Access Glasgow and Health Information Needs

Access Glasgow and Health Information Needs
Jenny Harbour

Abstract

Internet health resources are becoming increasingly important in meeting public demand for information. The Access Glasgow Health information gateway is one such resource, provided by a partnership of NHS, public and further education libraries. A preliminary evaluation of the gateway highlighted deficiencies in content and coverage. Questionnaire surveys of public health information needs demonstrated a requirement for information provision and an interest in health websites. Based on the results of this study recommendations for improving the Access Glasgow Health gateway are made and a sample of suitable resources for addition to the site provided.

Introduction

Public demand for health information is increasing [1] as a result of demographic changes, improved education and literacy levels, increased confidence with new technologies and the need for informed choice [2]. With over 70,000 health related websites existing in 2000 [3], a recent survey [4] showed that health information is one of the most frequently sought topics on the Internet. The Internet is therefore a potentially valuable means of providing people with health information and the opportunity to take responsibility for their health [5].

A major element of NHS strategy is to get patients involved in their medical treatment through access to accurate health information [6]. Health gateways play a vital role in providing this access. Proposed as part of the Modernising Government initiative [7] the Access Glasgow project aims to develop a user-centred service across all sectors to meet the information needs of the community [8]. Electronic access to information is a central element of the project resulting in the creation of a prototype gateway called Access Glasgow Health (www.accessglasgowhealth.org.uk).

Aims and Objectives

The purpose of this study was to identify public health information needs and provide recommendations for improving the Access Glasgow Health gateway. The project is divided into three sections:

• Evaluation of the Access Glasgow Health prototype
• Surveys of public library customers and staff to identify health information needs
• Selection of quality health resources for addition to the gateway

Methods

Evaluation of the Access Glasgow Health gateway was carried out first to minimise bias generated by opinions arising in the surveys. Criteria used to evaluate the website were taken from Clausen’s (1999) “Evaluation of library websites” [9] and covered design, content, coverage, navigation, aesthetics and general impressions.

Two separate questionnaire surveys were conducted in 6 Glasgow public libraries covering a large geographical area within the city. Questionnaires consisted of closed questions with a few open questions covering broader topics or opinions. Both questionnaires were voluntary and conducted as structured interviews.

In each library 10 members of the public completed a questionnaire covering demographic information, where they find health information and why they need it, how the Internet is used for health information and what health topics are important. Members of staff in each library completed a questionnaire covering public health enquiries and resources consulted by librarians. Survey data was analysed using Excel.

Twenty-eight health websites were identified for addition to the Access Glasgow Health gateway based on the BIOME guidelines [10].

Results

The Access Glasgow Health gateway has a basic search function, and is organised into headings and sub-headings. Each heading leads to a set of sub-headings, which in turn lead to a list of websites, gateways or vital links.

The design of Access Glasgow Health is clear and simplistic with no multimedia and few graphics. There is no indication of authority or when information was last updated. The quality of content available is high, however the main criticism of the site is poor coverage. Navigation within the site is quick and easy, although links are not annotated. User support on the site is non-existent with an e-mail address for comments the only option available. In general Access Glasgow Health is user-friendly, however the small text size may cause problems for visually impaired users and there are no language alternatives.

Sixty members of the public participated in the survey. Age of participants ranged from under 24 to over 65. Gender was evenly divided between male and female. The majority of participants were of white ethnic origin (87%), due to a lack of ethnic minorities encountered and language barriers preventing completion of questionnaires.

43% of respondents had needed health information within the last year. Figure 1 indicates the resources used by participants to find health information.

The most common source of information remains the GP or health centre, particularly amongst older citizens. Libraries and the Internet are frequently used.

A broad spectrum of health topics of were identified as important (Figure 2). General health, women’s health, men’s health, child health, health for the elderly and oral health were all considered important.

Healthy eating and exercise are the most popular health topics. Treatment information, cancer, addictions, prescription information, self-esteem and dental care are also important. Significantly more women felt family planning was important (X2=10.12, p=0.05). The difference between male and female was almost significant for gynaecology, healthy eating and cancer. Little interest was expressed in pregnancy or sexually transmitted diseases although this may be due to the sensitive nature of the question.

 

When asked their reasons for seeking health information, 73% of respondents cited healthy living, finding out about a diagnosed condition or preparing to visit a GP. Over 70% indicated they sought information for themselves or their family. Preferred formats for receiving information were leaflets, books and websites.

67% of respondents indicated they felt confident using the Internet (X2=6.67, p=0.01). The majority of people not confident about using the Internet were elderly. Significantly fewer people used the Internet to look for health information (35%, X2=9.6, p=0.01). Most people using the Internet to look for health information used NHS Direct Online or generic search engines. Only 50% of people using the Internet considered who produced the website they found information on.

The most commonly cited positive features of health websites were:

• Ease of access
• Currency
• Concise and simple information
• Coverage
• Links and contacts

The most common negative features of health websites were:

• Information overload
• Too little information on topics of interest
• Not enough information on common complaints
• Frustration at not finding what you want

Seventeen members of library staff completed a questionnaire. The most common health enquiries were about depression, general health, prescriptions, cancer and stress. Staff indicated medical encyclopaedias, books and the Internet were the most common resources recommended to the public. Library staff identified speed, coverage and patient experiences as the best features of health websites. Negative features of websites included misleading information, missing information, information overload and problems arising due to literacy.

Discussion

Access Glasgow Health has a key role to play in guiding people towards high quality resources. Ensuring information is reliable, up to date and comprehensive increases the likelihood of use, encourages repeat visits and guards against confusion [5]. Selecting resources to improve coverage will help attract users to Access Glasgow Health. A number of papers are available that recommend sources of health information [4 and 1].

43% of respondents indicated they needed health information in the last year compared to 90% in previous studies [4]. This may be due to regional variations or survey methodology as Nicholas et al. [4] used an online questionnaire therefore contacting only Internet users. The 38% of participants using the Internet to find health information is similar to previous figures [4] validating the sample size used. 67% of participants felt confident about using the Internet, which is similar to previous figures of 69% [5]. People who did not use the Internet were mostly elderly people who relied on the GP for information. This mentality is common among the older generation resulting in a ‘grey gap’ in Internet use [3]. A sub-set of the community, both young and old, did not use the Internet, in agreement with previous surveys indicating there was a section of the community uninterested in the Internet [2].

The number of people preferring leaflets or books suggests the Internet should be used in conjunction with traditional information sources. This confirms data suggesting traditional media still outperform the Internet in relaying health information [4].

Peaks in interest in health eating, exercise, cancer and family planning are probably due to popular NHS and government media campaigns. Previous studies concluded that general health and diet are the most important health topics [11] with 50% of the population seeking alternative medicine information [4]. Previous surveys indicated 44% of people looked for online information relating to sensitive health issues [4]. The low interest in sensitive topics in this study may be a result of the methodology.

Variation in opinion of good features of websites suggest that health gateways such as Access Glasgow Health will need to provide information suitable for a variety of interests, reading levels and knowledge levels with options for further information. Recent surveys suggest a universal health website is unlikely to exist due to individual preferences and needs [11].

Recommendations

A number of recommendations can be made based on this study:

• Health information should be provided in leaflet form as this is preferred by customers
• Production of a ‘hints and tips’ leaflet on assessing website quality would be a cheap and effective way of improving the quality of information utilised by the public
• Addition of web resources to the Access Glasgow site to improve coverage is essential. In particular information on exercise, healthy eating, cancer, treatments, addictions, prescription drugs, common conditions, depression and stress should be added. Information on general health, women’s health, men’s health, child health and health for the elderly would also be useful
• Author details, contact details and date of last update should be added to the Access Glasgow Health website to improve consumer confidence.
• Options for alternative languages and text sizes would broaden the appeal of the gateway
• Advice for library staff on quality health websites to recommend to the public would be helpful
• Marketing the Access Glasgow brand is essential for expansion of the project.

Further Research

There are three areas of interest for further research:

• Research on effectiveness of Access Glasgow Health
• Surveys of socio-economic groups not covered in this study, for instance ethnic minorities or young people, to assess their health information needs
• Adding a counter to the Access Glasgow Health website to generate accurate statistics on use

Conclusion

In conclusion, the Internet contains a wealth of health information. The Access Glasgow Health gateway has the potential to be a useful information resource but needs to greatly increase its’ content coverage. Results from the survey suggest there are key areas of health that should be included in the site (see Recommendations).

References

1. Wallace, S. (1997) Health information in the new millennium and beyond: the role of computers and the Internet, Health Education, 3: 88-95.
2. Williams, P., Nicholas, D., Huntington, P. and Gunter, B. (2002) Doc.com: reviewing the literature on remote health information provision, Aslib Proceedings, 54 (2): 127-141.
3. Benigeri, M. and Pluye, P. (2003) Shortcomings of health information on the Internet, Health Promotion International, 18 (4): 381-386.
4. Nicholas, D., Huntington, P., Gunter, B., Russell, C. and Withey, R. (2003) The British and their use of the Web for health information and advice: a survey, Aslib Proceedings, 55 (5/6): 261-276.
5. Duffy, M., Wimbush, E., Reece, J. and Eadie, D. (2003) Net profits? Web site development and health improvement, Health Education, 103 (5): 278-285.
6. NHS Executive (1999) Information for health: an information strategy for the modern NHS 1998-2005, HMSO London. Available: http://www.doh.gov.uk (Accessed 20 February 2004).
7. Tomeny, A. (2000) Modernising government: Glasgow City Council “Access Glasgow” proposal, Glasgow City Libraries and Archives (Internal fax).
8. Dobson, M.S. (2004) Partnership sub-group meeting agenda. Access Glasgow Health: background and objectives, NHS Glasgow Library Strategy: Planning and Implementation Group (Internal document).
9. Clausen, H. (1999) Evaluation of library web sites, The Electronic Library, 17 (2): 83-87.
10. BIOME (2001) Summary of key evaluation questions. Available: http://biome.ac.uk (Accessed 10 February 2004).
11. Huntington, P., Nicholas, D. and Williams, P. (2003) Characterising and profiling health Web user and site types: going beyond “hits”, Aslib Proceedings, 55 (5/6): 277-289.

Jenny Harbour
MSc/PgDip Information and Library Studies Student

University of Strathclyde
Graduate School of Informatics
Livingstone Tower
26 Richmond Street
Glasgow
G1 1XH

jharbour@cis.strath.ac.uk