HSRPP Abstracts: Health literacy and the internet: implications for pharmacy practice

Gray NJ^a, Klein JD^b, Sesselberg TS^b, Cantrill JA^c, Noyce PR^c.
^aPharmacy Practice Group, The Pharmacy School, University of Nottingham, Nottingham, England NG7 2RD ([email protected])
^b University of Rochester School of Medicine and Dentistry, Rochester NY, USA
^c Drug Usage and Pharmacy Practice Group, University of Manchester, Manchester, England

Health literacy (HL) comprises three elements: functional (reading and writing), critical (evaluating information) and interactive (applying knowledge within health systems). A recent study has shown that health literacy is related to disease outcomes in diabetes¹. Good HL skills are crucial for patients to optimise their use of medicines and to find appropriate care for their health concerns. Many HL studies, however, have only explored functional literacy². Prior studies of Internet use have not considered the interdependence of information handling and HL. This is important when considering the role of the Internet in health and health care, as it is a text-based medium demanding consumer sophistication to find, evaluate and apply relevant information. Developing HL during adolescence may improve later access to care, use of medicines and health outcomes. This paper explores Internet health information seeking and HL of English-speaking adolescents in the United Kingdom (UK) and the United States (US).

27 focus groups were conducted with 160 students aged 11-19 years from a convenience sample of twelve schools with age, gender, ethnic and socio-economic diversity. Discussions explored students' Internet use; experiences and perceptions of searching for online health information, and other health information sources. Adolescents were given an opportunity to search for information during the group session. Discussions were recorded and transcribed verbatim. Qualitative analysis of transcripts identified common themes addressing functional, critical, and interactive HL issues.

Adolescents identified the Internet as a primary information source about any topic, but were challenged when trying to use the Internet to find health information. Functional HL difficulties included spelling names of medicines and conditions, and constructing questions for searches. They felt that interactive online consultations and 'frequently asked questions' on sites would help them address these issues. Critical HL challenges included managing the volume of information and judging its quality. Some adolescents were very critical consumers: others self-identified their own gullibility. US students' successful evaluation strategies included checking information consistency across multiple sites, and using a "trusted brand" encyclopaedia site. UK students were less likely to report cross-referencing, and the most "trusted brand" cited was the National Health Service. Interactive HL issues included frustration with information that was neither local nor, in the UK, country-specific.

Poor HL underlies some of the difficulties adolescents have when using the Internet for health information. The Internet has the potential to provide confidential and convenient access for youth to information about health and medicines, and is a useful 'window' through which their HL deficiencies might be identified and addressed. Pharmacists and other health care professionals need to be aware that young people use the Internet for health information, recognise the challenges that users face, and help them to make best use of this valuable resource.

1. Schillinger D, Grumbach K, Piette J, Wang F, Osmond D, Daher C, et al. Association of health literacy with diabetes outcomes. JAMA 2002; 288: 475-82.

2. Andrus MR, Roth MT. Health literacy: a review. Pharmacotherapy 2002; 22(3): 282-302.