Teaching Elderly Adults to Use the Internet to Access Health Care Information: Before-After Study (2)


A total of 60 participants began the Internet training program, and 42 completed the 5-week training seminar. These 42 participants also completed the baseline and 5-week follow-up Multidimensional Health Locus of Control surveys and Health Opinion Surveys. Participant makeup consisted of 34 (81%) females and 8 (19%) males. The average age of participants was 72 years, and 34 participants (81%) reported that they were retired. The respondents showed a much higher percentage of computer ownership than typically found in senior populations. Of the 42 participants, 30 (71%) owned a home computer, 25 (60%) reported having used the Internet, and 24 (57%) had used email. Seventeen (40%) respondents reported that they used the Internet to find health care information prior to the study, and 1 (2%) reported using the Internet to join an online support group. Prior to the study, 27 (64%) participants reported having some type of illness, with a subset of 19 (45%) reporting a chronic illness.
Before-After Analysis of Outcomes
Regarding the Health Opinion Surveys (HOS), scores for the 42 participants showed a statistically significant increase from baseline to 5-week follow-up (mean = 28.0 vs 29.6). Higher scores on the HOS indicate a greater desire for health information and self-treatment.

As far as the Multidimensional Health Locus of Control (MHLC) scale was concerned, male, female and overall participants' MHLC chance scores showed statistically significant differences between observed baseline and 5-week follow-up results, suggesting that participants' perceptions of the role chance plays in their health declined.

The Health Participation Survey (HPS) asked participants to identify the role they played on their last visit to their physician. There were very few changes from baseline to 1-year follow-up. Interestingly, none of the participants reported working together with their physicians to make important decisions. The HPS also asked participants to report how they prepared for physicians' visits. Although fewer respondents in the 1-year follow-up indicated preparing a list of questions prior to their last visit, they did, on average, ask their health care provider more questions than at baseline.

Administered at 1-year follow-up, the Internet Use Survey asked participants to rate their levels of participation during their last physician office visit. Ratings were based on a 5-point scale from (1) for “No participation” to (5) for “High participation.” Although the median score increased from 3 at baseline to 4 at 1-year follow-up, a Wilcoxon signed rank test used to compare participant responses showed no statistically significant increase in participation. Twenty-one of 27 (78%) respondents to the 1-year follow-up survey indicated that they had used the Internet to find health-related information; 11 respondents reported using the Internet for health information at least weekly.

Ten questions of the Internet Use Survey focused on the impact Internet-based health information had on participants' decision making. The first four questions related to participants' feelings regarding general health information retrieved from the Internet. The remaining six questions were aimed only at the 18 participants who said they were suffering from a chronic condition. The majority, 18 of 27 (67%) participants, agreed that the information improved their understanding of a health care topic, but most participants also felt that the information did not help them manage their health care needs, challenge them to seek care from another health provider or facility, or challenge them to change their diet or exercise habits. A similar pattern was observed for participants with chronic conditions; a majority agreed that the information helped them better understand their health problem, but only a minority reported that the retrieved health information helped them manage their chronic condition, affected treatments used to control their condition, helped to manage other conditions, or challenged them to change their diet or exercise.


This study explored the impact of training seniors to use the Internet to locate health information. In examining the viability of this endeavor, the authors chose to focus on four research questions (as stated in the Introduction) to explore how Internet usage may or may not affect a group of seniors' decision-making processes.
Willingness to Use Computers and Internet
The first question to be answered was whether or not participants would experience a reduced reluctance to use computers and an increased willingness to use the Internet to find health care information. Although 30 of the 42 participants already owned a personal computer at the onset of the study, only 17 (40%) reported that they had used the Internet to locate health information. A year after receiving Internet training, 21 of the 27 respondents (78%, or 50% of the 42 course completers) reported using the Internet, either weekly or as needed, to locate health information. This suggests that older adults are willing to use personal computers to locate health information.

However, since participants for this study were self-selected, it is likely that they had a greater interest in using the Internet prior to the study than the average senior.
Willingness to Use External Health Information
The second question sought to determine whether there was an increased willingness among participants to use external health information to manage their health care. Results indicated an increased desire for health information and self-treatment. However, the majority of participants did not use the Internet or any information source to prepare for health care provider office visits, or to review information after office visits.

These results suggest that use of the Internet to locate health information did not increase participants' willingness to use the information to manage their health care. Since the number of participants in this study was relatively low, topics for future research include finding out what factors determine a senior's likelihood to prepare for physician office visits, and what factors determine whether seniors value finding and using information in support of their health care.
Active Role in Managing Their Health
A third question focused on whether Internet use allowed participants to adopt a more active role in managing their health. When asked what role they played with their physician during an office visit, 78% of the participants felt they played a collaborative role. Yet, as mentioned above, the participants did not use the Internet to prepare for an office visit, or to verify information provided by their physicians after an office visit. Furthermore, participants reported that the Internet did not necessarily help them manage either a general health concern or a chronic condition. The results suggest that, if participants were collaborating with their physicians, they were not using information found on the Internet to promote this process. Future research needs to determine whether this observation indicates a problem with the training methodology or suggests other factors are at work, such as seniors' beliefs about how they should interact with physicians. Another possibility is that, although participants indicate that they collaborate with their physicians, they really are not collaborating, due to illness or other variables.
Locus of Control
A final question examined whether Internet use increased participants' perception of control over their health and wellness. The statistically significant reduction in MHLC chance scores from baseline to 5-week follow-up suggests that health care providers or educators can intervene and shift perceptions about seniors' ability to manage their own health care. However, it may also be that those participants who believed that chance plays a major role in their overall health status were more likely to discontinue the course, biasing the analysis of the observed results..

It is interesting to note that female participants had a higher internal locus of control score than men, starting with the baseline surveys and continuing through 5-week and 1-year follow-ups. The study results suggest that the Internet is one more tool women can use to maintain their internal health locus of control. It also matches past research showing that women take a more active role in their health care, while men are generally more passive. Further research is needed to determine why this gender difference exists.


Results from this study seem to suggest that the training sessions had a positive impact on participants in several ways. For example, the participants experienced an increased willingness to use personal computers to locate health information. However, it did not translate into a willingness to take a more active role in their health care or to use the Internet when making important health care decisions. Elderly adults may be willing to use the Internet as a source for general health information, but when making decisions about their health care, our participants seemed to adhere to a physician-centered model of care. Demographic and situational variables (such as health status and type of office visit) may play a large role in determining which seniors will use the Internet for making behavioral decisions about their health care, and in which scenarios they will do so.

Future studies should examine the qualitative impact of teaching seniors to use the Internet for health care information. Although the instruments used can show how seniors' behaviors and perceptions are changing in aggregate, it would be equally important to attempt to determine how the participants' attitudes toward their health and health care providers change as they gain information-seeking skills. That seniors' health will decline over time is axiomatic. However, the authors believe that increased understanding of their health can give seniors an increased sense of empowerment, self-worth, and dignity. Studies addressing these and other issues would be equally valuable.
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The article on which the piece above is based was originally published in the Journal of Medical Internet Research (http://www.jmir.org ), June 30, 2005. Except where otherwise noted, articles published in the Journal of Medical Internet Research are distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited, including full bibliographic details and the URL, and this statement is included. The full citation for the original article we excerpted is as follows:

Campbell RJ, Nolfi DA
Teaching Elderly Adults to Use the Internet to Access Health Care Information: Before-After Study
J Med Internet Res 2005;7(2):e19
URL: http://www.jmir.org/2005/2/e19/

Dr. Don Rose writes books, papers and articles about computers, the Internet, science and technology, and issues related to seniors.

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