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Robert James Campbell Duquesne University, Pittsburgh USA The Internet is one important way for health consumers to participate actively in their health care. This new found ability has lead more and more consumers to question, not only the type of care they receive, but also the quality of that care. However, as Internet usage continues to grow, differences in how demographic groups use this resource to locate health related information are becoming more pronounced. Review of Literature A recent survey by the University of Pittsburgh (2000), shows that 62% of the residents of Pittsburgh and surrounding Allegheny County have access to the Internet. However, the average older adult in Allegheny County, the second largest population of older adults in the nation, has the lowest levels of computer ownership and more limited access to the Internet than other county residents. Furthermore, these elderly adults, who make up 17.8% (228,416) of the countys 1,281,666 residents lack the essential knowledge of how to use the Internet to locate health information. Nationally, research shows that older Americans are in danger of being cut off from one of the most provocative communication mediums of the 21st century. In the United States, elderly adults make up 13% of the population with only 4% using the Internet. Overall 56% of America is online and out of that percentage, only 15% age 65 and over have direct access to the Internet (Fox & Rainie, 2000; Fox, 2001; Fox & Rainie, 2002). 93 million American adults use the Internet to locate health related information, with only 4 million aged 65 and older (Fox & Fallows, 2003). Because older adults are more likely to suffer health problems and make frequent use of the health care system (AOA, 2001), knowledge of how the Internet can be used to locate health information to manage ones care would benefit senior citizens. By manage, it is assumed that individuals will use the Internet to investigate illness states, treatment regimens, the background and training of their physicians, and the efficacy of taking specific medications. Personal Health Care: Why Get Involved? The literature shows that the majority of patients prefer to leave their medical decisions to their physicians (Kaplan et. al., 1996; Arora & McHorney, 2000). Not only is this the case for older and less educated patients (Ende et. al., 1989; Frosh & Kaplan, 1999; Benbassat, Pilpel, & Tidhar, 1998; Bilodeau & Degner, 1996; Kaplan et. al., 1995; Beisecker, 1988), but also physicians perpetuate this trend as their experience and education increases (Beisecker et. al., 1996; Paterson, 2001). Over the years, studies have shown that patients over 60 years of age have a lower desire for control over their health care when compared to younger adults (Stiggelbout & Kiebert, 1997; Smith et. al., 1988; Woodward & Wallston, 1987; Cassileth et. al.,1980; Haug, 1979). Moreover, older patients and men are more likely to let the physician make decisions regarding their treatment (Breemhaar, Visser & Kleunen, 1990). This suggests that the elderly tend to have an external locus of control when it comes to health beliefs (Caress, 1997), as opposed to an internal locus of control. Although the majority of patients prefer to let their physician make the decisions, the more a patient learns about her illness, the more likely she is to ask questions of her physician (Frederikson & Bull, 1995; Mullen, Main, & Velez, 1992; Kaplan, Greenfield, Ware, Jr., 1989; Sharf, 1988; Mullen, Green Persinger, 1985). Studies have shown that patients who ask questions, elicit treatment options, express opinions, and state their preferences regarding treatment during office visits with their physicians have measurably better health outcomes than those who do not communicate (Kohn Corrigan, & Donaldson, 2000; Rost et. al., 1991; Mahler & Kulik, 1990; Barry et. al., 1988; Greenfield et. al., 1988; Greenfield, Kaplan & Ware, Jr., 1985). Reaching Older Adults Beginning in 2001, a program was developed at Duquesne University to train older adults how to use the Internet to manage their health care. The program consisted of five one hour and half sessions presented over a five week period. The sessions were held in local public libraries and senior community centers in Pittsburgh and surrounding communities. The sessions included basic instruction on how to use a computer and web browser, search engines, evaluating web sites, and learning how to use specific medical web sites to answer health care concerns. Along with the instructional component, the program measured participants health locus of control, levels of self efficacy, opinions on health care, and their levels of participation in their health, both before and after taking part in the program. Thus far the program has trained close to 200 older adults. The program has now partnered with the Carnegie Library of Pittsburgh, and has received a grant from the National Library of Medicine to continue to training older adults in the Greater Pittsburgh area how to use the Internet to manage their health care. This presentation will explore the relationship that exists between the Internet to the elderly and the factors that may influence their use of the Internet as a
resource for locating health information. Moreover, the presentation will explore the impact that Internet training has had on the elderly with regard to their participation in their own health care. Did they view the Internet as a novelty, something to fear, or did they express a desire to use the Internet to become more informed health consumers, and as a more informed consumer, did they desire a more participatory role in their own health care, or did they remain passive?
