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The use of the Internet to search for medical and health-related information is increasing and associated with concerns around quality and safety.
We investigated the current use and perceptions on reliable websites for children’s health information by parents.
Following institutional ethics approval, we conducted a survey of parents/guardians of children presenting for day surgery. A 20-item survey instrument developed and tested by the investigators was administered.
Ninety-eight percent of respondents reported that they used the Internet to search for information about their child’s health. Many respondents reported beginning their search at public search engines (80%); less than 20% reported starting their search at university/hospital-based websites. Common conditions such as colds/flu, skin conditions and fever were the most frequently searched, and unique conditions directly affecting the child were second. Despite low usage levels of university/hospital-based websites for health information, the majority of respondents (74%) regarded these as providing safe, accurate, and reliable information. In contrast, only 24% of respondents regarded public search engines as providing safe and reliable information. Fifty percent of respondents reported that they cross-checked information found on the internet with a family physician.
An unprecedented majority of parents and guardians are using the Internet for their child’s health information. Of concern is that parents and guardians are currently not using reliable and safe sources of information. Health care providers should begin to focus on improving access to safe, accurate, and reliable information through various modalities including education, designing for multiplatform, and better search engine optimization.
The use of the Internet to search for medical and health-related information is increasing in Canada and worldwide [
Institutional approval was obtained before starting the survey, participants were informed that consent was implied by participation in the study.
Following a pilot among parents in January and February 2013, the survey took place between May and July 2013 in the parent waiting room of the Hospital for Sick Children, a pediatric tertiary care facility in Toronto, Canada. Surveys were conducted after the children had gone into the operating room.
A review of the literature discussing websites used by parents informed the development of the survey instrument. A 20-item survey instrument was constructed using the online tool, Qualtrics Offline (Qualtrics, LLC), based on previously published methodology for the design of surveys [
The final survey tool (
With 16,000 surgical procedures performed in our institution annually, assuming a 95% confidence interval and an 8% margin of error, 149 participants were required. Our target population and sampling frame consisted of parents and guardians of children presenting to the preoperative waiting room for same day surgery and procedures. Excluded were parents who did not speak/understand English, those who declined to participate in the survey, and those who were employees at the hospital.
Three researchers conducted the survey and entered responses onto a tablet computer in real time; responses were then transferred to an Excel spreadsheet (Microsoft Corporation) for analysis.
Data analysis was performed using Prism version 5.0b for Mac OS X (GraphPad Software); descriptive statistics were used to summarize the data.
Of the 146 parents agreeing to participate in the study, 125 (85.6%) spoke English as their first language (
Primary language of respondents.
Primary Language | n (%) |
English | 125 (85.6) |
Spanish | 5 (3.4) |
Farsi | 3 (2.1) |
Arabic | 2 (1.4) |
Gujarati | 2 (1.4) |
Albanian | 1 (0.7) |
Bulgarian | 1 (0.7) |
Chinese | 1 (0.7) |
Hindi | 1 (0.7) |
Hungarian | 1 (0.7) |
Persian | 1 (0.7) |
Somali | 1 (0.7) |
Twi | 1 (0.7) |
Almost all parents (143, 97.9%) reported using the Internet to search for health information regarding their child. Parents reported being most familiar with public search engines as a source of health information (117, 80.1%) and least familiar with child-specific websites run by healthcare professionals (39, 26.7%) (
Respondents’ familiarity with various websites for access to information on children’s health.
Frequency of Internet use for health related information.
Public search engines were used as a starting point by 117 respondents (80.1%) (
Information sought and factors influencing Internet searching.
Search Topics |
|
n (%) |
|
|
|
|
Specific conditions | 126 (86.3) |
|
Surgical/diagnostic procedures | 23 (15.8) |
|
Child development | 15 (10.3) |
|
Diet/feeding | 7 (4.8) |
|
Medications/treatments | 4 (2.7) |
|
Child behavior | 3 (2.1) |
|
|
|
|
Cough, cold, flu | 22 (15.1) |
|
Skin conditions (rash, eczema, acne) | 22 (15.1) |
|
Fever | 19 (13.0) |
|
Cancer | 16 (10.9) |
|
Allergies | 13 (8.9) |
|
Congenital heart disease | 9 (6.2) |
|
Asthma | 9 (6.2) |
|
Eye conditions (strabismus, cataracts) | 9 (6.2) |
|
Abscesses, cysts | 9 (6.2) |
|
Gastrointestinal (vomiting, diarrhea) | 9 (6.2) |
|
Hypospadias | 7 (4.8) |
|
Chromosomal abnormalities | 7 (4.8) |
|
Diabetes | 6 (4.1) |
|
Cleft lip/palate | 6 (4.1) |
|
Bone lesions | 6 (4.1) |
|
|
|
|
Health concern/question | 99 (67.8) |
|
Upcoming surgery/procedure | 7 (4.8) |
|
New diagnosis | 4 (2.7) |
|
New medication/treatment | 4 (2.7) |
|
Need for additional information not |
4 (2.7) |
|
Urgent need for information | 4 (2.7) |
|
Availability of doctor | 4 (2.7) |
Sites first accessed for health-related information.
Parents reported that they regarded hospital/university websites as safe, accurate, and useful sources of health-related information (105, 71.9%; 104, 71.2%; and 111, 76.0%, respectively). Very few parents regarded public search engines and popular parenting websites as safe sources (35, 23.9% and 18, 12.3%, respectively) or accurate sources (16, 11.0% and 12, 8.2%, respectively)(
Websites parents were likely to use in the future for their child health information and crosscheck information they found.
Primary sources, n (%) | ||||
|
Not likely | Neutral | Likely | No answer |
Hospital/university-based |
44 (30.1) | 15 (10.3) | 83 (56.8) | 4 (2.7) |
Medical journal/ |
64 (43.8) | 22 (15.1) | 56 (34.8) | 4 (2.7) |
Government websites | 36 (24.7) | 19 (13.0) | 84 (57.5) | 7 (4.8) |
Public search engines | 16 (11.0) | 19 (13.0) | 107 (73.3) | 4 (27.3) |
Other health websites | 61 (41.8) | 10 (6.8) | 65 (44.5) | 10 (6.8) |
Popular parenting websites | 82 (56.2) | 14 (9.6) | 39 (26.7) | 11 (7.5) |
Likely to cross-check information from the following websites, n (%) | ||||
Hospital/university-based |
33 (22.6) | 14 (9.6) | 93 (63.7) | 6 (4.1) |
Medical journal/ |
38 (26.0) | 21 (14.4) | 81 (55.5) | 6 (4.1) |
Government websites | 36 (24.7) | 19 (13.0) | 85 (48.2) | 6 (4.1) |
Public search engines | 16 (11.0) | 19 (13.0) | 107 (73.3) | 6 (4.1) |
Other health websites | 40 (27.7) | 15 (10.3) | 81 (55.5) | 10 (6.8) |
Popular parenting websites | 39 (26.7) | 14 (9.6) | 81 (55.8) | 12 (8.2) |
Parent’s perception of safe, accurate and useful websites.
The results of our study demonstrate that almost all respondents use the Internet to search for child health information. Of the 97.9% (143) of parents and guardians who use the Internet to search for information, almost half were frequent users who searched anywhere from a few times a month to every day. This represents a significant increase in the use of the Internet compared to previous studies [
While the respondents participating in our study were at a tertiary care facility, the majority sought information on common childhood ailments (cold/flu, skin conditions, and fever) with a surprisingly smaller proportion (23, 15.7%) searching for information about an upcoming surgery or procedure. The development of web content pertaining to common conditions may remain a key focus for health care providers, web content developers and public health officers.
The majority of respondents reported that they use public search engines to search for health-related information for their child. Despite the choice of public search engines to search for health-related information, respondents rated public search engines low in terms of providing access to safe and accurate information. The use of the public search engines to search for health-related information raises concerns as several authors have reported the quality of health information found on the Internet to be poor [
Our study demonstrates that almost half of respondents reported that they cross-checked information found online with a family physician. Reasons for this may include a desire to check the reliability and accuracy of information or get clarification. This cross-check could potentially be linked to a telehealth presence, chat line, or mobile apps to help parents who have questions or concerns about what they have read about on the Internet.
Respondents in our study reported they were likely to continue to use desktop computers, laptops, tablet devices, and smart phones in almost equal proportions to search for information on their children’s health. Health information providers should consider designing websites that can be viewed and navigated easily on multiple platforms.
We used a convenience sample of parents of children presenting for surgery at a tertiary care hospital, so it is possible that the results may not reflect the general population. It would be important, when developing websites for individual facilities, that a needs assessment be done to ensure that the information contained on the website meets the needs of the intended audience.
We excluded parents who did not read and understand English. The patterns of Internet use may be influenced by culture and language, something our study did not investigate.
Finally, we relied on parents to self-report sources they access, which may be associated with recall bias. Our study had a large sample size and adequate response rate providing meaningful data for analyses and drawing significant findings and conclusions.
Our study demonstrates that almost all parents are using the Internet to seek health care information related to their children. Information sought is largely related to general childhood health issues and development. Parents do not routinely use websites that are known to provide safe, accurate, and reliable information. Health care providers should focus on improving access to safe, accurate, and reliable information for parents and guardians. The development by policy makers of resources to educate parents and guardians on how to use the Internet to search for health information may aid in improving this area of medicine.
Parent survey.
None declared.