Internet Self-Diagnosis: Mapping the Information Seeking Process

We’ve all been there. It’s early morning, and you wake up feeling groggier than usual, sensing the onset of a sore throat and a runny nose. Before crawling out of bed, you grab your smart phone and, naturally, Google “groggy sore throat runny nose symptoms.” Hundreds of results pop up, suggesting various illnesses and links to seemingly promising remedies. How could anyone filter through page after page of links, ranging from everyday allergies to deadly diseases?

Many of our health choices are made outside the doctor’s office. The simple decision of whether symptoms are severe enough to warrant visiting a healthcare provider is one of them. For some patients, that decision is easy, because regardless of the severity of symptoms, from a simple cough to leg pain, getting in to see a healthcare provider is easy. Unfortunately, many people still struggle to find a healthcare provider, get an appointment, and/or obtain transportation. These individuals are left to turn to other health information resources, such as the Internet, to determine whether their symptoms are severe enough to navigate these barriers.

The “digital divide” has become a catchphrase for how differences in educational, social, and economic backgrounds can affect access to web-based tools and services, as well as the general ability to use the Internet.

That divide has serious healthcare consequences: Though the web is not intended to replace traditional medical care, it may offer one of the few available sources of information for those with limited access to health services. While patients who regularly visit a provider are privy to the diagnostic processes of medical professionals, web-based tools may be critical in weighing the severity of symptoms for those with fewer resources and less access. 

The way the Internet is used to investigate and self-diagnose health concerns led my colleagues and me to look deeper into how individuals navigate web-based health information – and how individual experiences and abilities may influence this process.

Against this backdrop, my colleagues and I sought to explore how the digital divide may influence the way individuals seek health information and arrive at health decisions. Our study, “Characterizing internet health information seeking strategies by socioeconomic status: a mixed methods approach,” focused directly on how individuals of different educational, economic, and social backgrounds navigate web-based health information.

To begin, we created two clinical situations, each involving an acute illness of different clinical severity. We then developed two ways for measuring individuals’ information-seeking behavior – one focusing on decision-making processes, the other on the depth of information searched.

Drawing on academic literature related to the psychology of judgment and decision-making, we identified and classified two approaches for the decision-making processes used by individuals when searching the Internet for health information. System 1 processing involves the use of biases and heuristics (e.g., a “rule of thumb”), while System 2 processing is characterized by a careful evaluation of the information presented. System 2 processing, the systematic approach, most resembles the diagnostic process taught to medical professionals as well as information-processing strategies found in other studies to be associated with higher-quality decisions. Participants who had less education and were more reliant on social services, lower socioeconomic status (lower-SES), were more likely to engage in less complex and more intuitive searches.

Our exploration of the depth of searching by individuals making health decisions uncovered real differences in complexity. Those who had higher education and less need for support from social services, higher socioeconomic status (higher-SES), engaged in a more complex and expanded search process; they widened their searches to increase their information input. As a result, higher-SES individuals were exposed to additional information as well as a larger number of options for their decision-making.

While there were significant differences in the complexity of searches, we found that there were no significant differences between lower-SES and higher-SES individuals in whether the Internet search influenced an accurate guess at the cause of the symptoms. For this scenario, the complexity of the search did not result in better overall guesses at the symptoms. This may have to do with previous experiences with the symptoms and the hypothetical nature of the scenario. Overall, participants used three heuristics – the influence of prior clinical or symptom-related experience, how credible the source of information is to the participant, and whether the information found is consistent with other information they encountered during their search – to “fill in” information and guide their process of seeking health information.

We are concerned by the reliance on heuristics and the narrowing of searches by individuals of increased vulnerability, because the way they search for information reduces their exposure to information and results in fewer options for decision-making. Our next step will be to seek to determine what kinds of tools will facilitate more meaningful interaction and engagement for everyone. One big hope involves employing Web 2.0 gamification techniques to guide decision-making and to keep information seekers readily engaged in the decision-making process.

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2 replies »

  1. Speaking of timeliness as an attribute of Primary Healthcare for medical TRIAGE, I am newly aware that there are 11 medical schools who do NOT support a Family Medicine residency track. Eight of these eleven are located in the Northeast sector of our nation comprising about 100 million citizens. So, how is it that the professional recognition, mutual support and respect necessary for a Primary Physician’s over-all coordination of healthcare be taught to sub-specialists in these institutions? Yes, I realize that their are general Internists and Pediatricians involved…sort of! And, there are many sub-specialists who just “get it.” This will be an increasingly important, professional attribute as we slowly become re-involved in “risk-sharing.” I am aware that the tertiary medical centers have been extremely wary of this prospect since the “HMO” days 20-30 years ago. Its either adjust or get ready for increasingly “irrational rationing.” AND, there must be a widespread solution to the financing of post-graduate medical education. Supporting it as a Medicare line-item was fool-hardy, and it still is…in many ways.

  2. Ultimately, “medical TRIAGE” is most reliable when managed by telephone with a “caring” BSN level nurse at the office of a person’s Primary Physician. Using a small group of rotating nurses who also managed the office “through-put” during office hours, our hospital utilization for Medicare and employer groups was 25-30% lower for our capitated risk-sharing HMO Plan members than the Plan average, 10 years in a row. We used no medical assistants or secretaries to answer the phone. The range of inaccurate and misleading information on the internet is profound. Generally, only the “.gov” sites are accurate and free of bias. On the other hand, I always encouraged people to become informed as well as possible, even with its thorns of misleading information.
    Most importantly, unless the “medical TRIAGE” process is connected with a direct communication process as supported by a physician, timely issues won’t be accurately resolved. This is my best example: a woman calls at 8:00 AM, she is on birth control pills; she woke up in the morning and newly notices being “short of breath.” She called when we took the answering service off our line. We encountered about one person every 5 years with a PE. It takes a nurse to know that immediately, to arrange an immediate ED visit by 911, and to notify the ED along with sending appropriate records to the ED.