The 1996 Healthwise Communities Project, carried out in Boise, ID, provided all Boise households with a self-care reference guide, toll-free telephone advice nurses, and computerized information (Healthwise Knowledgebase that could be accessed by home computers or those set up in public libraries, businesses, and health care settings). Two studies, supported in part by the Agency for Healthcare Research and Quality (HS09997) and led by Todd H. Wagner, Ph.D., of the Stanford University School of Medicine, evaluated the impact of the project on consumer demand for and use of health information.
The first study found that the project increased demand for information. The second study found that those in poor health were more interested in health information, and people suffering from depression made the most use of all three sources of health information.
Wagner, T.H., Hu, T-W., and Hibbard, J.H. (2001). "The demand for consumer health information." Journal of Health Economics 20, pp. 1059-1075.
These researchers compared the demand for consumer health information in Boise, ID—the experimental site of the Healthwise Communities Project (HCP)—with the demand in two control sites, Billings, MT, and Eugene, OR. They gathered data from random household surveys at all three sites before (early 1996) and after (1998) initiation of the HCP. They found that the project increased the use of medical reference books, advice nurses, and computers for health information by about 15 percent, 6 percent, and 4 percent, respectively. Only 3.5 percent of those without a computer used a computer for health information, probably due to the inconvenience and costs associated with traveling to a publicly available computer.
In 1998, medical reference books were much more widely used than computers for health information. However, this is probably changing as more consumers turn to the Internet. Drawbacks to online information sources include the length of time needed to search for information and wide variation in the accuracy of online health information. Although the American Medical Association has issued guidelines for Internet health information, additional private and public regulations may be needed to make it easier for consumers to get high quality health information online, suggest the researchers.
Their findings also suggested that the Boise project was associated with a decreased reliance on health professionals for information. Boise residents called their physician significantly less frequently than residents in the control cities (9 percent less, and 13 percent less for people with children). Thus, encouraging consumers to use self-care resources may reduce demands on health care providers' time.
Wagner, T.H., and Hibbard, J.H. (2001). "Who uses self-care books, advice nurses, and computers for health information?" International Journal of Technology Assessment in Health Care 17(4), pp. 590-600.
The researchers randomly sampled households in Boise, ID, and two control cities about their use of health information in 1996, shortly before the HCP distributed health information to all Boise residents. They conducted a followup survey in 1998. Results revealed that few access, health, or demographic factors were consistently associated with using any of the project's health information resources. However, ownership of a computer and access to the Internet were highly associated with using a computer for health information.
People with a computer also were more likely to use a self-care book. Those with private insurance were more likely than the uninsured to use a computer for health information, perhaps due to the online services many health plans make available to their members. Household income and employment status were not related to using any of the three information sources.
People in poor health and those who had a chronic illness were more likely to use health information, with people suffering from depression consistently using more of all three resources. People with a high school education or less were less likely to use self-care books, but education was not associated with using a telephone advice nurse or a computer. Older adults were much less likely to use a telephone advice nurse than younger adults. Neither age nor education were related to using computers for health information. However, other studies have found lower use of computers and the Internet among lower income blacks than others. Even when people find relevant information, it may be too technical, in a different language, or overwhelming, all potential barriers to needed health information, conclude the researchers.