were prepared and administered. The questionnaire was structured with the help of various literature source and with the help of expert faculty
➢ The questionnaire was prepared in two languages. Both English and Kanada.
➢ The data is interpreted by using a Pie chart, Graph, Table showed the Number of respondents and its percentages.
Content Validity:
Content Validity refers to the extent to which an instrument measures what it is supposed to measure. The validity of the tools was established by the opinion and suggestion of expert from the fields of administration and statistics.
The setting of the study:
The study was conducted in a 2023 bedded Tertiary care Hospital in Manipal. The Prestigious institution is well known for its multitude and services. The Hospital is equipped with all Modern technologies and provides excellent medical care using a cost rational approach.
Sample and Sample Technique:
The sample selected for the study comprises of total 300 subjects n=300. Among these a) Student-60
b) Health check lounge patient from all department-100 c) Staff-60
d) General public -80
Sampling size formula for the Estimation of Proportion n=Z21-α/2 PQ/d2
n=Minimum sample size
Z21-α/2=1.96 at α = 0.05
p=Proportion of internet uses= 0.36 (36%) q=1-p
d=Margin of error (the amount by which sample results are expected to differ from those of the population)
d=15% 0f p=0.054
Putting the value in Formula we will get the sample size approx 302. But for the researcher convenience, the sample size was taken 300.
STUDY DURATION- Four months
EXCLUSION CRITERIA: Those who said No I am not a regular user of the internet are excluded in data analysis.
ANALYSIS: Percentage and co-relation using a statistical package.
Table No. 5.1: Usage of the internet.
Type Yes No Total
Health Check Lounge 77(77%) 23(23%) 100
General public 63(79%) 17(21%) 80
Staff 43(72%) 17(28%) 60
Student 50(83%) 10(17%) 60
Total 233 67 300
Interpretation: From the above data (233) 78% is the regular user of internet and (67) 22% are not.
Table No 5.2: Number of hours used.
Type <1 hr 1-2 hr 2-4 hr >4 hr Total
Health check lounge
19(25%) 27(35%) 16(21%) 15(19%) 77
General public
15(24%) 23(37%) 13(21%) 12(19%) 63
Staff 6(14%) 12(28%) 11(26%) 14(33%) 43
Student 3(6%) 12(20%) 17(28%) 18(30%) 50
Total 43 74 57 59 233
Interpretation: From the above table it is found that maximum (74) 32% people use the internet for 1-2 hours followed by (59) 25% who use it for 4 hours or more and (57) 24 % uses for 2-4 hour. The least percentage was (43) 18% of people who used the internet for less than 1 hour Table No.5.3: Source of Internet.
Type Mobile Laptop Computer Computer at Home
Office Computer
More Than one Device
Health Check Lounge
17(22%) 16(21%) 6(8%) 0(0%) 7(9%) 31(40%)
General public
14(22%) 8(13%) 5(8%) 3(5%) 6(10%) 27(43%)
Staff 9(15%) 7(12%) 1(2%) 0(0%) 2(3%) 24(38%)
Student 10(17%) 15(25%) 2(3%) 0(0%) 0(0%) 23(38%)
Total 50 46 14 3 15 105
Interpretation: From the above table a total maximum (105) 45% people use more than one device whereas the percentage of only mobile user 50(21%), whereas (46) 20% use laptop and (14) 6%
use only computer, and the (15) 6% use office computer, least 3 (1%) use computer at home.
Table No. 5.4: Reason for search.
Type Yes No Total
Health Check Lounge 60(78%) 17(22%) 77
General public 49(78%) 14(22%) 63
Staff 34(57%) 9(15%) 43
student 42(70%) 8(13%) 50
Total 185 48 233
Interpretation: From the above table and graph it is found that total (185) 79% people search for health-related enquires, (48) 21% don’t search for Health-related enquires.
Table .No.5.5: Purpose of using the internet.
Type Information on
Disease/Health
Search for Hospitals
Search for Doctors
Compare cost
Availability of
treatment facilities
More than one search
Health Check Lounge
37(48%) 7(9%) 3(4%) 2(3%) 4(5%) 24(31%)
General public
29(46%) 3(5%) 3(5%) 2(3%) 3(5%) 23(37%)
Staff 27(63%) 2(5%) 0(0%) 0(0%) 0(0%) 14(33%)
Student 17(34%) 7(14%) 3(6%) 0(0%) 0(0%) 23(46%)
Total 110 19 9 4 7 84
Interpretation: From the above table it is found that a total of maximum (110) 47% people search for the information on the disease, (84) 37% search for more than one information, search for the availability of treatment facilities (7) 3%, search for the Hospital (19) 8%, search for the doctors 9(4%), only (4) 2% search for the cost.
Table No.5.6: Time when the search is done.
Type When you are
feeling ill/sick
Before seeing a doctor
After seeing a doctor
Ticked more than one
Health check lounge
40 17 9 11
General public 31 13 7 12
Staff 22 6 1 14
Student 23 16 3 8
Total 116 52 20 45
Interpretation: From above table and it is found that a maximum (116) 50% people search when they are feeling ill/sick,(52) 22% search before seeing a doctor and only (20) 9% search after seeing a doctor. Whereas (45) 19% opted more than one answer.
Table No.5.7: People searching for the second opinion.
Type Yes No
Health check lounge 39(51%) 38(49%)
General public 36(57%) 27(43%)
Staff 32(74%) 11(26%)
Student 36(72%) 14(28%)
Total 143 90
Interpretation: From the above table and it is found that a total of (143) 61% people search for a second opinion and (90) 39 % don’t search for the second opinion.
Table No.5.8: Source of information for internet search.
Type Friends Family Doctors Search site More than one ticked Health check
lounge
14(18%) 14(18%) 11(14%) 31(40%) 7(9%)
General public
14(22%) 7(11%) 11(17%) 26(41%) 5(8%)
Staff 6(14%) 3(7%) 3(7%) 22(51%) 9(21%)
Students 7(14%) 6(12%) 13(26%) 20(40%) 4(8%)
Total 41 30 38 99 25
Interpretation: From the above table and it is found that maximum (91) 42% search on the search engines, (41) 18% ask a friend, (38) 16% ask doctors and (30) 13% ask their families. Whereas (25) 11% opted for more than two option.
Table No.5.9: Specific sites visited
Type Yes No
Health check lounge 17(22%) 60(78%)
General public 16(25%) 47(75%)
Staff 8(19%) 35(81%)
Student 23(46%) 27(54%)
Total 64 169
Interpretation: From the above table and graph it is found that the maximum (169) 73% don’t use any specific site or application and (64) 27% say they use various applications and sites.
Table No.5.10: Number of satisfied users.
Type Yes No
Health check lounge 52(68%) 25(32%)
General public 42(67%) 21(33%)
Staff 32(74%) 11(26%)
Student 36(72%) 14(28%)
Total 162(70%) 71(30%)
Interpretation: From the above table it is found that (162) 70% of people were satisfied with the resources available online whereas (71)30 % were not satisfied.
CORRELATION Table Number: 5.11
Male Female
Total 134 99
Graduated and
postgraduate
101 77
Health-related inquiry 117 68
Satisfied 98 64
Income more than 3 lakhs 87 55
Information on disease 73 37
Correlation of data among Males and Females with respect to various parameters analyzed in the study:
The correlation between male and females with respect to other parameters were found to be 0.92. This means even an increase in a single factor can cause 92% changes in other factors as well. Similarly, the correlation between Graduated and postgraduate Vs Health- related inquiry among male and female is found to be 0.70. On the other hand correlation between Health search inquiry, satisfaction, income, and information on disease search among male and female are found to be 0.92. Finally, the correlation between an Income of more than 3 lakhs and information on disease search among male and female is found to be 1. This is a perfect correlation.
Discussion
The data has been collected from a teaching tertiary care hospital in South India. The data are stored out into numerical data in the above-listed table. In this study, the researcher has collected the following information which has been presented above with the help of tables and figures.
With the advent of the modern era which has introduced us to new technologies, it won’t be wrong to say that our life is now a tech-oriented life. People now have become more aware of the beneficial aspects of technology and are thus using it for various day-to-day purposes. The Internet is now being used not only as a tool of entertainment but also as a vast source of knowledge and information. The number of internet users in India is growing at a rapid pace. NASSCOM (National Association of Software and Service Company). Internet survey showed an active subscriber base of 1.1 million in March 2011. The purpose of this study was to have an idea as to how many people use the resources provided on the internet with respect to the healthcare industry.
The results obtained are a clear indication that a majority of people now use the internet to address their health-related queries. 185 (79%) of the study population which included patients, students
as well as general people used the internet, at some point or the other to gain information about their health.
The first part of the study involved giving out questionnaires to patients visiting the health lounge area, the staff of the hospital, students of the attached medical college and the general public in the college campus. The results were tabulated and analyzed. A total of 233 (78%) were found to be regular internet users. 185(79%) used the internet resources for health-related enquires. The focus of the study also included the source of the internet being used. 50 (21%) people answered that they used their mobile phones, while 46 (20%) used their laptops. Whereas 105 (45%) says they use more than one device. One of the chief findings included the purpose of internet usage and it was found that 110 (47%) of users accessed the online resources for gaining information on diseases and health, whereas 19 (8%) searched for hospitals best suited for their needs and 7 (3%) searched for the availability of various treatment facilities.
Only 9 (4%) of the study population was found to search for doctors, while the least percentage of people, 4 (2%) used the internet to compare costs. A similar study was also conducted and the findings were almost similar. Only 1-5% people were found to search for cost comparison. (7) A search engine was the most common starting point for 99 (42%) of the study population to search for their health-related queries. (7) Our study also shows that 169 (73%) don’t use any regular site or specific application for their searches. One clear reason for this widespread practice can be attributed to the fact that there are a lot of sources which provide false claims which can misguide some users. This also manifests the intelligence of the users as to how aware they are with respect to such information. The study focuses specifically on the resources available on the internet which satisfies the users and it was found that 162 (70%) were satisfied while 71 (30%) were not satisfied.
Suggestions
1. Since a large number of people are seen approaching their doctors and health care providers for information on websites into which they can look into to know more about their conditions or additional information on associated disorders/symptoms/side-effects. It becomes the responsibility of the medical community to ensure adequate quality of online medical content, to educate the users about quality measures and to direct patients to sites which offer appropriate information.
2. Although the Internet is a preferred source of health information, challenges persist in streamlining the search process. Content providers should continue to develop new strategies and technologies aimed at accommodating diverse populations, vocabularies, and health information needs.
3. An absolute need to make the communication system more advanced remains one of the major challenges in this process. To overcome this, hospitals can develop their own applications, since there are a major fraction of people who access the internet through their mobile devices, which can provide them with appropriate information.
4. Since there are a lot of patients who use the internet services frequently, hospitals can start providing the patients with doctor-patient emails, consumer websites, online appointment scheduling, and prescription refills, online self-care guidelines, online support groups, and other online patient services.
5. Further studies can be done to find out the health condition of the patients who use the internet as a source versus those who don’t use the internet as a health-related source.
References :
1. Cline, R.J. and Haynes, K.M. (2001) Consumer health information seeking on the internet: The state of the art. Health Education Research, 16, 671-692. doi:10.1093/her/16.6.671
2. Dickerson et al. Journal of the American Medical Informatics Association, Volume 11, Issue 6, 1 November 2004, Pages 499–504, https://doi.org/10.1197/jamia.M1460
3. Edda Tandi Lwoga, Neema Florence Mosha, (2013) "Information seeking behavior of parents and caregivers of children with mental illness in Tanzania", Library Review, Vol. 62 Issue: 8/9, pp.567-584, https://doi.org/10.1108/LR-10-2012-0116
4. SK Pal, GS Pandey, A Kesari, G Choudhuri, B Mittal. Fighting cancer in the information age:
The role of Internet. Indian Journal of Experimental Biology 2003; 41: 189 – 200.
5. Dr. Janet M. Morahan-Martin.CyberPsychology & Behavior.Oct 2004. Volume: 7 Issue 5:
November 1, 2004
6.Ziebland Sue, Chapple Alison, Dumelow Carol, Evans Julie, Prinjha Suman, Rozmovits Linda et al. How the internet affects patients' experience of cancer: a qualitative study BMJ 2004; 328 :564
7. Akerkar SM, Kanitkar M, Bichile LS. Use of the internet as a resource of health information by patients: A clinic-based study in the Indian population. J Postgrad Med. 2005;51:116–8.
8. Iverson SA, Howard KB, Penny BK. Impact of internet use on health related behaviors and the patient-physician relationship: a survey-based study and review. J Am Osteopath Assoc. 2008;108(12):699–71.
9. Fiksdal AS, Kumbamu A, Jadhav AS, Cocos C, Nelsen LA, Pathak J, McCormick JB.
Evaluating the Process of Online Health Information Searching: A Qualitative Approach to Exploring Consumer Perspectives. J Med Internet Res 2014;16(10):e224
