This study examined the quality and use of health information found on the internet by students at Panjab University in Chandigarh, India. The researchers surveyed 200 students and analyzed health-related websites and advertisements. They found that while the majority of students found internet health information useful, the quality was poor and advertisements often violated regulations. Most students searched for beauty, hair, and skin topics. The study highlights both the benefits and risks of internet health searches, as well as the need for better oversight of online health information and advertising.

1. Quality of health information available on internet & its use by
students of Panjab University Chandigarh, India
Dr Birpreet, Dr Amarjeet Singh, Dr Manoj Kumar
Bhojia Dental College and Hospital,
Budh, Distt. Solan, Himachal Pradesh, India
E mail: docbirpreet@gmail.com
Abstract
21st century is the era of information technology. Internet is becoming a popular source of
information on various subjects even in developing countries. A cross sectional exploratory
study was done among 200 randomly chosen students during January 2010 to April 2010 to
ascertain the extent & pattern of internet based health information use by students of
Panjab University, Chandigarh ,to determine the factors affecting such use of internet .
Health related sites and advertisements on internet were also studied to evaluate the
quality of internet based health information and to determine the impact of such use of
internet based health information on health behavior of students. A scoring system was
developed to evaluate the quality of internet based health information for ten selected
products.
Majority of the students first checked and then retrieved health information from internet
before using it. Most of them reported no adverse effects from the advice given online.
Majority of them found health information available online useful. Skin / beauty/hair
related searches were more frequent. Quality of information on various health products
was not found to be satisfactory. Key words- E health, information technology, internet
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2. Introduction
21st century is the era of information technology. In the globalised world, computers are
omnipotent and omnipresent. Our daily lives are becoming more and more dependent on
computer based applications. Internet is becoming a popular source of information on various
subjects including health. Worldwide, about 4.5% of all Internet searches are for health-related
information (Fox 2005).Before the information era, knowledge of medicine belonged only to the
physician. The patient's role was only to passively comply with physician’s advice. However, the
Internet has opened up the doors of information like never before. There are innumerable sites
ready to give detailed information about various diseases.
In this context, E Health has emerged as a relatively recent term which encompasses a range of
services that are at the cutting edge of medicine/healthcare and information technology
(Wikipedia).
E-health improves the efficiency of health care delivery by:
•Improving health status by supporting healthy life styles,
• Improving health related decisions and enhancing health care quality;
•Empowering people to take greater control of their health by supporting better informed health
decisions and self care;
•Enhancing clinical care and public health services by facilitating information retrieval by health
professionals.
•Providing greater speed and efficiency in transmitting feedbacks to the participants.
• Internet based information can be hyperlinked to more in depth information and
interactive programmes that can help the individual get started immediately on health
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3. intervention. This may be supplemented with daily news feeds on health topics of interest,
moderated chat rooms and live video feeds from experts on health and behavioral change topics.
•Video and internet conferencing allows for contact between patient and doctor from great
distances.
(http://www.telehealth.com.)
However, despite these changes in the health information scenario, very few studies are available
to reflect the extent to which Indian people use internet for this purpose. Against this background
study was planned with following objectives:
• To ascertain the extent & pattern of internet based health information use by students of
Panjab University, Chandigarh.
• To determine the factors affecting such use of internet.
• To evaluate the quality of internet based health information.
• To determine the impact of such use of internet based health information on health
behavior of students.
Material and methods
This cross sectional exploratory study was done among 200 randomly chosen students from 20
different departments of Panjab University (including graduates, post graduates, M.phil students,
PhDs) during January 2010 to April 2010. Health related sites and advertisements on internet
were also studied. The students who were willing to participate in the survey were explained the
purpose of study and questionnaires were handed over to them for completion.
The questionnaire comprised of 7 sections viz. : Section A – Socio demographic details and
family background, Section B – Personal details, Section C – General computer use, Section D -
Frequency of use of internet ,Section E – Use of internet for seeking health information , Section
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4. F – Impact of health information sought from internet ,Section G–Problems faced while using
internet.
For interview of students, a pre tested, pilot tested interview schedule was used. A list of health
topics was first developed, viz. – beauty tips, hair problems, weight loss, height gain, skin related
problems, diet, sexual behavior, illness, sleep, memory enhancers and other such issues. A
proforma was developed for assessment of quality of health information available online. It had
questions on following aspects of online health information: Why was the site created? Who is
responsible for funding? Who is responsible for the information? Is the subject coverage
complete and in-depth? Is the information up-to-date? How easy is the site to use; Warning
signs; whether there is complete product information; whether the personal information remains
confidential?
For evaluation of health related websites / advertisements, first a list of different health related
topics was made and requisite information was sought on the internet. Thereafter, a scoring
system was developed for evaluation. Every question had sub questions, each of which was
given a score of 1 in case of a positive response. Reverse scoring was done in case of negatively
worded items. After marking the responses total score was calculated. Three score ranges were
computed, viz. 0-15 scores indicated poor quality, 16-31 fair quality, and 31-60 scores indicated
good quality information. For each health topic, a search was made on internet using Google.
Out of all items that appeared on the first page, every alternate item was clicked to get the
details. Apart from this, for every health related item selected, every alternate advertisement that
appeared on screen was selected. Three such advertisements were selected for each health
problem/issue. Duplicate and irrelevant items were deleted. The details were saved in a folder in
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5. the computer created for this project. Using the scoring system developed for this study these
advertisements were assessed for quality and credibility.
Percentage/mean and Chi square test were used for analysis. Informed consent was taken.
Confidentiality of the data was ensured.
Results
Out of 200 students questioned, majority were females (152; 76%) and 112 (56%) were of the
age group 21-30 years. Majority of the respondents were Hindus (135; 68%).Half of the students
was post graduates (99; 50%) and rest were graduates (94; 47%). Majority of the students
received monthly pocket money ranging from Rs 1000-5000(126; 63%).Most of the students
(155; 93%) had separate bank account. Out of 200 students interviewed, families of 189; (95%)
students owned a computer and majority (130; 65%) had one PC at home. Some of them had
acquired a computer during last 5 yrs (85; 42.5%) while some of them owned a computer for last
5 – 10 yrs (81; 40.5%). Most of them used computer for watching movies (164; 82%) & listening
to music (172; 86%).Some students used computers for typing (100; 50%), playing games (106;
53%) or analysis of data (87; 43.5%). Most commonly used accessory device was a pen drive
(186; 93%), followed by CD (186; 84%), speaker (165; 82.5%) and webcam (105; 52.5%). Most
(186; 93%) students had access to internet. Majority of them accessed internet through home
(125; 67%) or department (107; 58%) followed by cyber cafe (91; 49%). Both Google and
Yahoo were the commonly used search engines (125; 62%).
Most of the students perceived their health as OK (176; 88%).Majority made efforts to stay
healthy (118; 59%) that included exercise, yoga, jogging etc. Most of the students sought health
information from internet for themselves (100; 57%) or their relatives (41; 24%) or friends (25;
14%).
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6. Majority of the students first checked and then retrieved health information from internet before
using it (101; 54%). Only (45; 24%) students consulted internet before going to doctor. Most of
them (116; 87%) reported no adverse effects from the advice given online. Majority of them (99;
53%) found health information available online useful. Most of the students (123; 95%) had
never mailed a health query or subscribed to a news letter. Nobody had ever participated in any
online discussion forum or attended any health programme online or ever used e mail to contact
a health professional.
Students faced many problems while using internet for seeking health information like slow
internet connection (113;30%) followed by sponsored sites (53;14%), useless information
(50;13%), paid sites (43;12%), lack of information seeking skills (39;11%), unfamiliar medical
terms (31;8%), difficult key words (24;6%), difficulty in comprehension (11;3%) .Most of the
students (151; 86%) told that they intended to use internet in future also.
None of the products had a score in the range of 31-50, seven items scored in the range 16-30
and 23 items scored in the range of 0 -15.
In all advertisements there was no up to date information and no assurance of confidentiality.
Only hair products had scores more than 15 for all three advertisements while for beauty related,
skin, height, sleep and weight related advertisements none of the three scored more than 15.
Discussion
In modern society, the doctor patient relationship has changed drastically. There has been a
tangible shift towards internal locus of control among the patients. Doctor’s opinions and actions
are increasingly being challenged by patients. Until recently, the thought that a patient would
participate so fully in treatment process was unheard of in India.
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7. Among the literate sections of society, doctors often have to confront now empowered and
enlightened patients who intend to take larger responsibility of their treatment. They refer to all
the resources at their disposal -- from opinion of people to the printed word. They use such
knowledge to help make decisions about the treatment to be imparted to them.
Now a days , people tend to gather information about their diseases and the prescription .They
use resources that range from observation, recording symptoms and family histories,
participating in medical tests, discussions with providers and other patients, using the internet
and libraries for researching relevant diseases, conditions and treatments. In fact, now people
have become smart healthcare consumers.
In the present study also, it was found that many students (24%) consulted internet before going
to a doctor. This represents the above mentioned change in patient’s behaviour. Most of them
checked the health related information retrieved from internet before using it. This shows their
concern for quality of the information available online.
In today’s society, much attention of the health care industry has been devoted to the potential
use of the mass media to modify attitudes, shape behaviour, and generally persuade audiences to
use their products. With their broad reach and reliance on visual and audible communication,
internet-based resources appear to belong in the category of mass communication. However, the
interactive capabilities of these resources suggest that they also share important characteristics
with interpersonal communication and may therefore share its capacity for effecting persuasion.
In many countries, evidence is available that people use internet to access health information. For
instance, 86% of adult internet users utilized the Internet to do research on a specific disease or
health care (Harris Interactive, 2001). Most of these individuals used the Internet for health
related purposes at least once a month. Half of them told that access to information on the
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8. Internet improved the way they took care of themselves (Pew Internet and American Life
Project, 2000).
The present study revealed that majority of the students (65%) never used internet for seeking
health information. Only a few students (14%) regularly sought health information online. In
another study conducted in 2004 by Castren et al, 12% of Finnish undergraduate students had
used the web-based health advice service provided by the Finnish Student Health Service.
Escoffery et al reported that 74% of the students reported having ever received health
information online, and more than 40% reported that they frequently searched the Internet for
information. Baker et al found that approximately 40% of respondents used the Internet to look
for advice or information about health or health care in 2001.
Most of the students in our study considered themselves as healthy. They appeared to be quite
health conscious as they looked for health information from different sources including internet.
Most common reason to use internet by students was to find answers to their health queries. The
most common queries were hair problems skin troubles, diet related problems and beauty tips.
This reflects the desire among the students to look good. They also looked for home remedies on
the internet. This indicates their hesitation to see a doctor directly for consultation. Rather, they
inclined to do something on their own for their health problem. A few students also used internet
to know more about tests prescribed by doctors. This reveals lack of adequate interaction
between doctor and patient. This also hints at the inquisitiveness of the patients.
Similarly, Castren et al (2004) found that the internet was a method suitable for sensitive,
stigmatized, or disquieting health issues. It represented an anonymous way of asking questions
on delicate themes.
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9. Many of our respondents reported that the material they gathered from internet directly affected
their decisions about getting care and treatment for their illnesses. It has also been reported that
consumers are also using internet-gathered material to enhance their face-to-face interactions
with health care providers. The most important effect of the Internet may be its influence on how
patients approach their health care providers. Those who seek information online report that it
influences how they manage their overall health and how they comply with prescribed treatments
(Harris Interactive, 2001).
The present study revealed that the number of students willing to use internet in future is quite
high (86%).This implies the need for regulation of internet based information to make sure that
quality information reaches the seekers and they get the maximum benefit out of that .As stated
by Landor, ‘Products are made in factories but brands are created in our minds’. Market forces
and advertisements seriously influence our thought process. Today, our life and thinking is
continuously invaded by product information bombarded through advertisements in every sphere
possible (SMS, phone, TV, internet, newspapers, magazines, hoardings, pamphlets and wall
paintings).We can protect ourselves now from sun, rains and wind but not from advertisements.
Our subconscious mind is influenced by endless repetition of advertisements in media.
Keeping in mind the above issues related to e- health and in an effort to promote better quality of
healthcare resources on the internet, the Internet Healthcare Coalition (IHC), a group of
organizations that include for-profit and not for profit members introduced an international code
of ethics for health care sites and services on the internet. (Journal of Medical Internet Research-
health code of ethics by Helga Ripen, MD, PhD, 2000)
However, many malpractices in internet advertisement have been reported and these can be
potentially harmful. In the present study, majority of the students found health related
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10. information online. However, 13% of them reported that they experienced adverse effects on
following the advice available online.
In the present study it was found that majority of internet advertisements scored poorly as far as
their quality was concerned. Majority of advertisements were not following the laid down
guidelines and were liable to strict legal action. There are various statutes impacting advertising
like -The Drugs and Magic Remedies (Objectionable Advertisements) Act (DMRA) This statute
prohibits advertisements of drugs for certain purposes and of treatment of certain diseases and
disorders. It also prohibits misleading advertisements relating to drugs and advertisements of
magical remedies for the treatment of certain diseases and disorders. In similar way, Consumer
Protection Act promotes and protects the rights of the consumer, including protection against
unfair trade practices. Information Technology Act, 2000 (IT Act) prohibits the publication and
transmission in electronic form of material which is misleading.
Internet has been a boon to consumers who want research information on various health topics at
the tip of their fingers. However, simultaneously, the ease of Web publishing has also given an
unregulated forum to unreliable sources to post their ware on the net. Therefore, the quality of
such information is open to question. Careful scrutiny and a healthy dose of skepticism is
necessary to separate chaff from grain and determine what applies to you and what may need a
second opinion.
Conclusion
Majority of the students (65%) never used internet for seeking health information. Most of those
who did so (73%) found health information available on internet useful.
Most common health problems for which information was sought were- beauty tips, hair
problems and skin care related queries. Quality of health information available on internet was
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11. found to be poor. Common deficiency in all advertisements was lack of up to date information
and lack of assurance of maintaining confidentiality of information. All the advertisements
violated the Online Advertising Act and Drugs and Magical Remedies Act.
Limitations
The present study was conducted in Chandigarh which is a modern and relatively rich city with a
high literacy rate. The chosen sample from Panjab University was computer literate students who
belonged to middle, upper middle and high socioeconomic class. So, results should be
interpreted accordingly. Evaluation of limited number of health advertisements was done. Small
sample size was taken due to time constraints. The "topics of health information" were
purposively selected. Responses to the questions on each topic were treated as a dichotomous
variable measured in a Yes/No format. It did not provide information about the degree of
consumer use of the different health topics. Further exploration of the depth of use was not done.
Recommendations
Quality and content of all internet advertisements should be properly and scientifically screened
before these are released for public exposure. A code of ethics needs to be evolved and violators
and defaulters of this code should be punished. People should be educated about the dangers of
self diagnosis and self medication based on online health information. For this there is a need for
a regulatory body or expert committee to enforce ethics in advertising on internet
References
Akerkar SM, Bichile LS .Doctor patient relationship: Changing dynamics in the information
age. E-medicine 2004; 50(2):120-122
11

12. Baker L, Wagner TH, Singer S and Bundorf MK. Use of the Internet and e-mail for health care
information: results from a national survey. Journal of American Medical Association 2003;
Vol. 289.
Castrén J , HuttunenT and Kunttu K . Users and non-users of web-based health advice service
among Finnish university students – chronic conditions and self-reported health status (a cross-
sectional study). BMC Medical informatics and Decision Making 2008; 8: 8.
Culver, J D, Gerr, R, & Frumkin, H . Medical information on the Internet: A study of an
electronic bulletin board. Journal of General Internal Medicine 1997 ; 12(8): 466-70
Diaz JA, Griffith RA, Ng JJ, Reinert SE, Friedmann PD, Moulton AW Patients' use of the
Internet for medical information. Journal of General Internal medicine 2002 ; 17:180-5.
Donald, A, Lindenberg B & Humphreys L. Medicine and health on the Internet: The good, the
bad, and the ugly. Journal of American Medical Association 1998 ; 280 : 1303-1306.
Dudley, T E, Falvo, D. R., Podell, R. N., & Renner, J.The informed patient poses a different
challenge. Patient Care 1996; 30 : 128-138.
Dutta-Bergman MJ . Health Attitudes, Health Cognitions, and Health Behaviors among Internet
Health Information Seekers: Population-Based Survey. J Med Internet Res. 2004 Apr–Jun; 6(2):
e15.
Eastin MS.Credibility Assessments of Online Health Information: The Effects of Source
Expertise and Knowledge of Content. Journal of Computer-Mediated Communication (JCMC)
2001; 6(4)
Escoffery C, Miner KR, Adame DD, Butler S, McCormick L, Mendell E. Internet use for health
information among college students. Journal of American College Health 2005;53(4):183-8.
12

13. Flanigan, A, & Metzger, M. Perceptions of Internet information credibility. Journalism & Mass
Communication Quarterly 2000; 77: 515-540.
Gaziano,C., & McGrath, K. Measuring the concept of credibility. Journalism Quarterly 1986 ;
63:451-462.
Gerber BS, Eiser AR. The Patient Physician Relationship in the Internet Age: Future Prospects
and the Research Agenda .J Med Internet Res 2001; 3(2):edition15
Herman ES , Mcchesney RW . The Global Media: The New Missionaries Of Corporate
Capitalism. Delhi: Madhyam Books ; 1998.106 -126
http://www.ehealthinstitute.org/index.aspx
http://www.pewinternet.org/Reports/2002/Vital-Decisions-A-Pew-Internet-Health-Report
http://www.quackwatch.com/01QuackeryRelatedTopics/quackweb.html
Indu V, Archana S , Neha A, Ankita G . E-Health and Ethics . Saarthi conference on medical
ethics ;17-18 Jan 2010 ; Chandigarh
Jacabson P . Empowering the physician patient relationship, effect of internet. Canadian Journal
of Library and Information Practice and Research 2007; vol.2
Kotler P . Marketing Management : Pearson Education Inc ; 2004
Morahan-Martin JM . How internet users find, evaluate, and use online health information: a
cross-cultural review. Cyberpsychology and Behaviour 2004 Oct;7(5):497-510
Parameswaran MG . Understanding Consumer : Tata Mc Graw Hill Publishing Company ;
Pellegrino ED. The commodification of medical and health Care: The Moral consequences of a
paradigm shift from a professional to a market ethic. Journal of Medicine and Philosophy 1999
;24 : 243
13

14. Singh R, Vij S . Socio-Economic and Ethical Implications of Advertising – A Perceptual Study
International Marketing Conference on Marketing & Society ; 2007 8-10 April ; IIMK
Talwar K.K. An opportunity to be Knowledge city. Ht Live Chandigarh 2010 May 7
Wagner TH . Baker LC , Bundorf MK and Singer S .Use of the Internet for Health Information
by the Chronically Ill . Preventing chronic diseases: public health research , practice and policy
October 2004; 1(4)
Wright, J. B. Quality connection on the Internet. Healthcare Executive 1998; 13: 44-45.
Table 1 Frequency and pattern of use of internet by students (n= 186)
Variables Number Percentage
Internet used today 85 45
Internet used once or twice per week
75 40
Internet used thrice or more per week 114 61
Preferred to use on weekends 130 69
Time preferred
Day 18 4
Night 07 11
Any time 161 85
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15. Internet used for
Mail
136 73
Academic purposes
129 69
Chat
96 52
Download movies/songs
68 36
Health information
27 14
Air/railway ticket
16 8
Movie ticket
11 6
Bills payment / e-Banking
6 3
Table 2 Pattern of use of internet for health related information
Variables Number Percentage
Sources of health information
TV/newspapers/magazines 126 68
84 45
Family member/friend
Doctor 113 15
Internet 84 11
Internet used for
93 50
Finding answers to queries
To look for home remedy 44 24
To know more about tests prescribed
25 13
To retrieve related articles
24 13
To know about treatment options
30 13
Specific health problems
Hair problems 80 43
Skin query 78 42
Diet related 77 41
Beauty tips 66 35
Weight loss 43 23
Height gain 29 16
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16. Illness related 27 15
Sexual behaviour 21 11
Table 3 Impact of health information sought from internet
Variable Number Percentage
What did you do with information retrieved
Used after verification
Ignored right away 101 54
Ignored after verification 18 10
Used without verification 3 2
11 6
Ever consulted a doctor for health problem
81 44
Internet consulted before going to doctor
45 24
Online advice had adverse effect on health
18 10
Information useful 99 53
Ever mailed a health query 7 4
Got response on mail 3 2
Subscription of any health news letter
5 4
Table 4 Score range of 10 kinds of health related products advertised on internet
Product Score range
0-15 16-30
Beauty 8,8,12
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17. Hair care 22,25,27
Skin care 4,5,10
Weight loss 2,5,8
Height gain 4,5,10
Diet related 8,15 23
Sexual behavior 5,9 20
Illness related 10,12 17
Sleep 7,7,10
Memory 6,7 16
The three figures in each row represent scores for the three advertisements scrutinized for each product.
Maximum possible score was 60
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