Internet use can help patients with stigmatized illness, study finds
Research has shown that people with stigmatized health conditions, such as mental illness or sexually transmitted diseases, tend to avoid discussing the problem and seeking treatment -- a situation that can harm the patient as well as others.
A recent study co-authored by CHP/PCOR fellows Laurence Baker and Todd Wagner, however, finds that the Internet can be a valuable tool to help break through the stigma of such illnesses, by enabling patients to anonymously seek information and treatment. The study, published in the October 2005 issue of Social Science and Medicine, found this was particularly true for psychiatric illnesses such as anxiety and depression.
"The Internet is potentially very useful in situations where getting good medical advice out to patients is challenging," said Baker. "For conditions that can be hard for patients to talk about, the Internet may be of great benefit since it provides a chance to gain information without having to discuss sensitive issues face-to-face."
While several studies have examined patterns of Internet use among various populations -- including those seeking health information -- none had specifically examined Internet use among those with stigmatized illnesses. Baker, Wagner and colleague Magdalena Berger hypothesized that people with a stigmatized illness would be more likely than those with non-stigmatized illnesses to use the Internet to seek information and communicate about their health condition. They also hypothesized that, since people with stigmatized illnesses often don't know about available treatments, those who searched the Internet would be more likely to report that their Internet use increased their use of medical services.
To test these hypotheses, the researchers analyzed a large nationally representative survey of Internet use for health information, enabling them to examine patterns of Internet use among patients with stigmatized and non-stigmatized illnesses. For purposes of the study, the researchers identified four stigmatized illnesses: anxiety, depression, herpes and urinary incontinence. Patients who reported having one or more of these conditions were compared with patients who had one or more non-stigmatized chronic illnesses, such as diabetes, hypertension or back pain.
The researchers explored the respondents' Internet use in detail by evaluating how often they used the Internet to seek health information; how often they used it to communicate with healthcare providers, family members or others about their condition; how satisfied they were with the information they obtained online; how much time they spent on the Internet overall; and whether their Internet use affected the number of times they saw a doctor or other healthcare provider. The researchers controlled for many factors, but cautioned against drawing causal relationships given the cross-sectional nature of the data.
The study results largely confirmed the researchers' hypotheses: People with stigmatized illnesses were more likely to have used the Internet for health information and to have communicated with a physician online. Significantly, those with a stigmatized illness were more likely to report that they increased their use of healthcare services after using the Internet. In particular, people with psychiatric illnesses (in this case, anxiety and depression) were more likely to turn to the Internet for health information than those with non-psychiatric stigmatized illnesses. Similarly, people with psychiatric conditions were more likely than those with other stigmatized illnesses to report that their Internet use increased their healthcare utilization.
The results aren't surprising, the authors say, given the privacy and anonymity the Internet allows. "Online information ... can be casually perused without classifying oneself as having a mental (or other) illness," they write in their paper. "This informality may make searching for health information online less intimidating than seeking advice from a health professional."
The authors conclude that "the Internet may be a good public health education and intervention tool for targeting some people with stigmatized illness." But these benefits, they caution, assume that (1) the information patients obtain online is accurate and unbiased, and that (2) patients are not overutilizing healthcare services as a result of their Internet use. They note that "the Internet is replete with information of questionable value," and that "there have been instances of pathological use of the Internet among those with ... mental illnesses."
Despite these caveats, Wagner said he is encouraged by the study results, because they highlight the significant potential health benefits of Internet use, particularly for hard-to-reach patients. "The Internet has made it much easier for the average person to find an enormous amount of medical information very quickly and anonymously," he said. "This study shows us how patients can benefit from the anonymity of the Internet."
Wagner noted that while some physicians are wary of their patients' use of the Internet for medical information, he believes that "physicians shouldn't disregard this information; instead, they should help their patients manage it." For example, he suggests that physicians compile for their patients a list of the health Web sites that provide, in their judgment, the most accurate and unbiased information.
This study was funded in part by a grants from the Center on the Demography and Economics of Health and Aging (CDEHA).
- Laurence C. Baker
Professor of Health Research and Policy and Stanford Health Policy Fellow
- Todd H. Wagner
Consulting Associate Professor in Health Research and Policy and Health economist with the VA Palo Alto Health Care System; Stanford Health Policy Associate
- Center on the Demography and Economics of Health and Aging (CDEHA)
CHP/PCOR, CHPINTL Program