What’s New in the New Pew Data?
By Josh Seidman | Popularity: 37%The latest version of the e-health bible was published today by Susannah Fox & Sydney Jones at the Pew Internet & American Life Project. For nearly a decade, many of us have relied on Pew’s data to understand consumer needs with respect to health information technology (HIT). Susannah gave a sneak preview of some of Pew’s new data at our April “Health 2.0 Meets Information Therapy Conference,” but there’s nothing quite like getting to sink your teeth into 70 pages of Pew data.
Some of what’s most interesting is what has changed in the last 8 or 9 years. In recent conversations I’ve had about Healthy People 2020 or other prognostications about the next decade of HIT developments, we sometimes forget how quickly the world changes technologically speaking. Comparing Pew’s 2000 data to Nov-Dec 2008 sample of American adults:
- Internet access: Jumped from 46% to 71%
- Looking online for health information: Jumped from 25% to 61%
- Broadband access: Jumped from from 5% to 57%
Just as importantly, however, there’s a little bit of plus ça change, plus c’est la même chose. Despite the growing popularity of the Web, more people turn to a health care professional (86%) and a friend or family member (68%) than the Internet (57%).
Perhaps what I’ve always found most important about the Pew data is understanding the impact of the Web on how consumers make health decisions. After all, if a Google search falls in the forest and nobody does anything with the tree they downloaded, has it really made a difference?
Indeed, Pew data demonstrate that the information found on the Internet does influence decision making for a majority of consumers who go online. Of those people:
- 60% say the information found online affected a decision about how to treat an illness or condition.
- 56% say it changed their overall approach to maintaining their health or the health of someone they help take care of.
- 53% say it lead them to ask a doctor new questions, or to get a second opinion from another doctor.
- 49% say it changed the way they think about diet, exercise, or stress management.
- 38% say it affected a decision about whether to see a doctor.
- 38% say it changed the way they cope with a chronic condition or manage pain.
And, on the critical “help or hurt” question, 60% of online health users say they or someone they know has been helped by following medical advice or health information found on the Internet, in contrast to just 3% who say it has caused harm. The former figure has nearly doubled since 2006, whereas the latter has stayed the same.
I’m not disappointed (but not surprised) that consumer engagement tools seem to not have done a great job so far. Only 19% of online health users have signed up to receive updates about health or medical issues. We clearly need to do a better job of meeting people where they are at in order to get them more engaged in online management of their health.
Finally, for understanding the impact of demographics on Americans’ use of the Internet, broadband, and cell phones, there’s nothing that tells the story as well as Pew’s access thermometers, which have now been updated with December 2008 data.
(Methodology Sidebar: Pew — in part made possible by its partnership with the California HealthCare Foundation — deserves special credit for two methodological advances. First, Pew now surveys (I think they added this a year or two ago) using both landline and cell phone samples, recognizing that an increasing and unevenly distributed portion of the US population cannot be reached by landline (this issue got a lot of press — particularly from places like Pollster.com and 538.com — during the 2008 presidential primaries and general election, as many thought that could lead to underestimations of the Obama vote). Second, they did Spanish-language interviewing to capture information from the second most prevalent language spoken in the US. This substantially improves the validity of all of Pew’s demographic comparisons that involve Latinos.)
Thanks to Pew for continuing to facilitate a data-driven conversation about consumer behavior with respect to the Internet.
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June 11th, 2009 at 9:32 am
Josh,
Are you like me and dusting off your French to get ready for Health 2.0 2010 in Paris? There is indeed a “plus ca change” trendline in the findings — I called it “comfort food” data over on e-patients.net.
I love your image of a Google search falling in the forest. It is a key question: What difference does all this make? I was surprised by that jump from 31% to 60% of e-patients who say say they or someone they know has been helped by following medical advice or health information found on the internet.
I’d love to hear theories about what has made the difference in the past two years.
My theories run toward the increasing roll-out of “always on” broadband connections which encourage people to use the internet as an information appliance, plus an increase in the percentage of people who have sharpened their search & retrieval skills, maybe in other contexts, and then they use those tools when a health question crops up.
In any case, thanks for the thoughtful commentary!
June 11th, 2009 at 9:55 am
Susannah,
Well, the last time I was in France, my accent was so bad that the Parisians thought that I was Italian.
RE: Your question about what has made the difference — I think you’re definitely right about “always on” broadband being part of the answer. Here are a few other hypotheses:
1. Clinician acceptance — A decade ago, when I talked to practicing docs, I often heard the, “I hate it when my patients bring out a stack of printed info from the Web!” I just don’t hear that as much anymore. That also begs a “why?” question,” which brings us to…
2. Consumer expectation changing — As your Pew focus groups from a couple of years ago proved, when told by docs to stop going online, consumers either switch physicians or (in your words) “go underground.” At some point, clinicians realize that’s bad for both them and their patients.
3. Web information may be getting better — I don’t have any empirical evidence to suggest that’s true, but info quality certainly could have improved since my own dissertation research, which dates back almost as long as Pew’s first health surveys (Yikes! We e-health researchers ARE getting old!).
4. Consumers are better e-learners now — Again, no empirical evidence, but as comfort & experience has increased, consumers are better at sifting through info and triangulating answers from multiple sources.
5. More Ix being prescribed — (Of course, I have to say this, and you know we’d love to see that in future Pew surveys.) Increased proactive delivery of information and shared decision making facilitates more participatory medicine and renders the info found on the Web more useful for decision making.
Lots more answer are out there, I’m sure. Others, please join in the discussion.
Josh
June 11th, 2009 at 10:27 am
There may be another reason for the difference: people may have become more open about their health-related activities over the last 2 years.
The tone of the public/press/media reporting has definitely changed with more and more positive reporting of the Internet effect. That should ease members of the public willingness to talk (positively) about their own experience.
June 11th, 2009 at 10:30 am
[…] Article Josh Seidman, Information Therapy (Ix) Blog, 11 June 2009 SHARETHIS.addEntry({ title: “What’s New in the New Pew Data?”, url: “http://articles.icmcc.org/2009/06/11/what%e2%80%99s-new-in-the-new-pew-data/” }); […]
June 11th, 2009 at 3:45 pm
Susannah, thanks for your stunning article (my goals is one day to be called ‘hip’ by Susannah Fox) and Josh, thanks for your insightful commentary.
You asked, Susannah, for theories on Why the big jump in two years in people who know someone helped by the health internet?
I see truth in each of the hypotheses put forward by you, Josh, and Gilles. Two further thoughts:
1) The iPhone. Fullstop.
And iTouch (where web use has been growing even faster). And WAN cards. And other handheld or netbook hardware. Their growth in the last two years makes always-on access more availalbe at both the moment and location where you have a question.
2) The change in laptop culture. When I visited potential colleges to attend with my now-22-year-old, a few students had laptops open during some lectures. When I did the college visit thing with my now-20-year old, about half of the students had laptops open during class. But when I visited colleges with my 18-year-old daughter this year, almost every student in every class had laptops open and were online taking notes, checking email, instant messaging, reading the news — and searching on whatever came to mind. Big change. Fast.
Josh, the Google searches aren’t just falling in forests (love that image!), they’re falling in lecture halls — and restaurants, parks, plazas, trains, cars, coffee shops, and other venues where they weren’t as common two years ago. And desktop computers are starting to become a bit like landline telephones.
June 11th, 2009 at 4:10 pm
Gilles & Alan have added very good insights.
Alan’s points about iPhone & laptop culture return us to one of what Susannah called the “big winners” (according to the new Pew data): Mobile apps. I think laptops (particularly with air cards, etc.) probably count there. I also think you might be right about the parallels with other industries, though Pew has consistently found higher dependence on professional in health care (Susannah’s “will not budge” adapted from the book on “Social Life of Information”) than in other industries.
What can we learn from other industries to answer the IMPACT question, and what is different?
June 13th, 2009 at 6:11 pm
When I spoke at a couple of meetings recently (you were at one of them), I turned the Pew numbers on their head: when I saw “Internet access: Jumped from 46% to 71%” (2000 to 2008), I saw “The number who DON’T have access dropped from 54% to 29%… approximately half.” And that’s in ~8 years.
The number who HAVEN’T sought health info online dropped from 75% to 39% - again about half.
The number who DON’T have broadband dropped from 95% to 43%.
The writing on the wall is pretty clear: duh, people are going online pretty darn quickly. And mobile? Remember that the iPhone has changed the world and was introduced just 29 months ago. It’s not a mass-market “appliance,” by far, but the behavior the leading edge is clear and the trickle-down is predictable, IMO.
The thing is, as people keep hearing stories of people who won when the docs were stumped, a person in trouble will (you bet your BUTT) go online. Example stories: “Moms, do not give up” (ABC News), or CNN’s Teen diagnoses her own disease in science class.
Increasingly my two mantras are “Patients can help” and “Give us our data.” They’re both in the slides and video of my remarks at the NeHC board meeting last week.
Note that none of the above in any way diminishes the value of authoritative medical knowledge, nor the value of professional medical judgment. The teen who spotted the granuloma on her tissue slide called her teacher over; the teacher verified it as much as she could (on the internet!); and they took the idea to the doctors. Same with the mother who figured out what her son had.
And as for “what difference does it make,” it makes a ton of difference: it means policy people should think ahead, and write policies today that will serve us well ten years from now.
At the CDT meeting where you and I sat together, people talked at length about how HIPAA was written when the Web was brand new and nobody had a clue what today’s world would be like. Let’s not make that mistake again: it’s pretty clear what direction the public is heading … more and more and more online. (I said plan for 2020; Bob Coffield’s testimony to NCVHS said to plan for 20 and even 50 years out.)
In the foreseeable future, the life or well-being of someone you care about will be impacted by the regulations we’re writing now. Let’s enable participation, not inhibit it.
June 15th, 2009 at 1:19 pm
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June 19th, 2009 at 4:53 pm
All of these responses are spot on, I think, but I’ll add one additional thought, which really is more of a clarification of what’s already been said. Consistent with the idea that consumer expectations have changed is that consumers expect more than just access to information to help them learn about their health and health issues. Increasingly, they expect their providers to engage them as active partners in managing their health. By nature, this requires that information flow – and be used – in both directions. We have to start making progress in 2011 to help patients and their physicians do this, first through secure email communication and granting patients timely access to key information, such as lab results and prescription history. After these basic steps are achieved, we must then work toward receiving patient-generated information into electronic medical records.
I like what e-Patient Dave says: “Note that none of the above in any way diminishes the value of authoritative medical knowledge, nor the value of professional medical judgment.” This is important. Patients want their providers’ help and expertise. Taking the steps discussed here will enhance providers’ ability to give their patients guidance on their area of expertise, which is the practice of medicine, while at the same time receiving guidance from their patients on THEIR area of expertise, which is the daily experience of their health and health care in the full context of their lives.
August 2nd, 2009 at 2:13 pm
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