Internet Usage by Low-Literacy Adults Seeking Health Information: An Observational Analysis

Abstract

Background Adults with low literacy may encounter informational obstacles on the Internet when searching for health information, in part because most health Web sites require at least a high-school reading proficiency for optimal access.Objective The purpose of this study was to 1) determine how low-literacy adults independently access and evaluate health information on the Internet, 2) identify challenges and areas of proficiency in the Internet-searching skills of low-literacy adults.Methods Subjects (n=8) were enrolled in a reading assistance program at Bidwell Training Center in Pittsburgh, PA, and read at a 3rd to 8th grade level. Subjects conducted self-directed Internet searches for designated health topics while utilizing a think-aloud protocol. Subjects' keystrokes and comments were recorded using Camtasia Studio screen-capture software. The search terms used to find health information, the amount of time spent on each Web site, the number of Web sites accessed, the reading level of Web sites accessed, and the responses of subjects to questionnaires were assessed.Results Subjects collectively answered 8 out of 24 questions correctly. Seven out of 8 subjects selected "sponsored sites"-paid Web advertisements-over search engine-generated links when answering health questions. On average, subjects accessed health Web sites written at or above a 10th grade reading level. Standard methodologies used for measuring health literacy and for promoting subjects to verbalize responses to Web-site form and content had limited utility in this population.Conclusion This study demonstrates that Web health information requires a reading level that prohibits optimal access by some low-literacy adults. These results highlight the low-literacy adult population as a potential audience for Web health information, and indicate some areas of difficulty that these individuals face when using the Internet and health Web sites to find information on specific health topics.

Recent Internet Use and Associations with Clinical Outcomes among Patients Entering Addiction Treatment Involved in a Web-Delivered Psychosocial Intervention Study

“…1,4 Prior studies have reported that while most web-related content is written at the 10th grade level or higher, the average American reads at an 8th grade level or less, and this has been associated with a poorer understanding of web-based health information. 15,35 In this study, research support staff assisted patients during their initial use of the web-based TES intervention. In addition, modules used precision learning strategies that required participants to complete quiz items correctly in order to proceed to subsequent modules.…”

Internet skills

“…A problem that almost all subjects experienced is the limited use of most search results; typically, the first three results attracted attention, and the second page with results was only opened sporadically. This is in accordance with information-seeking studies (e.g., Aula & Nordhausen, 2005;Birru et al, 2004). The results also revealed that the older the subject, the less relevant search results were selected.…”

“…The typical Internet user only uses one or two terms per query (Aula & Nordhausen, 2006). A recurring mistake is the use of multiple terms without any spaces between them (Birru et al, 2004;Hargittai, 2002). In addition, students experience similar problems (Aula & Nordhausen, 2006;Mittermeyer, 2005).…”

“…However, when people use broad searching strategies in tandem with large-scale search engines, a vast number of often-unsuitable results will appear (Livingstone, Van Couvering, & Thumim, 2005). This problem is reinforced by the fact that information seekers often do not venture past the first page of search results (Aula & Nordhausen, 2006;Birru et al, 2004;Ozmutlu, Spink, & Ozmutlu, 2004). Jansen and Spink (2003) report that Web search engine users on average view about eight Web documents, with more than 66% of searchers examining fewer than five documents in a given session.…”

Characterizing the Digital Health Citizen: Mixed-Methods Study Deriving a New Typology (Preprint)

“…Achieving health outcomes depends on enablers around internet skills [5][6][7], particularly in terms of making sense of information quantity and quality [8] and health literacy in the sense of being able to translate the findings into health-promoting behaviours [9][10][11].…”