|Year : 2022 | Volume
| Issue : 2 | Page : 109-113
Influence of internet health information on patient compliance in dermatology: A survey
Pragya Ashok Nair, Jinal Tandel, Pratiksha Shah, Rutoo, Dharmesh Parmar, Brijesh Patel
Department of Dermatology, Shree Krishna Hospital, Karamsad, Gujarat, India
|Date of Submission||09-Apr-2021|
|Date of Decision||13-Dec-2021|
|Date of Acceptance||15-Jun-2022|
|Date of Web Publication||26-Aug-2022|
Pragya Ashok Nair
Department of Dermatology, Shree Krishna Hospital, Pramukhswami Medical College, Karamsad - 388 325, Gujarat
Source of Support: None, Conflict of Interest: None
Background: Many patients use the Internet to self-diagnose and find treatment options, thus avoiding the need to visit a doctor in person. Objectives: This study was done with the primary objective to determine how Internet health information impacts the patient–physician relationship, compliance, and its effect on patient treatment. Materials and Methods: It was a cross-sectional study, done at the Department of Dermatology, Venereology, and Leprosy, over a period of 6 months from January to June 2019. All patients with any dermatological diseases above the age of 12 years, who conducted an Internet search for the disease were included in the study. Participants were provided with an information sheet, outlining the details of the study. They were asked to fill out a questionnaire in their vernacular language. The questionnaire had questions about the patient's perspective toward his health as well as the doctor's advice before and after Internet usage. Descriptive analysis was used for statistical analysis. Results: A total of 110 patients were included in the study with 56.36% of males and 34.54% between 21 and 40 years of age group. Wikipedia was used by 51.81% of participants, followed by 40% who used Google. After Internet use, participants strongly agree that doctors possess more information than the information on Internet in 39.09%, while 61.81% of participants believe that there is good communication between doctor and patient. After Internet use, a maximum of 48.18% agree and followed the doctor's recommended medication. Conclusion: Online medical information has a positive effect on patient disease status and on patients' relationships with their physicians. Doctors should be more aware of the health information available online and should be able to guide patients to accurate and reliable websites.
Keywords: Compliance, dermatology, health, Internet
|How to cite this article:|
Nair PA, Tandel J, Shah P, Rutoo, Parmar D, Patel B. Influence of internet health information on patient compliance in dermatology: A survey. Clin Dermatol Rev 2022;6:109-13
|How to cite this URL:|
Nair PA, Tandel J, Shah P, Rutoo, Parmar D, Patel B. Influence of internet health information on patient compliance in dermatology: A survey. Clin Dermatol Rev [serial online] 2022 [cited 2022 Sep 26];6:109-13. Available from: https://www.cdriadvlkn.org/text.asp?2022/6/2/109/354748
| Introduction|| |
Patients increasingly use the Internet to seek health information and track personal health data. It is more commonly seen in educated consumers. Many patients use the Internet to self-diagnose and find treatment options, thus avoiding the need to visit a doctor in person. Prior studies have shown that seeking online health information and health-related social media is more common among women, younger patients, those with a college education, and with a higher income. The prevalence of health-related Internet uses among dermatology patients and how they use this information is not well studied. This study was done with the primary objective to determine how Internet health information impacts the patient–physician relationship, patient compliance, and its effect on patient treatment. The secondary objective of our study was to find the change in behavior, if any, of the patients who have acquired Internet health information before a doctor's consultation.
| Materials and Methods|| |
It was a cross-sectional study, done at the department of Dermatology, Venereology, and Leprosy, for 6 months from January to June 2019. After ethical approval from the institutional committee all patients with any dermatological diseases above the age of 12 years, who conducted an Internet search before consulting a physician, and those who have undergone consultation more than one time previously (i.e., follow-up patients), were included in the study. Patients above 12 years who presented to the OPD for the first time and who have not conducted an Internet search regarding their conditions were excluded from the study.
Participants were provided with an information sheet, outlining the details of the study. They were asked to fill out a questionnaire in their vernacular language, which was explained and guidance was provided if needed. The questionnaire was a self-made questionnaire, which has been validated on 10 patients previously. The questionnaire had questions about the patient's perspective toward his health as well as the doctor's advice before and after Internet usage. Data for all patients presenting with acute and chronic conditions were included in the study. Five-point Likert scale was used for response of various questions. Descriptive statistics has been used to describe the categorical data and Chi square test for independence (individual Likert scale questions).
| Results|| |
A total of 110 patients were included in the study with 62 (56.36%) males and a maximum of 38 (34.54%) in the 21–40 years of age group. Among the participants, 57 (51.81%) were undergraduates, followed by 43 (39.09%) who were educated up to the 12th standard. Sixty five (59.09%) participants had income <5000/month [Table 1]. Among 110 participants, 71 (64.54%) presented with chronic conditions while 39 (35.45%) presented with acute condition [Table 2].
|Table 1: Demographic data of patients using the Internet for dermatological disorders|
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Wikipedia was used by 57 (51.81%) and Google by 44 (40%) participants for Internet search [Figure 1].
Patient's perspective toward doctor after Internet usage shows that 43 (39.09%) strongly agree and 40 (36.36%) agree that, the doctor possesses more information than the information on Internet. Of 110 participants, 59 (53.63%) strongly agree and 31 (28.18%) agree that the doctors perform their role very well and seem to be very knowledgeable, while 68 (61.81%) strongly agree and 30 (27.27%) agree that there is good communication between doctor and patient [Table 3].
Patients' perspective toward their health after Internet usage shows that 53 (48.18%) agree and followed the doctor's recommended medication, 71 (64.54%) strongly agree that there is a change in the behavior because of Internet health information, 62 (56.36%) strongly felt that doctor is willing to answer all questions [Table 4].
Patient's perspective about doctor's advice before Internet usage shows that 73 (66.36%) participants always used to follow doctors' advice as closely as possible, while 27 (24.54%) followed most of the advice as closely as possible [Table 5].
|Table 5: Patient's perspective about doctor's advice before Internet usage|
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| Discussion|| |
The Internet has served as a means to disseminate information about health and health care, enhance communication, and facilitate a wide range of interactions between patients and the health-care delivery system.
Online information about the medical condition will increase the patient's sense of self-efficacy while encouraging appropriate consultation for potentially harmful skin conditions. A total of 4.5% of Internet searches worldwide are health-related, to gain information on symptoms, disorders, and treatments.
Very few studies on Internet use by dermatology outpatients have been carried out.,, Our study included patients who accessed Internet before consulting a dermatologist.
In a study by AlGhamdi et al. who searched for online medical information 31% of participants visited their doctors' personal websites than other sites, whereas in our study 51.81% used Wikipedia and 40% Google. InTan SS et al study. most patients indicated that they would trust online health information if it had been written by a doctor or belonged to a health institution. Thus, people still rely on doctors as the main source of information on their condition, even if they do search for online information.
In the study by AlGhamdi et al., 91% of patients were <45 years old, and more than half were aged 26–45 years similar to our study where 34.54% of patients were in the age group from 20 to 40 years. It is in contrast to other studies where elderly people have been heavily represented. Due to increased comfort with technology and its integration into daily life, certain groups were more likely to have searched for medical information online, which included younger women, college graduates, and those with higher incomes;, however in our study, 51.81% were undergraduates, 56.36% were male and of 59.09% were from lower-income group.
In Wolf et al., study online sources about dermatologic conditions were consulted most frequently for information about potential skin cancers, moles, and unknown spots, while in our study Internet searches were for chronic dermatosis in 64.54% of participants and 35.45% for acute conditions.
Most patients (93%) in a study by AlGhamdi et al. considered their doctor as a primary source of information, and the majority (60%) of them preferred and were more satisfied (86%) with a direct explanation of their condition given by their doctor. Patients' perspective toward doctors after Internet use was very positive in our study where majority agree to strongly agreed that doctors possess more information than the information on Internet and 61.81% strongly felt that there is good communication between doctor and patient. Discussing the medical information found online with their doctors had positive effects on their skin disease and on their relationship with their physician. This indicates that patients should be asked about their Internet search practice as part of medical history-taking procedures to harness the advantages to be gained by discussing the subject. The physician needs to guide the patient to reliable resources and websites pertaining to the condition. Strengthening the patient–doctor relationship is essential to involve the patient in any decision-making process around his or her condition. Information from the Internet may improve patients' ability to interact efficiently and productively with their treating doctors and be better able to care for themselves.
Although Internet does not have a direct impact on actual health care, but indirectly makes patients more comfortable and confident about their care, due to the availability of information. The Patient's perspective toward his health after Internet usage was variable in our study. Majority agree to strongly agree that they follow the doctor's recommended medication and return or plan to return on the doctor's suggested schedule. An equal percentage agree and disagree that they follow doctors' advice less closely. Seeing a doctor less often and asking more questions to a doctor were agreed by 36.36% and 40%, respectively. Herbs and supplements not prescribed by the doctor were used by 20%.
Studies have shown that there are disadvantages of online patient resources such as reduced physician influence, as the patient may no longer view the physician as the ultimate health-care authority. It can lead to self-treatment, delay in appropriate treatment, more time spent on patients' questions, and can also add burden on the cost of treatment due to requests for inappropriate testing or treatment.
Noncompliance rates can be as high as 80% which creates a number of serious problems for the individual in the form of reduced quality and quantity of life, lower income due to inability to work, and higher medical costs.  Our study showed that more than 90% followed the recommendation prescribed by the doctor. It has been suggested compliance can be improved through better patient-–physician communication, collaboration and participative decision-making, and better concordance between patients and physicians with respect to medical diagnoses and treatment regimens.
| Conclusion|| |
Internet as a means to obtain resources and knowledge about health care and its delivery by patients is unavoidable. It can have both positive and negative impacts on their health. Doctors should be aware of the health information available online and should be able to guide patients to reliable sources. Internet use can empower patients to become more active partners in their own health management and have a positive impact on patient–doctor relationship.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Since the questionnaire has been administered by dermatologists, there is a possibility of bias in the response of patients, which is one of the limitations of our study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Atkinson NL, Saperstein SL, Pleis J. Using the internet for health-related activities: Findings from a national probability sample. J Med Internet Res 2009;11:e4.
Bhandari N, Shi Y, Jung K. Seeking health information online: Does limited healthcare access matter? J Am Med Inform Assoc 2014;21:1113-7.
Eysenbach G, Kohler Ch. What is the prevalence of health-related searches on the World Wide Web? Qualitative and quantitative analysis of search engine queries on the internet. AMIA Annu Symp Proc. 2003;2003:225-9.
Qureshi AA, Kvedar JC. Patient knowledge and attitude toward information technology and teledermatology: Some tentative findings. Telemed J E Health 2003;9:259-64.
Asai Y, Kotani K, Kurozawa Y. The status of Internet access in adult patients with atopic dermatitis in Japan. Tohoku J Exp Med 2006;210:37-40.
Zargari O, Kimyai-Asadi A. Attitudes of Iranian patients with skin problems towards using the Internet as a medical resource. Int J Dermatol 2006;45:535-7.
AlGhamdi KM, Almohideb MA. Internet use by dermatology outpatients to search for health information. Int J Dermatol 2011;50:292-9.
Tan SS, Goonawardene N. Internet Health Information Seeking and the Patient-Physician Relationship: A Systematic Review. J Med Internet Res. 2017 Jan 19;19(1):e9. doi: 10.2196/jmir.5729. PMID: 28104579; PMCID: PMC5290294.
Neelapala P, Duvvi SK, Kumar G, Kumar BN. Do gynaecology outpatients use the Internet to seek health information? A questionnaire survey. J Eval Clin Pract 2008;14:300-4.
Pennekamp PH, Diedrich O, Schmitt O, Kraft CN. Frequency and utility of Internet use by orthopaedic patients. Z Orthop Ihre Grenzgeb 2006;144:459-63.
Hsu LL. An exploratory study of Taiwanese consumers' experiences of using health-related websites. J Nurs Res 2005;13:129-40.
Wolf JA, Moreau JF, Patton TJ, Winger DG, Ferris LK. Prevalence and impact of health-related internet and smartphone use among dermatology patients. Cutis 2015;95:323-8.
Hart A, Henwood F, Wyatt S. The role of the Internet in patient-practitioner relationships: Findings from a qualitative research study. Med Internet Res 2004;6:e36. Available from: http://www.jmir.org/2004/3/e36/
. [Last accessed on 2008 Nov 17].
Hausman A. Taking your medicine: Relational steps to improving patient compliance. Health Mark Q 2001;19:49-71.
Erdem SA, Harrison-Walker LJ. The role of the Internet in physician-patient relationships: The issue of trust. Bus Horiz 2006;49:387-93.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]