The Web of Health Care

Readers may notice a common theme in many of our commentaries–skepticism about the many health care innovations which are touted for their cost-lowering and quality-improving effects.  One of these is the supposed beneficial effects of the internet as used in health care, and particularly its role in raising consumers’ engagement and involvement in their health and health care.  A study reported in the Journal of Health Communication does nothing to ease our skepticism.    (Journal Article)   The researchers were conducting a study on the relative effects of a web-based and a print intervention to try and improve colorectal screening among women, but along the way they made some surprising findings.

The study involved a randomized trial of over 300 women.  The educational content in each channel was identical but the web site was more visually appealing and the researchers thought it would be more engaging.  In followup phone calls, participants were asked about their use of the materials or web site.  The researchers were also able to track actual usage of the web site by participant.   Only 25% ever used the site and the great majority only visited it once and most of the people who did visit it did so more than 20 days after the start of the intervention.  By self-report, however, a number of people who did use the site, said they didn’t; and even more who didn’t use it, said they did.  For comparison, only 25% of subjects who got print material said they didn’t read it.   Younger persons were more likely to use the site than older ones.

As the authors note, there is great fervor for health uses of the internet, reflected in over 2000 studies on web-based health interventions, but few of these studies report on actual real-world or study uptake.  There is little reason to suspect the findings in this study as being atypical, so it is likely that no matter how well-designed and wiz=bang a web tool is, the number of consumers who actually use it is very small, nor is it clear what change in outcomes occurs when the tools are used.  More research like this might help developers and purveyors of these tools figure out to make them really attractive and useful to consumers.  Otherwise, like so many health care services innovations, this one will turn out to be largely hype.